FMGE-FOREIGN MEDICAL GRADUATE
EXAMINATION | ALL QUESTIONS AND ANSWERS |
A+ GRADED | COMPREHENSIVE EXAM GUIDE
2026/2027
1. A 24-year-old woman presents with fatigue, weight loss, heat intolerance, tremor, and
palpitations. Examination reveals a diffusely enlarged thyroid and bilateral lid retraction.
Which mechanism best explains the underlying disease?
A. Destruction of thyroid follicles by cytotoxic T cells
B. Antibodies stimulating the TSH receptor
C. Autonomous secretion of T3 from thyroid adenomas
D. Excessive iodine-induced inhibition of thyroid hormone synthesis
Answer: B
Rationale: Graves disease is caused by thyroid-stimulating immunoglobulins that bind and
activate the TSH receptor, producing diffuse thyroid enlargement and hyperthyroidism.
2. A 58-year-old man with a 40-pack-year smoking history presents with painless
hematuria. Urinalysis confirms numerous red blood cells, but urine culture is negative.
What diagnosis should be considered most strongly?
A. Renal papillary necrosis
B. Acute cystitis
C. Urothelial carcinoma
D. Benign prostatic hyperplasia
Answer: C
Rationale: Painless gross hematuria in an older smoker is a classic presentation of urothelial
malignancy and requires evaluation for urinary tract cancer.
3. A 6-year-old child develops periorbital edema and frothy urine two weeks after an upper
respiratory infection. Laboratory testing shows heavy proteinuria and hypoalbuminemia.
Which finding is most characteristic of minimal change disease?
A. Normal light microscopy with diffuse podocyte foot-process effacement on electron
microscopy
B. Subepithelial immune-complex deposits on electron microscopy
C. Crescent formation on light microscopy
D. Nodular glomerulosclerosis
Answer: A
,Rationale: Minimal change disease typically has normal-appearing glomeruli on light
microscopy, while electron microscopy demonstrates diffuse podocyte foot-process effacement.
4. A 32-year-old woman presents with sudden unilateral lower abdominal pain and vaginal
spotting. Pregnancy testing is positive. Transvaginal ultrasonography shows no
intrauterine gestational sac and a complex adnexal mass. What is the most likely diagnosis?
A. Complete hydatidiform mole
B. Threatened abortion
C. Placenta previa
D. Ectopic pregnancy
Answer: D
Rationale: A positive pregnancy test combined with abdominal pain, vaginal bleeding, an
empty uterus, and an adnexal mass strongly suggests ectopic pregnancy.
5. A patient with severe asthma develops increasing wheezing and respiratory distress
despite repeated inhaled bronchodilator therapy. Which medication should be added
promptly in an acute severe exacerbation?
A. Oral montelukast
B. Inhaled corticosteroid alone
C. Systemic corticosteroid
D. Long-acting beta-2 agonist monotherapy
Answer: C
Rationale: Systemic corticosteroids reduce airway inflammation and are an essential
component of treatment for moderate-to-severe acute asthma exacerbations.
6. A 67-year-old man develops sudden right-sided weakness and expressive aphasia 90
minutes after symptom onset. CT of the brain shows no intracranial hemorrhage. Which
treatment may be appropriate if eligibility criteria are satisfied?
A. Intravenous thrombolysis
B. Immediate oral warfarin
C. High-dose corticosteroids
D. Mannitol as definitive therapy
Answer: A
Rationale: In eligible patients with acute ischemic stroke presenting within the appropriate
therapeutic window, intravenous thrombolytic therapy can improve neurological outcomes
after hemorrhage has been excluded.
7. A woman presents with proximal muscle weakness, difficulty climbing stairs, and a
heliotrope rash around the eyes. Which diagnosis is most likely?
A. Systemic sclerosis
,B. Dermatomyositis
C. Rheumatoid arthritis
D. Sjögren syndrome
Answer: B
Rationale: Proximal muscle weakness with characteristic heliotrope discoloration and other
cutaneous findings is strongly associated with dermatomyositis.
8. A 3-year-old child has recurrent respiratory infections, chronic diarrhea, and failure to
thrive. Examination reveals absent tonsillar tissue. Which immunodeficiency is most likely?
A. Severe combined immunodeficiency
B. Chronic granulomatous disease
C. Selective IgA deficiency
D. X-linked agammaglobulinemia
Answer: D
Rationale: X-linked agammaglobulinemia causes profound B-cell deficiency, resulting in
markedly reduced immunoglobulins and absent or very small tonsils.
9. A patient presents with crushing substernal chest pain and ST-segment elevation in leads
II, III, and aVF. Which coronary artery is most commonly responsible?
A. Left circumflex artery
B. Left anterior descending artery
C. Right coronary artery
D. Left main coronary artery
Answer: C
Rationale: Inferior myocardial infarction is most commonly caused by occlusion of the right
coronary artery, although the left circumflex artery can also be involved.
