FMGE 2025 Practice Questions

Q: A man was abducted from his home, and his son subsequently claimed rights to his father’s property. As per Section 111 of the Bharatiya Sakshya Adhiniyam (BSA), until when is the son not entitled to claim inheritance?

7 years. ***7 years*** - Section 111 of the **Bharatiya Sakshya Adhiniyam (BSA)** (previously Sec 108 of the Indian Evidence Act) establishes the presumption of death after a person has not been heard of for **seven years**. - Inheritance claims based on the father's presumed death cannot be entertained until this mandated **seven-year period** has elapsed, as the person is legally presumed alive until then. *5 years* - This period is insufficient under the BSA to raise a legal **presumption of death** necessary for transferring property rights. - The minimum statutory period required for shifting the burden of proof regarding the existence of the missing person is longer than **five years**. *6 years* - Although close, **six years** does not meet the legal threshold established by **Section 111 of the BSA** for the presumption of death. - The burden of proof remains on the party asserting the death until the full **seven-year period** is completed. *10 years* - This duration exceeds the statutory period required; the courts can legally presume death and allow inheritance claims after the mandatory **seven years**. - Waiting **10 years** is unnecessary, as the right to claim inheritance based on presumed death arises immediately after the completion of the **seven-year requirement**.

Q: A person was found dead in a swimming pool. On autopsy, his stomach and lungs were filled with water, and there was evidence of mucoid froth at the nose and mouth. What is the most likely mode of death?

Wet drowning. ***Wet drowning***- The presence of water in the lungs and stomach confirms significant **aspiration of water**, which is the definitional characteristic of **wet drowning**.- **Mucoid froth** (or *foam*) at the nose and mouth is formed by the mixing of aspirated water, air, and pulmonary **surfactant** due to violent respiratory efforts and subsequent **pulmonary edema**.*Dry drowning*- Death is caused by sustained, irreversible **laryngospasm**, preventing water from entering the lower respiratory tract; thus, the lungs are typically congested but **dry**.- This scenario would not exhibit the volume of water in the stomach and lungs described, nor the formation of abundant pulmonary **froth**.*Near drowning*- This is a clinical term, used when a patient survives a drowning incident for at least **24 hours** after the submersion event.- It describes a **survival outcome** requiring resuscitation, not the pathological findings observed at **autopsy** for an immediate fatal drowning.*Cardiac arrest*- While cardiac arrest is the inevitable **terminal event** following the asphyxia of drowning, it is not the specific *mode* or mechanism of death described by the autopsy findings.- The findings (water in lungs/stomach, froth) specifically indicate death by **asphyxia** due to **fluid aspiration** (wet drowning).

Q: Which medication can be administered to reduce the frequency of future headache episodes in a 26-year-old female patient who experiences one-sided pulsating headaches accompanied by nausea, vomiting, and sensitivity to light and finds relief in a dimly lit environment?

Propranolol. ***Propranolol***- This is a non-selective **beta-blocker** and is considered a first-line prophylactic agent for the reduction of frequency and severity in patients with **episodic migraine** [1].- The patient's symptoms (unilateral, pulsating headache, **nausea, vomiting, and photophobia**) [2] are classic features of migraine, making **Propranolol** an appropriate choice for maintenance therapy [3].*Alprazolam*- This medication is a **short-acting benzodiazepine** primarily indicated for the acute management of anxiety and panic disorders [3].- It has **no established role** in the long-term prophylactic management of migraine and carries risks of sedation and dependence.*Diazepam*- This is a **long-acting benzodiazepine** commonly used as a muscle relaxant, anxiolytic, and for acute seizure management.- Similar to Alprazolam, it is **not recommended** for headache prophylaxis due to lack of efficacy and significant abuse potential [3].*Fluoxetine*- This drug is a selective serotonin reuptake inhibitor (**SSRI**) primarily used to treat **major depressive disorder** and anxiety [3].- While some antidepressants (like TCAs) are used for migraine prophylaxis, **Fluoxetine** is generally not considered a standard or preferred first-line agent for preventing migraine attacks.

