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Sample MDCG Pre-Registration Assessment Practice Questions

Try these sample questions to review concepts for the MDCG Pre-Registration Assessment exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 28-year-old male farmer in Brikama presents to the outpatient clinic with a 3-day history of high intermittent fevers, chills, profuse sweating, headache, and generalized body aches. Physical examination reveals a temperature of 38.8°C, mild pallor, and no signs of altered mental state, respiratory distress, or severe jaundice. A rapid diagnostic test (RDT) and Giemsa-stained thick blood smear confirm Plasmodium falciparum malaria with a parasite density of 1.2%. According to national clinical guidelines in The Gambia, which of the following is the recommended first-line therapy for this patient?
A.Artemether-lumefantrine orally twice daily with fatty food for 3 days
B.Oral chloroquine 600 mg base immediately followed by 300 mg daily for 2 days
C.Oral quinine sulfate monotherapy 600 mg every 8 hours for 7 days
D.Intravenous artesunate 2.4 mg/kg single bolus dose followed by oral sulfadoxine-pyrimethamine
Explanation: Artemisinin-based combination therapy (ACT), specifically artemether-lumefantrine (or artesunate-amodiaquine), is the standard first-line treatment for uncomplicated Plasmodium falciparum malaria in The Gambia and across Sub-Saharan Africa. Administering artemether-lumefantrine with fatty food or milk is essential to optimize the oral bioavailability of lumefantrine.
2A 34-year-old female is brought to the emergency department of Edward Francis Small Teaching Hospital (EFSTH) in Banjul with a 4-day history of deteriorating febrile illness, confusion, and generalized tonic-clonic seizures. On examination, she is comatose (Glasgow Coma Scale score 7/15), deeply jaundiced, tachypneic (respiratory rate 32 breaths/min), and anuric for the past 12 hours. A thick blood film reveals Plasmodium falciparum trophozoites with a 9% parasitemia. What is the immediate drug of choice for parenteral antimalarial therapy?
A.Intravenous artesunate 2.4 mg/kg at 0, 12, and 24 hours, then once daily until oral therapy can be tolerated
B.Intravenous quinine dihydrochloride loading dose of 20 mg/kg infused over 4 hours, then 10 mg/kg every 8 hours
C.Intramuscular artemether 3.2 mg/kg stat followed by 1.6 mg/kg daily for 5 days
D.Intravenous chloroquine infusion 10 mg base/kg over 8 hours followed by 5 mg/kg every 8 hours
Explanation: Intravenous artesunate is the definitive drug of choice for severe malaria in adults and children worldwide. Randomized clinical trials (AQUAMAT and SEAQUAMAT) demonstrated that IV artesunate significantly reduces mortality compared to IV quinine, achieves faster parasite clearance, and carries a much lower risk of life-threatening hypoglycemia.
3A 42-year-old male carpenter presents to a divisional health centre in Basse with a 4-week history of productive cough, evening fevers, drenching night sweats, anorexia, and involuntary weight loss of 6 kg. Physical examination reveals bronchial breathing in the right upper zone and apical crepitations. Sputum GeneXpert MTB/RIF assay demonstrates Mycobacterium tuberculosis with no rifampicin resistance detected. What is the standard national regimen for this patient's newly diagnosed drug-susceptible pulmonary tuberculosis?
A.2 months of Rifampicin, Isoniazid, Pyrazinamide, and Ethambutol (2RHZE) followed by 4 months of Rifampicin and Isoniazid (4RH)
B.2 months of Streptomycin, Isoniazid, and Rifampicin (2SHR) followed by 7 months of Isoniazid and Ethambutol (7HE)
C.6 months of Rifampicin, Isoniazid, and Pyrazinamide continuously without an ethambutol phase
D.9 months of high-dose Isoniazid and Ethambutol monotherapy with pyridoxine supplementation
Explanation: The standard WHO-recommended treatment for newly diagnosed drug-susceptible pulmonary tuberculosis consists of an intensive phase of 2 months with four drugs: Rifampicin (R), Isoniazid (H), Pyrazinamide (Z), and Ethambutol (E), followed by a continuation phase of 4 months with two drugs: Rifampicin and Isoniazid (2RHZE / 4RH). Pyridoxine (vitamin B6) should be co-administered to prevent isoniazid-induced peripheral neuropathy.
