FMGE 2026 Practice Questions

Q: A patient from TN, presents with a long -standing painless swelling of the foot with multiple discharging sinuses, as shown in the image. HYPHAE in biopsy. What is the most appropriate treatment?

Long -term antifungal therapy with surgical debridement. ***Long-term antifungal therapy with surgical debridement*** - This patient presents with features of **eumycetoma** (a fungal form of mycetoma), characterized by painless swelling, sinus tracts, and the presence of **hyphae** on biopsy. - Because fungal infections in mycetoma can be deep-seated and difficult to clear, the standard of care involves a combined approach of **prolonged antifungal therapy** (such as itraconazole or voriconazole) alongside **surgical debridement** of necrotic tissue. *Immediate amputation* - Amputation is reserved for cases with severe, extensive tissue destruction, secondary infection, or loss of function, rather than an initial management step. - Most cases of mycetoma can be managed conservatively with medical and surgical interventions before considering aggressive measures like amputation. *Short-term antifungal therapy alone* - **Eumycetoma** is a chronic, slow-growing infection that requires very long courses of antifungal therapy, often lasting for months or even years. - Short-term treatment is ineffective and will result in high **relapse rates** given the deep, granulomatous nature of the fungal infection. *Surgical debridement only* - Surgical debridement alone is insufficient as the fungal elements often infiltrate deep into the subcutaneous tissue and bone, leading to high rates of **local recurrence**. - Medical therapy is essential to treat the residual fungus that surgery alone cannot clear, necessitating the **combined therapeutic approach**.

Q: A patient with bronchial asthma on long -term inhaled corticosteroid therapy presents with whitish plaques over the palate and tonsillar region. What is the most likely diagnosis?

Oral candidiasis. ***Oral candidiasis*** - Inhaled corticosteroids suppress local oral immunity, predisposing patients to opportunistic **Candida albicans** infection, characterized by **creamy white plaques** that can be scraped off. - The palate and tonsillar region are classic sites for this infection in patients using **metered-dose inhalers (MDI)** without proper oral rinsing techniques. *Oral lichen planus* - Typically presents as **lace-like white lines** (Wickham striae) on the buccal mucosa, rather than wipeable plaques. - It is a **chronic inflammatory condition** often characterized by T-cell mediated autoimmune destruction of basal keratinocytes, not an infectious process. *Aphthous ulcer* - Presents as painful, **shallow ulcerations** with necrotic centers and erythematous halos, not as white plaques. - These are **recurrent ulcers** typically found on non-keratinized mucosa and are associated with stress, trauma, or nutritional deficiencies. *Leukoplakia* - Presents as **white patches** or plaques on the oral mucosa that **cannot be rubbed off**. - It is a **potentially premalignant lesion** associated with chronic irritation like tobacco or alcohol use, unlike the reversible fungal infection seen here.

Q: A patient with HIV infection who is also on immunosuppressive therapy presents with dry cough, progressive weight loss, and generalized weakness. What is the most likely diagnosis?

Pneumocystis jirovecii. ***Pneumocystis jirovecii*** - This organism remains the most common **opportunistic infection** in patients with HIV and significantly low **CD4 counts** (<200 cells/µL). - Classically presents with an **insidious onset** of non-productive (dry) **cough**, progressive dyspnea, and systemic symptoms like fever and **weight loss**. *Histoplasma capsulatum* - Typically presents with symptoms resembling **tuberculosis**, such as fever, cough, and hepatosplenomegaly, often in endemic areas like the **Ohio and Mississippi River valleys**. - Diagnosis usually requires detecting **urinary antigen** or visualization of small yeasts in macrophages, which is less specific to the presentation of dry cough without other endemic findings. *Candida albicans* - Primarily associated with **oropharyngeal candidiasis** (thrush) or **esophagitis** in HIV patients, not pulmonary disease. - Pulmonary involvement is extremely rare and usually superficial, not causing the profound systemic **respiratory symptoms** described here. *Mycobacterium tuberculosis* - While a major consideration, it typically presents with **hemoptysis**, night sweats, and **upper lobe cavitation** or miliary patterns on chest imaging. - Distinguishing features often include a more chronic course and specific exposures, whereas *Pneumocystis* is the classic cause of **interstitial pneumonia** in this clinical context.

