FULL MOCK EXAM UNDER TIMED CONDITIONS

A 55-year-old gentleman with known type-2-diabetes presents to you with an acutely swollen great right toe.

The patient has erythema isolated to the base of his right toe.

Observations are stable.

What is the maximum dose of colchicine offered in a single course?

6 milligrams

Correct Incorrect Correct answer

500 micrograms

Correct Incorrect Correct answer

1 milligram

Correct Incorrect Correct answer

2 milligrams

Correct Incorrect Correct answer

No maximum dose

Correct Incorrect Correct answer

Which of the following medications would be considered a double-dose proton pump inhibitor?

Esomeprazole 20mg once a day

Correct Incorrect Correct answer

Lansoprazole 30mg once a day

Correct Incorrect Correct answer

Rabeprazole 20mg once a day

Correct Incorrect Correct answer

Omeprazole 40mg once a day

Correct Incorrect Correct answer

Lansoprazole 15mg once a day

Correct Incorrect Correct answer

A patient with advanced dementia is refusing to eat and drink. The care home has requested that the patient should be referred for PEG feeding due to ongoing weight loss.

The patient has a lasting power of attorney for welfare. They agree with the care home staff.

There is an advanced directive stating that if he was to lose capacity, the patient does not want any invasive procedure to assist with nutrition.

Which of the following options are incorrect? Please select one or more that apply.

The patient has made an unwise decision and you should overrule the decision.

Correct Incorrect Correct answer

Advanced decisions do not apply to life-saving treatments.

Correct Incorrect Correct answer

The next of kin can overrule the decision as they act as an attorney for the patient.

Correct Incorrect Correct answer

The age of the patient adds to the credibility of his advanced decision.

Correct Incorrect Correct answer

The patient should be PEG fed to a point where his capacity can be reassessed.

Correct Incorrect Correct answer

A 14-year-old boy has presented to your clinic with his father. The school have informed the parents that the child is refusing to take part in physical education lessons and would like your expert opinion.

On examination, you find a circle of firm tissue present under both nipples.

There are no axillary lymph nodes present and the skin overlying the breast area appears normal.

He is pubertal development is otherwise normal.

What would be the most appropriate advice regarding the resolution of symptoms?

The patient should be considered for surgical removal of breast tissue.

Correct Incorrect Correct answer

Tamoxifen would be an appropriate treatment to commence in secondary care.

Correct Incorrect Correct answer

The symptoms will often resolve within two years.

Correct Incorrect Correct answer

The symptoms will often resolve within a year of presentation.

Correct Incorrect Correct answer

The patient will require investigation for Klinefelter syndrome.

Correct Incorrect Correct answer

Which of the following antibiotics should be avoided in a patient with prolonged QTc.

Select the single most likely answer.

Amoxicillin

Correct Incorrect Correct answer

Erythromycin

Correct Incorrect Correct answer

Doxycycline

Correct Incorrect Correct answer

Clindamycin

Correct Incorrect Correct answer

Flucloxacillin

Correct Incorrect Correct answer

A 35-year-old patient presents with painless progressive weakness in his limbs. He reports difficulties when speaking and swallowing which have gradually worsened.

Select the single most likely diagnosis.

Myasthenia gravis

Correct Incorrect Correct answer

Myositis

Correct Incorrect Correct answer

Lymes disease

Correct Incorrect Correct answer

Syringomyelia

Correct Incorrect Correct answer

Motor neuron disease

Correct Incorrect Correct answer

HIV

Correct Incorrect Correct answer

Which of the following would best describe this skin lesion?

Image reference Primary Care Dermatology Society

Basal cell carcinoma

Correct Incorrect Correct answer

Superficial spreading melanoma

Correct Incorrect Correct answer

Nodular melanoma

Correct Incorrect Correct answer

Lentigo maligna melanoma

Correct Incorrect Correct answer

Acral-lentiginous melanoma

Correct Incorrect Correct answer

A 4-year-old child has presented to the out of hours GP with a 2-week history of severe cough. On examination, the child has a faint, non-blanching petechial rash present above the upper chest wall and shoulders.

There is no history of fever. The child examines well.

What is the likely diagnosis?

Mechanical petechiae

Correct Incorrect Correct answer

Viral illness

Correct Incorrect Correct answer

Meningococcal disease

Correct Incorrect Correct answer

Thrombocytopenia

Correct Incorrect Correct answer

Henoch-Schönlein Purpura

Correct Incorrect Correct answer

A 50-year-old patient developed a one-hour history of central chest pain radiating into his right jaw. The patient felt hot and sweaty and gradually found that his pain eased. He has attended your clinic complaining of feeling unwell this morning.

On examination, you can hear an early systolic murmur that can be best heard at the apex, with a radiating murmur in the left axilla.

Which of the following murmurs is likely to be present?

Aortic stenosis

Correct Incorrect Correct answer

Tricuspid regurgitation

Correct Incorrect Correct answer

Aortic regurgitation

Correct Incorrect Correct answer

Mitral regurgitation

Correct Incorrect Correct answer

Pulmonary stenosis

Correct Incorrect Correct answer

A study is investigating a new drug and its effectiveness in reducing colitis episodes in patients with ulcerative colitis.

255 patients have taken part in this study.

What is the mean age of the study participants?

30.2 years old

Correct Incorrect Correct answer

24.8 years old

Correct Incorrect Correct answer

28.7 years old

Correct Incorrect Correct answer

31.2 years old

Correct Incorrect Correct answer

29.1 years old

Correct Incorrect Correct answer

Which condition is most likely to be demonstrated within this genetic pedigree?