Q: A patient presents with complaints of excessive thirst and increased urination of around 6–7 liters per day. He had a history of cerebral trauma one month ago. What is the most appropriate treatment?

Desmopressin. ***Desmopressin***- This clinical presentation of excessive thirst and massive polyuria (6–7 L/day) following **cerebral trauma** strongly suggests **Central Diabetes Insipidus (CDI)**, which results from inadequate production or release of **Antidiuretic Hormone (ADH)/Vasopressin** in the posterior pituitary or hypothalamus.- **Desmopressin** (DDAVP) is a synthetic ADH analog and acts as the highly effective hormone replacement therapy [1], directly addressing the underlying deficiency and drastically reducing urine output.- This causes water permeability of the collecting ducts to increase through binding of ADH to the V2 receptor, which enhances collecting duct water permeability through the insertion of aquaporin (AQP-2) channels into the luminal cell membrane [2].*Hydrochlorothiazide*- This medication is paradoxically used in the treatment of **Nephrogenic Diabetes Insipidus (NDI)**, where the renal tubules fail to respond to ADH [1].- It works by inducing mild volume depletion, which leads to increased proximal tubule reabsorption of solutes and water, thereby decreasing fluid delivery to the collecting duct.*Tolvaptan*- **Tolvaptan** is a **V2 vasopressin receptor antagonist** primarily used to promote water excretion in conditions like **SIADH** (Syndrome of Inappropriate ADH) to correct hyponatremia.- Administering an ADH antagonist in a state of ADH deficiency (Diabetes Insipidus) would be contraindicated, as it would worsen polyuria and potentially cause severe **hypernatremia**.*Insulin*- **Insulin** is the definitive treatment for **Diabetes Mellitus**, a condition characterized by high blood glucose levels and subsequent osmotic diuresis leading to polyuria.- While Diabetes Mellitus can cause polyuria, the history of recent **cerebral trauma** and the absence of expected accompanying symptoms like persistent hyperglycemia and glycosuria make CDI the far more likely diagnosis.

Q: A patient with known rheumatic heart disease is now found to have a 1–2 cm aneurysm on imaging. What is the most appropriate next step in management?

IV antibiotics. ***IV antibiotics*** - In a patient with **rheumatic heart disease (RHD)**, the finding of an aneurysm on imaging should raise strong suspicion for a **mycotic aneurysm**, especially given the increased risk of **infective endocarditis (IE)** in RHD patients [1]. - **Mycotic aneurysms** are infected arterial wall dilations that occur as a complication of IE, resulting from septic emboli or direct bacterial invasion of the vessel wall [2]. - **First-line management** consists of **prolonged IV antibiotics** (4-6 weeks) targeting the causative organism, along with close monitoring for aneurysm expansion or rupture. - Blood cultures, echocardiography, and infectious disease consultation are essential components of the workup [1]. *Aspirin lifelong* - While **aspirin** is important for long-term secondary prevention in RHD patients to reduce thromboembolic risk, it is **not the immediate priority** when an aneurysm is discovered. - In the setting of a **mycotic aneurysm**, aspirin may actually **increase bleeding risk** if the aneurysm ruptures and should be used cautiously [3]. - Long-term antiplatelet therapy would be considered after the acute infectious complication is addressed. *Aspirin + Clopidogrel* - **Dual antiplatelet therapy (DAPT)** is reserved for acute coronary syndromes or post-percutaneous coronary intervention, not for routine management of aneurysms in RHD. - In the context of a potential **mycotic aneurysm**, DAPT would significantly increase the risk of **catastrophic bleeding** without providing benefit. *Aspirin for 3 weeks* - Short-term aspirin therapy does not address the underlying pathology of a **mycotic aneurysm**, which requires targeted antimicrobial therapy. - This duration is insufficient for either treating the infection or providing adequate long-term vascular protection in RHD.

