Free Family Medicine mock test

Family Medicine sample questions with answers

10 more original exam-style Family Medicine questions, worked in full. They are not real or recalled exam questions, and none of them is in the mock above or on the bank page, so sit the mock first if you have not.

1. Question 1 · Neurology, Ophthalmology, Renal-Urology, Haematology, Geriatrics and Palliative Care

   A 72-year-old man with hypertension and atrial fibrillation describes painless, instantaneous, near-complete loss of vision in the left eye 50 minutes ago. Acuity is hand movements only, there is a left relative afferent pupillary defect, and fundoscopy shows a pale oedematous retina with a cherry-red spot at the macula. What is the most appropriate immediate management?

   1. APrescribe high-dose aspirin and arrange an outpatient carotid Doppler within two weeks
   2. BStart high-dose oral prednisolone for presumed giant cell arteritis and refer to rheumatology
   3. CEmergency transfer to a hyperacute stroke or ophthalmic emergency service for immediate assessment
   4. DReassure that vision usually recovers spontaneously and review the next day
   Show answer and explanation

   Correct answer: C. Emergency transfer to a hyperacute stroke or ophthalmic emergency service for immediate assessment

   A cherry-red spot with a pale retina and an afferent pupillary defect indicates central retinal artery occlusion, which is an acute ischaemic stroke of the eye; current guidance is emergency transfer to a stroke or ophthalmic emergency service for urgent evaluation, including consideration of reperfusion within the hyperacute window and same-day search for a carotid or cardioembolic source. Outpatient investigation over two weeks misses the high early risk of cerebral stroke. Steroids are indicated only if arteritic features and raised inflammatory markers suggest giant cell arteritis, and spontaneous recovery is uncommon.

   Reference: American Heart Association/American Stroke Association Scientific Statement: Management of Central Retinal Artery Occlusion (Stroke, 2021); AAO Preferred Practice Pattern: Retinal and Ophthalmic Artery Occlusions (2020)

2. Question 2 · Endocrinology, Diabetes and Metabolic Disorders

   An 81-year-old man with type 2 diabetes is brought in after four days of increasing drowsiness following a chest infection. He is profoundly dehydrated, glucose is 44 mmol/L (792 mg/dL), capillary ketones 0.6 mmol/L, and calculated serum osmolality is 345 mOsm/kg. Which statement about his condition is most accurate?

   1. AThis is hyperosmolar hyperglycaemic state; fluid replacement is the priority and osmolality should be lowered gradually rather than rapidly
   2. BThis is diabetic ketoacidosis; high-dose intravenous insulin should be started before fluids
   3. CRapid correction of glucose with a large insulin bolus is the key to preventing cerebral oedema
   4. DAnticoagulation is contraindicated because of the risk of intracranial bleeding
   Show answer and explanation

   Correct answer: A. This is hyperosmolar hyperglycaemic state; fluid replacement is the priority and osmolality should be lowered gradually rather than rapidly

   Marked hyperglycaemia with osmolality above 320 mOsm/kg and minimal ketonaemia defines hyperosmolar hyperglycaemic state; intravenous fluid replacement is the cornerstone of treatment and osmolality should fall gradually (approximately 3-8 mOsm/kg/h) to avoid cerebral oedema and osmotic demyelination. Ketones are low so this is not DKA, rapid insulin-driven glucose correction precipitates rather than prevents cerebral oedema, and prophylactic anticoagulation is generally recommended because of the very high thrombotic risk.

   Reference: Joint British Diabetes Societies, Management of the Hyperosmolar Hyperglycaemic State in Adults with Diabetes (2022); ADA Standards of Care, Section 16 (2024)

3. Question 3 · Women's Health, Obstetrics and Gynaecology

   A 35-year-old woman at an estimated 12 weeks of gestation has severe vomiting and irregular vaginal bleeding. The uterus is palpable at the umbilicus, no fetal heart is heard, serum hCG is 480,000 IU/L and ultrasound shows a heterogeneous echogenic intrauterine mass with multiple small cystic spaces and no fetus. What is the most appropriate management?

   1. AReferral for suction curettage and registration with a gestational trophoblastic disease centre with serial hCG follow-up
   2. BMedical management with misoprostol to expel the products of conception
   3. CExpectant management with repeat ultrasound in two weeks
   4. DImmediate systemic methotrexate
   Show answer and explanation

   Correct answer: A. Referral for suction curettage and registration with a gestational trophoblastic disease centre with serial hCG follow-up

   The clinical picture and the classical vesicular or snowstorm ultrasound appearance with a markedly elevated hCG indicate a complete hydatidiform mole, which is treated by suction evacuation followed by registration and serial hCG surveillance to detect persistent gestational trophoblastic neoplasia. Prostaglandin-only medical evacuation is discouraged for complete moles because of concerns about embolisation and the risk of needing chemotherapy. Expectant management risks haemorrhage and delays diagnosis, and methotrexate is chemotherapy given only if neoplasia develops, not as primary evacuation.

