Free DHA GP exam mock test — 150 questions, 3 hours, Prometric format 🇦🇪

8 original practice questions written by Myndaq in the UAE GP / Doctor License style. They are not taken from this mock paper or from official past papers. Try each one, then open the answer.

1. Question 1Internal MedicineOne correct answer

   A 58-year-old man with type 2 diabetes attends for review. He had a myocardial infarction two years ago. He takes metformin 1 g twice daily, atorvastatin 80 mg, aspirin, bisoprolol and ramipril. His BMI is 31 kg/m², blood pressure 128/78 mmHg, HbA1c 7.9% (63 mmol/mol) and eGFR 68 mL/min/1.73 m². He has no symptoms of heart failure. Which medicine is the most appropriate to add?

   1. A. Glimepiride
   2. B. Empagliflozin
   3. C. Sitagliptin
   4. D. Insulin glargine
   Show answer and explanation

   Answer: B

   He has type 2 diabetes with established atherosclerotic cardiovascular disease (previous myocardial infarction). ADA Standards of Care recommend adding an SGLT2 inhibitor or a GLP-1 receptor agonist with proven cardiovascular benefit in this situation, regardless of the HbA1c and of metformin use. Empagliflozin reduced cardiovascular death in its outcome trial, works at an eGFR of 68, causes modest weight loss and carries a low risk of hypoglycaemia.

   Glimepiride lowers glucose but causes hypoglycaemia and weight gain and has no cardiovascular benefit. Sitagliptin is safe but cardiovascularly neutral, so it does not reduce events. Insulin glargine is not needed at an HbA1c of 7.9% without catabolic symptoms, and it causes weight gain and hypoglycaemia without cardiovascular benefit.

2. Question 2PaediatricsOne correct answer

   A 5-month-old boy, born at term, is brought in during winter with 2 days of runny nose followed by cough and noisy breathing. He is taking about three-quarters of his usual feeds and has normal wet nappies. Temperature 37.9 °C, respiratory rate 52/min, heart rate 150/min and oxygen saturation 96% on room air. There is mild subcostal recession, with fine inspiratory crackles and scattered wheeze on both sides of the chest. He has had no apnoeas. What is the most appropriate management?

   1. A. Nebulised salbutamol and review after 1 hour
   2. B. Oral prednisolone for 3 days
   3. C. Supportive care at home with feeding advice and clear return precautions
   4. D. Oral amoxicillin for 5 days
   Show answer and explanation

   Answer: C

   Coryza followed by cough, wheeze and bilateral fine crackles in an infant in winter is bronchiolitis, usually caused by RSV. This is mild disease: oxygen saturation is above 92%, the respiratory rate is only moderately raised, he is feeding more than half his usual amount, he has had no apnoeas and he has no risk factors (he was born at term, is older than 3 months and has no heart or lung disease). Treatment is supportive, at home, with advice on small frequent feeds and on when to return: worsening breathing, feeding less than half of normal, fewer wet nappies, pauses in breathing or a blue colour.

   NICE and AAP guidance advise against bronchodilators such as salbutamol, corticosteroids such as prednisolone and antibiotics, because none of them improves the course of bronchiolitis. The crackles are typical of bronchiolitis and, with a low-grade fever, do not point to a bacterial pneumonia, so amoxicillin is not indicated.

3. Question 3Obstetrics and GynaecologyOne correct answer

   A 27-year-old primigravida at 36 weeks' gestation is admitted with pre-eclampsia with severe features (blood pressure 166/112 mmHg, headache and 3+ proteinuria). Her blood pressure is controlled with intravenous labetalol, and magnesium sulfate is started as a loading dose followed by an infusion of 1 g/hour. Four hours later she feels drowsy and flushed. Her patellar reflexes are absent. Respiratory rate is 16/min, oxygen saturation 98% on room air and urine output has averaged 45 mL/hour over the last 4 hours. What is the most appropriate next step?

   1. A. Continue the infusion at the same rate and recheck the reflexes in 1 hour
   2. B. Stop the infusion and check the serum magnesium level urgently
   3. C. Give intravenous calcium gluconate and prepare for intubation
   4. D. Increase the infusion to 2 g/hour because drowsiness may precede eclampsia
   Show answer and explanation

   Answer: B

   Loss of the patellar reflexes is the earliest clinical sign of magnesium toxicity, and drowsiness and flushing fit the same picture. It appears at lower serum levels than respiratory depression or cardiac arrest, so the correct response is to stop the infusion, check the serum magnesium level and restart at a lower rate only once the reflexes return and the level is known. Her urine output is adequate, so her kidneys are clearing magnesium, but toxicity must still be excluded.

