General Practitioner (GP) Prometric exam questions with answers

1. Question 1Family Medicine & Primary Caremedium

   A 45-year-old man who smokes 20 cigarettes a day is motivated to quit and has no relevant medical history. Which single pharmacological option is most effective for achieving long-term abstinence?

   1. AA single form of nicotine replacement therapy
   2. BVarenicline
   3. CBupropion
   4. DNortriptyline
   Show answer and explanation▾

   Answer: B. Varenicline

   Varenicline, a partial agonist at nicotinic receptors, is the most effective single pharmacotherapy for smoking cessation, with combination NRT (patch plus a short-acting form) giving similar results. A single form of NRT and bupropion are both effective but less so than varenicline, and nortriptyline is only a second-line option. Combining any medication with behavioural support improves quit rates further.

2. Question 2Internal Medicinehard

   A 76-year-old man with treated hypertension is found to have permanent atrial fibrillation. He has no history of stroke, heart failure, diabetes or vascular disease, and no bleeding risk factors. What is the most appropriate stroke prevention?

   1. AStart low-dose aspirin 75 mg daily
   2. BNo antithrombotic treatment until the score is reassessed in a year
   3. CStart aspirin combined with clopidogrel
   4. DStart a direct oral anticoagulant such as apixaban
   Show answer and explanation▾

   Answer: D. Start a direct oral anticoagulant such as apixaban

   He scores 3 on CHA2DS2-VASc (age 75 or over = 2, hypertension = 1), well above the threshold for oral anticoagulation, and current ESC and NICE guidance prefer a DOAC over warfarin in non-valvular AF. Aspirin is the tempting option, but it is ineffective for stroke prevention in AF and carries a similar bleeding risk, and dual antiplatelet therapy is inferior to anticoagulation.

3. Question 3Internal Medicinemedium

   A 62-year-old woman has fatigue, tingling in her feet and unsteady gait. Haemoglobin is 9.8 g/dL with an MCV of 112 fL, and serum vitamin B12 is low with positive intrinsic factor antibodies. What is the most appropriate treatment?

   1. AIntramuscular hydroxocobalamin with loading doses
   2. BOral folic acid 5 mg daily before giving vitamin B12
   3. COral cyanocobalamin 50 micrograms daily
   4. DRed cell transfusion followed by dietary advice
   Show answer and explanation▾

   Answer: A. Intramuscular hydroxocobalamin with loading doses

   Pernicious anaemia with neurological involvement needs parenteral vitamin B12, given as frequent intramuscular hydroxocobalamin injections until there is no further improvement, then lifelong maintenance. Giving folic acid alone first can worsen the neurological damage, including subacute combined degeneration of the cord, and low-dose oral B12 is poorly absorbed without intrinsic factor.

4. Question 4Pediatricseasy

   A previously well 18-month-old has a single generalised seizure lasting 2 minutes during a febrile illness, and recovers fully within an hour. Examination is normal apart from an upper respiratory tract infection. What is the most appropriate advice?

   1. AStart long-term prophylactic anticonvulsant medication
   2. BArrange an urgent electroencephalogram and brain MRI
   3. CReassure the parents and manage the underlying febrile illness
   4. DGive regular antipyretics to prevent any further seizures
   Show answer and explanation▾

   Answer: C. Reassure the parents and manage the underlying febrile illness

   This is a simple febrile seizure (generalised, under 15 minutes, not recurring within 24 hours, full recovery), which has an excellent prognosis and does not need routine EEG, imaging or anticonvulsants. Antipyretics improve comfort but have not been shown to prevent recurrence of febrile seizures, a common misconception among parents and clinicians.

5. Question 5Pediatricsmedium

   A 9-month-old has episodes of inconsolable crying with drawing up of the legs every 15-20 minutes, vomiting and a stool resembling redcurrant jelly. A sausage-shaped mass is felt in the right upper abdomen. Which investigation is most appropriate first?

   1. AContrast barium meal and follow-through
   2. BPlain erect chest radiograph
   3. CAbdominal ultrasound
   4. DCT abdomen with oral contrast
   Show answer and explanation▾

   Answer: C. Abdominal ultrasound

   The features suggest intussusception, and ultrasound is the first-line investigation, showing a target or doughnut sign with high sensitivity and no radiation; air or contrast enema can then reduce it if the child is stable. CT is not needed for diagnosis and adds radiation and delay, and a barium meal assesses the upper GI tract rather than the ileocolic region.