Image reference Khan Academy

Haemophilia A

Correct Incorrect Correct answer

Cystic fibrosis

Correct Incorrect Correct answer

Sickle cell disease

Correct Incorrect Correct answer

Marfan syndrome

Correct Incorrect Correct answer

Retinitis pigmentosa

Correct Incorrect Correct answer

An 18-year-old has suffered from a 2-day history of loose stool and frequency. He has noted fresh blood mixed within his stool.

The stool sample is positive for campylobacter.

Observations:
HR 90 bpm
RR 19
Sats 100% air
BP 130/70
Temp 38.5

What would be the first-line treatment?

Reassure the patient and monitor symptoms.

Correct Incorrect Correct answer

Oral Clarithromycin 500mg twice daily.

Correct Incorrect Correct answer

Oral Metronidazole 400mg three times daily.

Correct Incorrect Correct answer

Oral Ciprofloxacin 500mg twice daily.

Correct Incorrect Correct answer

Oral rehydration solution.

Correct Incorrect Correct answer

An 85-year-old patient has developed urinary hesitancy when passing urine. On examination, he has a hard, irregular nodule localised to his prostate on digital rectal examination.

What would be the single most appropriate investigation for this patient?

Prostate‑specific antigen (PSA)

Correct Incorrect Correct answer

CT pelvis

Correct Incorrect Correct answer

Multiparametric MRI

Correct Incorrect Correct answer

TRUS biopsy

Correct Incorrect Correct answer

Ultrasound scan prostate

Correct Incorrect Correct answer

What would be the most appropriate treatment?

Image reference Primary Care Dermatology Service

Miconazole oral gel

Correct Incorrect Correct answer

Nystatin suspension

Correct Incorrect Correct answer

Oral fluconazole

Correct Incorrect Correct answer

Chlorhexidine mouthwash

Correct Incorrect Correct answer

Topical clotrimazole

Correct Incorrect Correct answer

The parent of a 21-year-old patient is extremely concerned about her son’s behaviour. She has found that he is refusing to go to work, she cannot remember the last time he showered and she often finds that he is awake in the early hours of the morning. She reports that the patient’s father had similar behaviours before he left home 18 years ago.

What is the single most likely diagnosis?

Psychosis

Correct Incorrect Correct answer

Depression

Correct Incorrect Correct answer

Mania

Correct Incorrect Correct answer

Hypomania

Correct Incorrect Correct answer

Anxiety

Correct Incorrect Correct answer

Hyperthyroidism

Correct Incorrect Correct answer

A number of patients have been invited to your practice to share their opinion on continuing with a triage first appointment system. You have set a number of questions to encourage patients to discuss their personal opinions of the existing triage model with each other.

Which of the following methods is being described?

Field observation

Correct Incorrect Correct answer

Open interview

Correct Incorrect Correct answer

Closed interview

Correct Incorrect Correct answer

Focus group

Correct Incorrect Correct answer

Consensus method

Correct Incorrect Correct answer

A patient presents to your clinic complaining of an intense itch, which is worst at night.

On examination, there are irregular burrows present in between the fingers with heavily excoriated skin.

What would be the most appropriate management?

Oral Chlorpheniramine

Correct Incorrect Correct answer

Topical Betamethasone

Correct Incorrect Correct answer

Topical Permethrin

Correct Incorrect Correct answer

Topical Malathion

Correct Incorrect Correct answer

Topical Hydrocortisone

Correct Incorrect Correct answer

A 62-year-old patient with known chronic obstructive pulmonary disease (COPD) has recently suffered from repeated exacerbations of his COPD. After completing three courses of oral prednisolone, his cough symptoms have settled.

He has presented to your clinic complaining of a new fever, muscle aches and dizziness.

What would be the single most likely diagnosis?

Lower respiratory tract infection

Correct Incorrect Correct answer

Myositis

Correct Incorrect Correct answer

Rhabdomyolysis

Correct Incorrect Correct answer

Sepsis

Correct Incorrect Correct answer

Adrenal insufficiency

Correct Incorrect Correct answer

A patient has suffered from a gradual increase of pain in his neck. He now reports numbness to both arms when having a hot shower. On examination, he describes a reduced pain sensation to both arms and upper chest wall.

Select the single most likely diagnosis.

Myasthenia gravis

Correct Incorrect Correct answer

Myositis

Correct Incorrect Correct answer

Lymes disease

Correct Incorrect Correct answer

Syringomyelia

Correct Incorrect Correct answer

Motor neuron disease

Correct Incorrect Correct answer

HIV

Correct Incorrect Correct answer

You have reviewed a 52-year-old smoker who has presented with a three-week history of hoarseness.

Which of the following investigations would be diagnostic?

Upper GI endoscopy

Correct Incorrect Correct answer

Flexible nasendoscopy

Correct Incorrect Correct answer

MRI Neck

Correct Incorrect Correct answer

CT Neck

Correct Incorrect Correct answer

Thudiculum’s speculum

Correct Incorrect Correct answer

A patient taking carbimazole has developed a fever, what would be the most appropriate investigation for this patient?

C-reactive protein

Correct Incorrect Correct answer

Full blood count

Correct Incorrect Correct answer

Erythrocyte sedimentation rate

Correct Incorrect Correct answer

Liver function test

Correct Incorrect Correct answer

Urea and electrolytes

Correct Incorrect Correct answer

Which of the following would you administer in a syncopal patient with a heart rate of 40 bpm?