10. A 45-year-old woman has recurrent episodes of severe unilateral headache associated
with nausea and photophobia. She prefers to remain in a dark room during attacks. Which
diagnosis is most likely?
A. Migraine
B. Tension-type headache
C. Cluster headache
D. Temporal arteritis
Answer: A
Rationale: Recurrent unilateral headache with nausea, photophobia, and functional
impairment is characteristic of migraine.
, 11. A newborn develops respiratory distress shortly after birth. The infant was delivered at
30 weeks' gestation. Chest radiography shows diffuse reticulogranular “ground-glass”
appearance. What is the most likely cause?
A. Meconium aspiration
B. Neonatal respiratory distress syndrome due to surfactant deficiency
C. Congenital diaphragmatic hernia
D. Transient tachypnea of the newborn
Answer: B
Rationale: Prematurity predisposes to surfactant deficiency, producing neonatal respiratory
distress syndrome with diffuse atelectatic and ground-glass changes on radiography.
12. A patient receiving unfractionated heparin develops thrombocytopenia and a new
lower-extremity thrombosis several days after treatment begins. What is the most
appropriate immediate management?
A. Increase the heparin dose
B. Continue heparin and administer platelets routinely
C. Stop heparin and begin an alternative non-heparin anticoagulant
D. Switch directly to aspirin alone
Answer: C
Rationale: The combination of thrombocytopenia and new thrombosis after heparin exposure
suggests heparin-induced thrombocytopenia, requiring immediate discontinuation of heparin
and alternative anticoagulation.
13. A 19-year-old college student develops fever, severe headache, neck stiffness, and
photophobia. Lumbar puncture shows neutrophilic pleocytosis, elevated protein, and low
glucose. Which organism is a major cause of acute bacterial meningitis in this age group?
A. Neisseria meningitidis
B. Listeria monocytogenes
C. Cryptococcus neoformans
D. Mycobacterium tuberculosis
Answer: A
Rationale: Neisseria meningitidis is an important cause of bacterial meningitis in adolescents
and young adults and can produce rapidly progressive meningococcemia.
14. A patient with chronic kidney disease has fatigue and normocytic normochromic
anemia. Iron studies do not suggest iron deficiency. Which mechanism most directly
contributes to the anemia?
A. Increased erythrocyte destruction by splenic macrophages
B. Reduced intestinal iron absorption as the sole mechanism
EXAMINATION | ALL QUESTIONS AND ANSWERS |
A+ GRADED | COMPREHENSIVE EXAM GUIDE
2026/2027
1. A 24-year-old woman presents with fatigue, weight loss, heat intolerance, tremor, and
palpitations. Examination reveals a diffusely enlarged thyroid and bilateral lid retraction.
Which mechanism best explains the underlying disease?
A. Destruction of thyroid follicles by cytotoxic T cells
B. Antibodies stimulating the TSH receptor
C. Autonomous secretion of T3 from thyroid adenomas
D. Excessive iodine-induced inhibition of thyroid hormone synthesis
Answer: B
Rationale: Graves disease is caused by thyroid-stimulating immunoglobulins that bind and
activate the TSH receptor, producing diffuse thyroid enlargement and hyperthyroidism.
2. A 58-year-old man with a 40-pack-year smoking history presents with painless
hematuria. Urinalysis confirms numerous red blood cells, but urine culture is negative.
What diagnosis should be considered most strongly?
A. Renal papillary necrosis
B. Acute cystitis
C. Urothelial carcinoma
D. Benign prostatic hyperplasia
Answer: C
Rationale: Painless gross hematuria in an older smoker is a classic presentation of urothelial
malignancy and requires evaluation for urinary tract cancer.
3. A 6-year-old child develops periorbital edema and frothy urine two weeks after an upper
respiratory infection. Laboratory testing shows heavy proteinuria and hypoalbuminemia.
Which finding is most characteristic of minimal change disease?
A. Normal light microscopy with diffuse podocyte foot-process effacement on electron
microscopy
B. Subepithelial immune-complex deposits on electron microscopy
C. Crescent formation on light microscopy
D. Nodular glomerulosclerosis
Answer: A
,Rationale: Minimal change disease typically has normal-appearing glomeruli on light
microscopy, while electron microscopy demonstrates diffuse podocyte foot-process effacement.
4. A 32-year-old woman presents with sudden unilateral lower abdominal pain and vaginal
spotting. Pregnancy testing is positive. Transvaginal ultrasonography shows no
intrauterine gestational sac and a complex adnexal mass. What is the most likely diagnosis?
A. Complete hydatidiform mole
B. Threatened abortion
C. Placenta previa
D. Ectopic pregnancy
Answer: D
Rationale: A positive pregnancy test combined with abdominal pain, vaginal bleeding, an
empty uterus, and an adnexal mass strongly suggests ectopic pregnancy.