6. Question 6Obstetrics & Gynecologymedium

   A 38-year-old woman has heavy menstrual bleeding with no pelvic pain, a normal pelvic examination and no wish for pregnancy in the next few years. Full blood count is normal. What is the first-line treatment recommended by NICE?

   1. ALevonorgestrel-releasing intrauterine system
   2. BTranexamic acid taken throughout the cycle
   3. CNorethisterone 5 mg three times daily continuously
   4. DEndometrial ablation
   Show answer and explanation▾

   Answer: A. Levonorgestrel-releasing intrauterine system

   NICE recommends the levonorgestrel-releasing intrauterine system as first-line treatment for heavy menstrual bleeding without significant structural pathology, particularly when contraception is also wanted. Tranexamic acid is an alternative, but it is taken only during menstruation, not throughout the cycle. Ablation is a surgical option considered when medical treatment fails or is declined.

7. Question 7Emergency Medicine (Adult & Pediatric)hard

   A 58-year-old man presents to a rural hospital 2 hours after the onset of chest pain, with ST elevation in leads V1-V4. The nearest PCI-capable centre is 3 hours away by transfer and he has no contraindications. What is the most appropriate reperfusion strategy?

   1. ATransfer directly for primary PCI without fibrinolysis
   2. BGive aspirin and heparin only and arrange elective angiography
   3. CWait for high-sensitivity troponin before deciding on reperfusion
   4. DGive fibrinolysis now and then transfer to the PCI centre
   Show answer and explanation▾

   Answer: D. Give fibrinolysis now and then transfer to the PCI centre

   Primary PCI is preferred only when it can be delivered within 120 minutes of diagnosis; when the expected delay is longer, fibrinolysis should be given without delay to patients presenting within 12 hours, followed by transfer for angiography. Direct transfer for primary PCI is tempting but here would delay reperfusion beyond the recommended window. Troponin should never delay reperfusion in STEMI.

8. Question 8Emergency Medicine (Adult & Pediatric)hard

   A 30-year-old man has chest trauma, severe respiratory distress, hypotension, distended neck veins and absent breath sounds on the right with tracheal deviation to the left. Which immediate intervention is recommended in current ATLS guidance for an adult?

   1. ANeedle decompression at the 2nd intercostal space, midclavicular line, on the left
   2. BDecompression at the 4th or 5th intercostal space, anterior to the midaxillary line
   3. CUrgent chest radiograph before any decompression is attempted
   4. DPericardiocentesis via the subxiphoid approach
   Show answer and explanation▾

   Answer: B. Decompression at the 4th or 5th intercostal space, anterior to the midaxillary line

   This is tension pneumothorax, a clinical diagnosis that requires immediate decompression without waiting for imaging; the 10th edition of ATLS recommends the 4th or 5th intercostal space just anterior to the midaxillary line in adults because the chest wall is thinner there. The 2nd intercostal space approach is the older site, and decompressing the left side would target the wrong hemithorax.

9. Question 9Psychiatry & Mental Healthmedium

   A 15-year-old girl has moderate to severe depression that has not responded to 6 weeks of psychological therapy. If an antidepressant is added alongside therapy, which drug is recommended first-line?

   1. AFluoxetine
   2. BVenlafaxine
   3. CAmitriptyline
   4. DParoxetine
   Show answer and explanation▾

   Answer: A. Fluoxetine

   NICE recommends fluoxetine as the first-line antidepressant for children and young people with moderate to severe depression, given in combination with psychological therapy and with close monitoring for suicidal thoughts. Paroxetine and venlafaxine are not recommended in this age group because of unfavourable benefit-risk profiles, and tricyclics are ineffective and dangerous in overdose.

10. Question 10Dermatologyeasy

    A 70-year-old man with long-term outdoor sun exposure has a slowly enlarging lesion on his nose with a pearly, rolled edge, surface telangiectasia and a central ulcer. What is the most likely diagnosis?

    1. ASeborrhoeic keratosis
    2. BActinic keratosis
    3. CBasal cell carcinoma
    4. DAmelanotic melanoma
    Show answer and explanation▾

    Answer: C. Basal cell carcinoma

    A pearly papule or nodule with rolled edges, telangiectasia and central ulceration (a rodent ulcer) on sun-exposed skin is typical of basal cell carcinoma, which grows slowly and rarely metastasises. Actinic keratoses are rough scaly patches rather than pearly nodules, and seborrhoeic keratoses have a stuck-on, warty appearance.

