Family Medicine Prometric exam questions with answers

1. Question 1Principles of Family Medicine, Consultation Skills and Practice Managementeasy

   You need to tell a 58-year-old woman that her biopsy confirms breast cancer. You have arranged a private room, invited her husband at her request and switched off your phone. According to the SPIKES protocol, what is the next step?

   1. AGive the diagnosis clearly in the first sentence
   2. BOutline the treatment plan and referral timeline
   3. CAsk what she already understands about why the biopsy was done
   4. DOffer written information and arrange follow-up
   Show answer and explanation▾

   Answer: C. Ask what she already understands about why the biopsy was done

   SPIKES proceeds through Setting, Perception, Invitation, Knowledge, Emotions and Strategy with summary. After setting up the interview, the clinician explores the patient's perception of the situation, which reveals misunderstandings and allows the news to be pitched appropriately. Giving the diagnosis comes after inviting her to say how much she wants to know, and treatment planning belongs to the final strategy step.

2. Question 2Preventive Medicine, Screening, Health Promotion and Community Healthmedium

   A 35-year-old woman has a negative primary high-risk HPV test at routine cervical screening. She is immunocompetent and has no previous abnormal results. When should her next screening test be performed?

   1. AIn 5 years
   2. BIn 1 year
   3. CIn 3 years
   4. DIn 2 years
   Show answer and explanation▾

   Answer: A. In 5 years

   After a negative primary HPV test in an immunocompetent woman aged 30 to 65, the recommended screening interval is 5 years, reflecting the high negative predictive value of HPV testing for high-grade lesions. A 3-year interval applies to screening with cytology alone. Annual or 2-yearly screening offers no added benefit and increases unnecessary colposcopy and overtreatment.

3. Question 3Women's Health, Obstetrics and Gynaecologyeasy

   A 30-year-old woman planning pregnancy had a previous pregnancy affected by a neural tube defect. She has no other medical conditions. Which folic acid regimen is recommended?

   1. A400 micrograms daily from confirmation of pregnancy
   2. B400 micrograms daily starting 3 months before conception
   3. C1 mg daily from 12 weeks of gestation
   4. DHigh-dose 4 to 5 mg daily from before conception until 12 weeks
   Show answer and explanation▾

   Answer: D. High-dose 4 to 5 mg daily from before conception until 12 weeks

   Women at high risk, including those with a previous pregnancy affected by a neural tube defect, should take high-dose folic acid (4 mg in North American guidance, 5 mg in UK guidance) starting before conception and continuing until 12 weeks of gestation. The standard 400 microgram dose is for women at low risk. Starting after pregnancy is confirmed is too late because the neural tube closes about 4 weeks after conception.

4. Question 4Cardiovascular Medicineeasy

   A 48-year-old man has a clinic blood pressure of 152/94 mmHg, confirmed on a second reading at the same visit. He has no symptoms, no target organ damage and no diabetes. What is the most appropriate next step?

   1. AStart an ACE inhibitor today
   2. BConfirm the diagnosis with ambulatory or home blood pressure monitoring
   3. CRepeat clinic blood pressure in 12 months
   4. DArrange an echocardiogram before deciding on treatment
   Show answer and explanation▾

   Answer: B. Confirm the diagnosis with ambulatory or home blood pressure monitoring

   When clinic blood pressure is between 140/90 and 180/120 mmHg, guidelines recommend confirming hypertension with ambulatory monitoring, or home monitoring if ambulatory monitoring is unsuitable, to identify white-coat hypertension and avoid unnecessary treatment. Starting treatment immediately is reserved for very high readings or evidence of target organ damage. Waiting a year risks leaving true hypertension untreated, and echocardiography is not part of routine diagnosis.

5. Question 5Cardiovascular Medicinemedium

   A 66-year-old man with heart failure with reduced ejection fraction (LVEF 30%) remains in NYHA class II despite sacubitril-valsartan, bisoprolol and spironolactone at tolerated doses. eGFR is 52 mL/min/1.73 m2 and potassium 4.6 mmol/L. Which addition is most appropriate?

   1. ADigoxin
   2. BIvabradine
   3. CHydralazine with isosorbide dinitrate
   4. DDapagliflozin or empagliflozin
   Show answer and explanation▾

   Answer: D. Dapagliflozin or empagliflozin

   SGLT2 inhibitors are one of the four foundational therapies for HFrEF, alongside an ARNI or ACE inhibitor, a beta-blocker and a mineralocorticoid receptor antagonist, and reduce cardiovascular death and heart failure hospitalisation regardless of diabetes status. Ivabradine is reserved for patients in sinus rhythm with a heart rate of 70/min or more despite maximal beta-blockade. Digoxin and hydralazine-nitrate are later options for persistent symptoms or specific populations.

6. Question 6Endocrinology, Diabetes and Metabolic Disordersmedium

   A 61-year-old man with type 2 diabetes had a myocardial infarction 2 years ago. He takes metformin and his HbA1c is 62 mmol/mol (7.8%). eGFR is 75 mL/min/1.73 m2 and BMI 33 kg/m2. Which is the most appropriate addition?