0.5 ml 1:1000 adrenaline

Correct Incorrect Correct answer

1.0 ml 1:1000 adrenaline

Correct Incorrect Correct answer

10 ml 1:10 000 adrenaline

Correct Incorrect Correct answer

5 ml 1: 10 000 adrenaline

Correct Incorrect Correct answer

300mg IV Amiodarone

Correct Incorrect Correct answer

6mg IV Adenosine

Correct Incorrect Correct answer

500mcg IV Atropine

Correct Incorrect Correct answer

You have commenced Clarithromycin in a patient with a known lower respiratory tract infection.

Which of the following medications would you stop during treatment with Clarithromycin?

Select the single most likely answer.

Atorvastatin

Correct Incorrect Correct answer

Amlodipine

Correct Incorrect Correct answer

Semaglutide

Correct Incorrect Correct answer

Paracetamol

Correct Incorrect Correct answer

Naproxen

Correct Incorrect Correct answer

Patients should receive acknowledgement of a complaint within;

Two months

Correct Incorrect Correct answer

One month

Correct Incorrect Correct answer

Seven days

Correct Incorrect Correct answer

Three days

Correct Incorrect Correct answer

Two weeks

Correct Incorrect Correct answer

Which of the following medications should not be initiated in chronic primary pain?

Select all that apply.

Citalopram

Correct Incorrect Correct answer

Gabapentin

Correct Incorrect Correct answer

Duloxetine

Correct Incorrect Correct answer

Diazepam

Correct Incorrect Correct answer

Codeine

Correct Incorrect Correct answer

Buprenorphine

Correct Incorrect Correct answer

Paracetamol

Correct Incorrect Correct answer

A study is investigating the association between presenting features of an acute exacerbation of COPD in primary care and antibiotic prescribing.

Which of the following results are statistically insignificant?

Crackles

Correct Incorrect Correct answer

Wheeze

Correct Incorrect Correct answer

Diminished vesicular breathing

Correct Incorrect Correct answer

Clinician-reported evidence of consolidation

Correct Incorrect Correct answer

Patient cannot complete a full sentence without stopping

Correct Incorrect Correct answer

A patient with known angina has recently started a new medication. He presents with a new ulcer formation at his anus.

Which medication is likely to have caused anal ulceration?

Bisoprolol

Correct Incorrect Correct answer

Isosorbide mononitrate

Correct Incorrect Correct answer

Ivabradine

Correct Incorrect Correct answer

Ranolazine

Correct Incorrect Correct answer

Nicorandil

Correct Incorrect Correct answer

You have an 82-year-old patient who has presented with peripheral vascular disease. He suffers from hypertension and type-2-diabetes. He has had poorly controlled diabetes for many years.

Which of the following features may not be present in critical limb ischaemia for this patient?

Rest pain

Correct Incorrect Correct answer

Night pain

Correct Incorrect Correct answer

Rubor

Correct Incorrect Correct answer

Pallor on elevation

Correct Incorrect Correct answer

Intermittent claudication

Correct Incorrect Correct answer

A meta-analysis has taken place to assess the effectiveness of quality-improvement interventions to reduce systolic blood pressure in people with CKD in primary care.

Which of the following statements are correct?

The results from Tobe 2006 are statistically significant.

Correct Incorrect Correct answer

The combined results from the randomised controlled trials favours the use of quality-improvement interventions.

Correct Incorrect Correct answer

Chisholm 2002 has the most influence on the combined result.

Correct Incorrect Correct answer

Three randomised controlled trials statistically support the use of QI in reducing blood pressure.

Correct Incorrect Correct answer

Patients should not be routinely excluded from statin therapy unless their serum transaminases are;

Select the single most appropriate answer.

Greater than 2x the upper limit of normal

Correct Incorrect Correct answer

Greater than 3x the upper limit of normal

Correct Incorrect Correct answer

Above the upper limit of normal

Correct Incorrect Correct answer

Normal

Correct Incorrect Correct answer

Diagnosed with fatty liver disease

Correct Incorrect Correct answer

Which of the following anti-emetic is most likely to cause an oral cleft if exposed during pregnancy?

Metoclopramide

Correct Incorrect Correct answer

Cyclizine

Correct Incorrect Correct answer

Prochlorperazine

Correct Incorrect Correct answer

Ondansetron

Correct Incorrect Correct answer

Xonvea

Correct Incorrect Correct answer

A 35-year-old office clerk presents with a five-month history of needing to pass urine frequently. She is having trouble at work and is requesting a fit note. On further questioning, she informs you that always feels thirsty despite drinking between 2 and 3 litres of water.

Her initial investigations show;

Urine dipstick NAD

FBC – NAD
U&E – Na 135, K 4.3, Urea 4.1, Creatinine 50
Bone profile – NAD
LFT – NAD
HbA1c – 41

Urine osmolality 650 mOsm/kg (>800 mOsm/kg)
Serum osmolality 280 mOsm/kg (280 mOsm/kg to 300 mOsm/kg)

What would be the most appropriate investigation for this patient?

Serum ketones

Correct Incorrect Correct answer

Parathyroid hormone

Correct Incorrect Correct answer

Short-synacthen test

Correct Incorrect Correct answer

Fluid deprivation test

Correct Incorrect Correct answer

Response to desmopressin

Correct Incorrect Correct answer

You are treating a 35-year-old patient with Asthma. Their initial regime included salbutamol PRN and fostair 100/6 1 puff BD. At the next review, you increased the fostair 100/6 to 2 puffs BD. This achieves little improvement for the patient.

The patient consults one of your colleagues six months ago who adds in montelukast. Whilst on the montelukast the patient has experienced no wheeze symptoms.

The patient is eager to stop his medication.

What would be the most suitable management plan?