   Reference: RCOG Green-top Guideline No. 38, Gestational Trophoblastic Disease (2020); FIGO Cancer Report, Gestational Trophoblastic Disease (2021)

4. Question 4 · Musculoskeletal Medicine, Rheumatology, Orthopaedics and Sports Medicine

   A 72-year-old woman has been receiving denosumab 60 mg subcutaneously every 6 months for 5 years. She wishes to stop treatment because she now feels well. What is the most important advice to give?

   1. ADenosumab can simply be stopped, as its effect persists for several years like bisphosphonates
   2. BStopping denosumab without follow-on antiresorptive therapy risks rapid bone loss and multiple vertebral fractures, so a bisphosphonate should be given
   3. CShe should take a 2-year drug holiday and then restart denosumab
   4. DShe should stop denosumab and take calcium and vitamin D alone
   Show answer and explanation

   Correct answer: B. Stopping denosumab without follow-on antiresorptive therapy risks rapid bone loss and multiple vertebral fractures, so a bisphosphonate should be given

   Denosumab's effect is fully reversible; on discontinuation there is a rebound increase in bone turnover with rapid loss of the gained bone mineral density and a documented risk of multiple spontaneous vertebral fractures. Consolidation with a bisphosphonate (for example zoledronate or alendronate) after the last denosumab dose is therefore required. The concept of a drug holiday applies to bisphosphonates, which persist in bone, and never to denosumab; calcium and vitamin D alone do not prevent the rebound.

   Reference: Tsourdi et al., Fracture risk and management of discontinuation of denosumab therapy, ECTS/EJE position statement (2021); EMA/MHRA denosumab safety advice

5. Question 5 · Principles of Family Medicine, Consultation Skills and Practice Management

   A primary care centre has high burnout scores across its physicians. Which intervention has the STRONGEST evidence for reducing burnout at the level of the organisation?

   1. AOffering an optional evening mindfulness course for interested staff
   2. BStructural changes such as reducing documentation burden, adjusting workload and schedules, and improving teamwork and clinician control over the work environment
   3. CDistributing resilience-training booklets to all clinicians
   4. DIntroducing an annual staff appreciation event and wellness newsletter
   Show answer and explanation

   Correct answer: B. Structural changes such as reducing documentation burden, adjusting workload and schedules, and improving teamwork and clinician control over the work environment

   Systematic reviews and meta-analyses show that both individual and organisational interventions reduce burnout, but organisation-directed structural changes to workload, workflow and clinician control produce the larger and more durable effects. Optional mindfulness courses, resilience booklets and appreciation events are individual-level or symbolic measures that do not address the underlying work-system drivers and consistently show smaller effect sizes.

   Reference: Panagioti M et al. Controlled interventions to reduce burnout in physicians: a systematic review and meta-analysis. JAMA Internal Medicine (2017); West CP et al. Interventions to prevent and reduce physician burnout. Lancet (2016)

6. Question 6 · Mental Health and Behavioural Medicine

   A malnourished, chronically alcohol-dependent 49-year-old man is brought to your clinic confused and unsteady, with nystagmus and impaired lateral gaze. A capillary glucose reads 2.6 mmol/L and intravenous access is obtained. What is the most important management principle?

   1. AGive parenteral thiamine before or together with the glucose to avoid precipitating Wernicke encephalopathy
   2. BGive intravenous glucose first and start oral thiamine after 24 hours
   3. CWithhold all glucose until MRI of the brain has excluded other causes
   4. DGive intravenous phenytoin as first-line treatment for the confusion
   Show answer and explanation

   Correct answer: A. Give parenteral thiamine before or together with the glucose to avoid precipitating Wernicke encephalopathy

   The triad of confusion, ophthalmoplegia and ataxia in a malnourished drinker indicates Wernicke encephalopathy; carbohydrate loading consumes residual thiamine as a cofactor and can precipitate or worsen the encephalopathy, so parenteral thiamine must be given before or at the same time as glucose. Hypoglycaemia must still be corrected promptly, so withholding glucose pending imaging is unsafe. Oral thiamine is poorly and unreliably absorbed in this setting, and phenytoin does not treat Wernicke encephalopathy.

   Reference: NICE CG100 Alcohol-use disorders: physical complications (2010, updated 2017); Royal College of Physicians and EFNS guidelines on Wernicke encephalopathy

7. Question 7 · Cardiovascular Medicine

   A 54-year-old man was treated with rivaroxaban for a pulmonary embolism that occurred with no identifiable provoking factor. He has completed three months of therapy, has normal renal function, no bleeding events and no active cancer. What is the most appropriate advice about the duration of anticoagulation?