Q: A patient presents with a painless genital ulcer followed by painful inguinal buboes (lymphadenopathy). Which strains of Chlamydia trachomatis are responsible for this condition?

L1–L3. ***L1–L3*** - These serovars of **Chlamydia trachomatis** are the causative agents of **lymphogranuloma venereum (LGV)**, a sexually transmitted infection. - The clinical presentation involves a transient, **painless genital ulcer** followed by the classic development of **painful inguinal lymphadenopathy** (buboes). *A, B, C* - These serovars are responsible for causing **trachoma**, a chronic keratoconjunctivitis that is the leading infectious cause of blindness worldwide. - They are typically transmitted via direct or indirect contact with eye, nose, or throat secretions rather than sexual contact. *D–K* - These strains cause common **sexually transmitted infections** including **urethritis**, **cervicitis**, and **pelvic inflammatory disease (PID)**. - They are the most frequent cause of bacterial sexually transmitted infections in developed countries but do not typically present with the pronounced **lymphadenopathy** seen in LGV. *B, C, D* - This grouping combines serovars associated with **trachoma** (B, C) and those causing **urogenital infections** (D), making it clinically incorrect. - There is no specific pathological entity associated with this collective group of **Chlamydia trachomatis** serovars.

Q: Which of the following organisms is most likely responsible for this finding?

Candida albicans. ***Candida albicans*** - This organism is a common cause of **esophagitis** in immunocompromised patients, such as those with HIV or hematologic malignancies, often presenting with **white plaques (thrush)**. - Diagnosis is typically confirmed via endoscopy, which reveals **pseudomembranes** that can be scraped off, with biopsy showing **pseudohyphae** and **yeast cells**. *Aspergillus fumigatus* - Primarily causes **pulmonary disease**, such as **allergic bronchopulmonary aspergillosis (ABPA)** or **invasive aspergillosis** in neutropenic patients. - Histologically defined by **septate hyphae** with **acute-angle (45-degree) branching**. *Cryptococcus neoformans* - Primarily associated with **meningitis** in immunocompromised individuals, often presenting with subacute headache and altered mental status. - Typically identified by **india ink staining** of cerebrospinal fluid (CSF), showing **encapsulated yeast** with a **halo effect**. *Mucor species* - A highly aggressive fungal infection (mucormycosis) most commonly seen in patients with **diabetic ketoacidosis (DKA)**. - Characterized by **aseptate hyphae** with **wide-angle (90-degree) branching** and angioinvasion leading to tissue necrosis.

Q: A patient develops acute flaccid paralysis after consuming improperly canned food the previous day. The illness is attributed to Clostridium botulinum toxin. What is the mode of transmission in this case?

Vehicle-borne transmission. ***Vehicle-borne transmission*** - Ingestion of food contaminated with **pre-formed toxins**, such as those produced by *Clostridium botulinum* in improperly canned food, is classified as a classic example of **vehicle-borne transmission**. - A vehicle is an inanimate intermediate (like food, water, or blood) that carries an infectious agent or toxin from a reservoir or source to a susceptible host. *Direct transmission* - This involves immediate transfer of an infectious agent via **person-to-person contact** (e.g., touching, kissing, or sexual intercourse). - Botulism is not contagious; therefore, it cannot be transmitted from an infected person to a susceptible person through direct contact. *Indirect transmission* - This implies mechanisms like **airborne transmission** of droplet nuclei or transmission via **fomites** (inanimate objects like bedding or doorknobs). - While the canned food is inanimate, the specific categorization where food or water serves as the contaminated medium is strictly defined as vehicle-borne, which is a more specific subset of indirect transmission. *Vector-borne transmission* - This requires a living intermediary, typically an **arthropod** (e.g., mosquitoes, ticks, or fleas), to mechanically or biologically transfer a pathogen. - *Clostridium botulinum* is a soil-dwelling bacterium that produces toxins in anaerobic environments like cans; it does not rely on insect vectors for dissemination.