   Intravenous calcium gluconate is the antidote for respiratory depression or cardiac effects of magnesium; she is breathing at 16/min with normal oxygen saturation, so calcium gluconate and intubation are not indicated. Continuing the infusion unchanged risks progression to respiratory depression, and increasing it would make the toxicity worse, since her drowsiness is explained by magnesium rather than impending eclampsia.

4. Question 4SurgeryOne correct answer

   A 44-year-old woman presents with 20 hours of constant right upper quadrant pain and vomiting. Temperature 38.3 °C, pulse 98/min and blood pressure 126/80 mmHg. There is right upper quadrant tenderness with a positive Murphy sign. White cell count is 14.2 × 10^9/L; bilirubin, ALT, alkaline phosphatase and lipase are normal. Ultrasound shows multiple gallstones, a gallbladder wall thickness of 5 mm, pericholecystic fluid and a common bile duct of 4 mm with no stones seen. She has no significant medical conditions. Intravenous fluids, analgesia and antibiotics have been started. What is the most appropriate definitive management?

   1. A. Continue antibiotics, then elective cholecystectomy after 6 weeks
   2. B. ERCP with sphincterotomy
   3. C. Laparoscopic cholecystectomy during this admission
   4. D. Percutaneous cholecystostomy
   Show answer and explanation

   Answer: C

   Fever, a positive Murphy sign, a raised white cell count and ultrasound findings of gallstones with a thickened wall and pericholecystic fluid confirm acute calculous cholecystitis. It is mild (Tokyo Guidelines grade I) in a fit patient. Tokyo Guidelines and NICE recommend early laparoscopic cholecystectomy during the same admission, ideally soon after presentation. Compared with delayed surgery it has similar complication rates, fewer recurrent attacks and a shorter total hospital stay.

   Delaying surgery for 6 weeks leaves her at risk of recurrent cholecystitis, biliary colic or pancreatitis while she waits, and offers no advantage. ERCP treats stones in the common bile duct and cholangitis; normal liver tests and a non-dilated duct with no stones make that unlikely, and ERCP does not treat the inflamed gallbladder. Percutaneous cholecystostomy is reserved for patients who are too unwell or too high-risk for surgery.

5. Question 5Emergency MedicineOne correct answer

   A 30-year-old man weighing 75 kg develops widespread urticaria, swelling of the lips, a hoarse voice and wheeze 10 minutes after eating a prawn dish at a restaurant. On arrival in the emergency department his pulse is 124/min, blood pressure 84/50 mmHg, respiratory rate 28/min and oxygen saturation 91% on room air. High-flow oxygen has been started. What is the most appropriate immediate drug treatment?

   1. A. Adrenaline 0.5 mg (0.5 mL of 1 mg/mL) intramuscularly into the anterolateral thigh
   2. B. Adrenaline 1 mg (1 mL of 1 mg/mL) as a rapid intravenous bolus
   3. C. Intravenous chlorphenamine 10 mg and intravenous hydrocortisone 200 mg
   4. D. Nebulised salbutamol 5 mg, then reassess after 15 minutes
   Show answer and explanation

   Answer: A

   Sudden airway involvement (hoarse voice, lip swelling), breathing difficulty (wheeze, low oxygen saturation) and low blood pressure after a likely food allergen is anaphylaxis. International guidance (WAO, AHA, Resuscitation Council UK) gives intramuscular adrenaline first, 0.01 mg/kg up to 0.5 mg in an adult, using the 1 mg/mL solution in the anterolateral mid-thigh. The dose is repeated after 5 minutes if there is no improvement, and IV fluids are given for the low blood pressure.

   A rapid 1 mg intravenous bolus is the cardiac arrest dose; in a patient with a pulse it can cause severe hypertension, arrhythmias and myocardial ischaemia. Intravenous adrenaline is used only as a carefully titrated infusion for refractory anaphylaxis. Antihistamines and corticosteroids do not reverse airway swelling or shock and must not delay adrenaline. Salbutamol can help bronchospasm that persists after adrenaline, but it does nothing for the airway swelling or low blood pressure.

6. Question 6Family MedicineOne correct answer

   A 29-year-old woman presents with 2 days of burning on passing urine, urinary frequency and suprapubic discomfort. She has no fever, flank pain or vaginal discharge. A urine pregnancy test is negative, she has no known kidney disease, no drug allergies, and she has had no urinary infection in the past year. Urine dipstick is positive for leucocyte esterase and nitrites. What is the most appropriate management?