4A 36-year-old male with known advanced HIV disease (baseline CD4 count 38 cells/μL) who defaulted on antiretroviral therapy presents with a 2-week history of progressively worsening headache, low-grade fever, neck stiffness, and photophobia. Neurological examination reveals neck rigidity and positive Kernig's sign without focal neurological deficits. Lumbar puncture reveals clear cerebrospinal fluid (CSF) with an opening pressure of 280 mm H₂O, lymphocytic pleocytosis (45 cells/μL), elevated protein (1.2 g/L), low glucose (1.6 mmol/L), and India ink preparation demonstrating numerous encapsulated budding yeast cells. Which of the following represents the preferred first-line induction antifungal regimen?
A.A single high dose (10 mg/kg) of liposomal Amphotericin B with 14 days of oral Flucytosine (100 mg/kg/day in four divided doses) plus Fluconazole 1200 mg daily
B.Oral Fluconazole monotherapy (400 mg once daily) for 6 weeks
C.Intravenous Caspofungin (70 mg loading dose then 50 mg daily) for 14 days
D.Intravenous Ceftriaxone 2 g twice daily plus oral Acyclovir 800 mg 5 times daily for 21 days
Explanation: Cryptococcal meningitis is a major cause of HIV-associated mortality. Since March 2022 the WHO-preferred induction regimen is a single high dose (10 mg/kg) of liposomal amphotericin B combined with 14 days of flucytosine (100 mg/kg/day in four divided doses) and fluconazole 1200 mg daily, based on the AMBITION-cm trial. Where liposomal amphotericin B is unavailable, the recommended alternative is 7 days of amphotericin B deoxycholate (1 mg/kg/day) plus flucytosine, followed by 7 days of fluconazole 1200 mg daily. Therapeutic lumbar punctures to control raised intracranial pressure (opening pressure >200 mm H₂O) are also critical.
5A 48-year-old male teacher undergoes pre-employment health screening in Serekunda. Serology reveals that he is hepatitis B surface antigen (HBsAg) positive, hepatitis B e-antigen (HBeAg) positive, and antibody to hepatitis C virus (anti-HCV) negative. Quantitative real-time PCR reveals a serum HBV DNA level of 85,000 IU/mL. Serum alanine aminotransferase (ALT) is 98 U/L (more than twice the upper limit of normal), and transient elastography demonstrates significant liver fibrosis (stage F2). Which of the following is the most appropriate first-line antiviral monotherapy for this patient?
A.Tenofovir disoproxil fumarate (TDF) 300 mg orally once daily
B.Lamivudine 100 mg orally once daily
C.Adefovir dipivoxil 10 mg orally once daily
D.Subcutaneous pegylated interferon alfa-2a monotherapy for 12 weeks
Explanation: Tenofovir disoproxil fumarate (TDF) or Entecavir are the preferred first-line nucleos(t)ide analogues for chronic hepatitis B with high viral load, elevated ALT, and evidence of significant liver fibrosis. Both agents possess high antiviral potency and a very high genetic barrier to resistance, unlike older drugs like lamivudine.
6A 16-year-old boy living in a village bordering the River Gambia in the Central River Region presents with a 2-month history of recurrent, painless terminal hematuria and mild dysuria. He frequently swims and fishes in local freshwater streams. Physical examination is unremarkable. Microscopic examination of centrifuged urine sediment reveals characteristic elongated eggs with a prominent terminal spine. What is the definitive treatment of choice for this parasitic infection?
A.Praziquantel 40 mg/kg orally as a single dose (or divided into two doses 4 hours apart)
B.Albendazole 400 mg orally once daily for 3 consecutive days
C.Metronidazole 400 mg orally three times daily for 7 days
D.Diethylcarbamazine 6 mg/kg daily in divided doses for 12 days
Explanation: The clinical presentation of terminal hematuria and terminal-spined eggs in urine is pathognomonic for urinary schistosomiasis (Schistosoma haematobium), which is hyperendemic along freshwater tributaries of the River Gambia. Praziquantel at a dose of 40 mg/kg is the drug of choice, exerting direct anthelmintic activity by increasing parasite membrane permeability to calcium ions.
7A 24-year-old university student in Kanifing presents to the emergency department with acute-onset high fever, severe throbbing headache, neck stiffness, photophobia, and a petechial/purpuric skin rash on the lower extremities. Vital signs include blood pressure 100/60 mmHg, heart rate 116 bpm, and temperature 39.5°C. Lumbar puncture yields turbid CSF with an opening pressure of 260 mm H₂O, white blood cell count of 3,200/μL (92% neutrophils), protein of 2.8 g/L, and CSF glucose of 1.1 mmol/L (simultaneous blood glucose 5.8 mmol/L). Gram stain demonstrates Gram-negative bean-shaped diplococci. Which empirical antimicrobial therapy is most appropriate?
