FMGE 2026 Practice Questions

Q: Identify the triangle shown in the image.

Submental triangle. ***Submental triangle*** - This triangle is located in the **anterior triangle of the neck** and is bordered by the **anterior bellies of the digastric muscles** laterally and the **hyoid bone** inferiorly. - Its floor is formed by the **mylohyoid muscle**, and it contains the **submental lymph nodes**, which drain lymph from the chin, tip of the tongue, and lower incisors. *Muscular triangle* - This area is bounded by the **superior belly of the omohyoid**, the **sternocleidomastoid muscle**, and the **midline of the neck**. - It serves as a space for structures like the **sternohyoid** and **sternothyroid muscles**, as well as the **thyroid** and **parathyroid glands**. *Carotid triangle* - This triangle is defined by the **superior belly of the omohyoid**, the **posterior belly of the digastric**, and the **sternocleidomastoid muscle**. - It is clinically significant as it contains the **common carotid artery**, the **internal jugular vein**, and the **vagus nerve** within the **carotid sheath**. *Digastric triangle* - Also known as the **submandibular triangle**, it is bounded by the **mandible** and the two bellies of the **digastric muscle**. - This space houses the **submandibular gland**, the **facial artery and vein**, and the **submandibular lymph nodes**.

Q: A patient with parathyroid hyperplasia, pancreatic neuroendocrine tumor, and recurrent peptic ulcer disease most commonly has mutation of which gene?

MEN1 (menin gene). ***MEN1 (menin gene)*** - This patient presents with the classic triad of **Multiple Endocrine Neoplasia type 1 (MEN1)** syndrome: **primary hyperparathyroidism** (due to hyperplasia), **pancreatic neuroendocrine tumors** (such as gastrinomas causing ZES), and **pituitary adenomas**. - The MEN1 condition is caused by a germline mutation in the **MEN1 tumor suppressor gene**, which encodes the protein **menin**. *RET* - Mutations in the **RET proto-oncogene** are characteristically associated with **Multiple Endocrine Neoplasia type 2 (MEN2A and MEN2B)**. - MEN2 conditions typically involve **medullary thyroid carcinoma**, **pheochromocytoma**, and **parathyroid hyperplasia** (in MEN2A), rather than the pancreatic/gastrinoma presentation described. *TP53* - Mutations in the **TP53 tumor suppressor gene** are pathognomonic for **Li-Fraumeni syndrome**. - This syndrome is characterized by a high predisposition to a wide variety of early-onset malignancies, such as **sarcomas**, breast cancer, and adrenal cortical carcinomas, not the endocrine triad described. *VHL* - Mutations in the **von Hippel-Lindau (VHL) gene** are responsible for **VHL syndrome**. - This disorder is marked by **hemangioblastomas**, **renal cell carcinoma**, and **pheochromocytomas**, which do not correlate with the patient's presentation of hyperparathyroidism and peptic ulcer disease.

Q: A 22-year-old male presents with anemia. Peripheral smear is given, and reticulocyte count is 6%. What is the most likely diagnosis?

Sickle cell disease. ***Sickle cell disease*** - In **Sickle cell disease**, the chronic hemolysis leads to a compensatory **reticulocytosis** (reticulocyte count > 2-3%), as the bone marrow attempts to replace destroyed red blood cells. - The peripheral smear typically reveals **sickled cells (drepanocytes)**, Howell-Jolly bodies (due to autosplenectomy), and target cells, confirming a diagnosis of hemolytic anemia. *Iron deficiency anemia* - Presents with **microcytic, hypochromic** anemia, and typically shows an **inappropriately low reticulocyte count** due to insufficient iron for erythropoiesis. - The peripheral smear classically demonstrates **pencil cells** and cigar-shaped cells, not the findings associated with hemolytic anemias. *Thalassemia trait* - Characterized by **microcytic, hypochromic** anemia with a very high red blood cell count out of proportion to the degree of anemia. - Reticulocyte counts in thalassemia trait are usually **normal or only slightly elevated**, reflecting the production of defective but not massively hemolyzed cells. *Aplastic anemia* - Defined by **pancytopenia** (affecting RBCs, WBCs, and platelets), meaning the bone marrow is failing. - The reticulocyte count is characteristically **very low (reticulocytopenia)** because the bone marrow is unable to produce new red blood cells.