Stop the fostair inhaler.

Correct Incorrect Correct answer

Stop the montelukast.

Correct Incorrect Correct answer

Stop the patients medication.

Correct Incorrect Correct answer

Encourage the patient to continue taking his prescribed regime.

Correct Incorrect Correct answer

Reduce the fostair dose back to 100/6 1 puff BD.

Correct Incorrect Correct answer

A 25-year-old female patient at birth consults you regarding gender dysphoria. The patient would like her gender to be changed on her medical records. She has lived within the acquired gender for twelve months.

What would be the single most appropriate action?

Encourage the patient to acquire a gender recognition certificate before amending the health records.

Correct Incorrect Correct answer

Refer to secondary care services for authorisation.

Correct Incorrect Correct answer

Request a new NHS number first.

Correct Incorrect Correct answer

Refuse to make adjustments as this will exclude the patient from cancer screening.

Correct Incorrect Correct answer

Make adjustments to the patient’s medical record as per the request.

Correct Incorrect Correct answer

Which of the following investigations is least appropriate when making an asthma diagnosis?

Chest X-ray

Correct Incorrect Correct answer

FeNO testing

Correct Incorrect Correct answer

Spirometry

Correct Incorrect Correct answer

Bronchodilator reversibility

Correct Incorrect Correct answer

Variable peak expiratory flow

Correct Incorrect Correct answer

You are reviewing a 22-year-old patient who has suffered from itchy erythema around her lips extending into her nasolabial folds for 8 weeks. She describes multiple papules present in the same distribution.

She has tried topical hydrocortisone for a week which has worsened her symptoms.

What is the next step in the management?

Topical betamethasone

Correct Incorrect Correct answer

Topical pimecrolimus

Correct Incorrect Correct answer

Oral clindamycin

Correct Incorrect Correct answer

Oral isotretinoin

Correct Incorrect Correct answer

Topical clindamycin

Correct Incorrect Correct answer

A 32-year-old patient has presented with a five-week history of upper abdominal pain, associated nausea which occurs following meals. He has not lost any weight and otherwise feels well in himself.

He has tried Gaviscon which helps but does not entirely alleviate his symptoms.

He informs you that he has taken his friend’s omeprazole tablets for two weeks.

What would be the most appropriate treatment for this patient?

Prescribe 20mg Omeprazole for a four-week trial.

Correct Incorrect Correct answer

Arrange an immediate stool antigen test for H.pylori.

Correct Incorrect Correct answer

Prescribe 20mg Omeprazole for a further two-week trial.

Correct Incorrect Correct answer

Offer the patient a routine upper GI endoscopy.

Correct Incorrect Correct answer

Offer an immediate carbon-13 urea breath test.

Correct Incorrect Correct answer

A patient was reviewed in the emergency department with an acutely swollen atraumatic ankle. The patient has struggled to weight bear and had the following investigations undertaken in the ED department.

Ankle Xray – no abnormality detected, normal alignment and joint spaces.

On examination, there is a full range of movement within the ankle.
Patient remains apyrexial.

Hb 162
Plt 280
WCC 9.2

Renal NAD
CRP <4
Uric acid 280micromol/L (<300 micromol/L)

What would be the likely diagnosis?

Ankle sprain

Correct Incorrect Correct answer

Acute gout

Correct Incorrect Correct answer

Osteoarthritis

Correct Incorrect Correct answer

Osteomyelitis

Correct Incorrect Correct answer

Functional pain

Correct Incorrect Correct answer

A five-year-old child has been reviewed by the community health team. He is able to walk up and down stairs unaided. Mum is happy with his ability to understand complex instructions and he is able to express himself appropriately.

His school teachers are happy with how he has developed and often spends extra time in the cooking corner within his class.

He is able to draw a circle, a horizontal and vertical line, but is yet to draw a cross and square.

Which of the following developmental areas may be of concern?

No concerns in development

Correct Incorrect Correct answer

Gross motor

Correct Incorrect Correct answer

Speech and language

Correct Incorrect Correct answer

Fine motor

Correct Incorrect Correct answer

Social

Correct Incorrect Correct answer

A 22-year-old patient with known asthma has experienced worsening wheeze symptoms affecting him during the night.

He is currently using;

Clenil Modulite 100 micrograms inhaler – 2 puffs twice daily
Salbutamol 2 puffs PRN

What would be the most appropriate add on therapy?

Montelukast

Correct Incorrect Correct answer

Beclometasone 800 micrograms twice daily

Correct Incorrect Correct answer

Inhaled Ipratropium 250 micrograms three times daily

Correct Incorrect Correct answer

Theophylline

Correct Incorrect Correct answer

Prednisolone

Correct Incorrect Correct answer

A 23-year-old patient presents with a several week history of feeling tired and occasionally short of breath. She reports sleeping more than normal.

She is otherwise fit and well.

She has recently been prescribed mefenamic acid by your colleague.

Blood tests:

Platelets 570

What is the likely diagnosis?

Iron deficiency anaemia

Correct Incorrect Correct answer

Upper GI cancer

Correct Incorrect Correct answer

Ovarian cancer

Correct Incorrect Correct answer

Inflammatory bowel disease

Correct Incorrect Correct answer

Coeliac disease

Correct Incorrect Correct answer

Your colleague is away on leave and they request a renal profile for an 82-year-old patient under their care. The renal profile was taken as the patient was recently commenced on a new medication.

You have been presented with the following results;

Na 128, K 4.6, Urea 6.2, eGFR >90

The patients regular medications include;

Aspirin
Bisoprolol
Furosemide
Ramipril
Oromorph

Which of the following medications has this patient started?

