FMGE Medicine previous year questions

1. Q1. A child has been convulsing for 20 minutes despite two adequate doses of intravenous lorazepam. What is the next appropriate step?

   • A. Give a third dose of lorazepam
   • B. Start oral carbamazepine
   • C. Load with intravenous levetiracetam
   • D. Observe for spontaneous termination

   Answer: C. Load with intravenous levetiracetam

2. Q2. A hypertensive patient taking hydrochlorothiazide is found to have a serum potassium of 3.0 mmol/L. Adding which agent would best correct this while maintaining blood pressure control?

   • A. Furosemide
   • B. Acetazolamide
   • C. Metolazone
   • D. Spironolactone

   Answer: D. Spironolactone

1. Q1. An older man has back pain, anaemia, hypercalcaemia and an M-spike on serum protein electrophoresis. Which urinary finding supports myeloma, and why does a standard dipstick miss it?

   • A. Haemoglobinuria, because the dipstick detects only intact red cells
   • B. Free immunoglobulin light chains, because the dipstick detects albumin rather than globulins
   • C. Glycosuria, because the dipstick threshold is set too high
   • D. Myoglobinuria, because the dipstick cannot separate it from haem

   Answer: B. Free immunoglobulin light chains, because the dipstick detects albumin rather than globulins

2. Q2. A young woman has headaches, transient visual blurring and easy bruising. Platelets are 900 x 10^9/L with normal haemoglobin and white cell count, and a JAK2 V617F mutation is present. What is the diagnosis?

   • A. Polycythaemia vera
   • B. Reactive thrombocytosis
   • C. Primary myelofibrosis
   • D. Essential thrombocythaemia

   Answer: D. Essential thrombocythaemia

1. Q1. An elderly man has weeks of unexplained fever and weight loss. The tuberculin test is negative and the chest radiograph normal, yet disseminated tuberculosis is confirmed on bone marrow biopsy. What explains the negative tests?

   • A. Prior BCG vaccination masking the tuberculin response
   • B. A false-negative film from poor inspiration
   • C. Non-tuberculous mycobacterial infection, which does not cross-react
   • D. Cryptic disseminated tuberculosis, in which anergy suppresses the tuberculin response and lesions are too small to see on plain film

   Answer: D. Cryptic disseminated tuberculosis, in which anergy suppresses the tuberculin response and lesions are too small to see on plain film

2. Q2. The Child-Pugh score grades severity of chronic liver disease. Which of the following is not one of its five components?

   • A. Serum creatinine
   • B. Serum bilirubin
   • C. Serum albumin
   • D. Prothrombin time or INR

   Answer: A. Serum creatinine

1. Q1. A patient has paraesthesiae in the hands and feet, an unsteady wide-based gait, pallor and impaired joint position sense. Which deficiency is this, and which tracts are affected?

   • A. Vitamin B12 deficiency, affecting the dorsal columns and corticospinal tracts
   • B. Thiamine deficiency, affecting the mamillary bodies
   • C. Vitamin B6 deficiency, affecting peripheral nerves only
   • D. Vitamin E deficiency, affecting the cerebellum alone

   Answer: A. Vitamin B12 deficiency, affecting the dorsal columns and corticospinal tracts

2. Q2. A long-term smoker develops dysphagia from a centrally located lung tumour compressing the oesophagus. Which histological type is most likely, and which paraneoplastic syndrome is associated?

   • A. Adenocarcinoma, associated with hypertrophic osteoarthropathy
   • B. Small cell carcinoma, associated with SIADH
   • C. Squamous cell carcinoma, associated with hypercalcaemia from PTH-related peptide
   • D. Large cell carcinoma, associated with gynaecomastia

   Answer: C. Squamous cell carcinoma, associated with hypercalcaemia from PTH-related peptide

1. Q1. A patient with sudden pleuritic chest pain and dyspnoea has a raised D-dimer and is haemodynamically stable. Which investigation confirms pulmonary embolism?

   • A. Doppler echocardiography
   • B. CT pulmonary angiography
   • C. Ventilation-perfusion scanning in all patients
   • D. Chest radiography

   Answer: B. CT pulmonary angiography

2. Q2. A young man develops an asymmetrical large-joint arthritis, sterile urethritis and conjunctivitis about three weeks after an episode of dysentery. What is the diagnosis, and which HLA is associated?

   • A. Rheumatoid arthritis, with HLA-DR4
   • B. Reactive arthritis, with HLA-B27
   • C. Gonococcal arthritis, with no HLA association
   • D. Psoriatic arthritis, with HLA-Cw6

   Answer: B. Reactive arthritis, with HLA-B27

1. Q1. A woman has tight shiny skin extending above the elbows, Raynaud phenomenon, reflux, interstitial lung disease and anti-topoisomerase I antibodies. Which subtype is this, and which complication most threatens life?

