DHA GP Exam common mistakes
DHA GP Exam · Understand the traps and how to avoid them.
Selecting the diagnosis option that matches the first abnormal finding in the stem, then skimming the rest of the vignette (e.g., committing to ACS in a 55-year-old with chest pain before reaching the sentence about pleuritic pain, recent flight and unilateral leg swelling).
Long stems plus a per-question time limit push candidates into pattern-matching on the first familiar keyword; exam writers deliberately place the discriminating detail later in the stem.
What to do instead
Read every stem twice: first pass to the final line with the options hidden, second pass underlining the positives and, critically, the pertinent negatives and risk factors. Only then open the options. If an option became attractive before you reached the last sentence, treat it as suspect.
Answering the diagnostic or therapeutic question without checking the vital signs and mental status printed in the stem, so a physiologically unstable patient is given an outpatient or oral-therapy plan.
Attention is captured by the diagnostic puzzle (the rash, the murmur, the lab value) and vitals are read as background data rather than as the branching point of the question.
What to do instead
Before reading the options, write down a one-line physiological summary (HR, BP, RR, SpO2, temperature, GCS/AVPU, glucose). If any parameter is abnormal, the correct answer almost always involves resuscitation, admission or escalation rather than investigation or discharge.
Over-investigating low-risk primary care presentations: ordering CT head, endoscopy, ultrasound or specialist referral for a patient who meets guideline criteria for reassurance, symptomatic treatment and safety-netting.
Hospital-based training rewards excluding the worst-case diagnosis with imaging; candidates carry that reflex into a primary care setting where pre-test probability and guideline-directed stewardship determine the 'best' answer.
What to do instead
Memorise the specific presentations where watchful waiting is the guideline answer (isolated headache without red flags, mechanical low back pain, uncomplicated acute otitis media in older children, acute sinusitis under 10 days, uncomplicated UTI in a stable woman) and learn that presentation's named red flags so the decision is deliberate, not habitual.
Managing only the presenting complaint and ignoring the preventive or chronic-disease element the question is actually testing, such as missing an overdue cervical smear, colorectal screening, vaccination or statin initiation in a patient seen for an unrelated minor illness.
The acute complaint is vivid and the preventive item is a single clause in the history, so the candidate answers the illness the patient came with rather than the opportunity the consultation represents.
What to do instead
Adopt a fixed primary care checklist applied to every vignette: age, sex, smoking, BMI, BP, immunisation status, and last due screening. Ask yourself 'what else is due for this patient at this visit?' before choosing.
Using adult dosing logic in children - picking a weight-based dose without calculating the paediatric maximum, or selecting an adult formulation or a drug contraindicated by age (e.g., aspirin, codeine, tetracyclines, fluoroquinolones).
Dose options are written to look plausible at a glance, and candidates estimate 'roughly right' instead of performing the arithmetic; age-related contraindications are recalled as adult indications.
What to do instead
For every paediatric prescribing question, do the explicit calculation on the screen or scratchpad (mg/kg × weight in kg), then compare against the stated maximum. Separately memorise the short list of drugs contraindicated by age band and check the child's age against it before selecting.
Applying outpatient risk stratification to a young febrile infant, e.g., arranging review in 24 hours for a 5-week-old with a temperature of 38.5 °C who looks well and has no focus of infection.
The child's reassuring appearance dominates the judgement, and the candidate reasons as they would for a toddler rather than applying the age-banded sepsis rules that exist precisely because well-appearing young infants can deteriorate rapidly.
What to do instead
Anchor three age bands in memory: under 28 days - full sepsis screen and admission with parenteral antibiotics; 29 days to 3 months - urgent assessment with full blood count, blood culture, urine and, depending on risk criteria, lumbar puncture; over 3 months - risk-stratified approach. State the band out loud before choosing.
Choosing a digital vaginal examination as the next step in a woman with painless third-trimester vaginal bleeding, instead of abstaining until placental localisation is confirmed.
Pelvic examination is the reflexive 'next step' for vaginal bleeding learned in gynaecology, and the stem rarely states 'placenta praevia' - the candidate must infer it from painless bleeding, a high presenting part or a previously low-lying placenta.
What to do instead
Build the reflex: any bleeding after 20 weeks gets speculum-free, digital-free assessment with ultrasound first, plus anti-D if the woman is Rh-negative and bleeding is significant. Reserve digital examination for the situation where labour is established and previa has been excluded.
Prescribing a combined oestrogen-containing contraceptive, or an ACE inhibitor/ARB, to a woman whose history contains a contraindication (migraine with aura, smoker over 35, uncontrolled hypertension, current or previous thromboembolism; pregnancy for the renin-angiotensin drugs).
The contraindication is buried in the social or past-medical history while the indication for the drug is the explicit question, so the candidate selects the effective drug and never screens the history against it.
What to do instead
Before selecting any drug in an obstetrics/gynaecology question, run a two-second screen: 'is she pregnant, could she be, or is she breastfeeding?' and 'does her history contain a UKMEC category 3/4 condition?' Treat any such condition as eliminating every combined-hormonal and teratogenic option.
Choosing a definitive or diagnostic step ahead of resuscitation in an unstable emergency patient - ordering a CT abdomen for a hypotensive trauma patient, or requesting an ECG before addressing an obstructed airway.
The question 'what is the next step' is misread as 'what is the diagnosis' or 'what is the definitive treatment', and the intellectually satisfying investigation competes with the less glamorous but immediately life-saving manoeuvre.
What to do instead
Force the ABCDE sequence onto every emergency stem: state which airway, breathing and circulation problem exists, fix it, and only then consider investigation. If the patient is unstable, eliminate every answer that involves leaving the patient's side for imaging, and remember that a FAST or bedside test is often the intended compromise.
Treating a time-critical surgical diagnosis as a routine outpatient problem - analgesia and review for a suspected testicular torsion, an open fracture, a hot swollen joint or a suspected cauda equina syndrome - instead of immediate senior referral.
The presentation may be mild-sounding and the analgesia option looks compassionate and correct; candidates underestimate how a short delay in these specific conditions causes irreversible loss of organ function or neurology.
What to do instead
Memorise a short list of 'never go home' diagnoses (torsion, open or neurovascularly compromised fracture, septic arthritis, cauda equina, acute limb ischaemia, ruptured AAA, ectopic pregnancy) and rehearse the same answer for each: immediate senior/surgical referral, nothing by mouth, analgesia and definitive imaging coordinated by the receiving team, not deferred to a clinic.