FMGE MUST-REVISE FACTS BEFORE THE EXAM

The days before FMGE are the time to reinforce the concepts you know well and correct the mistakes you have made in the past. It is not the time to be studying everything from square one or switching resources. You want to focus on the facts that link clinical presentations, diagnoses, investigations, and treatment.

Some topics are worth quick revision because they are commonly confused with one another. Some of these are drug-antidote pairs, adverse effects of drugs, epidemiological formulas, national health programmes, postmortem changes, psychiatric emergencies, anaesthetic agents, and image-based investigations. Here is a checklist of important topics to revise before the exam.

1. MEDICINE & PHARMACOLOGY: CLINICAL ASSOCIATIONS, DRUG PROPERTIES

It is essential to understand Medicine and Pharmacology from the perspective of associations. While revising a medical condition, try to remember the most common presentation, the first-line investigations and treatment, contraindications (if any), and the adverse effects of commonly used drugs. It is important not to memorise a drug as the answer for everything.

Important drug-antidote pairs to revise:

Remember that the choice of antidote usually depends on the inciting toxin, the dose, duration, route, contraindications, and the patient’s condition. For the exam, it is enough to know the association, but it helps to know the exceptions and additional considerations.

Antihypertensives: revise the common adverse effects of each class of drugs and their relative contraindications. For example, ACE inhibitors can cause cough and hyperkalaemia, and dihydropyridine calcium-channel blockers can cause peripheral oedema. Beta-blockers can worsen asthma or cause bradycardia.

Heart failure: remember the different drugs that are used for chronic heart failure with reduced ejection fraction (HFrEF) and acute decompensation. For example, in addition to diuretics, renin-angiotensin system (RAS) inhibitors/ARNI, beta-blockers, and mineralocorticoid receptor antagonists are used for chronic HF. SGLT2 inhibitors are also indicated for HFrEF.

ECGs: Practice reading ECGs and learn to interpret the waveform patterns for different arrhythmias, tachycardias, heart blocks, electrolyte imbalances, and other conditions. It is not enough to memorise what the waveforms look like; it is more important to understand what they mean.

For tuberculosis: learn about the importance of the HRZE drugs (isoniazid, rifampicin, pyrazinamide, ethambutol), their adverse effects, and indications. For example, isoniazid can cause peripheral neuropathy, rifampicin can cause hepatotoxicity, and pyrazinamide can raise uric acid levels. The drug regimen depends on the type of TB, resistance, and other factors.

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2. PSM: EPIDEMIOLOGY, STATISTICS, NATIONAL PROGRAMMES, VITAL STATISTICS

When studying Community Medicine, focus on definitions, denominators, formulas, and key elements of various public health programmes. It is easy to mix up epidemiology terms, so revise them together rather than memorising them in isolation.

Epidemiology and statistics: revise the definitions and formulas, including the differences between them, if any.

Remember that incidence measures new cases, whereas prevalence reflects existing cases. Sensitivity and specificity are dependent on the reference standard, whereas predictive values are dependent on disease prevalence in the tested population.

National health programmes and immunisation: revise the National Tuberculosis Elimination Programme (NTEP) and the Universal Immunization Programme (UIP). For each of these programmes, remember the aim, target population, key interventions, and associated challenges.

When studying immunisation, focus on the vaccines, their administration route, storage, cold chain, and the national immunisation schedule. Remember that schedule for the exam.

For vital statistics: revise the definitions of birth rate, death rate, infant mortality rate, neonatal mortality rate, maternal mortality rate, and total fertility rate.

Remember the denominator for each of these rates and the multiplier, if any. For example, the maternal mortality ratio uses the number of maternal deaths per 100,000 live births, and not the whole population.

3. FORENSIC MEDICINE: POSTMORTEM CHANGES, TOXICOLOGY, OTHER TOPICS

When studying Forensic Medicine, remember to learn the definitions and the conditions under which a change or sign develops. Many postmortem changes are dependent on the surrounding conditions, such as temperature, humidity, clothing, and body types. Therefore, the time of occurrence can vary.