Omeprazole

Correct Incorrect Correct answer

Carbamazepine

Correct Incorrect Correct answer

Amiodarone

Correct Incorrect Correct answer

Citalopram

Correct Incorrect Correct answer

Theophylline

Correct Incorrect Correct answer

A 62-year-old male patient of Sudanese origin presents to your clinic with an ambulatory blood pressure of 162/90. He has type 2 diabetes and currently takes metformin.

Which of the following medications would be first line?

Ramipril

Correct Incorrect Correct answer

Candesartan

Correct Incorrect Correct answer

Amlodipine

Correct Incorrect Correct answer

Indapamide

Correct Incorrect Correct answer

Verapamil

Correct Incorrect Correct answer

You are conducting a medication review on a 68-year-old patient who has recently been discharged from the hospital.

Medication list:

Clopidogrel 75mg
Lansoprazole 15mg
Simvastatin 40mg
Bisoprolol 5mg
Amlodipine 10mg

Select the two medications from this list that are most likely to interact;

Clopidogrel 75mg

Correct Incorrect Correct answer

Lansoprazole 15mg

Correct Incorrect Correct answer

Simvastatin 40mg

Correct Incorrect Correct answer

Bisoprolol 5mg

Correct Incorrect Correct answer

Amlodipine 10mg

Correct Incorrect Correct answer

You have recently undertaken testing for serum immunoglobulin (Ig)A tissue transglutaminase antibody (tTGA) and total IgA for a 20-year-old patient with suspected coeliac disease.

You have received the following results;

Tissue Transglutaminase antibody (tTGA) 29 U/ml

Reported as weakly positive.

Total IgA – normal

What would be the most appropriate management?

Repeat tTGA in eight weeks.

Correct Incorrect Correct answer

Refer for biopsy confirmation.

Correct Incorrect Correct answer

Trial patient on a gluten-free diet.

Correct Incorrect Correct answer

Request faecal calprotectin.

Correct Incorrect Correct answer

Check serum IgA endomysial antibody.

Correct Incorrect Correct answer

The practice nurse has undertaken a health check for a female patient. She informs the nurse that she has not had a period for the last 18 months which is unusual for her.

She is otherwise fit and well. She exercises daily as she is preparing for her first marathon.

What would be the likely cause for secondary amenorrhoea?

Hypothyroidism

Correct Incorrect Correct answer

Polycystic ovary syndrome

Correct Incorrect Correct answer

Hyperprolactinaemia

Correct Incorrect Correct answer

Premature ovarian insufficiency

Correct Incorrect Correct answer

Hypothalmic dysfunction

Correct Incorrect Correct answer

Image reference BMJ

What is the most appropriate treatment?

Ganciclovir

Correct Incorrect Correct answer

Timolol

Correct Incorrect Correct answer

Latanoprost

Correct Incorrect Correct answer

Tropicamide

Correct Incorrect Correct answer

Hypromellose

Correct Incorrect Correct answer

How many rescue breaths should you offer during paediatric life support?

2 rescue breaths.

Correct Incorrect Correct answer

5 rescue breaths.

Correct Incorrect Correct answer

1 rescue breath.

Correct Incorrect Correct answer

15 rescue breaths.

Correct Incorrect Correct answer

No rescue breaths.

Correct Incorrect Correct answer

A total of 324 patients with pancreatic endocrine tumours, consecutively diagnosed and treated at a tertiary referral centre, were retrospectively evaluated. The severity of the tumour was classified using the WHO classification.

WHO I Well-differentiated neuroendocrine tumour
WHO II Well-differentiated neuroendocrine carcinoma
WHO III Poorly differentiated neuroendocrine carcinoma

Patient survival was measured and recorded.

Which of the following statements is correct?

Patients with a well-differentiated neuroendocrine tumour had the worst prognosis.

Correct Incorrect Correct answer

Patients with a well-differentiated neuroendocrine carcinoma had a worse prognosis than patients with a poorly differentiated neuroendocrine carcinoma.

Correct Incorrect Correct answer

There was no change in mortality for patients with a poorly differentiated neuroendocrine carcinoma between 50 and 100 months.

Correct Incorrect Correct answer

Patients with a poorly differentiated neuroendocrine carcinoma had the best prognosis.

Correct Incorrect Correct answer

Your colleague is due to revalidate with the GMC. He has completed the following evidence during this cycle;

A multi-source feedback from within his practice.
280 hours CPD hours.
A significant event analysis based on a missed diagnosis last year.
A patient feedback cycle.

Which of the following is missing from his revalidation cycle?

Declaration of complaints.

Correct Incorrect Correct answer

Quality improvement activity.

Correct Incorrect Correct answer

Personal health statement.

Correct Incorrect Correct answer

Probity declaration.

Correct Incorrect Correct answer

Evidence of teaching.

Correct Incorrect Correct answer

An 8-year-old boy presents with a four-day history of knee and ankle pain. The child has recently recovered from a viral upper respiratory tract infection.

On examination, the child has palpable purpura to both buttocks extending to his ankles.

What would be the most appropriate first-line investigation?

C-reactive protein

Correct Incorrect Correct answer

Erythrocyte sedimentation rate

Correct Incorrect Correct answer

Urinalysis

Correct Incorrect Correct answer

Blood cultures

Correct Incorrect Correct answer

Lumbar puncture

Correct Incorrect Correct answer

How many cycles should clomiphene treatment be limited to?

