FMGE 2026 Practice Questions

Q: A patient with a long history of betel nut chewing presents with a progressively enlarging mass protruding through the mouth. What is the IOC of likely diagnosis?

Edge biopsy. ***Edge biopsy (Incisional biopsy)*** - An **incisional biopsy** performed at the edge of the lesion is the **gold standard** (standard of care) for diagnosing oral malignancies, as it allows for the evaluation of both the **tumor tissue** and the **adjacent normal tissue** to assess the depth of invasion. - By sampling the **interface** of the lesion's border, the pathologist can confirm the diagnosis, determine the **histological grade**, and evaluate the **tumor margins** effectively. *Brush biopsy* - This technique, often referred to as **oral brush cytology** or **exfoliative cytology**, is primarily a **screening tool** rather than a diagnostic one. - It has a high rate of **false negatives** because it only collects superficial cells and cannot evaluate the **depth of invasion** or architectural patterns required for a definitive **malignancy** diagnosis. *Punch biopsy* - While useful for some superficial skin conditions, it is generally considered insufficient for deep, complex **oral masses** compared to an **incisional edge biopsy**. - There is a significant risk of **under-sampling** or missing the most representative area of the tumor, potentially leading to inaccurate staging or **misdiagnosis** of the malignancy.

Q: Diagnosis?

Crohn's disease. ***Crohn's disease*** - Characterized by **transmural inflammation** that can affect any part of the gastrointestinal tract, often with **skip lesions** and a **cobblestone appearance** on endoscopy. - Frequently presents with **terminal ileitis**, leading to complications like **anemia** due to malabsorption of B12 and iron, as well as strictures and **fistulae**. *UC* - Typically limited to the **mucosa and submucosa** and involves only the **colon and rectum** in a continuous pattern. - Hallmark symptoms include **bloody diarrhea** and **tenesmus** without the perianal involvement or transmural complications seen in Crohn's. *Ileal cancer* - Rarer than inflammatory bowel disease and typically presents with symptoms akin to bowel obstruction, such as **weight loss**, **abdominal pain**, and **vomiting**. - Usually diagnosed via imaging or colonoscopy showing a localized mass rather than the widespread, patchy inflammation found in Crohn's. *Gut malrotation* - A congenital anomaly often presenting in infancy with **bilious vomiting** and signs of midgut volvulus, though it can occasionally present in adults. - Diagnosis relies on imaging studies like a **barium swallow** or **CT scan** showing the abnormal positioning of the bowel loops, distinct from the inflammatory pathologies of IBD.

Q: A patient (drug abuser) presents with pain in the right upper quadrant, fever, chills with rigor, anorexia. The patient was HIV positive with increased enzymes. What is the likely diagnosis?

Liver abscess. ***Liver abscess*** - The classic triad of **right upper quadrant pain**, **fever with chills/rigors**, and potential hepatomegaly points strongly toward **liver abscess**, particularly in immunocompromised patients (e.g., **HIV**). - Intravenous **drug abuse** is a significant risk factor for pyogenic abscesses due to the potential for seeded infection or compromised immune status. *HCC* - Usually presents with **weight loss**, abdominal mass, or decompensation in patients with underlying **cirrhosis** or chronic hepatitis B/C. - While liver enzymes may be elevated, the acute febrile illness with rigors is more characteristic of an infectious process rather than a malignancy. *Hydatid cyst* - Typically presents as an **asymptomatic abdominal mass** or localized pain due to mass effect; it is not commonly associated with systemic symptoms like high fever and rigors unless there is superinfection or rupture. - Generally manifests as a fluid-filled cystic lesion on imaging with specific signs like **daughter cysts** rather than abscess features. *Liver METS* - Often presents with hepatomegaly, anorexia, and **weight loss**, but fever is a less common presenting feature unless the primary tumor is necrotic or there is extensive disease burden. - Usually diagnosed by identifying a primary malignancy elsewhere, and clinical presentation is typically chronic/subacute rather than acute infectious mimicry.