Q: A patient with asthma on inhaled corticosteroids and LABA continues to have exacerbations. FEV1 is normal, and there is no improvement with salbutamol challenge. The symptoms worsen seasonally. Which of the following is the most appropriate next step?

Increase dose of ICS. ***Increase dose of ICS*** - In the stepwise management of asthma, if a patient on a low or medium-dose **inhaled corticosteroid (ICS)** and **long-acting beta-agonist (LABA)** combination continues to have poor control or exacerbations, the next appropriate step is to increase the dose of the ICS [1]. - This addresses the underlying **airway inflammation**, which is the primary driver of asthma symptoms and exacerbations, especially in a patient with seasonal worsening suggesting an allergic component. *Add LAMA* - Adding a **long-acting muscarinic antagonist (LAMA)**, such as tiotropium, is typically considered at **Step 5** of asthma management, for patients who remain symptomatic despite being on a high-dose ICS-LABA. - It is not the next step after a standard-dose ICS-LABA and should only be considered after optimizing the ICS dose [1]. *Add Theophylline* - **Theophylline** is generally considered a low-preference alternative or add-on therapy due to its **narrow therapeutic index** and significant potential for side effects (e.g., cardiotoxicity, neurotoxicity). - Modern guidelines recommend other options, such as increasing the ICS dose or adding a LAMA, before considering theophylline [1]. *Add Omalizumab* - **Omalizumab** is a biologic agent (anti-IgE) reserved for **Step 5** management of severe, persistent **allergic asthma** that is poorly controlled on high-dose ICS-LABA. - Its initiation requires confirmation of an allergic phenotype (e.g., elevated IgE levels) and is not indicated before optimizing standard controller therapies [1].

Q: A 75 kg person is administered a drug with a half-life of 3 hours. What is the approximate clearance of the drug?

23 mL/min. ⚠️ **Note:** This question cannot be solved using standard pharmacokinetic formulas without the volume of distribution (Vd). The answer relies on estimation principles rather than exact calculation. ***23 mL/min*** - This represents a **low to moderate clearance** value, typical for drugs that undergo hepatic metabolism with low-to-intermediate extraction ratios - For context: Normal **creatinine clearance** (marker of GFR) is approximately 90-120 mL/min in adults [1], so 23 mL/min represents roughly 20-25% of renal clearance capacity - This is a plausible value for drugs with **predominantly hepatic metabolism** with low hepatic extraction ratio - Using the relationship $Cl = \frac{0.693 \times Vd}{t_{1/2}}$, this would correspond to a Vd of approximately 6 liters (if t½ = 3 hours) [2] *210 mL/min* - This represents **moderate to high clearance**, suggesting efficient elimination - Comparable to **renal plasma flow** (approximately 600-700 mL/min × filtration fraction) - Would require a Vd of approximately 54 liters with the given half-life - Typical for drugs with good renal excretion or intermediate hepatic extraction *1670 mL/min* - This is extremely high clearance, approaching **total hepatic blood flow** (1500 mL/min) - Would require Vd of approximately 433 liters, which exceeds total body water (42L in a 70kg person) - Only seen with high extraction ratio drugs (>0.7) with extensive first-pass metabolism - Physiologically implausible for most drugs *6770 mL/min* - This clearance is **physiologically impossible** as it exceeds cardiac output (5-6 L/min = 5000-6000 mL/min) [3] - Clearance cannot exceed the blood flow to the eliminating organ [3] - Clearly a distracter option with no pharmacokinetic validity

Q: A patient with a history of peptic ulcer disease presents with arthritis and develops carditis. Which of the following is the most appropriate anti-inflammatory drug?