   1. AA GLP-1 receptor agonist with proven cardiovascular benefit
   2. BA sulfonylurea such as gliclazide
   3. CA DPP-4 inhibitor such as sitagliptin
   4. DBasal insulin glargine
   Show answer and explanation▾

   Answer: A. A GLP-1 receptor agonist with proven cardiovascular benefit

   In type 2 diabetes with established atherosclerotic cardiovascular disease, a GLP-1 receptor agonist or SGLT2 inhibitor with proven cardiovascular benefit is recommended independent of HbA1c, and a GLP-1 receptor agonist also promotes weight loss. Sulfonylureas and insulin lower glucose but cause weight gain and hypoglycaemia without cardiovascular benefit. DPP-4 inhibitors were cardiovascularly neutral in outcome trials.

7. Question 7Endocrinology, Diabetes and Metabolic Disordershard

   A 32-year-old woman with primary hypothyroidism, well controlled on levothyroxine 100 micrograms daily, has a positive home pregnancy test at 5 weeks. What is the most appropriate immediate step?

   1. AContinue the same dose and check TSH at 12 weeks
   2. BReduce the dose to avoid fetal thyrotoxicosis
   3. CIncrease the dose by about 25 to 30%, for example two extra doses each week
   4. DSwitch to liothyronine for the rest of the pregnancy
   Show answer and explanation▾

   Answer: C. Increase the dose by about 25 to 30%, for example two extra doses each week

   Thyroxine requirements rise early in pregnancy and the fetus depends on maternal thyroxine during the first trimester, so guidelines advise increasing the dose by about 25 to 30% as soon as pregnancy is confirmed, commonly by taking two extra daily doses per week, then checking TSH about every 4 weeks in the first half of pregnancy. Waiting until 12 weeks risks maternal hypothyroxinaemia during critical fetal neurodevelopment. Liothyronine crosses the placenta poorly and is not recommended.

8. Question 8Respiratory Medicine and Otolaryngologymedium

   A 27-year-old man with asthma uses salbutamol alone about three times a week for symptoms and has no night waking. He has had no exacerbations. Following GINA, which is the preferred treatment?

   1. AContinue as-needed salbutamol alone
   2. BAs-needed low-dose budesonide-formoterol
   3. CRegular montelukast with as-needed salbutamol
   4. DRegular medium-dose inhaled corticosteroid with LABA
   Show answer and explanation▾

   Answer: B. As-needed low-dose budesonide-formoterol

   GINA no longer recommends SABA-only treatment because it increases the risk of severe exacerbations and asthma death. For mild asthma, the preferred track uses as-needed low-dose ICS-formoterol, which reduces severe exacerbations compared with SABA alone and performs similarly to daily low-dose ICS. Montelukast is less effective and carries neuropsychiatric warnings, and medium-dose ICS-LABA is excessive at this level of symptoms.

9. Question 9Gastroenterology, Hepatology and Nutritionmedium

   A 34-year-old woman with iron deficiency anaemia and bloating started a strict gluten-free diet on her own 3 months ago and feels better. She asks to be tested for coeliac disease. Which is the most appropriate advice?

   1. ACheck tissue transglutaminase IgA now; a negative result excludes coeliac disease
   2. BProceed directly to duodenal biopsy without serology
   3. CTest for HLA-DQ2 and DQ8 to make the diagnosis
   4. DReintroduce gluten for several weeks before serology and biopsy
   Show answer and explanation▾

   Answer: D. Reintroduce gluten for several weeks before serology and biopsy

   Coeliac serology and duodenal histology normalise on a gluten-free diet, so testing now risks a false-negative result; a gluten challenge is needed before tissue transglutaminase IgA testing (with total IgA) and endoscopic biopsy. HLA-DQ2 and DQ8 testing has a high negative predictive value and can help exclude coeliac disease if negative, but a positive result cannot confirm it because these haplotypes are common in the general population.

10. Question 10Musculoskeletal Medicine, Rheumatology, Orthopaedics and Sports Medicinehard

    A 44-year-old man with a week of low back pain now has bilateral sciatica and reports altered sensation when wiping after defecation. He is passing urine normally and has no faecal incontinence. What is the most appropriate management?

    1. AEmergency referral for same-day MRI of the lumbosacral spine
    2. BAnalgesia and review in 2 weeks if not improving
    3. CBladder scan, with referral only if post-void residual is raised
    4. DRoutine outpatient MRI and physiotherapy referral
    Show answer and explanation▾

    Answer: A. Emergency referral for same-day MRI of the lumbosacral spine

    Bilateral sciatica with saddle sensory change indicates suspected cauda equina syndrome, which needs emergency MRI and spinal surgical assessment the same day; outcomes are best when decompression occurs before urinary retention develops. Waiting for bladder dysfunction means the syndrome may already be complete, with a worse prognosis. A normal post-void residual does not exclude the diagnosis, and routine referral or watchful waiting is unsafe.