Q: Which option correctly matches both thyroid conditions with their associated antibodies?

Both Hyperthyroidism - LATS and Hypothyroidism - Anti-TPO. ***Both Hyperthyroidism - LATS and Hypothyroidism - Anti-TPO*** - **Long-Acting Thyroid Stimulator (LATS)** is an autoantibody historically identified in **Graves' disease**, which acts as a thyroid-stimulating immunoglobulin (TSI) by activating the **TSH receptor**. - **Anti-thyroid peroxidase (Anti-TPO)** antibodies are the hallmark serological marker for **Hashimoto's thyroiditis**, which is the most common cause of autoimmune primary hypothyroidism. *Hyperthyroidism - LATS only* - While LATS is associated with hyperthyroidism (Graves' disease), this option is incomplete because the question asks for the correct match for *both* conditions, and LATS is not the exclusive antibody associated with hyperthyroidism (TSH receptor antibodies are the modern nomenclature). - This option ignores the accurate association of Anti-TPO with hypothyroidism, making it less comprehensive than the correct choice. *Hypothyroidism - Anti-TPO only* - Although Anti-TPO is correctly linked to hypothyroidism (Hashimoto's), this option is incomplete because it fails to acknowledge the LATS association with hyperthyroidism. - The premise of the question requires identifying both valid associations, rendering this option incorrect by omission. *Neither pair is correct* - This option is incorrect because both presented associations represent classic, well-established immunological markers for their respective thyroid pathologies. - Recognizing these specific autoantibodies is essential for the serological diagnosis of common autoimmune thyroid disorders.

Q: A 5-year-old female is brought to OPD with a red mass protruding from the anal verge after defecation. On examination, the mass is 4 cm long and demonstrates concentric mucosal folds. What is the most appropriate initial management?

Conservative. ***Conservative management*** - Pediatric **rectal prolapse** is most commonly self-limiting and resolved by treating the underlying cause, such as **constipation**, **parasitic infection**, or **diarrhea**, and teaching the child to avoid prolonged straining. - Biofeedback or behavioral modifications, such as using a footstool while defecating to achieve a better anatomic position, are highly effective **initial management** strategies. *Injection Sclerotherapy* - This invasive procedure involves injecting an **irritant solution** into the perirectal space to create inflammation and fibrosis, which is generally reserved for patients who have failed long-term conservative treatment. - It carries significant risks, including **rectal ulceration**, **stricture formation**, and **perirectal abscess**, making it unsuitable as a primary approach. *Suture Rectopexy* - This is a surgical intervention indicated only for **refractory cases** or those unresponsive to comprehensive medical management and conservative measures. - It is overly aggressive for a typical 5-year-old presenting without red flags or complications, meaning surgery should be deferred until non-surgical avenues are exhausted. *Thiersch Stitch* - This procedure involves encircling the anal verge with a foreign material (like wire or suture) to narrow the anal opening, which is rarely indicated and primarily reserved for frail, elderly patients with **incontinence**. - It is associated with high rates of **fecal impaction** and infection, making it inappropriate and unnecessary for a pediatric patient.

Q: What is the likely diagnosis of the X -ray below ?

Sialolith. ***Sialolith*** - A **sialolith** or salivary stone appears as a radiopaque mass, commonly located within the **submandibular duct** (Wharton's duct) due to its long, tortuous course and thick mucoid saliva. - Clinical presentation often involves **postprandial swelling** and pain in the submandibular region, which is pathognomonic for obstructive sialadenitis caused by a stone. *Foreign body* - While typically radiopaque, a foreign body usually has a distinct, often irregular shape that does not conform to the anatomic path of a salivary gland duct. - Lack of associated obstructive symptoms like **postprandial swelling** makes a foreign body less likely than a sialolith in the context of glandular region radiopacities. *Dental implant* - A dental implant has a highly characteristic, uniform structure (screw-like or cylinder) composed of dense metal alloy, which appears distinctly different from the calcified, variable density of a **sialolith**. - It is typically anchored within the **alveolar bone** of the mandible or maxilla, rather than appearing as a soft-tissue calcification within the salivary ducts. *RCT abscess* - An abscess of endodontic origin (RCT failure) typically presents as a **radiolucent (dark)** periapical lesion rather than a radiopaque (bright) calcific mass, indicating bone resorption. - It is localized strictly to the apex of a tooth with a history of **root canal therapy**, lacking the ductal anatomy location associated with sialoliths.