Q: A patient is diagnosed with paroxysmal nocturnal hemoglobinuria (PNH). Which of the following drugs is used to reduce complement -mediated hemolysis in PNH?

Eculizumab. ***Eculizumab*** - Eculizumab is a **monoclonal antibody** that binds to **complement protein C5**, preventing the formation of the **membrane attack complex (MAC)**. - By inhibiting terminal complement activation, it effectively reduces **intravascular hemolysis**, stabilizes hemoglobin levels, and decreases the need for blood transfusions in patients with PNH. *Rituximab* - Rituximab is an **anti-CD20 monoclonal antibody** primarily used for **B-cell lymphoproliferative disorders** and certain autoimmune diseases like rheumatoid arthritis. - It has no role in the direct inhibition of the **complement cascade** required to manage the pathophysiology of PNH. *Prednisolone* - Prednisolone is a **corticosteroid** used to suppress the immune system in conditions like autoimmune hemolytic anemia (AIHA). - It is generally ineffective for the **complement-mediated lysis** seen in PNH, as the disease is driven by a defect in **CD55/CD59 expression** rather than lymphocyte-mediated mechanisms. *Hydroxyurea* - Hydroxyurea is an **antimetabolite** used to treat myeloproliferative neoplasms like **polycythemia vera** or essential thrombocythemia by reducing cell production. - It does not target the **complement pathway** and offers no therapeutic benefit in preventing the hemolysis associated with PNH.

Q: A 45-year-old man presents with splenomegaly and weight loss. Peripheral smear shows leukocytosis with a left shift. Bone marrow is hypercellular. Cytogenetic analysis reveals t(9;22). What is the treatment of choice?

Imatinib. ***Imatinib*** - This drug acts as a **tyrosine kinase inhibitor** that specifically targets the **BCR-ABL fusion protein** created by the **t(9;22)** chromosomal translocation. - It is the **first-line therapy** for chronic phase Chronic Myeloid Leukemia (CML) due to its high efficacy and minimal side-effect profile compared to older treatments. *Rituximab* - A monoclonal antibody directed against **CD20**, used primarily in the treatment of **B-cell non-Hodgkin lymphomas** and certain autoimmune conditions. - It is not indicated for CML treatment because the malignant cells in CML do not typically express the CD20 surface antigen. *IFN alpha* - Historically used as the treatment of choice for CML before the development of targeted therapies like tyrosine kinase inhibitors. - It is now mostly relegated to a second-line role or used when target-specific therapy is contraindicated, as it is associated with significant **flu-like side effects**. *Hydroxyurea* - A non-specific **myelosuppressive agent** used to provide temporary control of leukocyte counts in CML. - While it helps in reducing cytoreduction, it does not induce **molecular remission** or address the underlying BCR-ABL molecular driver, so it is not the curative treatment of choice.

Q: A middle-aged woman presents with weight gain, cold intolerance, and painless enlargement of th e thyroid gland. Which of the following antibodies is most commonly associated with this condition?

Anti TPO. ***Anti TPO*** - This patient presents with classic signs of **hypothyroidism** (weight gain, cold intolerance, thyroid enlargement), highly suggestive of **Hashimoto's thyroiditis**, which is an **autoimmune disorder**. - **Anti-thyroid peroxidase (anti-TPO)** antibodies are the most sensitive and specific markers found in the vast majority of patients with Hashimoto's thyroiditis. *Anti mitochondrial ab* - These antibodies are the hallmark diagnostic marker for **Primary Biliary Cholangitis (PBC)**, an autoimmune liver disease. - Clinical features of PBC include **pruritus** and elevated **alkaline phosphatase**, which are distinct from the thyroid dysfunction described here. *Anti ds DNA ab* - These are highly specific antibodies associated with **Systemic Lupus Erythematosus (SLE)**. - SLE typically presents with multisystem involvement, such as a **malar rash**, **arthritis**, and **serositis**, rather than isolated thyroid autoimmunity. *Anti TSH Rc* - These antibodies (Thyroid-stimulating immunoglobulin) are characteristic of **Graves' disease**, which causes **hyperthyroidism** rather than hypothyroidism. - They act to stimulate the **TSH receptor**, resulting in an overactive thyroid, tachycardia, and weight loss, opposite to this patient's presentation.