A.Intravenous Ceftriaxone 2 g every 12 hours
B.Intravenous Vancomycin 1 g every 12 hours monotherapy
C.Intravenous Gentamicin 5 mg/kg once daily
D.Oral Ciprofloxacin 500 mg stat dose alone
Explanation: The clinical picture and CSF Gram stain (Gram-negative diplococci) indicate meningococcal meningitis caused by Neisseria meningitidis, a pathogen of major epidemic concern across the African Meningitis Belt, which encompasses The Gambia. High-dose third-generation cephalosporins (intravenous Ceftriaxone 2 g every 12 hours) provide excellent CSF penetration and bactericidal activity.
8A 30-year-old female presents with a 10-day history of step-ladder pattern fever, persistent frontal headache, anorexia, dry cough, and constipation followed by watery greenish ('pea-soup') diarrhea. Physical examination reveals a toxic-appearing woman with a temperature of 39.8°C and a pulse rate of 74 bpm (relative bradycardia). Faint, blanching erythematous macules ('rose spots') are noted on her upper abdomen, and palpation reveals mild splenomegaly. Which diagnostic investigation provides the highest sensitivity for confirming enteric (typhoid) fever during this second week of illness?
A.Blood culture
B.Widal agglutination serological test
C.Stool wet mount microscopy
D.Erythrocyte sedimentation rate (ESR)
Explanation: Blood culture is the standard gold-standard diagnostic modality for typhoid (enteric) fever caused by Salmonella enterica serovars Typhi and Paratyphi, remaining positive in 60% to 80% of patients during the first two weeks of illness before widespread antibiotic exposure. Bone marrow culture has higher sensitivity, but blood culture is the practical clinical choice.
9A 55-year-old Gambian male with no past medical history attends an outpatient clinic for routine assessment. His blood pressure measurements on three separate occasions over 4 weeks average 154/96 mmHg. Physical examination, fundoscopy, ECG, serum creatinine (78 μmol/L), and urinalysis are completely normal, and he has no history of diabetes mellitus. According to standard WHO and international hypertension guidelines for individuals of African descent, which of the following is the preferred first-line pharmacological monotherapy?
A.Amlodipine 5 mg orally once daily
B.Enalapril 10 mg orally once daily
C.Atenolol 50 mg orally once daily
D.Spironolactone 50 mg orally once daily
Explanation: International guidelines (including WHO, ISH, and NICE guidelines for people of African descent) recommend a long-acting dihydropyridine calcium channel blocker (such as amlodipine) or a thiazide/thiazide-like diuretic as first-line monotherapy for hypertension in black African populations. Individuals of African origin characteristically exhibit low-renin hypertension, responding significantly better to CCBs and thiazides than to ACE inhibitors or ARBs as initial monotherapy.
10A 62-year-old male with a history of anterior myocardial infarction 2 years ago presents with progressively worsening exertional dyspnea, orthopnea requiring three pillows, and paroxysmal nocturnal dyspnea. On physical examination, his jugular venous pressure (JVP) is elevated to 6 cm above the sternal angle, bibasilar lung crackles are audible, and there is 2+ pitting bilateral pedal edema. Transthoracic echocardiography reveals a dilated left ventricle with an ejection fraction of 28% (HFrEF). He is started on oral furosemide 40 mg daily for symptom relief. Which of the following combinations represents the core evidence-based disease-modifying therapy proven to reduce long-term cardiovascular mortality in HFrEF?
A.ACE inhibitor (or ARNI), beta-blocker (bisoprolol/carvedilol), and mineralocorticoid receptor antagonist (spironolactone)
B.Digoxin, furosemide, and isosorbide dinitrate
C.Amlodipine, hydrochlorothiazide, and aspirin
D.Hydralazine, verapamil, and simvastatin
Explanation: Foundational guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF, LVEF ≤40%) includes neurohormonal blockade with an ACE inhibitor/ARNI, an evidence-based beta-blocker (bisoprolol, carvedilol, or sustained-release metoprolol succinate), and a mineralocorticoid receptor antagonist (spironolactone or eplerenone), alongside SGLT2 inhibitors. These classes have been definitively proven to reverse cardiac remodeling and reduce all-cause mortality.

