FMGE 2026 Practice Questions

Q: During nasogastric tube insertion, obstruction is encountered at 40cm due to ?

Diaphragmatic constriction. ***Diaphragmatic constriction*** - The **esophagus** passes through the **esophageal hiatus** of the diaphragm at approximately **40 cm** from the upper incisor teeth. - This narrowing represents the final physiological constriction of the esophagus where clinical obstruction can occur during **nasogastric intubation**. *Arch of aorta* - The **arch of the aorta** causes an esophageal indentation at approximately **22-25 cm** from the incisors where it crosses the esophagus anteriorly. - This is a normal anatomical indentation and does not represent an obstruction point at the 40 cm mark. *Cricopharyngeal constriction* - This is the site of the **upper esophageal sphincter** and is located approximately **15 cm** from the incisor teeth. - It is generally the narrowest part of the esophagus and the primary site where a nasogastric tube might get stuck during the initial phase of insertion. *None of above* - Medical literature consistently identifies specific anatomical points of narrowing in the esophagus based on distance from the incisors. - The obstruction at 40 cm corresponds clinically to the **esophageal hiatus** of the diaphragm.

Q: A patient presents with signs of early vitamin A deficiency. Based on clinical findings, which of the following is the earliest manifestation on the skin or eyes?

Night blindness. ***Night blindness*** - **Night blindness** (nyctalopia) is the earliest clinical manifestation of **vitamin A deficiency** due to the depletion of **rhodopsin** in the rod cells of the **retina**. - It represents a functional impairment of dark adaptation before any structural ocular changes occur in the conjunctiva or cornea. *Conjunctival xerosis* - This finding appears after night blindness and manifests as dryness, thickening, and wrinkling of the **conjunctiva**, often followed by **Bitot spots**. - It is a structural abnormality resulting from keratinization of the epithelial cells, which happens later in the progression of the deficiency. *Corneal xerosis* - This condition involves the drying of the **cornea** due to reduced production of **mucus**-secreting goblet cells and subsequent **keratinization**. - It is a more advanced sign than conjunctival xerosis and indicates a significant, prolonged lack of **retinol**. *Corneal ulceration* - This is a severe, late-stage complication known as **keratomalacia**, which leads to liquefactive necrosis and potential permanent blindness. - It represents the terminal phase of ocular involvement in **vitamin A deficiency** and is significantly preceded by earlier signs like xerosis and Bitot spots.

Q: A 12-year-old girl is being evaluated for pubertal development. On examination, she has early breast development and sparse, thin pubic hair. Based on the Tanner staging diagram provided, what stage does she correspond to?

Stage II. ***Stage II*** - Stage II breast development (thelarche) is characterized by **breast bud development**, which appears as a small mound of breast tissue and enlargement of the **areola**. - Pubic hair in Stage II typically consists of sparse, long, pigmented, straight, or slightly curly hair, mainly along the **labia majora**. *Stage I* - This represents the **prepubertal** state, where there is **no palpable breast tissue** and the nipples lie flat against the chest wall. - There is **no sexual hair** (vellus hair only) present in the pubic region during this stage. *Stage III* - In this stage, the breast and areola are further enlarged, though they continue to have a single contour without separation of the areola from the breast mound. - Pubic hair becomes darker, coarser, curlier, and spreads over the **mons pubis**, exhibiting a more typical adult-like texture but in a smaller area. *Stage IV* - This stage features the **areola and papilla (nipple)** forming a secondary mound projecting above the contour of the rest of the breast. - Pubic hair resembles adult type but covers a smaller area than in a mature adult, with **no spread to the medial surfaces of the thighs**.

Q: A child was brought to the hospital with fever and rashes at both lower extremities. Labs: normal PT, APTT, & decreased platelet count. Peripheral smear: increased megakaryocyte count. What is the most probable diagnosis?

ITP. ***ITP (Immune Thrombocytopenic Purpura)*** - The combination of **isolated thrombocytopenia** (decreased platelet count with normal PT and APTT) and **increased bone marrow megakaryocytes** is the hallmark diagnostic finding for **ITP**. - This condition is often **autoimmune** in origin, frequently following a **viral infection** in children, resulting in peripheral platelet destruction. *Measles* - Presents with a **maculopapular rash** typically starting on the face and spreading downward, accompanied by **Koplik spots** and cough/coryza/conjunctivitis. - It does not cause a isolated significant **thrombocytopenia** with increased megakaryocytes on a peripheral smear. *Mumps* - Characterized primarily by **parotitis** (inflammation of the parotid glands) and fever. - It is not a typical cause of **petechial/purpuric rashes** or isolated **thrombocytopenia**. *Chicken pox* - Presents with a **vesicular rash** at various stages of development (

Q: Which among the following channels is affected in CFTR gene mutation?