5. A patient with severe asthma develops increasing wheezing and respiratory distress
despite repeated inhaled bronchodilator therapy. Which medication should be added
promptly in an acute severe exacerbation?
A. Oral montelukast
B. Inhaled corticosteroid alone
C. Systemic corticosteroid
D. Long-acting beta-2 agonist monotherapy
Answer: C
Rationale: Systemic corticosteroids reduce airway inflammation and are an essential
component of treatment for moderate-to-severe acute asthma exacerbations.
6. A 67-year-old man develops sudden right-sided weakness and expressive aphasia 90
minutes after symptom onset. CT of the brain shows no intracranial hemorrhage. Which
treatment may be appropriate if eligibility criteria are satisfied?
A. Intravenous thrombolysis
B. Immediate oral warfarin
C. High-dose corticosteroids
D. Mannitol as definitive therapy
Answer: A
Rationale: In eligible patients with acute ischemic stroke presenting within the appropriate
therapeutic window, intravenous thrombolytic therapy can improve neurological outcomes
after hemorrhage has been excluded.
7. A woman presents with proximal muscle weakness, difficulty climbing stairs, and a
heliotrope rash around the eyes. Which diagnosis is most likely?
A. Systemic sclerosis
,B. Dermatomyositis
C. Rheumatoid arthritis
D. Sjögren syndrome
Answer: B
Rationale: Proximal muscle weakness with characteristic heliotrope discoloration and other
cutaneous findings is strongly associated with dermatomyositis.
8. A 3-year-old child has recurrent respiratory infections, chronic diarrhea, and failure to
thrive. Examination reveals absent tonsillar tissue. Which immunodeficiency is most likely?
A. Severe combined immunodeficiency
B. Chronic granulomatous disease
C. Selective IgA deficiency
D. X-linked agammaglobulinemia
Answer: D
Rationale: X-linked agammaglobulinemia causes profound B-cell deficiency, resulting in
markedly reduced immunoglobulins and absent or very small tonsils.
9. A patient presents with crushing substernal chest pain and ST-segment elevation in leads
II, III, and aVF. Which coronary artery is most commonly responsible?
A. Left circumflex artery
B. Left anterior descending artery
C. Right coronary artery
D. Left main coronary artery
Answer: C
Rationale: Inferior myocardial infarction is most commonly caused by occlusion of the right
coronary artery, although the left circumflex artery can also be involved.
10. A 45-year-old woman has recurrent episodes of severe unilateral headache associated
with nausea and photophobia. She prefers to remain in a dark room during attacks. Which
diagnosis is most likely?
A. Migraine
B. Tension-type headache
C. Cluster headache
D. Temporal arteritis
Answer: A
Rationale: Recurrent unilateral headache with nausea, photophobia, and functional
impairment is characteristic of migraine.
, 11. A newborn develops respiratory distress shortly after birth. The infant was delivered at
30 weeks' gestation. Chest radiography shows diffuse reticulogranular “ground-glass”
appearance. What is the most likely cause?
A. Meconium aspiration
B. Neonatal respiratory distress syndrome due to surfactant deficiency
C. Congenital diaphragmatic hernia
D. Transient tachypnea of the newborn
Answer: B
Rationale: Prematurity predisposes to surfactant deficiency, producing neonatal respiratory
distress syndrome with diffuse atelectatic and ground-glass changes on radiography.
12. A patient receiving unfractionated heparin develops thrombocytopenia and a new
lower-extremity thrombosis several days after treatment begins. What is the most
appropriate immediate management?
A. Increase the heparin dose
B. Continue heparin and administer platelets routinely
C. Stop heparin and begin an alternative non-heparin anticoagulant
D. Switch directly to aspirin alone
Answer: C
Rationale: The combination of thrombocytopenia and new thrombosis after heparin exposure
suggests heparin-induced thrombocytopenia, requiring immediate discontinuation of heparin
and alternative anticoagulation.
13. A 19-year-old college student develops fever, severe headache, neck stiffness, and
photophobia. Lumbar puncture shows neutrophilic pleocytosis, elevated protein, and low
glucose. Which organism is a major cause of acute bacterial meningitis in this age group?
A. Neisseria meningitidis
B. Listeria monocytogenes
C. Cryptococcus neoformans
D. Mycobacterium tuberculosis
Answer: A
Rationale: Neisseria meningitidis is an important cause of bacterial meningitis in adolescents
and young adults and can produce rapidly progressive meningococcemia.
14. A patient with chronic kidney disease has fatigue and normocytic normochromic
anemia. Iron studies do not suggest iron deficiency. Which mechanism most directly
contributes to the anemia?
A. Increased erythrocyte destruction by splenic macrophages
B. Reduced intestinal iron absorption as the sole mechanism
