FMGE (FOREIGN MEDICAL GRADUATE
EXAMINATION) PRACTICE EXAM WITH 100 QUESTIONS. THE
QUESTIONS ARE DESIGNED TO MATCH THE HIGH-YIELD
TOPICS FOR FMGE: MEDICINE, SURGERY, OBSTETRICS &
GYNECOLOGY, PEDIATRICS, ORTHOPEDICS, OPHTHALMOLOGY,
ENT, PHARMACOLOGY, PATHOLOGY, MICROBIOLOGY,
FORENSIC MEDICINE, PSYCHIATRY, RADIOLOGY, ANESTHESIA,
DERMATOLOGY, AND COMMUNITY MEDICINE. EACH
QUESTION HAS THE CORRECT ANSWER IN BOLD AND
THE RATIONALE IN ITALICS.
Question 1
A 45-year-old man from a rural area presents with progressive dysphagia, first to
solids then to liquids, weight loss, and regurgitation of undigested food. Barium
swallow shows a “bird-beak” appearance. What is the most likely diagnosis?
A) Achalasia cardia
B) Carcinoma esophagus
C) Plummer–Vinson syndrome
D) Diffuse esophageal spasm
E) Peptic stricture
Rationale: Bird-beak appearance is classic for achalasia cardia due to failure of
LES relaxation and absent peristalsis. Carcinoma esophagus shows irregular “rat’s
tail” narrowing.
Question 2
,A 28-year-old primigravida at 34 weeks gestation presents with BP 150/95 mmHg
and 2+ proteinuria. She has no headache or visual disturbance. What is the most
appropriate next step?
A) Labetalol and expectant management until 37 weeks
B) Immediate delivery by cesarean section
C) Magnesium sulfate and delivery
D) Nifedipine and discharge
E) Methyldopa and delivery at 34 weeks
*Rationale: Non-severe preeclampsia at 34 weeks: expectant management with
antihypertensives (labetalol, nifedipine, methyldopa) and delivery at 37 weeks.
Magnesium sulfate is for severe preeclampsia or eclampsia.*
Question 3
A 5-year-old child presents with fever, cough, coryza, and conjunctivitis for 3 days,
followed by a maculopapular rash starting on the face and spreading downward.
Koplik spots are seen on the buccal mucosa. What is the most common
complication in India?
A) Pneumonia
B) Encephalitis
C) Otitis media
D) Subacute sclerosing panencephalitis (SSPE)
E) Diarrhea
Rationale: Measles (rubeola). The most common complication in India is
pneumonia, especially in malnourished children. SSPE is a late complication (years
later).
Question 4
,A 35-year-old woman presents with painless progressive jaundice, pruritus, and
weight loss for 3 months. LFTs show elevated ALP and GGT. Ultrasound shows
dilated intrahepatic biliary radicals with a normal-caliber common bile duct. What
is the most likely cause?
A) Cholangiocarcinoma (Klatskin tumor)
B) Gallbladder carcinoma
C) Pancreatic head carcinoma
D) Primary sclerosing cholangitis
E) Choledochal cyst
Rationale: Painless jaundice with pruritus, dilated intrahepatic ducts but normal
CBD suggests a hilar obstruction (Klatskin tumor = cholangiocarcinoma at the
hilum). Pancreatic head cancer would dilate CBD.
Question 5
A 60-year-old man with COPD presents with worsening dyspnea and purulent
sputum. He is on tiotropium and salbutamol. Chest X-ray shows no infiltrate. What
is the most appropriate antibiotic in India?
A) Amoxicillin-clavulanate
B) Azithromycin
C) Ciprofloxacin
D) Doxycycline
E) Cefpodoxime
*Rationale: For COPD exacerbation with purulent sputum (Anthonisen type 1),
antibiotics are indicated. In India, amoxicillin-clavulanate or a macrolide are first-
line.*
Question 6
, A 25-year-old man presents with acute-onset severe scrotal pain, nausea, and
vomiting. Exam: left testis tender, elevated, absent cremasteric reflex. Doppler
ultrasound shows absent flow. What is the most appropriate next step?
A) Emergency surgical exploration (orchidopexy)
B) Manual detorsion
C) Antibiotics and scrotal elevation
D) Pain management and follow-up
E) Ultrasound-guided aspiration
Rationale: Testicular torsion is a surgical emergency. Surgical detorsion and
bilateral orchidopexy within 6 hours can salvage the testis.
Question 7
A 45-year-old woman with rheumatoid arthritis on methotrexate presents with
fever, cough, and dyspnea. Chest X-ray shows bilateral reticulonodular opacities.
What is the most likely diagnosis?
A) Methotrexate-induced pneumonitis
B) Pulmonary tuberculosis
C) Rheumatoid lung disease
D) Community-acquired pneumonia
E) Heart failure
Rationale: Methotrexate can cause acute or subacute pneumonitis. Withdrawal of
methotrexate and corticosteroids is treatment. Rule out infection first.
Question 8
A 30-year-old woman presents with a thyroid swelling that moves with
deglutition. Ultrasound shows a 2 cm solitary nodule with microcalcifications and
irregular margins. TSH is normal. What is the most appropriate next step?