   1. A. Oral nitrofurantoin
   2. B. Oral ciprofloxacin
   3. C. Oral amoxicillin
   4. D. Urine culture, starting antibiotics only if the culture is positive
   Show answer and explanation

   Answer: A

   Typical lower urinary symptoms with positive nitrites, and no fever, flank pain or pregnancy, make this acute uncomplicated cystitis. IDSA guidance lists nitrofurantoin as a first-line empirical choice, given as a short course (5 days in IDSA guidance; some national guidance, such as NICE, uses 3 days). It reaches high levels in urine and E. coli resistance to it remains low. Trimethoprim-sulfamethoxazole (where local resistance is low) and single-dose fosfomycin are alternatives.

   Fluoroquinolones such as ciprofloxacin are kept for more serious infections because of tendon, nerve and aortic adverse effects and growing resistance. Amoxicillin works poorly as an empirical treatment because many E. coli strains are resistant to it. A culture is not needed before treating a typical uncomplicated episode, and waiting for the result only prolongs her symptoms; culture is advised in pregnancy, in men, after treatment failure, for recurrent infections or when the presentation is atypical. Nitrofurantoin is not suitable for pyelonephritis or when kidney function is significantly reduced.

7. Question 7Internal MedicineOne correct answer

   A 71-year-old man has an ECG for palpitations that shows atrial fibrillation, and repeat recordings confirm it is persistent. He has treated hypertension and no other medical conditions. Echocardiography shows a structurally normal heart with no valve disease. He weighs 84 kg, serum creatinine is 88 µmol/L (eGFR 78 mL/min/1.73 m²), haemoglobin and platelet count are normal and he has no history of bleeding. His heart rate is well controlled on bisoprolol. What is the most appropriate therapy to prevent stroke?

   1. A. Aspirin 75 mg once daily
   2. B. Apixaban 5 mg twice daily
   3. C. Warfarin with a target INR of 2.0 to 3.0
   4. D. No antithrombotic therapy, because his stroke risk is low
   Show answer and explanation

   Answer: B

   His CHA2DS2-VASc score is 2: 1 point for age 65 to 74 and 1 for hypertension (the score is the same on the newer CHA2DS2-VA score). For a man with a score of 2 or more, AHA/ACC/HRS and ESC guidelines recommend oral anticoagulation. A direct oral anticoagulant is preferred over warfarin unless the patient has a mechanical heart valve or moderate-to-severe mitral stenosis, because it prevents strokes at least as well, causes less intracranial bleeding and needs no INR monitoring.

   The apixaban dose is reduced to 2.5 mg twice daily only if at least two of these apply: age 80 or over, weight 60 kg or less, or serum creatinine 133 µmol/L or more. He meets none, so 5 mg twice daily is correct. Aspirin does not prevent stroke effectively in atrial fibrillation and still causes bleeding, so it is not recommended for this. Warfarin is an acceptable alternative only if a direct oral anticoagulant cannot be used. A score of 2 is not low risk, so leaving him untreated is wrong.

8. Question 8Emergency MedicineOne correct answer

   A 19-year-old university student who manages her type 1 diabetes with an insulin pump is brought in by her flatmate. The pump cannula came out overnight without her noticing, and since early morning she has vomited repeatedly and has central abdominal pain and deep, sighing respirations. She is alert. Heart rate 118/min, blood pressure 102/64 mmHg. Results: capillary glucose 24 mmol/L (432 mg/dL), venous pH 7.14, bicarbonate 9 mmol/L, blood beta-hydroxybutyrate 5.2 mmol/L, sodium 134 mmol/L, potassium 2.9 mmol/L. The ECG shows sinus tachycardia with flattened T waves. An infusion of 0.9% sodium chloride is running. What is the most appropriate next step?

   1. A. Start a fixed-rate intravenous insulin infusion immediately
   2. B. Give intravenous sodium bicarbonate
   3. C. Add intravenous potassium replacement and delay insulin until the potassium has risen to a safe level
   4. D. Give a subcutaneous dose of long-acting insulin and observe
   Show answer and explanation

   Answer: C

   High glucose, acidosis (pH 7.14, bicarbonate 9 mmol/L) and high ketones confirm diabetic ketoacidosis. Total body potassium is depleted in DKA, and insulin drives potassium into cells. Starting insulin at a potassium of 2.9 mmol/L could therefore cause life-threatening hypokalaemia with arrhythmias or respiratory muscle weakness; the flattened T waves already show its effect. The ADA-led international consensus advises giving intravenous potassium with the fluids, monitoring the heart, and delaying insulin until the potassium is corrected to a safe level.

   Bicarbonate is reserved for very severe acidosis (pH below 7.0). At pH 7.14 it brings no benefit and would push potassium even lower. Subcutaneous long-acting insulin alone is absorbed unpredictably in a dehydrated patient, cannot be titrated, and would still lower the potassium. Intravenous insulin is started once the potassium is safe.