Q: A patient presents with fever, sore throat, cervical lymphadenopathy, and laboratory findings show atypical lymphocytes on peripheral blood smear. Which of the following is the most likely causative organism?

Epstein–Barr virus. ***Epstein–Barr virus*** - This virus is the primary cause of **infectious mononucleosis**, characterized by the classic triad of **fever, tonsillar pharyngitis, and posterior cervical lymphadenopathy**. - The peripheral blood smear typically demonstrates **atypical lymphocytosis** (reactive CD8+ T cells), which is a key diagnostic hallmark alongside positive **heterophile antibody tests**. *Cytomegalovirus* - Often presents with a **mononucleosis-like syndrome** but typically lacks the severe **pharyngitis** and **cervical lymphadenopathy** seen in EBV infections. - Patients are usually **heterophile antibody negative** and may present with hepatitis or pneumonitis in immunocompromised hosts. *Human herpesvirus -6* - Primarily causes **exanthem subitum (roseola infantum)**, which typically presents in infants with a high fever followed by a **maculopapular rash**. - While it can occasionally cause lymphadenopathy, it does not typically present with the classic **acute pharyngitis** or widespread **atypical lymphocytosis** associated with EBV. *Adenovirus* - Frequent cause of **pharyngoconjunctival fever**, which includes pharyngitis, fever, and **conjunctivitis**. - Unlike EBV, it does not classically produce **atypical lymphocytes** on a peripheral blood smear.

Q: Which of the following organisms is most likely represented?

Mycoplasma. ***Mycoplasma*** - This genus is characterized by the **absence of a cell wall**, rendering **beta-lactam antibiotics** like penicillin ineffective. - It is a common cause of **atypical pneumonia** (often called 'walking pneumonia') and typically requires diagnosis via **serology** or **PCR** rather than Gram stain, as they do not stain well. *Chlamydia* - These are **obligate intracellular** bacteria that require host cell ATP for energy, unlike the free-living *Mycoplasma*. - They are well-known to cause **urethritis** and **cervicitis** via Elementary and Reticulate body life cycles, which are distinct from the *Mycoplasma* life cycle. *Legionella* - This is a **Gram-negative rod** that typically resides in **aquatic environments** and contaminated **HVAC systems** or water supplies. - It requires **buffered charcoal yeast extract (BCYE) agar** with iron and cysteine for growth and often presents with gastrointestinal symptoms alongside pneumonia. *Ureaplasma* - Belonging to the family **Mycoplasmataceae**, it is distinguished by its ability to metabolize **urea** using the enzyme **urease**. - While closely related to *Mycoplasma*, it is classically associated with **urogenital infections** and adverse pregnancy outcomes, whereas *Mycoplasma pneumoniae* is primarily respiratory.

Q: The Paul-Bunnell test is primarily used for the diagnosis of:

Epstein-Barr Virus (Infectious Mononucleosis). ***Epstein-Barr Virus (Infectious Mononucleosis)*** - The **Paul-Bunnell test** functions as a **heterophile antibody test** that detects antibodies produced by the body in response to an EBV infection, which agglutinate sheep or horse red blood cells. - It is historically considered a specific, though less sensitive, diagnostic marker for **infectious mononucleosis** caused by the **Epstein-Barr Virus**. *Cytomegalovirus infection* - **Cytomegalovirus (CMV)** typically causes heterophile-negative mononucleosis, meaning it does not trigger the production of the antibodies detected by the **Paul-Bunnell test**. - Diagnosis of CMV is usually confirmed through **serology (IgM/IgG)** or **PCR testing** for viral DNA, rather than heterophile antibody agglutination. *Herpes Simplex Virus infection* - **Herpes Simplex Virus (HSV)** infections primarily manifest as vesicular lesions or encephalitis; they are not associated with heterophile antibody production. - The **Paul-Bunnell test** has no role in the diagnosis of HSV, which is typically identified via **viral culture** or **PCR**. *Rubella* - **Rubella** is a viral infection characterized by a maculopapular rash and lymphadenopathy, but it does not produce the heterophile antibodies targeted by the **Paul-Bunnell test**. - Diagnosis relies on the detection of specific **rubella-specific IgM** or a rise in **IgG titers**.