About the MDCG Pre-Registration Assessment Exam

The Medical and Dental Council of The Gambia (MDCG) Pre-Registration Assessment is the Council's Assessment of Medical and Dental Competence, run under the mandate the Medical and Dental Practitioners Act 1988 gives the MDCG to regulate medical and dental practice in The Gambia. It applies to applicants whose primary medical or dental qualification comes from a country where the Council has no prior experience of assessing graduates' competence, and the Council reserves the discretion to select which countries and facilities are covered. The assessment ensures that practitioners entering the health system demonstrate the diagnostic competence, clinical judgment, procedural safety, and ethical conduct required to deliver safe patient care across Gambian hospitals and health centres.

Exam sponsor: Medical and Dental Council of The Gambia (MDCG). The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

The assessment is organised into three parts. Part 1 is a single 3-hour written paper of 200 multiple-choice questions on basic and clinical sciences; the MDCG names the clinical sciences as internal medicine, obstetrics and gynaecology, paediatrics, general surgery, therapeutics, and dentistry for candidates who will practise dentistry. An applicant is invited to Parts 2 and 3 only after scoring 50% or more on the written paper. Part 2 is a 2-hour clinical skills assessment in which the applicant reviews 10 clinical cases, demonstrating specific clinical skills and answering questions on each. Part 3 is an oral assessment in which a Panel of Assessors interviews the applicant on managing different clinical scenarios. A pass mark of 50% in each of the three parts is required for the MDCG Certificate of Competence. The MDCG does not publish percentage weightings for any written-paper subject.

Time Limit

3 hours for the Part 1 written paper; 2 hours for the Part 2 clinical skills assessment

Passing Score

50% in each part (50% on written paper required to advance to clinical and oral parts)

Exam / Certification Fees

Published by the MDCG as a scanned fee schedule on its Fees and Charges page; paid into the Council's Standard Chartered Bank Gambia Limited account (GMD or USD) with the pay-in slip uploaded to the application

Exam sponsor website

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

25 of 100

Internal Medicine

An MDCG-named written-paper subject. Covers infectious diseases prevalent in West Africa (malaria, tuberculosis, HIV, viral hepatitis, schistosomiasis, meningitis, typhoid), cardiovascular disorders (hypertension, heart failure, acute coronary syndromes), respiratory illnesses, nephrology, and endocrinology.

20 of 100

Obstetrics and Gynaecology

An MDCG-named written-paper subject. Covers antenatal care protocols, pre-eclampsia and eclampsia management, postpartum haemorrhage, obstructed labour, maternal sepsis, neonatal transition, contraception, and common gynaecological pathology.

20 of 100

Paediatrics and Child Health

An MDCG-named written-paper subject. Covers neonatal resuscitation, the Gambian EPI vaccination schedule, severe acute malnutrition (kwashiorkor, marasmus), childhood dehydration and ORS/zinc management, acute respiratory infections, paediatric malaria, and sickle cell disease.

15 of 100

General Surgery and Emergency Care

An MDCG-named written-paper subject. Covers acute abdomen diagnosis (appendicitis, peritonitis, bowel obstruction), initial trauma assessment (ATLS ABCDE approach), burn resuscitation using the Parkland formula, surgical asepsis, and wound care.

10 of 100

Therapeutics and Clinical Pharmacology

An MDCG-named written-paper subject. Covers rational prescribing, essential medicines usage, antimicrobial selection and stewardship, paediatric dosing calculations, adverse drug reactions, and critical drug interactions.

10 of 100

Medical Ethics, Jurisprudence, and Public Health

Supporting study rather than an MDCG-listed written-paper subject; aimed at the Part 3 oral assessment and at practising under Gambian registration. Covers the Medical and Dental Practitioners Act 1988, the WAHO-ECOWAS Harmonised Codes of Ethics and Practice issued by the MDCG, patient confidentiality, informed consent, medical negligence, notifiable infectious diseases, and epidemic disease surveillance.