EXAMINATION) PRACTICE EXAM WITH 100 QUESTIONS. THE
QUESTIONS ARE DESIGNED TO MATCH THE HIGH-YIELD
TOPICS FOR FMGE: MEDICINE, SURGERY, OBSTETRICS &
GYNECOLOGY, PEDIATRICS, ORTHOPEDICS, OPHTHALMOLOGY,
ENT, PHARMACOLOGY, PATHOLOGY, MICROBIOLOGY,
FORENSIC MEDICINE, PSYCHIATRY, RADIOLOGY, ANESTHESIA,
DERMATOLOGY, AND COMMUNITY MEDICINE. EACH
QUESTION HAS THE CORRECT ANSWER IN BOLD AND
THE RATIONALE IN ITALICS.
Question 1
A 45-year-old man from a rural area presents with progressive dysphagia, first to
solids then to liquids, weight loss, and regurgitation of undigested food. Barium
swallow shows a “bird-beak” appearance. What is the most likely diagnosis?
A) Achalasia cardia
B) Carcinoma esophagus
C) Plummer–Vinson syndrome
D) Diffuse esophageal spasm
E) Peptic stricture
Rationale: Bird-beak appearance is classic for achalasia cardia due to failure of
LES relaxation and absent peristalsis. Carcinoma esophagus shows irregular “rat’s
tail” narrowing.
Question 2
,A 28-year-old primigravida at 34 weeks gestation presents with BP 150/95 mmHg
and 2+ proteinuria. She has no headache or visual disturbance. What is the most
appropriate next step?
A) Labetalol and expectant management until 37 weeks
B) Immediate delivery by cesarean section
C) Magnesium sulfate and delivery
D) Nifedipine and discharge
E) Methyldopa and delivery at 34 weeks
*Rationale: Non-severe preeclampsia at 34 weeks: expectant management with
antihypertensives (labetalol, nifedipine, methyldopa) and delivery at 37 weeks.
Magnesium sulfate is for severe preeclampsia or eclampsia.*
Question 3
A 5-year-old child presents with fever, cough, coryza, and conjunctivitis for 3 days,
followed by a maculopapular rash starting on the face and spreading downward.
Koplik spots are seen on the buccal mucosa. What is the most common
complication in India?
A) Pneumonia
B) Encephalitis
C) Otitis media
D) Subacute sclerosing panencephalitis (SSPE)
E) Diarrhea
Rationale: Measles (rubeola). The most common complication in India is
pneumonia, especially in malnourished children. SSPE is a late complication (years
later).
Question 4
,A 35-year-old woman presents with painless progressive jaundice, pruritus, and
weight loss for 3 months. LFTs show elevated ALP and GGT. Ultrasound shows
dilated intrahepatic biliary radicals with a normal-caliber common bile duct. What
is the most likely cause?
A) Cholangiocarcinoma (Klatskin tumor)
B) Gallbladder carcinoma
C) Pancreatic head carcinoma
D) Primary sclerosing cholangitis
E) Choledochal cyst
Rationale: Painless jaundice with pruritus, dilated intrahepatic ducts but normal
CBD suggests a hilar obstruction (Klatskin tumor = cholangiocarcinoma at the
hilum). Pancreatic head cancer would dilate CBD.
Question 5
A 60-year-old man with COPD presents with worsening dyspnea and purulent
sputum. He is on tiotropium and salbutamol. Chest X-ray shows no infiltrate. What
is the most appropriate antibiotic in India?
A) Amoxicillin-clavulanate
B) Azithromycin
C) Ciprofloxacin
D) Doxycycline
E) Cefpodoxime
*Rationale: For COPD exacerbation with purulent sputum (Anthonisen type 1),
antibiotics are indicated. In India, amoxicillin-clavulanate or a macrolide are first-
line.*
Question 6
, A 25-year-old man presents with acute-onset severe scrotal pain, nausea, and
vomiting. Exam: left testis tender, elevated, absent cremasteric reflex. Doppler
ultrasound shows absent flow. What is the most appropriate next step?
A) Emergency surgical exploration (orchidopexy)
B) Manual detorsion
C) Antibiotics and scrotal elevation
D) Pain management and follow-up
E) Ultrasound-guided aspiration
Rationale: Testicular torsion is a surgical emergency. Surgical detorsion and
bilateral orchidopexy within 6 hours can salvage the testis.
Question 7
A 45-year-old woman with rheumatoid arthritis on methotrexate presents with
fever, cough, and dyspnea. Chest X-ray shows bilateral reticulonodular opacities.
What is the most likely diagnosis?
A) Methotrexate-induced pneumonitis
B) Pulmonary tuberculosis
C) Rheumatoid lung disease
D) Community-acquired pneumonia
E) Heart failure
Rationale: Methotrexate can cause acute or subacute pneumonitis. Withdrawal of
methotrexate and corticosteroids is treatment. Rule out infection first.
Question 8
A 30-year-old woman presents with a thyroid swelling that moves with
deglutition. Ultrasound shows a 2 cm solitary nodule with microcalcifications and
irregular margins. TSH is normal. What is the most appropriate next step?
