FMGE Pharmacology questions with answers

1. Q1. Six hours after his first dose of haloperidol, a young man develops sustained painful twisting of the neck and upward deviation of both eyes. Which treatment should be given immediately?

   • A. Oral propranolol
   • B. An intramuscular anticholinergic such as benztropine
   • C. Intravenous dantrolene
   • D. Conversion to a long-acting depot preparation

   Answer: B. An intramuscular anticholinergic such as benztropine

2. Q2. A trekker ascending rapidly above 3500 m develops headache, nausea and insomnia. Which drug both prevents and treats this by producing a metabolic acidosis that stimulates ventilation?

   • A. Furosemide
   • B. Prochlorperazine
   • C. Nifedipine
   • D. Acetazolamide

   Answer: D. Acetazolamide

1. Q1. Ethosuximide is first-line for childhood absence seizures. Which channel does it block, and where?

   • A. T-type calcium channels in thalamic neurons
   • B. Voltage-gated sodium channels in cortical neurons
   • C. GABA transaminase in presynaptic terminals
   • D. AMPA receptors in the hippocampus

   Answer: A. T-type calcium channels in thalamic neurons

2. Q2. A woman with asthma needs migraine prophylaxis. Which drug should be avoided, and why?

   • A. Topiramate, because it causes weight gain
   • B. Amitriptyline, because it lowers the seizure threshold
   • C. Flunarizine, because it raises blood pressure
   • D. Propranolol, because beta-2 blockade can precipitate bronchospasm

   Answer: D. Propranolol, because beta-2 blockade can precipitate bronchospasm

1. Q1. Labetalol is used in hypertensive emergencies including pre-eclampsia. What is its mechanism, and what practical advantage follows?

   • A. Pure beta-1 blockade, so heart rate falls without vascular effect
   • B. Combined alpha-1 and non-selective beta blockade, so pressure falls without reflex tachycardia
   • C. Direct arteriolar dilatation, so afterload falls with reflex tachycardia
   • D. Calcium channel blockade, so both rate and afterload fall

   Answer: B. Combined alpha-1 and non-selective beta blockade, so pressure falls without reflex tachycardia

2. Q2. A patient with a triglyceride level of 900 mg/dL is started on a fibrate. Which nuclear receptor does it activate, and what is the main lipid effect?

   • A. PPAR-gamma, improving insulin sensitivity and lowering glucose
   • B. The LXR receptor, increasing cholesterol efflux
   • C. The farnesoid X receptor, reducing bile acid synthesis
   • D. PPAR-alpha, increasing lipoprotein lipase activity and lowering triglycerides

   Answer: D. PPAR-alpha, increasing lipoprotein lipase activity and lowering triglycerides

1. Q1. A man with recurrent gout and a raised serum urate is started on long-term urate-lowering therapy. What is the mechanism of the usual first-line agent?

   • A. Inhibition of xanthine oxidase, reducing urate production
   • B. Inhibition of URAT1, increasing urate excretion
   • C. Inhibition of neutrophil microtubule assembly
   • D. Conversion of urate to allantoin

   Answer: A. Inhibition of xanthine oxidase, reducing urate production

2. Q2. A traveller returning from India has watery diarrhoea without fever or blood. Which antimotility agent may be used for symptom control, and when must it be avoided?

   • A. Octreotide, avoided in secretory diarrhoea
   • B. Bismuth subsalicylate, avoided in children
   • C. Rifaximin, avoided in renal impairment
   • D. Loperamide, avoided if there is fever or bloody stool suggesting invasive infection

   Answer: D. Loperamide, avoided if there is fever or bloody stool suggesting invasive infection

1. Q1. An obese diabetic woman on oral agents is admitted with symptomatic hypoglycaemia. Which class is most likely responsible, and why?

   • A. Metformin, which suppresses hepatic gluconeogenesis
   • B. A thiazolidinedione, which improves insulin sensitivity
   • C. A DPP-4 inhibitor, which prolongs incretin action
   • D. A sulfonylurea, which stimulates insulin release regardless of the blood glucose

   Answer: D. A sulfonylurea, which stimulates insulin release regardless of the blood glucose

2. Q2. Which antihypertensive is regarded as the safest first-line choice in pregnancy-induced hypertension, and which classes are absolutely contraindicated?

   • A. Methyldopa is safe; ACE inhibitors and ARBs are contraindicated because of fetal renal damage
   • B. Lisinopril is safe; beta-blockers are contraindicated
   • C. Losartan is safe; calcium channel blockers are contraindicated
   • D. Atenolol is safe; all other classes are contraindicated

   Answer: A. Methyldopa is safe; ACE inhibitors and ARBs are contraindicated because of fetal renal damage

1. Q1. A 4-year-old has generalised oedema, heavy proteinuria and hypoalbuminaemia, with no haematuria or hypertension. What is the likely histology, and the first-line treatment?