1

Correct Incorrect Correct answer

2

Correct Incorrect Correct answer

3

Correct Incorrect Correct answer

4

Correct Incorrect Correct answer

5

Correct Incorrect Correct answer

6

Correct Incorrect Correct answer

7

Correct Incorrect Correct answer

An 80-year-old patient has developed temporal arteritis and is currently taking high dose prednisolone. Which of the following vaccines would be contraindicated?

Select one or more that apply;

Influenza vaccine (Fluenz Tetra)

Correct Incorrect Correct answer

Shingles vaccine (Zostavax)

Correct Incorrect Correct answer

Varicella vaccine (Varilrix, Varilvax)

Correct Incorrect Correct answer

Yellow Fever vaccine

Correct Incorrect Correct answer

A randomised controlled trial is investigating whether aciclovir is effective at reducing postherpetic neuralgia in patients with shingles.

230 participants received oral aciclovir and 250 participants received a placebo.

119 patients in the experimental group experience postherpetic neuralgia.

The risk ratio is 0.76.

What is the risk for the control group?

0.52

Correct Incorrect Correct answer

0.76

Correct Incorrect Correct answer

1.46

Correct Incorrect Correct answer

0.68

Correct Incorrect Correct answer

A patient with squamous cell carcinoma is recurrently bleeding from the cancer site. The patient has no other comorbidities.

Which of the following can be used to treat the localised bleeding?

Tranexamic acid

Correct Incorrect Correct answer

Vitamin K

Correct Incorrect Correct answer

Mefenamic acid

Correct Incorrect Correct answer

Fresh frozen plasma

Correct Incorrect Correct answer

Which of the following patients would require further investigation for their amenorrhoea?

Select the correct answers which apply.

A 35-year-old patient who is not pregnant and has not had a period for two months despite having a regular monthly cycle.

Correct Incorrect Correct answer

A 12-year-old patient who is yet to start menstruating, despite her mother and sisters starting at 11-years-old.

Correct Incorrect Correct answer

A 14-year-old patient who has not established menstruation and is yet to establish any breast development.

Correct Incorrect Correct answer

A 17-year-old patient who has an irregular cycle varying from two to four months has not had a period for eight months.

Correct Incorrect Correct answer

A three-year-old child has developed weakness in his legs when walking. Mum reports that he started to crawl at 12 months and was walking by 2 years.

On examination, his calves appear bigger than his thighs.

What is the likely diagnosis?

Duchenne muscular dystrophy

Correct Incorrect Correct answer

Beckers muscular dystrophy

Correct Incorrect Correct answer

Turners syndrome

Correct Incorrect Correct answer

Downs syndrome

Correct Incorrect Correct answer

Polymyositis

Correct Incorrect Correct answer

A patient suffering from atrial fibrillation has started a new medication. He is now complaining of cough with progressive shortness of breath.

Which medication is likely contributing to his shortness of breath?

Verapamil

Correct Incorrect Correct answer

Diltiazem

Correct Incorrect Correct answer

Flecainide

Correct Incorrect Correct answer

Amiodarone

Correct Incorrect Correct answer

Apixaban

Correct Incorrect Correct answer

A 22-year-old has suffered from scaly, red plaques to her feet for several months. Recently she has noticed yellow pustules that have developed over the plaques.

She is struggling to walk and this is affecting her ability to work.

How would you best manage this patients immediate symptoms?

Prescribe flucloxacillin 500mg QDS for seven days

Correct Incorrect Correct answer

Start oral prednisolone 40mg OD for seven days

Correct Incorrect Correct answer

Prescribe Dovonex twice daily for eight weeks

Correct Incorrect Correct answer

Consult the dermatology on-call for advice

Correct Incorrect Correct answer

Prescribe an emollient to ease her symptoms

Correct Incorrect Correct answer

A 45-year-old university lecturer has presented to your clinic with a recent history of choking during meals. He finds that his mouth begins to weaken towards the end of meals. He has also found that during lectures, his voice sounds hoarse and he struggles to finish his sentences.

Which of the following investigations would be first-line?

Serum anti-acetylcholine receptor (ACh-R) antibody testing

Correct Incorrect Correct answer

Thyroid function test

Correct Incorrect Correct answer

Serum anti-muscle-specific kinase (MuSK) antibody testing

Correct Incorrect Correct answer

MR scan of the brain

Correct Incorrect Correct answer

CT Thymus

Correct Incorrect Correct answer

Tensilon test

Correct Incorrect Correct answer

A 15-year-old female has recently consulted you for advice regarding contraception. She has entered into a relationship with a boy who is of the same age. During the consultation, the patient informs you that she does not want her mother to know about her use of contraception.

Her mother has booked a telephone consultation with you requesting to know what was discussed in her last GP appointment.

Which of the following ethical principles is likely to be upheld in this scenario?

Autonomy

Correct Incorrect Correct answer

Beneficence

Correct Incorrect Correct answer

Non-maleficence

Correct Incorrect Correct answer

Justice

Correct Incorrect Correct answer

Which of the following foods should be avoided during pregnancy to avoid listeriosis?

Eggs

Correct Incorrect Correct answer

Shellfish

Correct Incorrect Correct answer

Green salads

Correct Incorrect Correct answer

Liver

Correct Incorrect Correct answer

Camembert

Correct Incorrect Correct answer

ECG reference – Life in the fast lane

You are reviewing a patient who has complained of palpitations this morning. He reports no chest pain and no shortness of breath.

Hemodynamically the patient is stable.

The patient has an immediate ECG in the practice.

How would you initially manage this patient?