   1. AStop anticoagulation now as three months is always sufficient
   2. BContinue for a total of six weeks more and then stop
   3. COffer extended anticoagulation of indefinite duration with periodic review of risk and benefit
   4. DSwitch to lifelong aspirin, which is equivalent to anticoagulation for recurrence prevention
   Show answer and explanation

   Correct answer: C. Offer extended anticoagulation of indefinite duration with periodic review of risk and benefit

   An unprovoked proximal pulmonary embolism carries a recurrence risk of roughly 10% in the first year and around 30% at five years after stopping, so guidelines recommend extended anticoagulation of indefinite duration, often at a reduced maintenance dose, with regular reassessment of bleeding risk and patient preference. Three months is the standard minimum, appropriate for events provoked by a major transient risk factor. Aspirin reduces recurrence far less effectively than a DOAC.

   Reference: 2019 ESC Guidelines for the Diagnosis and Management of Acute Pulmonary Embolism; NICE NG158 Venous Thromboembolic Diseases (2020, updated 2023)

8. Question 8 · Preventive Medicine, Screening, Health Promotion and Community Health

   Four asymptomatic patients ask about low-dose CT lung cancer screening. Which one is NOT eligible under current guideline criteria?

   1. AA 55-year-old who currently smokes with a 25 pack-year history
   2. BA 79-year-old who stopped smoking 3 years ago with a 40 pack-year history and good performance status
   3. CA 68-year-old who stopped smoking 10 years ago with a 30 pack-year history
   4. DA 62-year-old who stopped smoking 18 years ago with a 25 pack-year history
   Show answer and explanation

   Correct answer: D. A 62-year-old who stopped smoking 18 years ago with a 25 pack-year history

   Eligibility requires age 50-80 years, a smoking history of at least 20 pack-years, and current smoking or cessation within the past 15 years; the man who quit 18 years ago falls outside the cessation window, as his risk has declined and the balance of benefit to harm no longer favours screening. The other three all satisfy age, pack-year and cessation-interval criteria, and screening should be discontinued once a person has not smoked for 15 years or develops a health problem that limits life expectancy or willingness to have curative surgery.

   Reference: US Preventive Services Task Force, Screening for Lung Cancer, JAMA 2021

9. Question 9 · Respiratory Medicine and Otolaryngology

   A 69-year-old retired man has 10 months of progressive exertional breathlessness and a dry cough. He has fine bibasal end-inspiratory 'velcro' crackles and finger clubbing, with no oedema and normal heart sounds. Spirometry shows FEV1 78% predicted, FVC 72% predicted and FEV1/FVC 0.84. What is the most likely diagnosis and appropriate action?

   1. ACOPD; start dual bronchodilator therapy
   2. BHeart failure with preserved ejection fraction; start a loop diuretic
   3. CInterstitial lung disease such as idiopathic pulmonary fibrosis; arrange high-resolution CT of the chest and refer to respiratory services
   4. DAsthma; start inhaled corticosteroid-formoterol
   Show answer and explanation

   Correct answer: C. Interstitial lung disease such as idiopathic pulmonary fibrosis; arrange high-resolution CT of the chest and refer to respiratory services

   Insidious dyspnoea with a dry cough, bibasal fine inspiratory crackles, clubbing and a restrictive spirometric pattern with a preserved or raised FEV1/FVC ratio is characteristic of interstitial lung disease, and high-resolution CT with specialist referral is required because antifibrotic therapy depends on early diagnosis. COPD and asthma both produce an obstructive ratio below 0.70, and clubbing is not a feature of either. Heart failure typically causes orthopnoea, raised venous pressure and oedema rather than clubbing with a restrictive pattern.

   Reference: ATS/ERS/JRS/ALAT Clinical Practice Guideline: Idiopathic Pulmonary Fibrosis Diagnosis (2022); NICE CG163 (2013)

10. Question 10 · Child and Adolescent Health

    Which of the following bruising patterns should raise the greatest suspicion of physical abuse?

    1. ABruising over the shins of an active 3-year-old who runs and climbs
    2. BBruising of the ear and the side of the neck in a 5-month-old who is not yet mobile
    3. CA single bruise over the forehead of a 14-month-old who has just started walking
    4. DBruising over both knees in a 6-year-old who plays football
    Show answer and explanation

    Correct answer: B. Bruising of the ear and the side of the neck in a 5-month-old who is not yet mobile

    The strongest predictors of inflicted injury are bruising in a child who is not independently mobile and bruising in protected sites such as the ears, neck, torso, buttocks, genitalia and the frenulum - captured in the maxim 'those who don't cruise rarely bruise'. Accidental bruises overwhelmingly occur over bony prominences on the front of the body - shins, knees, elbows and forehead - in mobile, active children. The shin, forehead and knee patterns described are all developmentally consistent with normal childhood activity and are not, on their own, suspicious.

    Reference: NICE CG89, Child maltreatment: when to suspect maltreatment in under 18s (2009, updated 2017); Pierce MC et al., bruising characteristics discriminating abuse from accidental trauma, Pediatrics