Celecoxib. ***Celecoxib***- Celecoxib is a **selective COX-2 inhibitor**, meaning it primarily blocks the enzyme responsible for inflammation while largely preserving **COX-1** activity, which is crucial for gastric mucosal protection [2].- This selectivity significantly reduces the risk of **peptic ulcers** and gastrointestinal bleeding, making it the safest NSAID choice for patients with a history of **Peptic Ulcer Disease** (PUD) requiring treatment for arthritis and carditis [1].- **Note**: While COX-2 inhibitors carry cardiovascular risk warnings, in this clinical scenario (likely **rheumatic carditis** requiring anti-inflammatory therapy), celecoxib offers the best **risk-benefit profile** among NSAIDs by minimizing GI complications in a PUD patient [3]. Close cardiac monitoring is advised.*Ibuprofen*- Ibuprofen is a **non-selective NSAID** that inhibits both COX-1 and COX-2, leading to effective anti-inflammatory effects but also significant risk of **gastrointestinal (GI) toxicity**.- Inhibition of **COX-1** impairs the synthesis of protective mucosal prostaglandins, posing a high risk of ulcer recurrence or bleeding in patients with a PUD history [4].*Diclofenac*- Diclofenac is also a **non-selective NSAID** which carries a considerable risk of GI side effects by inhibiting **COX-1**, making it generally unsuitable for patients with pre-existing PUD.- Although sometimes exhibiting relative COX-2 preference compared to agents like naproxen, the GI risk remains high enough to warrant the use of a true COX-2 selective inhibitor like celecoxib in this high-risk patient [2].*Naloxone*- Naloxone is an **opioid receptor antagonist** used primarily to reverse the effects of opioid overdose; it has no **anti-inflammatory** properties.- This medication is completely irrelevant to the underlying inflammatory condition (arthritis and carditis) and the need for **pain and inflammation control**.

Q: Which of the following is a correct triple drug regimen for the treatment of Helicobacter pylori infection?

Omeprazole + Clarithromycin + Metronidazole. ***Omeprazole + Clarithromycin + Metronidazole*** - This is a **standard triple therapy regimen** containing **1 PPI (Omeprazole) + 2 antibiotics (Clarithromycin + Metronidazole)** - Also known as **PCM regimen**, recommended as first-line therapy for H. pylori eradication - Given for **14 days** with cure rates of 70-85% - Particularly useful in **penicillin-allergic patients** *Metronidazole + Omeprazole + Amoxicillin* - This is actually a **valid triple therapy** (PPI + Amoxicillin + Metronidazole = PAM regimen) - However, this combination is **less preferred** than clarithromycin-based regimens due to lower efficacy in areas with metronidazole resistance - Used as alternative when clarithromycin resistance is high *Omeprazole + Amoxicillin + Metronidazole* - Same as option A (PAM regimen), just reordered - Valid but **less preferred** than clarithromycin-based triple therapy *Metronidazole + Ciprofloxacin + Amoxicillin* - **Missing the PPI component** - incomplete triple therapy - Standard H. pylori triple therapy MUST include a **proton pump inhibitor** - Ciprofloxacin is not a first-line agent for H. pylori

Q: A patient developed Achilles tendonitis and leg swelling after taking a certain antibiotic. This adverse effect is commonly associated with fluoroquinolones. What is the most likely mechanism of action of the drug involved?

Inhibition of bacterial DNA gyrase and topoisomerase IV. ***Inhibition of bacterial DNA gyrase and topoisomerase IV*** - This is the characteristic mechanism of action for **fluoroquinolones** (e.g., ciprofloxacin, levofloxacin), which disrupts bacterial DNA replication and repair, leading to cell death. - This class of antibiotics is well-known for causing **tendinopathy** and **tendon rupture**, with the **Achilles tendon** being the most commonly affected site, as described in the clinical scenario. *Inhibition of bacterial protein synthesis at 50S subunit* - This mechanism is characteristic of antibiotic classes like **macrolides** (e.g., erythromycin, azithromycin) and **lincosamides** (e.g., clindamycin). - Their common adverse effects include **gastrointestinal distress** and **QT interval prolongation** (macrolides), not tendonitis. *Inhibition of bacterial folic acid synthesis* - This is the mechanism of action for **sulfonamides** (inhibiting dihydropteroate synthase) and **trimethoprim** (inhibiting dihydrofolate reductase). - These drugs are associated with adverse effects like **hypersensitivity reactions** (including Stevens-Johnson syndrome), **photosensitivity**, and **crystalluria**, not tendon-related issues. *Inhibition of bacterial cell wall synthesis* - This mechanism is used by a broad range of antibiotics, including **beta-lactams** (penicillins, cephalosporins) and **glycopeptides** (vancomycin). - Common adverse effects associated with these drugs are **hypersensitivity reactions** (beta-lactams) and **Red Man Syndrome** or **nephrotoxicity** (vancomycin).