Q: A 45-year-old female presents with a rapidly enlarging mass arising from the uterine wall along with perimenopausal bleeding. Histopathological examination is suggestive of malignant smooth muscle tumor. What is the most likely diagnosis?

Leiomyosarcoma. ***Leiomyosarcoma*** - Represents a **malignant smooth muscle tumor** arising from the uterine wall, typically presenting as a **rapidly enlarging mass** which is a hallmark clinical sign distinguishing it from benign lesions. - Histopathological diagnosis requires demonstrating high **mitotic activity**, cellular atypia, and **coagulative tumor cell necrosis**, which are classic features of this sarcoma. *Leiomyoma* - This is a **benign smooth muscle tumor** (fibroid) and is extremely common in perimenopausal women. - Unlike leiomyosarcoma, it grows slowly and lacks the criteria for high-grade malignancy, such as significant **cellular atypia** or extensive necrosis. *Endometrial carcinoma* - This cancer arises from the **glandular epithelium** of the endometrium rather than the smooth muscle of the uterine wall (myometrium). - While it presents with **postmenopausal or perimenopausal bleeding**, the mass effect is typically within the uterine cavity rather than an intramural smooth muscle malignancy. *Adenomyosis* - Characterized by the presence of **endometrial tissue** within the myometrium, leading to a uniformly enlarged, boggy uterus. - It is a **benign condition** and does not present as a discrete, rapidly growing malignant solid mass.

Q: The most likely diagnosis is?

Thalassemia. ***Thalassemia*** - In pediatric populations, thalassemia often presents as a **microcytic hypochromic anemia** with a **disproportionately low MCV** compared to the red cell count (Mentzer Index < 13). - Hallmark findings include **hemoglobin electrophoresis** showing elevated HbA2 or HbF and target cells on the **peripheral blood smear**. *IDA* - Iron Deficiency Anemia (IDA) is characterized by **low ferritin** and **low serum iron**, which is the primary differentiator from thalassemia where ferritin is usually normal or high. - It typically presents with a **high Red Cell Distribution Width (RDW)**, whereas thalassemia minor often presents with a normal RDW. *Sideroblastic anemia* - This condition is characterized by the presence of **ringed sideroblasts** in the bone marrow, which are not seen in thalassemia. - It is classically associated with **elevated serum iron** and **ferritin** levels, caused by defective heme synthesis rather than globin chain production. *Anemia of chronic disease* - This type of anemia is typically **normocytic** or mildly microcytic and is associated with chronic inflammatory states. - It is differentiated by **low serum iron** but **normal or high ferritin** levels, indicating adequate iron stores that are sequestered and unavailable for erythropoiesis.

Q: Crumpled tissue paper appearance.Patient with hepatosplenomegaly?

Gaucher disease. ***Gaucher disease*** - Characterized by the presence of **Gaucher cells** in the bone marrow or spleen, which are macrophages containing **glucocerebroside** that appear as **wrinkled tissue paper** or **crumpled tissue paper**. - It is an **autosomal recessive** lysosomal storage disease caused by a deficiency of the enzyme **glucocerebrosidase**, clinically manifesting with **hepatosplenomegaly**, **pancytopenia**, and **bone pain**. *Pompe disease* - Caused by a deficiency in **alpha-1,4-glucosidase** (acid maltase), leading to the accumulation of **glycogen** in lysosomes. - Primarily presents with **cardiomegaly** and **hypotonia** in infants, rather than the specific cytological finding of crumpled tissue paper. *Niemann–Pick disease* - Associated with **sphingomyelinase deficiency**, resulting in the accumulation of **sphingomyelin** within lysosomes. - Pathologically, it is characterized by the presence of **foam cells** (lipid-laden macrophages) rather than tissue paper cytoplasm; patients often present with hepatosplenomegaly and a **cherry-red spot** on the macula. *Tay–Sachs disease* - Caused by a deficiency of **hexosaminidase A**, leading to the accumulation of **GM2 ganglioside** in neurons. - It presents primarily with **neurodegeneration** (e.g., loss of milestones, exaggerated startle response) and a **cherry-red spot** on the exam, but typically lacks the hepatosplenomegaly seen in Gaucher disease.