Chloride. ***Chloride*** - The **CFTR gene** (Cystic Fibrosis Transmembrane Conductance Regulator) encodes a protein that functions as an **ATP-gated chloride channel** expressed in the epithelial cells of the lungs, pancreas, and sweat glands. - Mutations in this gene lead to defective **chloride transport**, resulting in thick, viscous secretions that cause the clinical manifestations of **cystic fibrosis**. *Potassium* - **Potassium channels** are vital for maintaining resting membrane potential and repolarization in cardiac and neural tissues, not for the pathogenesis of cystic fibrosis. - CFTR is specifically a transmembrane regulator for anions, not cations like potassium. *Sodium* - While sodium transport is dysregulated in cystic fibrosis (due to the **ENaC** channel becoming hyperactive because of the lack of inhibitory regulation by the CFTR protein), it is not the primary ion channel encoded by the CFTR gene. - The primary defect is the inability to transport **chloride** ions across the cell membrane, which secondarily impacts sodium and water movement. *Magnesium* - **Magnesium channels** (such as TRPM6 or TRPM7) regulate systemic magnesium homeostasis and intracellular signaling. - There is no involvement of magnesium transport in the pathophysiology associated with **CFTR gene mutations**.

Q: The ductus venosus in fetal circulation primarily functions to:

Umbilical vein → IVC. ***Umbilical vein → IVC*** - The **ductus venosus** serves as a specialized vascular shunt that allows approximately 30-50% of the oxygenated, nutrient-rich blood from the **umbilical vein** to bypass the hepatic microcirculation. - By shunting blood directly into the **inferior vena cava (IVC)**, it ensures that highly oxygenated blood is preferentially directed toward the **fetal heart** and brain. *Umbilical vein → liver* - While the **umbilical vein** does provide some blood to the liver (via the left portal vein), the primary function of the **ductus venosus** specifically is to *bypass* the liver rather than supply it. - If all flow went to the liver, the resistance would be too high and fetal hepatic blood flow would be dangerously restricted. *Pulmonary artery → aorta* - This describes the **ductus arteriosus**, which shunts blood away from the high-resistance **fetal lungs** to the systemic circulation via the descending aorta. - The **ductus arteriosus** connects the pulmonary trunk to the aorta, not the IVC. *Right atrium → left atrium* - This describes the **foramen ovale**, an anatomical opening in the atrial septum that allows right-to-left shunting of blood. - It acts as a bypass to keep oxygenated blood from the IVC moving toward the **left atrium**, avoiding the pulmonary circulation.

Q: What is CEAP staging of the given image?

C1. ***C1*** - Represents **telangiectasias** (spider veins) or **reticular veins**, which are the hallmark clinical finding for this stage. - These are typically defined as venous dilations measuring less than **3 mm** in diameter. *C2* - Characterized by the presence of **varicose veins**, which are defined as subcutaneous dilated veins measuring greater than **3 mm**. - Unlike C1, these veins are often palpable and visible as tortuous, bulging vessels. *C3* - Defined by the presence of venous-related **edema**, representing a more advanced stage of venous insufficiency. - The edema is typically **pitting** and worsens at the end of the day or after prolonged standing. *C4c* - Refers to **lipodermatosclerosis** or atrophie blanche, which are severe skin changes indicative of chronic venous disease. - This stage indicates significant **dermal fibrosis** and tissue remodeling, unlike the earlier stages of simple venous dilation.

Q: A lady got a stab wound on thyroid region, which zone and management?

Zone 2, surgical exploration. ***Zone 2, surgical exploration*** - **Zone 2** of the neck extends from the **cricoid cartilage** to the **angle of the mandible**, where the thyroid gland is located. - Penetrating trauma in Zone 2 is historically managed with **mandatory surgical exploration** due to the high density of critical structures, including the **carotid arteries**, **jugular veins**, and the **larynx/trachea**, which are easily damaged. *Zone 1 , surgical exploration* - **Zone 1** represents the area from the **clavicles** to the **cricoid cartilage**, containing the **great vessels** of the thoracic inlet. - While serious, modern management for Zone 1 often favors less invasive diagnostics like **CT angiography** or **endoscopy** rather than immediate mandatory neck exploration compared to the traditional approach. *Zone 1, conservative* - Management for neck injuries is rarely purely

Q: The given image is of right superficial parotidectomy to identify the marked structure?