   • A. Minimal change disease, treated with oral corticosteroids
   • B. Focal segmental glomerulosclerosis, treated with cyclosporine
   • C. Membranous nephropathy, treated with cyclophosphamide
   • D. Post-streptococcal glomerulonephritis, treated with penicillin

   Answer: A. Minimal change disease, treated with oral corticosteroids

2. Q2. An elderly man with benign prostatic enlargement becomes dizzy and hypotensive on a non-selective alpha-blocker. Which agent should replace it, and why?

   • A. Doxazosin, because it is longer acting
   • B. Terazosin, because it is better tolerated
   • C. Tamsulosin, because it is relatively selective for alpha-1A receptors in prostatic smooth muscle
   • D. Prazosin, because it has a shorter half-life

   Answer: C. Tamsulosin, because it is relatively selective for alpha-1A receptors in prostatic smooth muscle

1. Q1. A pregnant woman has an uncomplicated lower urinary tract infection. Which antibiotic is appropriate, and which class must be avoided?

   • A. Nitrofurantoin or cephalexin is appropriate; fluoroquinolones are avoided for fetal cartilage toxicity
   • B. Ciprofloxacin is appropriate; penicillins are avoided
   • C. Doxycycline is appropriate; cephalosporins are avoided
   • D. Co-trimoxazole is appropriate throughout pregnancy

   Answer: A. Nitrofurantoin or cephalexin is appropriate; fluoroquinolones are avoided for fetal cartilage toxicity

2. Q2. A non-pregnant woman has uncomplicated acute cystitis. Which agent is recommended first-line, and why?

   • A. Ciprofloxacin, because of its broad spectrum
   • B. Doxycycline, because it covers atypicals
   • C. Amoxicillin, because resistance is rare
   • D. Nitrofurantoin, because it concentrates in urine and spares the gut flora, limiting resistance

   Answer: D. Nitrofurantoin, because it concentrates in urine and spares the gut flora, limiting resistance

1. Q1. How is a drug's therapeutic index calculated, and what does a narrow index imply?

   • A. ED50 divided by LD50; a narrow index means a wide safety margin
   • B. LD50 divided by ED50; a narrow index means small dose changes may cause toxicity, so monitoring is required
   • C. Cmax divided by Cmin; a narrow index means rapid clearance
   • D. Volume of distribution divided by clearance; a narrow index means a short half-life

   Answer: B. LD50 divided by ED50; a narrow index means small dose changes may cause toxicity, so monitoring is required

2. Q2. Among the following opioids, which is the most potent by weight, and roughly how does it compare with morphine?

   • A. Pethidine, about one tenth as potent
   • B. Pentazocine, about equipotent
   • C. Fentanyl, roughly a hundred times more potent
   • D. Codeine, about a tenth as potent

   Answer: C. Fentanyl, roughly a hundred times more potent

1. Q1. Which corticosteroid has the shortest duration of action, and what is its main clinical use?

   • A. Hydrocortisone, used for physiological replacement and acute adrenal crisis
   • B. Dexamethasone, used for cerebral oedema
   • C. Triamcinolone, used intra-articularly
   • D. Deflazacort, used in muscular dystrophy

   Answer: A. Hydrocortisone, used for physiological replacement and acute adrenal crisis

2. Q2. A woman with epilepsy plans pregnancy. Which antiepileptic carries the highest teratogenic risk, and what defect is associated?

   • A. Lamotrigine, associated with cardiac defects
   • B. Carbamazepine, associated with limb defects
   • C. Sodium valproate, associated with neural tube defects and impaired neurodevelopment
   • D. Levetiracetam, associated with cleft palate

   Answer: C. Sodium valproate, associated with neural tube defects and impaired neurodevelopment

1. Q1. Exenatide is used in type 2 diabetes. What is its mechanism, and why does it rarely cause hypoglycaemia alone?

   • A. DPP-4 inhibition, prolonging endogenous incretins
   • B. A GLP-1 receptor agonist, which augments insulin release in a glucose-dependent manner
   • C. Inhibition of intestinal alpha-glucosidase
   • D. PPAR-gamma agonism, improving insulin sensitivity

   Answer: B. A GLP-1 receptor agonist, which augments insulin release in a glucose-dependent manner

2. Q2. Prostaglandins, thromboxanes and leukotrienes are all derived from which precursor, released from membrane phospholipid by phospholipase A2?

   • A. Stearic acid
   • B. Linoleic acid
   • C. Arachidonic acid
   • D. Linolenic acid

   Answer: C. Arachidonic acid

Every FMGE session paper, all 19 subjects together, is on our previous year questions page.