Q: Identify the radiographic sign seen in the IVP image given below:

Fish hook sign. ***Fish hook sign*** - This appearance is characteristic of a **ureter** that is displaced superiorly and medially by an **enlarged prostate** gland, often seen on an IVP. - The term describes the distal ureters taking an unusual hooked course as they enter the **bladder base** due to prostatic enlargement. *Adder head appearance* - This sign, also known as the **cobra head sign**, represents a **ureterocele** seen on IVP as a cystic dilatation of the distal ureter. - It appears as a round or oval lucency within the **bladder shadow** surrounded by a thin radiopaque rim of contrast. *Ball-on-tee sign* - This radiographic finding is associated with **osteonecrosis** of the femoral head, particularly in later stages. - It describes the fragmented and deformed femoral head sitting on the femoral neck, resembling a ball sitting on a tee. *Spoke-wheel sign* - This is a descriptive term often used in ultrasound or MRI, classically associated with **oncocytomas** of the kidney. - It refers to the central **stellate scar** with radiating vascularity, which is distinct from ureteral findings in IVP.

Q: Based on the given ultrasound of the ovary, which radiological pattern is observed?

String of pearls sign. ***String of pearls sign*** - This is a classic ultrasound finding in **Polycystic Ovary Syndrome (PCOS)**, representing multiple small, peripheral **follicular cysts** arranged along the ovarian cortex. - These follicles typically measure **2-9 mm** in diameter and are characteristically distributed in a circular or 'string of beads' pattern. *Chocolate cyst* - Also known as an **endometrioma**, it typically appears as a cyst with **low-level internal echoes** ('ground-glass' echogenicity). - It is associated with **endometriosis** and does not present as a peripheral arrangement of multiple small follicular cysts. *Honeycomb appearance* - This term is often used to describe the ultrasound appearance of a **gestational trophoblastic disease** (specifically **molar pregnancy**) in the uterus, not the ovary. - It represents multiple cystic spaces within the placenta due to **hydropic villi**, distinct from the follicular arrangement seen in PCOS. *Ground -glass appearance* - This sonographic texture is characteristic of an **endometrioma** (chocolate cyst), reflecting the presence of **old blood products**. - It is not associated with the follicular collection pattern seen in polycystic ovaries.

Q: An adult trauma patient presents with severe respiratory distress, hypotension (BP 80/50), and distended neck veins. X given below. What is the immediate next step in management

Needle decompression at 2nd intercostal space. ***Needle decompression at 2nd intercostal space*** - The clinical presentation of **severe respiratory distress**, **hypotension**, and **distended neck veins** (Beck's triad, though usually for tamponade, these signs are classic for **tension pneumothorax** in a trauma setting) indicates a life-threatening emergency requiring immediate decompression. - **Needle thoracostomy** is the definitive immediate intervention to convert a tension pneumothorax into a simple pneumothorax, performed typically in the **2nd intercostal space** at the mid-clavicular line. *Needle decompression at 7th intercostal space* - This location is inappropriate for anterior needle decompression of a tension pneumothorax. - The 7th intercostal space is far too inferior and is generally used for **tube thoracostomy** (chest drain) insertion, not the initial emergency decompression. *Intubation* - While securing the airway is critical in trauma, **tensions pneumothorax** causes obstructive shock due to decreased venous return; intubation can exacerbate this by increasing intrathoracic pressure. - Immediate **decompression** must be performed first to stabilize hemodynamic status before proceeding to definitive airway management. *100% O2 at 8 liters /Min* - Oxygen therapy is a supportive measure but is insufficient to treat **tension pneumothorax**. - The underlying physical obstruction to venous return must be mechanically relieved via **needle decompression** or tube thoracostomy to prevent cardiovascular collapse.