11. Question 11Women's Health, Obstetrics and Gynaecologymedium

    A 24-year-old woman requests emergency contraception 96 hours after unprotected intercourse. She has a BMI of 31 kg/m2, no contraindications and wants the most effective option. Which method should be recommended?

    1. ALevonorgestrel 1.5 mg orally
    2. BLevonorgestrel 3 mg orally
    3. CCopper intrauterine device
    4. DCombined oral contraceptive Yuzpe regimen
    Show answer and explanation▾

    Answer: C. Copper intrauterine device

    The copper IUD is the most effective emergency contraceptive, with a failure rate below 1 per cent; it can be inserted up to 120 hours after unprotected intercourse (or up to 5 days after the earliest estimated ovulation), is unaffected by body weight and provides ongoing contraception. Levonorgestrel is licensed up to 72 hours and is less effective at higher body weight, even at double dose. The Yuzpe regimen is less effective and causes more nausea.

12. Question 12Child and Adolescent Healthmedium

    An 8-year-old boy wets the bed 5 nights a week and has never been dry at night. He has no daytime symptoms, constipation or urinary infections, and fluid and toileting advice has not helped. The family is motivated and wants long-term dryness. Which is the most appropriate first-line treatment?

    1. ADesmopressin at bedtime
    2. BAn enuresis alarm
    3. COxybutynin at bedtime
    4. DImipramine at bedtime
    Show answer and explanation▾

    Answer: B. An enuresis alarm

    For primary monosymptomatic nocturnal enuresis that persists despite advice, an enuresis alarm is first-line for motivated families seeking lasting dryness and has lower relapse rates than medication. Desmopressin is preferred when rapid or short-term control is needed, such as for sleepovers, or when an alarm is unsuitable. Anticholinergics are reserved for children with daytime symptoms, and imipramine is a later option because of toxicity in overdose.

13. Question 13Dermatologyeasy

    A 26-year-old man has intensely itchy papules on the finger webs, wrists and genitals, worse at night, with short burrows in the finger webs. His partner has similar itching. What is the most appropriate management?

    1. APermethrin 5% to the whole body, repeated after 7 days, with close contacts treated simultaneously
    2. BTopical corticosteroid to affected areas, treating contacts only if they develop symptoms
    3. COral antihistamine and emollient, with review of the rash after 4 weeks
    4. DOral flucloxacillin for 7 days to treat secondary bacterial infection
    Show answer and explanation▾

    Answer: A. Permethrin 5% to the whole body, repeated after 7 days, with close contacts treated simultaneously

    Burrows in the finger webs with nocturnal itch and an affected partner indicate scabies. Permethrin 5% is applied to the whole body from the neck down (including the scalp and face in infants and older adults), washed off after 8 to 12 hours and repeated after 7 days, and all household and sexual contacts must be treated at the same time to prevent reinfestation. Topical steroids alone can worsen the infestation, and itch may persist for several weeks after successful treatment.

14. Question 14Acute and Emergency Care, Minor Surgery and Procedural Skillshard

    A 50-year-old farmer has a deep puncture wound contaminated with soil and manure from a pitchfork 4 hours ago. He cannot remember ever being vaccinated against tetanus. After wound cleaning and debridement, which is the most appropriate tetanus prophylaxis?

    1. ANo action, as the wound is less than 6 hours old
    2. BA tetanus toxoid-containing vaccine dose only
    3. CHuman tetanus immunoglobulin only
    4. DA tetanus toxoid-containing vaccine and human tetanus immunoglobulin
    Show answer and explanation▾

    Answer: D. A tetanus toxoid-containing vaccine and human tetanus immunoglobulin

    For a tetanus-prone wound in a patient with fewer than three documented doses or an unknown vaccination history, both a tetanus toxoid-containing vaccine and tetanus immunoglobulin should be given at different sites, followed by completion of the primary course. Vaccine alone is insufficient because protective antibody takes weeks to develop. The age of the wound does not remove the need for prophylaxis, and immunoglobulin alone gives only temporary passive protection.

15. Question 15Neurology, Ophthalmology, Renal-Urology, Haematology, Geriatrics and Palliative Carehard

    An 82-year-old woman with mild Alzheimer disease taking donepezil has urgency urinary incontinence that persists despite bladder training and caffeine reduction. Blood pressure is 132/78 mmHg. Which drug is most appropriate?

    1. AImmediate-release oxybutynin
    2. BTolterodine
    3. CMirabegron
    4. DDesmopressin
    Show answer and explanation▾

    Answer: C. Mirabegron

    Antimuscarinic bladder drugs such as oxybutynin and tolterodine add to anticholinergic burden, can worsen cognition and oppose the action of cholinesterase inhibitors, so the Beers criteria advise avoiding them in dementia. Mirabegron, a beta-3 agonist, avoids anticholinergic effects, although blood pressure should be monitored. Desmopressin does not treat urgency incontinence and carries a high risk of hyponatraemia in older adults.

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