11. Question 11Orthopedics & Musculoskeletalmedium

    A 22-year-old fell onto an outstretched hand and has tenderness in the anatomical snuffbox. Wrist and scaphoid radiographs are normal. What is the most appropriate management?

    1. AReassure him and discharge with a diagnosis of wrist sprain
    2. BImmobilise the wrist and arrange further imaging, preferably MRI
    3. CRefer immediately for open reduction and internal fixation
    4. DStart wrist mobilisation exercises and review in 6 weeks
    Show answer and explanation▾

    Answer: B. Immobilise the wrist and arrange further imaging, preferably MRI

    Scaphoid fractures are often not visible on initial radiographs, and a missed fracture risks non-union and avascular necrosis of the proximal pole, so suspected fractures are immobilised and further imaging such as MRI is arranged. Discharging the patient as a sprain on the basis of normal radiographs is the classic error.

12. Question 12Ophthalmologymedium

    A 65-year-old woman has a sudden painful red right eye, blurred vision with halos around lights, headache and vomiting. The cornea is hazy and the pupil is mid-dilated and poorly reactive. What is the most appropriate action?

    1. AStart chloramphenicol eye drops and review in 48 hours
    2. BInstil a mydriatic to examine the fundus more fully
    3. CPrescribe an oral antihistamine and lubricating eye drops
    4. DRefer for same-day emergency ophthalmology assessment
    Show answer and explanation▾

    Answer: D. Refer for same-day emergency ophthalmology assessment

    These features indicate acute angle-closure glaucoma, which needs immediate pressure-lowering treatment and same-day ophthalmology referral to prevent permanent visual loss. Dilating the pupil is dangerous because it can further close the drainage angle, and antibiotic drops are for bacterial conjunctivitis, which does not cause pupil changes or corneal haze.

13. Question 13Otolaryngology (ENT)easy

    A 3-year-old has had ear pain and fever for 1 day. The tympanic membrane is red and bulging. She is alert, eating and drinking, with no otorrhoea and no high-risk features. What is the most appropriate initial management?

    1. AImmediate oral amoxicillin for 5 to 7 days
    2. BUrgent referral to an ENT specialist for review
    3. CTopical antibiotic ear drops for 7 days
    4. DAnalgesia, with no antibiotic or a back-up prescription
    Show answer and explanation▾

    Answer: D. Analgesia, with no antibiotic or a back-up prescription

    Most acute otitis media resolves within 3 days without antibiotics, so NICE recommends paracetamol or ibuprofen with no antibiotic or a delayed (back-up) prescription in children who are not systemically unwell and have no high-risk features. Immediate antibiotics are reserved for children who are systemically unwell, have otorrhoea, or are under 2 years with bilateral infection.

14. Question 14Radiology & Investigationseasy

    A 40-year-old man has acute severe colicky loin-to-groin pain and microscopic haematuria. He has normal renal function and no fever. Which imaging is recommended first-line to confirm a ureteric stone?

    1. ALow-dose non-contrast CT of the urinary tract
    2. BIntravenous urography with delayed films
    3. CPlain abdominal radiograph (KUB) alone
    4. DContrast-enhanced MRI of the abdomen and pelvis
    Show answer and explanation▾

    Answer: A. Low-dose non-contrast CT of the urinary tract

    Non-contrast low-dose CT KUB is the first-line investigation for suspected renal colic in adults because it detects almost all stones, gives size and position, and identifies alternative diagnoses. A plain radiograph misses radiolucent and small stones, and intravenous urography has been replaced by CT. Ultrasound is preferred in pregnancy and children.

15. Question 15Preventive Medicine, Public Health, EBM, Ethics & Professionalismhard

    A new screening programme detects a cancer earlier than symptomatic diagnosis, and survival measured from the time of diagnosis appears longer, but mortality from the cancer is unchanged. Which bias best explains this apparent survival benefit?

    1. ALength-time bias
    2. BLead-time bias
    3. CSelection bias
    4. DRecall bias
    Show answer and explanation▾

    Answer: B. Lead-time bias

    Lead-time bias occurs when earlier detection moves the date of diagnosis forward, so survival from diagnosis lengthens even though the time of death is unchanged; this is why screening is judged on mortality rather than survival. Length-time bias is the tempting answer, but it refers to screening preferentially detecting slow-growing tumours, not to the earlier date of diagnosis itself.

Last reviewed September 2026. Questions are original and written to the published exam blueprint; they are not taken from any real paper.