Q: What is the most common cause of posterior duodenal ulcer bleeding name the artery involved?

Gastroduodenal artery. ***Gastroduodenal artery*** - Posterior duodenal ulcers are notorious for eroding into the **gastroduodenal artery**, which runs posterior to the first part of the duodenum. - This anatomical relationship makes these ulcers prone to **severe, life-threatening hemorrhage** rather than perforation. *Left epiploic artery* - The **left gastroepiploic artery** (also known as the left epiploic artery) typically runs along the greater curvature of the stomach. - It is not anatomically positioned to be affected by ulceration of the posterior duodenum. *Right epiploic artery* - The **right gastroepiploic artery** also runs along the greater curvature of the stomach and is a branch of the gastroduodenal artery. - While it branches from the gastroduodenal system, it is not the specific vessel eroded by posterior duodenal ulcers. *Intercostal artery* - **Intercostal arteries** are located within the thoracic cavity, beneath the ribs, and are completely unrelated to the anatomy of the duodenum. - These vessels are primarily involved in chest wall injuries or thoracic surgical procedures, not peptic ulcer disease.

Question 1

A patient with a long history of betel nut chewing presents with a progressively enlarging mass protruding through the mouth. What is the IOC of likely diagnosis?

Accepted Answer

Edge biopsy

Answer

Brush biopsy

Answer

Punch biopsy

Question 2

Diagnosis?

Accepted Answer

Crohn's disease

Answer

UC

Answer

Ileal cancer

Answer

Gut malrotation

Question 3

A patient (drug abuser) presents with pain in the right upper quadrant, fever, chills with rigor, anorexia. The patient was HIV positive with increased enzymes. What is the likely diagnosis?

Accepted Answer

Liver abscess

Answer

HCC

Answer

Hydatid cyst

Answer

Liver METS

Question 4

Which option correctly matches both thyroid conditions with their associated antibodies?

Accepted Answer

Both Hyperthyroidism - LATS and Hypothyroidism - Anti-TPO

Answer

Hyperthyroidism - LATS only

Answer

Hypothyroidism - Anti-TPO only

Answer

Neither pair is correct

Question 5

A 5-year-old female is brought to OPD with a red mass protruding from the anal verge after defecation. On examination, the mass is 4 cm long and demonstrates concentric mucosal folds. What is the most appropriate initial management?

Accepted Answer

Conservative

Answer

Injection Sclerotherapy

Answer

Suture Rectopexy

Answer

Thiersch Stitch

Question 6

What is the likely diagnosis of the X -ray below ?

Accepted Answer

Sialolith

Answer

Foreign body

Answer

Dental implant

Answer

RCT abscess

Question 7

Identify the radiographic sign seen in the IVP image given below:

Accepted Answer

Fish hook sign

Answer

Adder head appearance

Answer

Ball-on-tee sign

Answer

Spoke -wheel sign

Question 8

Based on the given ultrasound of the ovary, which radiological pattern is observed?

Accepted Answer

String of pearls sign

Answer

Chocolate cyst

Answer

Honeycomb appearance

Answer

Ground -glass appearance

Question 9

An adult trauma patient presents with severe respiratory distress, hypotension (BP 80/50), and distended neck veins. X given below. What is the immediate next step in management

Accepted Answer

Needle decompression at 2nd intercostal space

Answer

Needle decompression at 7th intercostal space

Answer

Intubation

Answer

100% O2 at 8 liters /Min

Question 10

What is the most common cause of posterior duodenal ulcer bleeding name the artery involved?

Accepted Answer

Gastroduodenal artery

Answer

Left epiploic artery

Answer

Right epiploic artery

Answer

Intercostal artery

FMGE 2026

Dermatology

Internal Medicine

Pediatrics

Radiology

Surgery