Offer 2.5mg Bisoprolol

Correct Incorrect Correct answer

Commence vagal manoeuvres

Correct Incorrect Correct answer

Give synchronised DC shock

Correct Incorrect Correct answer

Administer 6mg IV Adenosine

Correct Incorrect Correct answer

Offer no treatment and monitor closely

Correct Incorrect Correct answer

Give the patient 300mg of dispersible Aspirin

Correct Incorrect Correct answer

Patient A works as an IT contractor for multiple companies and is not employed by an agency. He is currently off work with a bad back.

Patient B is a GP receptionist who has been off work for 14 weeks due to stress.

Patient C works as a bricklayer. He is employed by a housing firm. This patient was off work with fatigue for 7 months. He has returned to work for 12 weeks, but has now signed himself off with fatigue.

Which of the following patients would be eligible for statutory sick pay?

Select one or more answers that apply.

Patient A

Correct Incorrect Correct answer

Patient B

Correct Incorrect Correct answer

Patient C

Correct Incorrect Correct answer

A patient presents with hot, swollen and tender joints to both hands for four weeks. The swelling is present in the proximal interphalangeal and metacarpophalangeal joints.

You have requested initial blood tests.

What would be the most appropriate step?

Refer urgently to rheumatology

Correct Incorrect Correct answer

Await bloods including Rheumatoid Factor and anti-cyclic citrullinated peptide [CCP]

Correct Incorrect Correct answer

Start Disease-modifying antirheumatic drugs

Correct Incorrect Correct answer

Arrange plain X-rays of both hands

Correct Incorrect Correct answer

Trial oral colchicine 500 micrograms QDS

Correct Incorrect Correct answer

Which of the following infections are most likely to precipitate sepsis?

Pneumonia

Correct Incorrect Correct answer

Urinary tract infection

Correct Incorrect Correct answer

Cellulitis

Correct Incorrect Correct answer

Meningitis

Correct Incorrect Correct answer

Intra-abdominal infection

Correct Incorrect Correct answer

A 55-year-old patient has struggled to control a recent exacerbation of her scalp psoriasis. She has used Betacap scalp solution for four weeks and this has made no improvement.

On examination, there is a thick scale overlying the patients scalp.

What would be the most appropriate management plan for this patient?

Apply Dovobet.

Correct Incorrect Correct answer

Continue Betacap.

Correct Incorrect Correct answer

Refer to dermatology.

Correct Incorrect Correct answer

Apply Capsal.

Correct Incorrect Correct answer

Apply Sebco.

Correct Incorrect Correct answer

An investigation is opened by the General Medical Council (GMC).

Which of the following options would conclude a GMC investigation?

Please select one or more that apply.

Issue a formal warning.

Correct Incorrect Correct answer

Conclude with no further action.

Correct Incorrect Correct answer

Refer your case to the Medical Practitioners Tribunal Service (MPTS).

Correct Incorrect Correct answer

Restrict certain duties.

Correct Incorrect Correct answer

Allow supervised work only.

Correct Incorrect Correct answer

Commit to retrain.

Correct Incorrect Correct answer

Under which of the following circumstances would immediate removal of a patient from a practice list be justified?

A patient has bitten a receptionist following an altercation regarding waiting times.

Correct Incorrect Correct answer

A patient has missed two face-to-face appointments.

Correct Incorrect Correct answer

A patient has requested an early repeat opiate prescription.

Correct Incorrect Correct answer

The patient has engaged in a negligence complaint against a GP partner.

Correct Incorrect Correct answer

The patient has used foul language during a telephone consultation.

Correct Incorrect Correct answer

An eight-year-old child has recently received a course of antibiotics and the parents have noted marked dental staining.

Which of the following antibiotics has caused this discolouration?

Doxycycline

Correct Incorrect Correct answer

Azithromycin

Correct Incorrect Correct answer

Flucloxacillin

Correct Incorrect Correct answer

Amoxicillin

Correct Incorrect Correct answer

Cefalexin

Correct Incorrect Correct answer

ECG reference – Life in the fast lane.

The patient is currently taking;

Atorvastatin, Candesartan, Bisoprolol, Metformin, Dapaglifozin and Edoxaban.

Which of the following medication was recently initiated?

Citalopram

Correct Incorrect Correct answer

Sertraline

Correct Incorrect Correct answer

Digoxin

Correct Incorrect Correct answer

Aspirin

Correct Incorrect Correct answer

Verapamil

Correct Incorrect Correct answer

A patient fell onto his left arm several weeks ago whilst under the influence of alcohol. He presents to your clinic complaining of tingling in his ring and little finger.

Select the single most likely diagnosis;

Carpal tunnel syndrome

Correct Incorrect Correct answer

Osteoarthritis

Correct Incorrect Correct answer

Cervical radiculopathy

Correct Incorrect Correct answer

De Quervains tenosynovitis

Correct Incorrect Correct answer

Inflammatory arthritis

Correct Incorrect Correct answer

Trigger finger

Correct Incorrect Correct answer

Hand-arm vibration

Correct Incorrect Correct answer

Peripheral neuropathy

Correct Incorrect Correct answer

Cubital tunnel syndrome

Correct Incorrect Correct answer

Raynauds phenomenon

Correct Incorrect Correct answer

Hb 85 (115 – 165)
MCV 110 (85 – 105)

Which of the following conditions would not cause this blood result?

Pernicious anaemia

Correct Incorrect Correct answer

Folate deficiency

Correct Incorrect Correct answer

Alcohol excess

Correct Incorrect Correct answer

Hypothyroidism

Correct Incorrect Correct answer

Haemolysis

Correct Incorrect Correct answer

Congenital sideroblastic disease

Correct Incorrect Correct answer

You are reviewing an adult patient with a four-month history of nasal blockage and post-nasal drip. They report a headache which is occasionally worse on leaning forward.