Q: Factor V,X?

Haemophilus influenzae. ***Haemophilus influenzae*** - **Haemophilus influenzae** is a fastidious organism that requires specific growth factors found in blood to survive in culture media. - Specifically, it requires **Factor X (hemin)** and **Factor V (NAD or NADP)**, which are present in **chocolate agar** but not in standard blood agar. *Rubella* - **Rubella** is a viral pathogen (togavirus) and does not require bacterial nutrient agar factors like X or V for replication. - Viral growth requirements are strictly **intracellular**, relying on host cell machinery rather than external biochemical factors. *HSV* - **Herpes Simplex Virus (HSV)** is an obligate **intracellular virus** that propagates within host cells, not on artificial agar media. - It does not have metabolic requirements for heme or NAD, distinguishing it completely from bacterial nutritional needs. *EBV* - **Epstein-Barr Virus (EBV)** is a herpesvirus that exhibits **B-lymphocyte tropism** and requires specialized cell culture lines for laboratory study. - Like other viruses, its replication is driven by **viral genetic material** integrated into host cells, independent of bacterial growth factors.

Question 1

A patient from TN, presents with a long -standing painless swelling of the foot with multiple discharging sinuses, as shown in the image. HYPHAE in biopsy. What is the most appropriate treatment?

Accepted Answer

Long -term antifungal therapy with surgical debridement

Answer

Immediate amputation

Answer

Short-term antifungal therapy alone

Answer

Surgical debridement only

Question 2

A patient with bronchial asthma on long -term inhaled corticosteroid therapy presents with whitish plaques over the palate and tonsillar region. What is the most likely diagnosis?

Accepted Answer

Oral candidiasis

Answer

Oral lichen planus

Answer

Aphthous ulcer

Answer

Leukoplakia

Question 3

A patient with HIV infection who is also on immunosuppressive therapy presents with dry cough, progressive weight loss, and generalized weakness. What is the most likely diagnosis?

Accepted Answer

Pneumocystis jirovecii

Answer

Histoplasma capsulatum

Answer

Candida albicans

Answer

Mycobacterium tuberculosis

Question 4

A patient presents with a painless genital ulcer followed by painful inguinal buboes (lymphadenopathy). Which strains of Chlamydia trachomatis are responsible for this condition?

Accepted Answer

L1–L3

Answer

A, B, C

Answer

D–K

Answer

B, C, D

Question 5

Which of the following organisms is most likely responsible for this finding?

Accepted Answer

Candida albicans

Answer

Aspergillus fumigatus

Answer

Cryptococcus neoformans

Answer

Mucor species

Question 6

A patient develops acute flaccid paralysis after consuming improperly canned food the previous day. The illness is attributed to Clostridium botulinum toxin. What is the mode of transmission in this case?

Accepted Answer

Vehicle-borne transmission

Answer

Direct transmission

Answer

Indirect transmission

Answer

Vector-borne transmission

Question 7

A patient presents with fever, sore throat, cervical lymphadenopathy, and laboratory findings show atypical lymphocytes on peripheral blood smear. Which of the following is the most likely causative organism?

Accepted Answer

Epstein–Barr virus

Answer

Cytomegalovirus

Answer

Human herpesvirus -6

Answer

Adenovirus

Question 8

Which of the following organisms is most likely represented?

Accepted Answer

Mycoplasma

Answer

Chlamydia

Answer

Legionella

Answer

Ureaplasma

Question 9

The Paul-Bunnell test is primarily used for the diagnosis of:

Accepted Answer

Epstein-Barr Virus (Infectious Mononucleosis)

Answer

Cytomegalovirus infection

Answer

Herpes Simplex Virus infection

Answer

Rubella

Question 10

Factor V,X?

Accepted Answer

Haemophilus influenzae

Answer

Rubella

Answer

HSV

Answer

EBV

FMGE 2026

Dermatology

Internal Medicine

Microbiology

Pediatrics