FMGE 2026 Practice Questions

Q: A 28-year-old man diagnosed with borderline tuberculoid (BT) leprosy was started on WHO -MDT. After 2 months of regular treatment, he now presents with sudden onset of tender, erythematous, oedematous lesions over the nose and forehead associated with mild fever. There is no new sensory loss or nerve tenderness. What is the most appropriate next step in management?

Continue MDT and start oral prednisolone. ***Continue MDT and start oral prednisolone*** - This patient is presenting with a **Type 1 Reaction (Reversal Reaction)**, which is an immunological response commonly seen in **borderline leprosy** (like BT) due to an increase in cell-mediated immunity against mycobacterial antigens. - **Systemic corticosteroids (prednisolone)** are the treatment of choice to reduce inflammation and prevent permanent **nerve damage**, while **MDT should be continued** as it helps clear the antigenic load. *Stop MDT and start oral prednisolone* - Stopping MDT is contraindicated because there is no evidence that the leprosy bacilli themselves are causing the increased inflammation; the reaction is host-driven. - Discontinuing the anti-leprosy medication could potentially lead to bacterial resurgence and treatment failure. *Stop MDT and start thalidomide.* - **Thalidomide** is the specific treatment for **Type 2 Reactions (Erythema Nodosum Leprosum)**, which typically occur in lepromatous (BL/LL) leprosy and present with crops of painful nodules. - This patient has BT leprosy, which is strongly associated with **Type 1 reactions**, not Type 2, making thalidomide inappropriate. *Continue MDT alone without steroids* - This approach is dangerous because untreated Type 1 reactions can rapidly lead to **irreversible nerve damage** and deformity. - Anti-inflammatory therapy with **corticosteroids** is mandatory to control the acute immune response and preserve nerve function.

Q: Patient has slurred sleech, keeps speaking alot but speaks meaningless words. Lesion is in superior temporal gyrus. Which area is involved?

Wernicke's area. ***Wernicke's area*** - Located in the **superior temporal gyrus** of the dominant hemisphere, it is primarily responsible for **language comprehension**. - Damage here leads to **Wernicke’s aphasia** (receptive aphasia), characterized by **fluent, meaningless speech** or "word salad," but preserved articulation. *Broca's area* - Located in the **inferior frontal gyrus**, damage to this area results in **non-fluent aphasia** (expressive aphasia). - Patients typically demonstrate *halting, effortful speech* but maintain relatively normal comprehension of spoken language. *Arcuate fasciculus* - This white matter tract connects **Wernicke's area** to **Broca's area**. - Lesions here result in **conduction aphasia**, typified by inability to *repeat phrases* despite intact comprehension and fluency. *Angular gyrus* - Located in the **parietal lobe**, it is involved in **reading, writing, and interpretation** of visual symbols. - Damage is typically associated with **Gerstmann syndrome** (acalculia, agraphia, finger agnosia, left-right disorientation) rather than isolated speech fluency disturbances.

Q: A 45-year-old male with severe postoperative pain is administered morphine 5 mg intravenously. You are monitoring him for opioid toxicity. Based on which of the following findings would you make the diagnosis of opioid overdose?

Bradypnea. ***Bradypnea*** - **Respiratory depression** (manifesting as bradypnea) is the most critical and reliable sign of **opioid overdose**. - A **decreased respiratory rate** is the primary cause of morbidity and potential mortality in cases of opioid toxicity. *Tachycardia* - Opioids typically cause **bradycardia** due to increased vagal tone, rather than tachycardia. - Tachycardia is not a clinical feature of opioid toxicity and is more suggestive of withdrawal or other drug ingestions like **sympathomimetics**. *Constriction of pupil* - While **miosis** (pinpoint pupils) is a hallmark sign of opioid toxicity due to **parasympathetic activation**, it is a clinical sign but **not the specific diagnostic criterion** used to measure the severity or acute overdose status compared to the life-threatening respiratory depression. - Miosis can also be absent or less prominent in mixed overdoses or with specific opioids like meperidine, making **respiratory depression** the more definitive indicator of toxicity. *Dilation of pupil* - **Mydriasis** (pupil dilation) is characteristically seen in **sympathomimetic** (e.g., cocaine, amphetamines) or anticholinergic overdose. - It is generally contraindicated in opioid toxicity and usually suggests **hypoxia** or the ingestion of substances that antagonize opioid effects.

Q: A 52-year-old diabetic patient with poorly controlled blood glucose presents with facial pain, nasal blockage, and a black necrotic lesion over the nasal turbinate (black sinus) along with fever. Imaging shows involvement of the maxillary sinus. What is the most appropriate management?