External jugular vein. ### ***External jugular vein*** - In the context of a superficial parotidectomy, the **external jugular vein** is a critical landmark often identified crossing the **sternocleidomastoid muscle**. - Its position relative to the **parotid gland** and the **greater auricular nerve** helps surgeons orient themselves before dissecting deeper structures. *Facial nerve* - The **facial nerve** lies much deeper than the surface landmarks usually highlighted in initial superficial dissections; it is located within the **parotid parenchyma**. - It emerges from the **stylomastoid foramen** and divides within the substance of the parotid gland, requiring meticulous dissection to preserve. *Parotid gland* - While the procedure is a parotidectomy, the parotid gland is the target organ being resected, not the specific structure marked for identification. - In a superficial parotidectomy, the **superficial lobe** is removed, but the gland itself is the volume of tissue rather than a single distinct landmark structure. *Digastric muscle* - The **posterior belly of the digastric muscle** is a vital deep landmark for locating the **facial nerve** trunk, but it is situated deeper than the superficial plane. - It serves as a superior boundary for the **carotid triangle** and is key for surgical orientation, but is not the superficial vessel commonly identified at this stage.

Q: During a laparoscopic cholecystectomy, a lateral injury to the Common Bile Duct is identified. What is the most appropriate next step in management?

Convert to open procedure with T -tube drainage. ***Convert to open procedure with T-tube drainage*** - Recognizing a common bile duct (CBD) injury intraoperatively requires immediate conversion to an **open procedure** to ensure adequate visualization and repair. - A **T-tube** is placed to provide biliary decompression and allow for healing across the primary repair or reconstruction, minimizing the risk of a post-operative **bile leak** or **stricture**. *Continue the laparoscopic procedure and place a drain* - Continuing laparoscopically after recognizing a major **CBD injury** is dangerous as it prevents adequate surgical exploration and repair of the ductal structure. - Placing a **drain** alone does not repair the duct; it only manages extravasated bile, leading to high morbidity and potentially life-threatening **biliary peritonitis**. *Ligate the duct proximal to the injury* - Simple ligation of the CBD will result in immediate **extrahepatic biliary obstruction**, causing obstructive **jaundice** and subsequent liver injury. - This approach is never acceptable; the integrity of the biliary tract must be maintained via **biliary reconstruction** (e.g., end-to-end anastomosis or hepaticojejunostomy). *Close the abdomen and refer for ERCP* - Closing the abdomen without addressing a known intraoperative iatrogenic injury is considered malpractice, as it leads to **peritonitis** and sepsis. - **ERCP** is reserved for postoperative management or diagnosis of leak/stricture; it cannot repair an acute, complete, or severe lateral injury identified during the original surgery.

Question 1

During nasogastric tube insertion, obstruction is encountered at 40cm due to ?

Accepted Answer

Diaphragmatic constriction

Answer

Arch of aorta

Answer

Cricopharyngeal constriction

Answer

None of above

Question 2

A patient presents with signs of early vitamin A deficiency. Based on clinical findings, which of the following is the earliest manifestation on the skin or eyes?

Accepted Answer

Night blindness

Answer

Conjunctival xerosis

Answer

Corneal xerosis

Answer

Corneal ulceration

Question 3

A 12-year-old girl is being evaluated for pubertal development. On examination, she has early breast development and sparse, thin pubic hair. Based on the Tanner staging diagram provided, what stage does she correspond to?

Accepted Answer

Stage II

Answer

Stage I

Answer

Stage III

Answer

Stage IV

Question 4

A child was brought to the hospital with fever and rashes at both lower extremities. Labs: normal PT, APTT, & decreased platelet count. Peripheral smear: increased megakaryocyte count. What is the most probable diagnosis?

Accepted Answer

ITP

Answer

Measles

Answer

Mumps

Answer

Chicken pox

Question 5

Which among the following channels is affected in CFTR gene mutation?

Accepted Answer

Chloride

Answer

Potassium

Answer

Sodium

Answer

Magnesium

Question 6

The ductus venosus in fetal circulation primarily functions to:

Accepted Answer

Umbilical vein → IVC

Answer

Umbilical vein → liver

Answer

Pulmonary artery → aorta

Answer

Right atrium → left atrium

Question 7

What is CEAP staging of the given image?

Accepted Answer

C1

Answer

C2

Answer

C3

Answer

C4c

Question 8

A lady got a stab wound on thyroid region, which zone and management?

Accepted Answer

Zone 2, surgical exploration

Answer

Zone 1 , surgical exploration

Answer

Zone 1, conservative

Answer

Zone 2, conservative

Question 9

The given image is of right superficial parotidectomy to identify the marked structure?

Accepted Answer

External jugular vein

Answer

Facial nerve

Answer

Parotid gland

Answer

Digastric muscle

Question 10

During a laparoscopic cholecystectomy, a lateral injury to the Common Bile Duct is identified. What is the most appropriate next step in management?

Accepted Answer

Convert to open procedure with T -tube drainage

Answer

Continue the laparoscopic procedure and place a drain

Answer

Ligate the duct proximal to the injury

Answer

Close the abdomen and refer for ERCP

FMGE 2026

Anatomy

Internal Medicine

Pediatrics

Physiology

Surgery