Preparing for the MDCG Pre-Registration Assessment Exam

What You Need to Know

  • Passing score: 50% in each part (50% on written paper required to advance to clinical and oral parts)
  • Assessment: The assessment is organised into three parts. Part 1 is a single 3-hour written paper of 200 multiple-choice questions on basic and clinical sciences; the MDCG names the clinical sciences as internal medicine, obstetrics and gynaecology, paediatrics, general surgery, therapeutics, and dentistry for candidates who will practise dentistry. An applicant is invited to Parts 2 and 3 only after scoring 50% or more on the written paper. Part 2 is a 2-hour clinical skills assessment in which the applicant reviews 10 clinical cases, demonstrating specific clinical skills and answering questions on each. Part 3 is an oral assessment in which a Panel of Assessors interviews the applicant on managing different clinical scenarios. A pass mark of 50% in each of the three parts is required for the MDCG Certificate of Competence. The MDCG does not publish percentage weightings for any written-paper subject.
  • Time limit: 3 hours for the Part 1 written paper; 2 hours for the Part 2 clinical skills assessment
  • Exam / certification fees: Published by the MDCG as a scanned fee schedule on its Fees and Charges page; paid into the Council's Standard Chartered Bank Gambia Limited account (GMD or USD) with the pay-in slip uploaded to the application Official sources

Using Our Practice Resources

  • Work through all 100 available questions
  • Review every answer and explanation
  • Track weak areas and revisit them
  • Use our AI tutor for tough concepts

MDCG Pre-Registration Assessment: Suggested Study Strategy

1Prioritize high-yield tropical infectious diseases endemic to The Gambia, particularly severe falciparum malaria, tuberculosis diagnosis via GeneXpert, HIV management, and schistosomiasis.
2Master emergency obstetric and neonatal protocols including magnesium sulfate loading and maintenance in severe pre-eclampsia/eclampsia and active management of the third stage of labour (AMTSL) for postpartum haemorrhage.
3Review the Gambian Expanded Programme on Immunization (EPI) schedule, dehydration classification using WHO/IMCI guidelines, and management of severe acute malnutrition (SAM) with F-75 and F-100 therapeutic milk.
4Practice surgical emergency decision-making, including acute abdomen differentiation, ATLS trauma resuscitation, and Parkland formula burn fluid calculations.
5Familiarize yourself with the Medical and Dental Practitioners Act 1988 and the WAHO-ECOWAS Harmonised Codes of Ethics and Practice that the MDCG issues as its Practitioners Guide on Ethics, emphasizing patient autonomy, confidentiality, informed consent, and mandatory disease notification.
6Rehearse out loud for the Part 3 oral assessment: talk through your differential, investigations, and management plan for common Gambian emergency presentations, since a panel interview tests reasoning you can articulate, not recognition of an answer option.

Frequently Asked Questions

What is the MDCG Pre-Registration Assessment?

It is the Assessment of Medical and Dental Competence conducted by the Medical and Dental Council of The Gambia for doctors and dentists holding a primary qualification from a country where the Council has no prior experience of assessing the competence of graduates from its training institutions. The Council selects which countries and facilities are subject to it, so it is not required of every internationally trained applicant.

What is the format and structure of the MDCG assessment?

The assessment comprises three parts: Part 1 is a single 3-hour written paper of 200 multiple-choice questions on basic and clinical sciences (internal medicine, obstetrics and gynaecology, paediatrics, general surgery, therapeutics, and dentistry for dental candidates); Part 2 is a 2-hour clinical skills assessment across 10 clinical cases; and Part 3 is an oral assessment in which a Panel of Assessors interviews the applicant on managing clinical scenarios.

Is this practice test an official MDCG paper?

No. This free 100-question bank is an independent English-language study aid written from the MDCG's published assessment policy and the clinical guidelines that policy's subjects rest on. It is not produced or endorsed by the Council and does not reproduce the official 200-item paper. It can rehearse the knowledge and judgement that Parts 2 and 3 draw on, but no MCQ set can simulate a bedside clinical skills assessment or an oral panel interview.

What is the passing score required to obtain registration?

Candidates must achieve at least 50% on the Part 1 written examination to be invited to participate in the clinical skills assessment and oral interview. Candidates must score at least 50% in each of the three individual parts to be awarded the Certificate of Competence.

What is the retake policy if a candidate fails?

The MDCG policy states that an applicant who fails will only be allowed to re-sit the assessment after six months, and that an applicant may have unlimited attempts at the assessment.

What language is the assessment conducted in?

English. It is the official language of The Gambia and the language of medical training and clinical practice there, and the MDCG publishes its assessment policy, registration guidance, and application forms in English. This practice bank is likewise in English.

How are fees paid for the assessment?

Payment is made into the Medical and Dental Council of The Gambia accounts at Standard Chartered Bank Gambia Limited (GMD account 0100130242800 or USD account 8700130242800, SWIFT SCBLGMGM), and the bank pay-in slip is uploaded with the online application. The Council publishes its fee schedule as scanned tables on its Fees and Charges page; confirm the current amount with the MDCG before paying.