Postmortem changes to revise:

Remember the sequence and characteristics of postmortem changes and how they are affected by external and individual factors. Try to estimate the postmortem interval with this information.

Poisoning: revise the common poison-antidote associations, the characteristic features of organophosphate poisoning, opioid overdose, and heavy metal poisoning. It is important to revise the mechanism and clinical manifestations of an overdose rather than memorising isolated facts.

Injuries: revise the different types of injuries, the difference between antemortem and postmortem injuries, consent, medical negligence, dying declaration, and age estimation. For toxicology, learn the relevant sections on medicolegal importance, such as the definitions of suicide, murder, and accidental poisoning.

Make sure to use the latest terminology and legal provisions, as some facts might have changed since you last studied these topics.

Before moving on, test your knowledge with some short exercises: for a given scenario or clinical presentation, identify the poison, the characteristic features, the indication for antidotes, and the limitations of evidence. This way, you can apply the facts you have revised.

4. PSYCHIATRY: DRUG ASSOCIATIONS, DIFFERENTIAL DIAGNOSIS

When studying Psychiatry, make tables comparing drugs with similar adverse effects and try to remember them. Remember that some conditions present similarly and can be differentiated by a few key findings. Learn to identify characteristic features of the disease, their mechanism, and the initial treatment and management options.

Psychotropic drugs: revise the most important associations for each group of drugs.

Serotonin syndrome vs neuroleptic malignant syndrome: revise the differences between these two syndromes and learn the principles of management.

Do not confuse serotonin syndrome with neuroleptic malignant syndrome or other conditions. Also, revise acute dystonia, tardive dyskinesia, lithium toxicity, alcohol withdrawal delirium, and other syndromes.

5. ANAESTHESIA: CLASSES OF DRUGS, MUSCLE RELAXANTS, AND EMERGENCIES

Anaesthesia is a good subject to revise because most of the important facts can be organised in tables comparing the drugs in different groups. Remember the mechanism of action, the differences between drugs, and the adverse effects and indications for each drug.

Important topics to revise:

• Inhalational agents: minimum alveolar concentration (MAC), factors that modify MAC, and the correlation between MAC and potency.
• Intravenous agents: propofol, ketamine, thiopentone- compare their mechanism, haemodynamic effects, and indications.
• Muscle relaxants: compare depolarising (succinylcholine) and non-depolarising blockers, mechanism of action, contraindications, and reversal agents.
• Regional anaesthesia: compare spinal and epidural techniques, location of injection, spread of the drug, and potential complications.

Malignant hyperthermia: remember the association with certain anaesthetic agents and succinylcholine, and the treatment with dantrolene and supportive care. Revise local anaesthetic systemic toxicity, aspiration, and management of anaesthetic emergencies. When studying reversal agents, make sure to differentiate between agents that block neuromuscular junctions and those that block GABA receptors.

6. PATHOLOGY AND MICROBIOLOGY: IMAGE-BASED FACTS

For Pathology and Microbiology, try to revise the most common associations and learn to identify the characteristic appearances of certain pathological processes. Do not try to memorise entire sections- go over the key points and reinforce your memory with images or videos.

Pathology: revise the key associations for the following conditions.

Microbiology: revise the key associations for the following topics:

Do not try to memorise the appearances of each stain or culture without knowing what they indicate. For image-based questions, first, identify the specimen or structure, then the findings, and then the diagnosis or the microorganism.

7. OTHER SUBJECTS YOU MAY HAVE NEGLECTED

Many students revise Surgery, Medicine, Pharmacology, and Community Medicine in detail, leaving less time for Embryology, Immunology, Biochemistry, ENT, Ophthalmology, and other short subjects. These subjects can be covered in one sitting without spending too much time on them.

Embryology: revise defects associated with neural crest, pharyngeal arches and pouches, and embryonic development of different organs. Remember the associations between developmental defects and pathologies.

Immunology: revise hypersensitivity mechanisms, complement deficiencies, patterns of immunodeficiency, and the roles of T cells, B cells, and immunoglobulins.

