Sample DHA Prometric MCQs for General Practitioners

1. Internal Medicine

Q1: A 55-year-old male with a history of hypertension and diabetes presents with chest pain that worsens with exertion and radiates to his left arm. His blood pressure is 160/95 mmHg, and he reports nausea and lightheadedness. Which of the following is the most likely diagnosis?
a) Acute gastritis
b) Myocardial infarction
c) Pulmonary embolism
d) Costochondritis
e) Gastroesophageal reflux disease (GERD)
Answer: b) Myocardial infarction
Explanation: Chest pain radiating to the left arm, particularly with exertion, is highly suggestive of myocardial infarction (MI) in a patient with hypertension and diabetes. Additional symptoms like nausea and lightheadedness further support this diagnosis. Risk factors such as hypertension and diabetes elevate the risk of coronary artery disease, and physical exertion often exacerbates ischemic chest pain. Pulmonary embolism may cause chest pain but typically presents with acute dyspnea, while GERD and gastritis would not cause radiation to the arm.

2. Pediatrics

Q2: A 2-year-old child presents with a high fever, a barking cough, and inspiratory stridor that worsens at night. His respiratory rate is 35 breaths per minute, and his oxygen saturation is 95% on room air. What is the most likely diagnosis?
a) Bronchiolitis
b) Epiglottitis
c) Croup
d) Asthma
e) Pneumonia
Answer: c) Croup
Explanation: Croup is characterized by a barking cough, inspiratory stridor, and often a low-grade to moderate fever, primarily affecting children aged 6 months to 3 years. The stridor, especially worsening at night, supports this diagnosis. Epiglottitis is another upper airway obstruction but presents with severe respiratory distress, high fever, and drooling, with children typically refusing to lie down. The oxygen saturation level is stable, further supporting croup over more severe conditions.

3. Obstetrics and Gynecology

Q3: A 28-year-old pregnant woman at 34 weeks gestation presents with sudden, severe abdominal pain and heavy vaginal bleeding. Her blood pressure is 90/60 mmHg, and fetal heart tones are absent. What is the most likely diagnosis?
a) Placenta previa
b) Placental abruption
c) Uterine rupture
d) Preterm labor
e) Miscarriage
Answer: b) Placental abruption
Explanation: Placental abruption involves the premature separation of the placenta, causing severe abdominal pain and bleeding, often in the third trimester. The presence of hypotension and fetal distress (or absent heart tones) points toward a severe abruption with potential for fetal compromise. Placenta previa typically presents with painless bleeding, and uterine rupture is rare without prior uterine surgery. Immediate intervention is required to manage both maternal and fetal complications.

4. Surgery

Q4: A 25-year-old male arrives in the emergency department with acute onset of right lower quadrant pain that started around the umbilicus and later localized to the lower abdomen. On examination, he has rebound tenderness at McBurney’s point and a positive Rovsing’s sign. Which of the following findings would most likely confirm the diagnosis?
a) Left lower quadrant pain
b) Positive Murphy’s sign
c) Rebound tenderness in the right lower quadrant
d) Decreased bowel sounds
e) Pain relief with walking
Answer: c) Rebound tenderness in the right lower quadrant
Explanation: Rebound tenderness at McBurney’s point, along with migration of pain from the periumbilical area to the right lower quadrant and a positive Rovsing’s sign, strongly suggests acute appendicitis. Appendicitis typically presents with localized pain that worsens on movement or palpation. Murphy’s sign is specific to gallbladder pathology, and decreased bowel sounds or left-sided pain would be atypical for appendicitis.

5. Psychiatry

Q5: A 40-year-old patient reports a persistent low mood, decreased energy, loss of interest in activities, and sleep disturbances for the past two months. They have experienced weight gain and report difficulty concentrating. Which of the following is the most appropriate initial diagnosis?
a) Generalized anxiety disorder
b) Major depressive disorder
c) Bipolar disorder
d) Schizophrenia
e) Post-traumatic stress disorder (PTSD)
Answer: b) Major depressive disorder
Explanation: Symptoms of persistent low mood, anhedonia (loss of interest in activities), fatigue, sleep disturbances, and weight changes lasting more than two weeks meet the criteria for major depressive disorder (MDD). MDD is diagnosed based on a minimum of two weeks of symptoms that impair daily functioning. Anxiety, bipolar disorder, and schizophrenia present differently, with distinct symptom profiles that do not align as closely with this patient’s complaints.

6. Pharmacology

Q6: A 70-year-old patient with atrial fibrillation is prescribed warfarin. Which of the following tests should be regularly monitored to assess the effectiveness of this medication?
a) Complete blood count (CBC)
b) Prothrombin time/International Normalized Ratio (PT/INR)
c) Liver function tests
d) Serum creatinine
e) Blood glucose levels
Answer: b) Prothrombin time/International Normalized Ratio (PT/INR)
Explanation: Warfarin is an anticoagulant that requires careful monitoring through PT/INR to maintain therapeutic anticoagulation and prevent bleeding or clotting complications. The target INR is typically between 2.0 and 3.0 for atrial fibrillation, but it may vary based on individual risk factors. INR levels should be checked frequently, especially when beginning therapy, to ensure effective dosing. CBC can be useful to monitor for bleeding but is not specific for warfarin monitoring.


7. Infectious Diseases

Q7: A 45-year-old hiker presents with fever, chills, and a distinctive bull’s-eye rash on his left leg. He recalls removing a tick from the area several days earlier. Which organism is most likely responsible for these symptoms?
a) Rickettsia rickettsii
b) Borrelia burgdorferi
c) Plasmodium falciparum
d) Streptococcus pyogenes
e) Staphylococcus aureus
Answer: b) Borrelia burgdorferi
Explanation: The bull’s-eye rash (erythema migrans) is a key diagnostic feature of Lyme disease, caused by Borrelia burgdorferi and transmitted by ticks. Lyme disease is often reported in tick-endemic areas and presents with systemic symptoms such as fever and headache. Rickettsia rickettsii, responsible for Rocky Mountain spotted fever, does not cause a bull’s-eye rash and presents with a different rash distribution. Plasmodium falciparum causes malaria, which is not associated with a rash.

8. Endocrinology

Q8: A 48-year-old patient with a known history of hypothyroidism complains of fatigue, weight gain, and cold intolerance despite taking their medication. Which of the following lab results is most consistent with this presentation?
a) High TSH, low T4
b) Low TSH, high T4
c) Normal TSH, high T3
d) High T3, low T4
e) Low TSH, normal T4
Answer: a) High TSH, low T4
Explanation: Persistent symptoms in a patient with known hypothyroidism suggest insufficient thyroid hormone levels, which would manifest as high TSH and low T4 if their current dose is inadequate. TSH rises as the pituitary attempts to stimulate thyroid hormone production when levels are low. Low TSH and high T4 would be expected in hyperthyroidism or overtreatment. Monitoring TSH and T4 helps assess the adequacy of replacement therapy.