Question 1

A man was abducted from his home, and his son subsequently claimed rights to his father’s property. As per Section 111 of the Bharatiya Sakshya Adhiniyam (BSA), until when is the son not entitled to claim inheritance?

Accepted Answer

7 years

Answer

10 years

Answer

5 years

Answer

6 years

Question 2

A person was found dead in a swimming pool. On autopsy, his stomach and lungs were filled with water, and there was evidence of mucoid froth at the nose and mouth. What is the most likely mode of death?

Accepted Answer

Wet drowning

Answer

Dry drowning

Answer

Cardiac arrest

Answer

Near drowning

Question 3

Which medication can be administered to reduce the frequency of future headache episodes in a 26-year-old female patient who experiences one-sided pulsating headaches accompanied by nausea, vomiting, and sensitivity to light and finds relief in a dimly lit environment?

Accepted Answer

Propranolol

Answer

Diazepam

Answer

Fluoxetine

Answer

Alprazolam

Question 4

A patient presents with complaints of excessive thirst and increased urination of around 6–7 liters per day. He had a history of cerebral trauma one month ago. What is the most appropriate treatment?

Accepted Answer

Desmopressin

Answer

Hydrochlorothiazide

Answer

Tolvaptan

Answer

Insulin

Question 5

A patient with known rheumatic heart disease is now found to have a 1–2 cm aneurysm on imaging. What is the most appropriate next step in management?

Accepted Answer

IV antibiotics

Answer

Aspirin for 3 weeks

Answer

Aspirin lifelong

Answer

Aspirin + Clopidogrel

Question 6

A patient with asthma on inhaled corticosteroids and LABA continues to have exacerbations. FEV1 is normal, and there is no improvement with salbutamol challenge. The symptoms worsen seasonally. Which of the following is the most appropriate next step?

Accepted Answer

Increase dose of ICS

Answer

Add Omalizumab

Answer

Add Theophylline

Answer

Add LAMA

Question 7

A 75 kg person is administered a drug with a half-life of 3 hours. What is the approximate clearance of the drug?

Accepted Answer

23 mL/min

Answer

6770 mL/min

Answer

1670 mL/min

Answer

210 mL/min

Question 8

A patient with a history of peptic ulcer disease presents with arthritis and develops carditis. Which of the following is the most appropriate anti-inflammatory drug?

Accepted Answer

Celecoxib

Answer

Diclofenac

Answer

Naloxone

Answer

Ibuprofen

Question 9

Which of the following is a correct triple drug regimen for the treatment of Helicobacter pylori infection?

Accepted Answer

Omeprazole + Clarithromycin + Metronidazole

Answer

Metronidazole + Omeprazole + Amoxicillin

Answer

Omeprazole + Amoxicillin + Metronidazole

Answer

Metronidazole + Ciprofloxacin + Amoxicillin

Question 10

A patient developed Achilles tendonitis and leg swelling after taking a certain antibiotic. This adverse effect is commonly associated with fluoroquinolones. What is the most likely mechanism of action of the drug involved?

Accepted Answer

Inhibition of bacterial DNA gyrase and topoisomerase IV

Answer

Inhibition of bacterial cell wall synthesis

Answer

Inhibition of bacterial folic acid synthesis

Answer

Inhibition of bacterial protein synthesis at 50S subunit

FMGE 2025

Forensic Medicine

Internal Medicine

Pharmacology