Master Medicine
for FMGE

What the FMGE Tests in Medicine

Candidates must demonstrate the ability to diagnose and manage common and emergency medical conditions presenting in adults, based on history, examination, and basic investigations. The exam tests knowledge of clinical features, diagnostic criteria (e.g., CURB-65, GCS, ACR criteria for lupus), first-line pharmacotherapy (e.g., beta-blockers in heart failure, ACE inhibitors in diabetic nephropathy), and acute management protocols (e.g., anaphylaxis, status epilepticus, acute asthma). Emphasis is on UK/European guidelines (NICE, BTS, ESC) and clinical decision-making for conditions like pneumonia, COPD exacerbation, myocardial infarction, stroke, meningitis, DKA, and sepsis. Candidates must know specific drug doses, contraindications, and monitoring parameters (e.g., INR for warfarin, metformin in renal impairment). Public health topics include TB screening, HIV post-exposure prophylaxis, and vaccination schedules.

High-Yield Concepts

• Community-Acquired Pneumonia Severity Assessment (CURB-65): CURB-65 score: Confusion (AMTS ≤8), Urea >7 mmol/L, Respiratory rate ≥30/min, Blood pressure (systolic <90 or diastolic ≤60), age ≥65. Score 0-1: treat at home; 2: consider hospital; ≥3: severe pneumonia, admit to ICU. First-line antibiotics: amoxicillin 500 mg TDS or doxycycline 200 mg stat then 100 mg OD for mild; co-amoxiclav plus clarithromycin for severe.
• Acute Myocardial Infarction (STEMI) Management: Diagnosis: chest pain + ST elevation ≥1 mm in limb leads or ≥2 mm in precordial leads + elevated high-sensitivity troponin. Immediate management: aspirin 300 mg chewed, ticagrelor 180 mg loading, unfractionated heparin (60 U/kg bolus, then 12 U/kg/h), primary PCI within 120 minutes. If PCI not available, give fibrinolysis (tenecteplase) within 30 minutes of arrival.
• Diabetic Ketoacidosis (DKA) Management Protocol: Diagnosis: glucose >11 mmol/L, ketonaemia ≥3 mmol/L or ketonuria ++, pH <7.3, bicarbonate <15 mmol/L. Management: IV 0.9% saline 1 L over 1 hour, then 1 L over 2 hours, then 1 L over 4 hours; fixed-rate insulin infusion 0.1 U/kg/h; when glucose falls below 14 mmol/L, switch to 10% dextrose with insulin. Monitor potassium hourly; replace if <5.5 mmol/L. Correct bicarbonate only if pH <7.0.
• Anaphylaxis Treatment (UK Resuscitation Council): First-line: IM adrenaline (epinephrine) 1:1000, 0.5 mg (0.5 mL) into anterolateral thigh, repeat after 5 minutes if no response. High-flow oxygen, IV fluids (0.9% saline 500 mL stat). Adjunctive: chlorphenamine 10 mg IM/IV, hydrocortisone 200 mg IM/IV. Monitor for biphasic reaction; observe for 6-12 hours.
• Status Epilepticus Management: Definition: seizure >5 minutes or recurrent without recovery. First-line: IV lorazepam 0.1 mg/kg (max 4 mg) or buccal midazolam 10 mg. Second-line: IV phenytoin 15-18 mg/kg (max 1 g) at 50 mg/min, or IV levetiracetam 60 mg/kg. If refractory: IV propofol or thiopental with EEG monitoring. Check glucose and correct hypoglycemia.
• Heart Failure with Reduced Ejection Fraction (HFrEF) Pharmacotherapy: First-line: ACE inhibitor (e.g., ramipril 2.5 mg BD titrated to 5 mg BD) plus beta-blocker (bisoprolol 1.25 mg OD, titrated to 10 mg OD). Add mineralocorticoid receptor antagonist (spironolactone 25 mg OD) if LVEF ≤35% and NYHA II-IV. SGLT2 inhibitor (dapagliflozin 10 mg OD) now recommended for all HFrEF. Target doses per ESC guidelines.
• Tuberculosis Treatment (Standard 6-Month Regimen): Intensive phase (2 months): rifampicin 10 mg/kg (max 600 mg), isoniazid 5 mg/kg (max 300 mg), pyrazinamide 25 mg/kg (max 2 g), ethambutol 15 mg/kg (max 1.6 g) daily. Continuation phase (4 months): rifampicin + isoniazid. Monitor LFTs; check for optic neuritis with ethambutol. Directly observed therapy (DOT) recommended.
• Sepsis Recognition and Management (Sepsis-3 / NICE): Suspected infection + qSOFA ≥2 (RR ≥22, SBP ≤100, altered mentation). Take blood cultures, lactate, start broad-spectrum antibiotics within 1 hour (e.g., piperacillin-tazobactam 4.5 g IV). IV fluids 30 mL/kg crystalloid within 3 hours if lactate ≥2 mmol/L or hypotension. Vasopressors (norepinephrine) if MAP <65 after fluids. Source control within 6 hours.

Common Traps in Medicine Questions

• Forgetting that CURB-65 uses mental test score ≤8 (not just confusion) and that age ≥65 is a separate point.
• Administering IV adrenaline for anaphylaxis instead of IM; IV is only for cardiac arrest.
• Using bicarbonate in DKA routinely — only correct if pH <7.0 due to risk of paradoxical CSF acidosis.
• Giving phenytoin too fast (>50 mg/min) causes hypotension and arrhythmias; always dilute in saline and monitor ECG.
• Starting beta-blockers in acute decompensated heart failure — they are only for stable, euvolemic patients.
• Assuming all STEMI patients need fibrinolysis — primary PCI is superior if available within 120 minutes.

How to Revise Medicine for the FMGE

Prioritise acute medical emergencies: anaphylaxis, status epilepticus, DKA, STEMI, sepsis, and asthma exacerbation — these frequently appear as single-best-answer or extended-matching questions. Memorise key diagnostic criteria (CURB-65, qSOFA, GCS, ACR/EULAR lupus criteria) and first-line drug doses (adrenaline 0.5 mg IM, lorazepam 4 mg IV, aspirin 300 mg). Practice interpreting ABGs, ECGs, and chest X-rays for common conditions (pneumonia, pneumothorax, pulmonary oedema). Questions often present a clinical scenario with a 'next step' — choose the most urgent intervention (e.g., oxygen before antibiotics in hypoxia). Review NICE and ESC guidelines for heart failure, hypertension, and diabetes. Spend extra time on TB and HIV management, as these are high-yield for FMGE. Use UK-based formularies (BNF) for drug doses.

Practise it: MedLumen has 50 Medicine questions for the FMGE, each with a full explanation and references.