TDM Exam Sample Questions (Practice Set)

The TDM exam is built from 55 cases, producing roughly 110 to 140 questions across two sections. There are two real question types: MCQs, where you pick exactly one correct answer from 3 to 25 options, and SMQs (short-menu questions), where the list may have one or more correct answers and you're asked to select one, or up to a specified number, including a real "None" option when nothing listed applies. There's no penalty for a wrong answer, so MCC explicitly recommends answering every question even under real uncertainty.

Below are four practice questions — two MCQ, two SMQ — in that same real format, TopQbank's own original items built to MCC's published specification (not real retired TDM questions, which MCC does not publish).

Question 1 (MCQ)

A 68-year-old woman with hypertension and type 2 diabetes presents for a routine visit. Her blood pressure is 148/92 mmHg on two occasions. She is currently on no antihypertensive medication. Which of the following is the most appropriate initial pharmacologic agent?

A) An ACE inhibitor

B) A beta-blocker

C) A loop diuretic

D) An alpha-blocker

Correct answer: A) An ACE inhibitor. In a patient with hypertension and diabetes, an ACE inhibitor (or ARB) is preferred first-line therapy given its added renal-protective benefit in diabetic patients, alongside standard antihypertensive efficacy. Beta-blockers are not first-line for uncomplicated hypertension without a compelling indication, and loop diuretics and alpha-blockers are not standard first-line choices here.

Question 2 (SMQ — select all that apply)

A 55-year-old man newly diagnosed with major depressive disorder is being considered for pharmacologic treatment. Which of the following are appropriate first-line options? Select all that apply.

A) An SSRI (e.g., sertraline)

B) An SNRI (e.g., venlafaxine)

C) A tricyclic antidepressant (e.g., amitriptyline)

D) A monoamine oxidase inhibitor (e.g., phenelzine)

E) None of the above

Correct answer: A and B. SSRIs and SNRIs are both considered appropriate first-line pharmacologic options for major depressive disorder, given their comparable efficacy and more favorable side-effect and safety profile relative to older agents. Tricyclic antidepressants and MAOIs are effective but generally reserved for treatment-resistant cases, given their more significant side-effect burden, drug interactions, and (for TCAs) toxicity in overdose.

Question 3 (MCQ)

A 30-year-old woman presents with a 3-day history of dysuria, urinary frequency, and suprapubic discomfort, without fever, flank pain, or nausea. Urinalysis shows leukocyte esterase and nitrites positive. What is the most appropriate treatment?

A) A short course of oral antibiotics for uncomplicated cystitis

B) IV antibiotics and hospital admission

C) Reassurance only, no treatment needed

D) Renal ultrasound before starting any treatment

Correct answer: A) A short course of oral antibiotics for uncomplicated cystitis. This presentation — dysuria, frequency, suprapubic discomfort, without systemic or upper-tract signs (fever, flank pain) — is classic for uncomplicated lower urinary tract infection (cystitis), appropriately treated with a short course of oral antibiotics as an outpatient. IV antibiotics and admission would be appropriate for pyelonephritis with systemic illness, not simple cystitis, and imaging isn't required before treating an uncomplicated first presentation.

Question 4 (SMQ — select up to 2)

A 45-year-old man on long-term metformin for type 2 diabetes reports new-onset fatigue and peripheral tingling in his feet. Which of the following are appropriate next steps? Select up to 2.

A) Check serum vitamin B12 level

B) Discontinue metformin immediately and switch to insulin

C) Reassure the patient this is expected and requires no workup

D) Assess for other causes of peripheral neuropathy (e.g., glycemic control, alcohol use)

E) Order an MRI of the brain

Correct answer: A and D. Long-term metformin use is associated with vitamin B12 deficiency, which can present with fatigue and peripheral neuropathy — checking a B12 level is a reasonable, targeted first step. Peripheral neuropathy in a diabetic patient also warrants assessment of other common causes, including glycemic control and other reversible contributors, rather than assuming B12 deficiency alone. Metformin does not need to be stopped outright for this workup, and an MRI brain is not indicated for peripheral (not central) neurologic symptoms.