How to Prepare for the TDM Exam

What does the TDM exam test?

The TDM Examination assesses therapeutic knowledge and clinical decision-making at the level expected of a family physician practising independently and safely in Canada. The MCC defines therapeutics as the pharmacologic and nonpharmacologic management of medical conditions.

You are assessed on choosing specific treatments, managing common adverse effects and drug interactions, and advising patients about their care. Cases also test awareness of alternative therapies, negotiating a therapeutic agreement, and recognising drug misuse and substance use disorders.

The blueprint sets the split. By dimension of care: health promotion and illness prevention about 10–20% (15% on average), acute about 20–30% (25%), chronic about 25–35% (30%), and safety and adverse effects about 25–35% (30%). By intervention: pharmacologic about 65–75% (70%) and nonpharmacologic about 25–35% (30%). More in the TDM blueprint and core topics.

How the questions work

The exam is a four-hour appointment with 55 cases and about 110 to 140 questions, split into two sections of an hour and a half with an optional 20-minute break. Each section has about 55 to 70 questions, including unscored pilot questions.

There are two question types. In a multiple-choice question you pick one answer; in a short-menu question you pick one, or up to a stated number, from a list. Lists run from 3 to 25 options, and some include “None”. There is no penalty for wrong answers, and if a question asks you to “Select 3” and you pick fewer, you still get credit for the correct ones you chose. You can move freely and flag questions within a section, but once you submit a section you can’t go back. The detail is in how TDM’s MCQ and SMQ questions work.

A practical plan built around the format

Start with the MCC’s free resources. The MCC offers eight free sample cases in the style of the exam, a list of core TDM exam topics, and a page on answering MCQs and short-menu questions. Do the sample cases first to see the format, and use the topics list as your checklist.

Revise by drug decision, not by disease alone. With pharmacologic interventions making up about 70% of the exam and safety and adverse effects about 30%, go through each core topic asking: what is first line, what are the key adverse effects and interactions, what are the contraindications, and what needs monitoring.

Practise whole sections against the clock. Each real section gives you an hour and a half for about 55 to 70 questions. Practise case sets of that size in 90 minutes, answer every question, and for “Select n” questions choose up to the number asked.

Book early. You now apply directly to the MCC. Applications for the January 13, 2027 exam close on October 26, 2026 at 4.00 p.m. Eastern Time, and the MCC advises checking the requirements of the PRA program you are aiming for before you apply.

Three TDM practice questions with answers

These come from the TopQbank TDM question bank, reviewed by licensed doctors. Like the real exam, each question belongs to a longer case, so you see the case first. They are not real TDM questions. For four more, in both MCQ and short-menu format, see TDM exam sample questions.

Question 1 · Dermatology

Case: A 38-year-old man presents with several enlarging pruritic annular plaques on the trunk and groin after joining a wrestling club. Examination shows sharply demarcated scaly advancing borders with partial central clearing and no pustules or systemic illness. He used an over-the-counter hydrocortisone-antifungal combination intermittently for 3 weeks; the lesions became less scaly but continued to spread. He has type 2 diabetes controlled with metformin and takes metoprolol for hypertension. He has normal renal function and mildly elevated ALT from known fatty liver disease.

Which treatment is MOST appropriate for his current extensive tinea corporis/cruris?

A) Fluconazole 150 mg orally once daily for 14 days because daily high-dose azole therapy is preferred over terbinafine for uncomplicated dermatophyte infection

B) Griseofulvin 500 mg orally twice daily for 12 weeks because it is uniformly more effective than terbinafine for adult tinea corporis

C) Itraconazole 200 mg orally twice daily for 6 weeks because all multifocal tinea requires prolonged systemic therapy

D) Terbinafine 250 mg orally once daily for a limited course because disease is extensive and has progressed despite topical treatment with assessment of hepatic suitability

E) Terbinafine 1% cream once or twice daily to lesions and a surrounding margin for 1–2 weeks because topical therapy remains sufficient regardless of extent

Correct answer: D) Terbinafine 250 mg orally once daily for a limited course because disease is extensive and has progressed despite topical treatment with assessment of hepatic suitability. Localized tinea corporis or cruris is usually treated topically. Oral treatment is reasonable when disease is extensive, involves hair-bearing/deeper sites or fails appropriate topical therapy. Adult oral terbinafine is commonly 250 mg once daily; treatment duration for corporis/cruris is generally shorter than for nail disease and should be individualized. His abnormal ALT makes hepatic assessment important before systemic terbinafine.

Question 2 · Allergy

Case: A 37-year-old woman presents with seasonal sneezing, clear rhinorrhea, nasal itching, congestion, and intermittent itchy wheals. Symptoms worsen with pollen exposure. She drives for work and wants to minimize sedation. She has no asthma exacerbation, anaphylaxis, fever, or purulent nasal discharge. The clinician reviews second-generation oral antihistamines, sedating first-generation antihistamines, and intranasal antihistamines.

Which oral antihistamine is a reasonable choice when minimizing sedation is particularly important?

A) Diphenhydramine taken before driving

B) Fexofenadine

C) Chlorpheniramine

D) Hydroxyzine

E) Promethazine

Correct answer: B) Fexofenadine. Second-generation antihistamines such as fexofenadine, bilastine, loratadine, desloratadine, and cetirizine are generally preferred over first-generation agents for allergic rhinitis and urticaria because they cause less sedation and fewer anticholinergic effects. Cetirizine can still cause somnolence in some patients.

Question 3 · Palliative care

Case: A 69-year-old woman with metastatic breast cancer receiving palliative treatment develops rapidly worsening thoracic back pain, bilateral leg weakness, difficulty walking, numbness below the umbilicus, and new urinary retention. Examination shows thoracic vertebral tenderness, reduced lower-extremity power, hyperreflexia, and a sensory level. Malignant spinal cord compression is suspected, and management is aligned with her goals of preserving mobility and neurologic function.

What is the most appropriate immediate medication when malignant spinal cord compression is strongly suspected in this patient with neurologic deficits?

A) Wait for tissue biopsy before treatment

B) Dexamethasone started promptly while urgent imaging and definitive specialist treatment are arranged

C) Gabapentin alone

D) Oral antibiotics

E) Routine high-dose methylprednisolone for traumatic spinal injury

Correct answer: B) Dexamethasone started promptly while urgent imaging and definitive specialist treatment are arranged. Dexamethasone is commonly started promptly when malignant spinal cord compression causes neurologic symptoms or signs. A commonly used regimen is 16 mg/day orally or IV, although exact loading, dosing, and tapering should follow local oncology protocols. Corticosteroids reduce edema but do not replace definitive treatment.

When you sit the exam, here is when and how TDM results are released. For case-based practice in the same style, try the TopQbank TDM question bank.