Biochemistry: revise glycogen storage diseases, urea cycle, amino acid metabolism, and vitamin deficiency manifestations. Learn the associations between an enzyme defect, a biochemical finding, and clinical presentations.

ENT and Ophthalmology: revise the important signs, tests, image appearances, and emergency presentations. For other short subjects, follow the same principles and revise what you know well rather than trying to memorise everything from scratch.

8. HOW TO USE THIS CHECKLIST

A revision checklist is only useful if you test your knowledge with it. Try to write down the answers to the questions posed in this checklist before you look at the solutions. This way, you will not only memorise the facts but also reinforce your recall ability.

Go over the questions you got wrong: for each fact you forgot, think about why you did not remember it. You may have mixed up two similar concepts or simply forgotten the fact.

Maintain an error log with the facts, associations, and questions you got wrong. It is easier to memorise a concept if you write it down several times rather than try to memorise a long list of facts.

Active recall is an effective learning technique that involves explaining the concept in your own words. Instead of reading the notes, try to write down what you know on a given topic.

When you are doing a revision session using this checklist, avoid switching between multiple resources and spending too much time on one topic. Use the notes and question banks you have prepared, and once you have completed a topic, move on to the next one.

This checklist is a revision aid, not a study guide: no one can guarantee which questions will appear on the exam. Many facts you know well will not be on the test, and some concepts you do not know well may appear.

Use this checklist to reinforce your knowledge and prepare well for the exam. There is no point in trying to memorise everything.

9. FINAL FMGE RAPID-RECALL CHECKLIST

Before the exam, make sure you can answer these commonly asked questions without looking at your notes:

• Common drug-antidote pairs, adverse effects of drugs, and clinical pharmacology facts.
• Drugs used for hypertension and heart failure, common adverse effects, contraindications.
• ECG interpretation, heart blocks, and electrolyte levels.
• HRZE drugs, their adverse effects, and the basics of TB treatment.
• Epidemiology terms and formulas, the difference between them, and the correct use of denominators.
• NTEP, UIP, immunisation schedules, and vaccines.
• Postmortem changes and toxicology facts.
• Medicolegal aspects of Forensic Medicine: important terms and recent changes in law.
• Clinical features of psychiatric emergencies, differentiating factors, and initial management.
• Common anaesthetic agents, muscle relaxants, and management of malignant hyperthermia.
• Pathology, microbiology, and diagnostic laboratory tests: key associations, image-based identifying features.
• Embryology and Immunology: key concepts and associations.
• Facts you got wrong in PYQs and other practice questions.

10. FREQUENTLY ASKED QUESTIONS

What are the most important subjects to revise before FMGE?

It depends on your preparation before the exam, but you always want to focus on topics where you made several mistakes or where the same fact keeps appearing. Medicine, Pharmacology, PSM, Forensic Medicine, Pathology, and Microbiology should always be on your list along with short subjects. The rest depends on your individual preparation.

Are previous year questions enough to prepare for FMGE?

PYQs are a great tool for revision, but they are not enough on their own. Make sure you understand why you got a particular question wrong and review the relevant topic. Do not try to memorise answers: use PYQs to identify weak areas and work on them.

Should I study a new resource before the exam?

Avoid switching to a new resource if possible: it will be easier to revise what you already know well than try to memorise something you do not know well. If you need to, use your existing knowledge, notes, and PYQs to create a shortlist of facts you need to be aware of.

What should I do the day before FMGE? I feel like I have so many things to revise.

Do not try to revise everything you have not studied yet. Focus on the facts you already know well, the comparisons between similar concepts, and the formulas and associations you keep forgetting. Get prepared in advance for the day of the exam, keep your revision sessions short, and do not exhaust yourself.

CONCLUSION

FMGE is the final step in preparing for the exam, and it is essential to revise what you already know well, not try to memorise everything from scratch. Practice PYQs, test your knowledge with revision checklists, and revise the differences between similar concepts. Make a list of the things you keep forgetting and revise them. Avoid switching between multiple resources.