Surgical debridement with antifungal therapy. ***Surgical debridement with antifungal therapy*** - This patient presents with classic signs of **rhino-orbital-cerebral mucormycosis**, characterized by necrotic black eschars on the nasal turbinates in the setting of **uncontrolled diabetes**. - The cornerstone of management is **aggressive surgical debridement** of infected tissue combined with systemic **antifungal therapy** (typically **liposomal amphotericin B**), as tissue necrosis limits drug penetration. *Surgical debridement only* - While surgery is vital to remove necrotic tissue and reduce organism burden, relying on surgery alone is insufficient to address the **invasive fungal infection**. - Without concurrent **antifungal systemic therapy**, the infection risk of disseminating to the brain or orbit remains critically high. *Surgical debridement with antibiotics* - **Antibiotics** are ineffective against fungal pathogens like *Mucorales*. - Using antibiotics instead of antifungals allows the **fungal infection** to propagate unchecked, likely leading to rapid progression and high morbidity. *Antibiotics only* - Mucormycosis is a fulminant **fungal** infection which does not respond to antibacterial drugs. - Delaying antifungal treatment and surgical intervention due to a reliance on antibiotics is life-threatening, as the infection exhibits **angioinvasion** and rapid tissue necrosis.

Q: At which point on the Pressure -Volume loop does the aortic valve open?

Point C. ***Point C*** - This represents the point of **isovolumetric contraction**, where the **left ventricular pressure** rises until it exceeds the **aortic diastolic pressure**. - Once the left ventricular pressure surpasses the aortic pressure, the **aortic valve opens**, initiating the period of **ventricular ejection**. *Point A* - This point marks the end of ventricular filling, where the **mitral valve closes**. - It signifies the beginning of **isovolumetric contraction**, where ventricular volume is at its maximum (**end-diastolic volume**). *Point B* - This represents the phase of **isovolumetric contraction** where ventricular pressure is still lower than the aortic pressure. - The heart is actively contracting, but **ventricular volume** remains constant because all valves are closed. *Point D* - This point marks the end of **ventricular ejection** and the closure of the **aortic valve**. - The remaining blood volume in the ventricle at this point represents the **end-systolic volume**.

Q: A patient undergoes a surgery where one lung is removed due to malignancy. Which of the following parameters should be measured to accurately assess the remaining lung's elasticity, independent of the change in lung volume?

Specific lung compliance. ***Specific lung compliance*** - Specific lung compliance is defined as the **compliance per unit of lung volume**, which normalizes the measurement against the actual volume of the remaining lung tissue. - This makes it the ideal parameter to assess the **intrinsic elastic properties** (or tissue elasticity) of the lung parenchyma, independent of absolute volume changes caused by surgical resection. *Chest wall compliance* - This metric specifically measures the **elasticity of the thoracic cage**, not the pulmonary parenchyma. - It does not provide information regarding the **intrinsic elastic properties** of the remaining lung tissue. *Total lung compliance* - Total lung compliance is heavily dependent on the **absolute lung volume**; removing a lung drastically reduces total compliance even if the remaining tissue is perfectly healthy. - It represents the combined elasticity of the entire system, making it an inaccurate measure of the **intrinsic elastic quality** of the restricted tissue mass. *Static compliance* - Static compliance is a measure of change in volume for a given change in pressure at **zero air flow**, reflecting the elastic properties of both the lung and the chest wall combined. - Like total compliance, it is a **volume-dependent variable**, and therefore reflects the function of the *remaining volume* rather than the specific, intrinsic elasticity of that tissue alone.

Q: A patient with a history of head trauma presents with signs of increased Intracranial Pressure. Which of the following sets of vital signs characterizes the Cushing Reflex?

Bradycardia and Hypertension. ***Bradycardia and Hypertension*** - The **Cushing reflex** is a physiological response in which the body attempts to maintain **cerebral perfusion pressure** in the face of elevated **intracranial pressure (ICP)**. - Increased ICP leads to **hypertension** (via the sympathetic nervous system) to overcome resistance, while the resulting stretch on **baroreceptors** induces a reflexive **bradycardia**. *Tachycardia and Hypertension* - **Tachycardia** is typically seen in early shock states rather than in the physiologic response to intracranial hypertension. - While hypertension may occur in various stress states, it is not part of the triad of signs defining the **Cushing reflex**. *Bradycardia and Hypotension* - **Hypotension** leads to a decrease in **cerebral perfusion pressure**, which would exacerbate, rather than compensate for, the risks associated with raised ICP. - This clinical pattern is more consistent with **neurogenic shock** or severe failure of the autonomic compensatory mechanisms. *Tachycardia and Hypotension* - This combination is the classic presentation of **hypovolemic shock**, where the body attempts to increase **cardiac output** due to volume loss. - This pattern does not address the need to maintain **cerebral blood flow** in the presence of space-occupying lesions or brain edema.

Q: A Strength-Duration curve is plotted for a skeletal muscle. Identify the parameters labeled in the correct order to successfully determine the tissue excitability.

