Repeat FMGE Question Patterns

PERIPHERAL NERVE INJURIES (Upper & Lower Limb)

• Core Concept: Identifying the specific nerve injured based on motor/sensory deficit or fracture site.
• Variations:
  • Wrist Drop/Radial Nerve: Tested via “Saturday night palsy” (sleeping on arm), fracture of the humerus shaft, or injury to the lateral cord.
  • Foot Drop/Common Peroneal Nerve: Tested as “injury to neck of fibula”, “inability to dorsiflex/evert foot”, or “anesthesia over dorsum of foot”.
  • Claw Hand/Ulnar Nerve: Tested via “injury to medial epicondyle”, “neuromonitoring during surgery”, or “froment sign/book test”.
  • Carpal Tunnel/Median Nerve: Tested as “tingling in lateral 3 digits”, “thenar wasting”, or “suturing finger injury”.

2. THYROID CARCINOMA & THYROIDECTOMY COMPLICATIONS

• Core Concept: Histopathological features of thyroid cancers and complications following surgery.
• Variations:
  • Papillary Carcinoma: Repeatedly tested via “Orphan Annie eye nuclei” or “Psammoma bodies” on histology.
  • Medullary Carcinoma: Tested via “Amyloid deposition”, “raised Calcitonin”, or association with MEN syndromes.
  • Post-Op Complications: “Tetany/Hypocalcemia/Chvostek sign” (damage to parathyroids), or “Hoarseness/inability to hit high notes” (Superior Laryngeal Nerve vs. Recurrent Laryngeal Nerve injury).

3. CONTRACEPTION & STERILIZATION

• Core Concept: Eligibility criteria (MEC), emergency contraception, and sterilization protocols.
• Variations:
  • Emergency Contraception: Rape victim/unprotected sex scenarios asking for the drug of choice (Levonorgestrel vs. Mifepristone vs. Copper T) depending on hours passed.
  • Vasectomy: “When to declare success?” (3 months/azoospermia).
  • Contraindications: “Who cannot use OCPs/IUCD?” (Breast cancer, Migraine with aura, Active PID, Wilson’s disease).
  • Post-Partum: “Lactational Amenorrhea” and “Progesterone-only pills (Mini-pill)” usage.

4. MENINGITIS (CSF ANALYSIS)

• Core Concept: Differentiating etiology (Bacterial vs. Viral vs. TB vs. Fungal) based on CSF protein, sugar, and cell type.
• Variations:
  • Cryptococcal Meningitis: HIV patient with headache, CSF shows “India Ink positive” or “budding yeast”.
  • Tubercular Meningitis: “Cobweb coagulum”, raised protein, low sugar, lymphocytes.
  • Pyogenic (Bacterial): Neutrophilic predominance, very low sugar, high protein.

5. BREAST PATHOLOGY (Benign vs. Malignant)

• Core Concept: Distinguishing lumps based on age, mobility, and growth pattern.
• Variations:
  • Fibroadenoma: Young female, mobile “mouse” in breast.
  • Phyllodes Tumor: “Leaf-like” growth, large rapidly growing mass, older age group compared to fibroadenoma.
  • Carcinoma Breast: “Peau d’orange” (lymphatic obstruction/Cooper’s ligament infiltration), or questions on TNM staging (especially T4 involving skin/chest wall).
  • Nipple Discharge: Bloody (Intraductal papilloma) vs. Greenish (Duct ectasia).

6. VITAMIN DEFICIENCIES

• Core Concept: Classic clinical triads and image-based identification.
• Variations:
  • Niacin (B3): Pellagra (Dermatitis, Diarrhea, Dementia), “Casal’s necklace” image.
  • Thiamine (B1): Alcoholic patient with confusion/ataxia (Wernicke’s) or lactic acidosis.
  • Vitamin A: “Bitot spots”, “Night blindness”, or “Follicular hyperkeratosis”.
  • Vitamin C: Scurvy (bleeding gums, perifollicular hemorrhage).

7. GLAUCOMA MANAGEMENT

• Core Concept: Diagnosis and drug choice for Open vs. Closed angle glaucoma.
• Variations:
  • Acute Congestive (Angle Closure): Sudden painful red eye, halos, stony hard eye. Tx: IV Mannitol/Acetazolamide/Pilocarpine.
  • Primary Open Angle: Painless, gradual vision loss, “Cupping” of disc. Tx: Latanoprost (PG analogues) or Timolol.
  • Contraindications: “Avoid Atropine in narrow angle” or “Avoid Timolol in Asthmatics”.

8. OBSTETRIC HEMORRHAGE (APH/PPH)

• Core Concept: Differentiating causes of bleeding and management sequence.
• Variations:
  • Placenta Previa: Painless bleeding, “warning hemorrhage”, contraindicated PV exam.
  • Abruptio Placentae: Painful bleeding, “woody hard/tender uterus”, associated with Pre-eclampsia/Trauma.
  • PPH Management: Sequence: Uterine massage -> Oxytocin -> Methylergometrine -> Carboprost -> Balloon Tamponade.

9. RENAL CALCULI & URETERIC STONES

• Core Concept: Imaging choice and management modalities.
• Variations:
  • Investigation: Non-contrast CT (NCCT) is the Gold Standard.
  • Management:
    • < 5-6mm: Medical expulsion therapy (Tamsulosin).
    • < 2cm (Renal): ESWL.
    • 2cm (Renal): PCNL.
    • Ureteric stones: Ureteroscopy (URS).

10. ECG DIAGNOSIS

• Core Concept: Identifying fatal arrhythmias and myocardial infarction territories.
• Variations:
  • Myocardial Infarction: ST elevation in II, III, aVF (Inferior wall) vs. V1-V4 (Anterior wall).
  • Hyperkalemia: Tall T-waves.

Arrhythmias: Saw-tooth pattern (Atrial Flutter), Irregularly irregular (Atrial Fibrillation).