   • A. Limited cutaneous systemic sclerosis, threatened by pulmonary hypertension
   • B. Dermatomyositis, threatened by malignancy
   • C. Diffuse cutaneous systemic sclerosis, threatened by scleroderma renal crisis and lung fibrosis
   • D. Mixed connective tissue disease, threatened by myositis

   Answer: C. Diffuse cutaneous systemic sclerosis, threatened by scleroderma renal crisis and lung fibrosis

2. Q2. A woman with essential thrombocythaemia and a JAK2 mutation asks why she is at risk despite a normal haemoglobin. What is the principal hazard, and what is the usual first-line treatment for a low-risk patient?

   • A. Bleeding only, treated with tranexamic acid
   • B. Marrow failure, treated with transfusion
   • C. Leukaemic transformation, treated with chemotherapy
   • D. Thrombosis and, less often, bleeding, treated with low-dose aspirin

   Answer: D. Thrombosis and, less often, bleeding, treated with low-dose aspirin

1. Q1. A patient with infective endocarditis has tender raised nodules on the finger pulps and separate painless flat macules on the palms and soles. What are these two lesions, and how do their mechanisms differ?

   • A. Both are septic emboli and both are tender
   • B. Osler nodes are septic emboli; Janeway lesions are immune complexes
   • C. Osler nodes are tender and immune-complex mediated; Janeway lesions are painless septic emboli
   • D. Both are immune complex deposits and both are painless

   Answer: C. Osler nodes are tender and immune-complex mediated; Janeway lesions are painless septic emboli

2. Q2. A man has episodic headache, palpitations and drenching sweats with paroxysmal hypertension, and raised 24-hour urinary metanephrines. What is the diagnosis, and which drug must be started first?

   • A. Phaeochromocytoma, starting alpha blockade before any beta blocker to avoid unopposed alpha stimulation
   • B. Essential hypertension, starting a thiazide
   • C. Renal artery stenosis, starting an ACE inhibitor
   • D. Thyrotoxicosis, starting carbimazole

   Answer: A. Phaeochromocytoma, starting alpha blockade before any beta blocker to avoid unopposed alpha stimulation

1. Q1. For which category of infection control precautions is a fit-tested N95 respirator required, and give an example.

   • A. Contact precautions, for example MRSA colonisation
   • B. Droplet precautions, for example influenza
   • C. Airborne precautions, for example pulmonary tuberculosis or measles
   • D. Standard precautions, for all patient contact

   Answer: C. Airborne precautions, for example pulmonary tuberculosis or measles

2. Q2. A newborn has a unilateral facial port-wine stain in the ophthalmic trigeminal distribution and later develops seizures and glaucoma. What is the syndrome, and which vessels are abnormal?

   • A. Sturge-Weber syndrome, with a leptomeningeal capillary-venous malformation
   • B. Klippel-Trenaunay syndrome, with limb overgrowth
   • C. Von Hippel-Lindau disease, with retinal haemangioblastoma
   • D. Hereditary haemorrhagic telangiectasia, with mucosal telangiectases

   Answer: A. Sturge-Weber syndrome, with a leptomeningeal capillary-venous malformation

1. Q1. Which statement about tremor is correct?

   • A. Essential tremor is rare, affecting under 1 in 1000 people
   • B. A resting tremor that improves on movement is typical of Parkinson disease
   • C. Physiological tremor is always pathological
   • D. Cerebellar tremor is maximal at rest

   Answer: B. A resting tremor that improves on movement is typical of Parkinson disease

2. Q2. A 20-year-old recruit has an HbA1c of 6.1% and a fasting glucose of 120 mg/dL, with no symptoms. How is this categorised?

   • A. Normal glucose tolerance
   • B. Prediabetes, with impaired fasting glucose
   • C. Diabetes mellitus
   • D. Maturity-onset diabetes of the young

   Answer: B. Prediabetes, with impaired fasting glucose

1. Q1. A resting ECG shows a short PR interval with a slurred initial upstroke of the QRS complex. What is that upstroke called, and what does it represent?

   • A. A J wave, representing hypothermia
   • B. A delta wave, representing ventricular pre-excitation through an accessory pathway
   • C. An epsilon wave, representing arrhythmogenic right ventricular cardiomyopathy
   • D. A U wave, representing hypokalaemia

   Answer: B. A delta wave, representing ventricular pre-excitation through an accessory pathway

2. Q2. Why must AV nodal blocking drugs be avoided in atrial fibrillation with Wolff-Parkinson-White syndrome?

   • A. They shorten the accessory pathway refractory period, allowing very rapid conduction to the ventricles and possible ventricular fibrillation
   • B. They cause profound bradycardia
   • C. They precipitate torsades de pointes
   • D. They have no effect on the accessory pathway

   Answer: A. They shorten the accessory pathway refractory period, allowing very rapid conduction to the ventricles and possible ventricular fibrillation

Every FMGE session paper, all 19 subjects together, is on our previous year questions page.