A: Chronaxie; B: Rheobase; D: Utilization Time. ***A: Chronaxie; B: Rheobase; D: Utilization Time*** - The **Strength-Duration curve** shows the inverse relationship between the **stimulus strength** and the **stimulus duration** required to elicit a response. - **Chronaxie** (A) is defined as the minimum duration of stimulus required to excite a tissue at twice the **rheobase** strength, while **rheobase** (B) is the minimal stimulus strength required to excite the tissue with a long duration, and **utilization time** (D) is the minimum duration required to excite with a stimulus of precisely rheobase strength. *A: Utilization Time; B: Rheobase; D: Chronaxie* - **Utilization time** is significantly longer than **chronaxie**; mislabeling these confuses the fundamental principles of **excitability threshold**. - Placing **chronaxie** at the end of the duration axis is anatomically incorrect as it is a specific, shorter duration compared to the total **utilization time**. *A: Rheobase; B: Chronaxie; D: Utilization Time* - **Rheobase** represents a measure of **stimulus voltage** (y-axis), not a point on the duration axis. - Assigning rheobase to the duration parameters ignores the distinction between **intensity** and **time constants**. *A: Chronaxie; B: Utilization Time; D: Rheobase* - **Utilization time** is the minimum stimulus duration at **rheobase** intensity, making it distinct from **chronaxie**. - Swapping these values disrupts the physiological definition of **tissue excitability** markers.

Question 1

A 28-year-old man diagnosed with borderline tuberculoid (BT) leprosy was started on WHO -MDT. After 2 months of regular treatment, he now presents with sudden onset of tender, erythematous, oedematous lesions over the nose and forehead associated with mild fever. There is no new sensory loss or nerve tenderness. What is the most appropriate next step in management?

Accepted Answer

Continue MDT and start oral prednisolone

Answer

Stop MDT and start oral prednisolone

Answer

Stop MDT and start thalidomide.

Answer

Continue MDT alone without steroids

Question 2

Patient has slurred sleech, keeps speaking alot but speaks meaningless words. Lesion is in superior temporal gyrus. Which area is involved?

Accepted Answer

Wernicke's area

Answer

Broca's area

Answer

Arcuate fasciculus

Answer

Angular gyrus

Question 3

A 45-year-old male with severe postoperative pain is administered morphine 5 mg intravenously. You are monitoring him for opioid toxicity. Based on which of the following findings would you make the diagnosis of opioid overdose?

Accepted Answer

Bradypnea

Answer

Tachycardia

Answer

Constriction of pupil

Answer

Dilation of pupil

Question 4

A 52-year-old diabetic patient with poorly controlled blood glucose presents with facial pain, nasal blockage, and a black necrotic lesion over the nasal turbinate (black sinus) along with fever. Imaging shows involvement of the maxillary sinus. What is the most appropriate management?

Accepted Answer

Surgical debridement with antifungal therapy

Answer

Surgical debridement only

Answer

Surgical debridement with antibiotics

Answer

Antibiotics only

Question 5

A 28-year-old man develops descending flaccid paralysis, diplopia and dysphagia after eating improperly canned food. Another patient develops rapid paralysis after eating puffer fish. Which of the following correctly matches the mechanism of action?

Accepted Answer

Botulinum toxin blocks ACh release: Tetrodotoxin blocks voltage-gated sodium channels

Answer

Botulinum toxin blocks Na channels: Tetrodotoxin blocks ACh release

Answer

Botulinum toxin blocks nicotinic ACh receptors: Tetrodotoxin blocks Ca²⁺

Answer

Botulinum toxin increases ACh release: Tetrodotoxin blocks K⁺ channels

Question 6

A 26-year-old man diagnosed with diabetes insipidus was started on hydrochlorothiazide. The beneficial effect of hydrochlorothiazide in this patient is due to which of the following mechanisms?

Accepted Answer

Inhibition of Na+ reabsorption in DCT, leading to mild volume depletion and increased proximal water reabsorption

Answer

Direct stimulation of V2 receptors in the collecting duct

Answer

Blocking aquaporin -2 channels in the collecting duct

Answer

Increasing medullary interstitial osmolarity

Question 7

At which point on the Pressure -Volume loop does the aortic valve open?

Accepted Answer

Point C

Answer

Point A

Answer

Point B

Answer

Point D

Question 8

A patient undergoes a surgery where one lung is removed due to malignancy. Which of the following parameters should be measured to accurately assess the remaining lung's elasticity, independent of the change in lung volume?

Accepted Answer

Specific lung compliance

Answer

Chest wall compliance

Answer

Total lung compliance

Answer

Static compliance

Question 9

A patient with a history of head trauma presents with signs of increased Intracranial Pressure. Which of the following sets of vital signs characterizes the Cushing Reflex?

Accepted Answer

Bradycardia and Hypertension

Answer

Tachycardia and Hypertension

Answer

Bradycardia and Hypotension

Answer

Tachycardia and Hypotension

Question 10

A Strength-Duration curve is plotted for a skeletal muscle. Identify the parameters labeled in the correct order to successfully determine the tissue excitability.

Accepted Answer

A: Chronaxie; B: Rheobase; D: Utilization Time

Answer

A: Utilization Time; B: Rheobase; D: Chronaxie

Answer

A: Rheobase; B: Chronaxie; D: Utilization Time

Answer

A: Chronaxie; B: Utilization Time; D: Rheobase

FMGE 2026

Dermatology

Internal Medicine

Pharmacology

Physiology