Q: An infant presents with features of premature ageing, growth failure, and early-onset atherosclerosis. The child has a characteristic progeroid appearance. Which of the following genes is most commonly associated with this condition? Options:

LMNA gene. ***LMNA gene*** - Mutations in the **LMNA gene** lead to the production of **progerin**, a defective form of **lamin A** protein, which causes **Hutchinson-Gilford progeria syndrome**. - This condition is characterized clinically by **failure to thrive**, **alopecia**, **sclerodermatous skin**, and early-onset **atherosclerosis** often leading to myocardial infarction or stroke. *WRN gene* - Mutations in the **WRN gene** (encoding a **DNA helicase**) cause **Werner syndrome**, which presents as **adult-onset** progeria rather than infantile. - Werner syndrome patients typically present in late adolescence or early adulthood with short stature, **cataracts**, and premature graying, lacking the early infantile onset of Hutchinson-Gilford. *C-KIT gene* - Mutations in the **C-KIT gene** (encoding a **tyrosine kinase receptor**) are primarily associated with **gastrointestinal stromal tumors (GIST)** and **piebaldism**. - They are not associated with progeroid syndromes or premature aging, but rather with defects in hematopoiesis and melanogenesis. *TP53 gene* - Mutations in the **TP53 gene** are strongly associated with **Li-Fraumeni syndrome**, which predisposes patients to a wide spectrum of childhood and adult-onset **cancers**. - While p53 has roles in **cellular senescence**, it is not the primary causative gene for classic progeroid syndromes like Hutchinson-Gilford.

Question 1

Identify the triangle shown in the image.

Accepted Answer

Submental triangle

Answer

Muscular triangle

Answer

Carotid triangle

Answer

Digastric triangle

Question 2

A patient with parathyroid hyperplasia, pancreatic neuroendocrine tumor, and recurrent peptic ulcer disease most commonly has mutation of which gene?

Accepted Answer

MEN1 (menin gene)

Answer

RET

Answer

TP53

Answer

VHL

Question 3

A 22-year-old male presents with anemia. Peripheral smear is given, and reticulocyte count is 6%. What is the most likely diagnosis?

Accepted Answer

Sickle cell disease

Answer

Iron deficiency anemia

Answer

Thalassemia trait

Answer

Aplastic anemia

Question 4

A patient is diagnosed with paroxysmal nocturnal hemoglobinuria (PNH). Which of the following drugs is used to reduce complement -mediated hemolysis in PNH?

Accepted Answer

Eculizumab

Answer

Rituximab

Answer

Prednisolone

Answer

Hydroxyurea

Question 5

A 45-year-old man presents with splenomegaly and weight loss. Peripheral smear shows leukocytosis with a left shift. Bone marrow is hypercellular. Cytogenetic analysis reveals t(9;22). What is the treatment of choice?

Accepted Answer

Imatinib

Answer

Rituximab

Answer

IFN alpha

Answer

Hydroxyurea

Question 6

A middle-aged woman presents with weight gain, cold intolerance, and painless enlargement of th e thyroid gland. Which of the following antibodies is most commonly associated with this condition?

Accepted Answer

Anti TPO

Answer

Anti mitochondrial ab

Answer

Anti ds DNA ab

Answer

Anti TSH Rc

Question 7

A 45-year-old female presents with a rapidly enlarging mass arising from the uterine wall along with perimenopausal bleeding. Histopathological examination is suggestive of malignant smooth muscle tumor. What is the most likely diagnosis?

Accepted Answer

Leiomyosarcoma

Answer

Leiomyoma

Answer

Endometrial carcinoma

Answer

Adenomyosis

Question 8

The most likely diagnosis is?

Accepted Answer

Thalassemia

Answer

IDA

Answer

Sideroblastic anemia

Answer

Anemia of chronic disease

Question 9

Crumpled tissue paper appearance.Patient with hepatosplenomegaly?

Accepted Answer

Gaucher disease

Answer

Pompe disease

Answer

Niemann –Pick disease

Answer

Tay–Sachs disease

Question 10

An infant presents with features of premature ageing, growth failure, and early-onset atherosclerosis. The child has a characteristic progeroid appearance. Which of the following genes is most commonly associated with this condition? Options:

Accepted Answer

LMNA gene

Answer

WRN gene

Answer

C-KIT gene

Answer

TP53 gene

FMGE 2026

Anatomy

Internal Medicine

Obstetrics and Gynecology

Pediatrics