On examination, there is tenderness above both eyes and there is inflammation to the nasal mucosa.

Which of the following features would not warrant a referral to secondary care?

Unilateral symptoms

Correct Incorrect Correct answer

No response following eight weeks of treatment

Correct Incorrect Correct answer

Recurrent otitis media

Correct Incorrect Correct answer

Unexplained nasal discharge

Correct Incorrect Correct answer

Significant impact on sleep

Correct Incorrect Correct answer

You review a patient with chronic cough. The patient reports the constant need to clear her throat.

On examination, there is a cobblestone appearance to the oropharyngeal wall.

What would be the most appropriate management?

Doxycycline

Correct Incorrect Correct answer

Amoxicillin

Correct Incorrect Correct answer

Omeprazole

Correct Incorrect Correct answer

Intranasal mometasone

Correct Incorrect Correct answer

Chlorphenamine

Correct Incorrect Correct answer

Spirometry result

FEV1/FVC 0.54

Post bronchodilator trial

FEV1/FVC 0.56

What is the likely diagnosis?

Asthma

Correct Incorrect Correct answer

COPD

Correct Incorrect Correct answer

Asbestosis

Correct Incorrect Correct answer

Aspergillosis

Correct Incorrect Correct answer

Idiopathic pulmonary fibrosis

Correct Incorrect Correct answer

Which of the following medications is most likely to interact with Atorvastatin?

Select the single most likely answer.

Colchicine

Correct Incorrect Correct answer

Prednisolone

Correct Incorrect Correct answer

Amoxicillin

Correct Incorrect Correct answer

Oxytetracycline

Correct Incorrect Correct answer

Paracetamol

Correct Incorrect Correct answer

A 52-year-old female patient presents to your clinic with a recent history of fatigue and itch.

Liver function tests show a borderline rise in transaminases with a rising alkaline phosphatase.

You suspect primary biliary cirrhosis.

Which of the following investigations would aid your diagnosis?

Anti-centromere antibody

Correct Incorrect Correct answer

Anti-smooth muscle antibody

Correct Incorrect Correct answer

Anti-Ro antibody

Correct Incorrect Correct answer

Anti-CCP antibody

Correct Incorrect Correct answer

Anti-mitochondrial antibody

Correct Incorrect Correct answer

A 45-year-old male patient presents with a bilateral symmetrical tremor to his upper limbs. He has found that the tremor is worse when using his hands. He has started to use alcohol on a daily basis to settle his tremor which he feels may be due to his anxiety.

Select the single most likely diagnosis.

Hyperthyroidism

Correct Incorrect Correct answer

Anxiety

Correct Incorrect Correct answer

Wilson’s disease

Correct Incorrect Correct answer

Parkinson’s disease

Correct Incorrect Correct answer

Multiple system atrophy

Correct Incorrect Correct answer

Benign essential tremor

Correct Incorrect Correct answer

Which of the following side effects may occur with the use of canagliflozin?

Select one or more that apply.

Diabetic ketoacidosis

Correct Incorrect Correct answer

Lower limb amputation

Correct Incorrect Correct answer

Fournier’s gangrene

Correct Incorrect Correct answer

Balanoposthitis

Correct Incorrect Correct answer

Diarrhoea

Correct Incorrect Correct answer

A patient was recently diagnosed with intermittent claudication by the local vascular surgery team. The patient was advised to attend supervised exercise therapy but did not attend his allocated appointments.

He has attended your clinic today asking for further management of his intermittent claudication.

He is very eager for his symptoms to improve, but is unable to make regular exercise sessions with work commitments.

What would be the most appropriate action for this patient?

Refer the patient to the on-call vascular team.

Correct Incorrect Correct answer

Patient to exercise at home for at least 30 minutes per day, three times per week.

Correct Incorrect Correct answer

Prescribe Naftidrofuryl oxalate for a twelve-month duration.

Correct Incorrect Correct answer

Refer for angioplasty.

Correct Incorrect Correct answer

Prescribe Apixaban.

Correct Incorrect Correct answer

A systematic review was conducted to determine the accuracy of 10 important signs and symptoms in acute coronary syndrome.

Twenty-eight studies were included in this systematic review.

Which of the following statements is incorrect?

This study demonstrates publication bias.

Correct Incorrect Correct answer

The majority of studies are of good study precision.

Correct Incorrect Correct answer

Egger’s test is commonly used to assess potential publication bias in a meta-analysis via funnel plot asymmetry.

Correct Incorrect Correct answer

Which of the following features would be important when gathering a family history for breast cancer?

Select the correct answers which apply.

First-degree maternal and paternal relatives

Correct Incorrect Correct answer

Second-degree maternal and paternal relatives

Correct Incorrect Correct answer

Age of cancer diagnosis

Correct Incorrect Correct answer

Site of tumours

Correct Incorrect Correct answer

Multiple cancer presentations

Correct Incorrect Correct answer

Jewish Ancestry

Correct Incorrect Correct answer

A two-year-old boy has collapsed in the waiting room. He has a delayed capillary refill of 4 seconds. Upon exposure, you notice a non-blanching rash.

What is the likely diagnosis?

Invasive Meningococcal Disease

Correct Incorrect Correct answer

Non-Accidental Injury

Correct Incorrect Correct answer

Idiopathic Thrombocytopenia

Correct Incorrect Correct answer

Henoch-Schönlein Purpura

Correct Incorrect Correct answer

Haemolytic Uraemic Syndrome

Correct Incorrect Correct answer

Twenty children have been included in a patient feedback survey. The ages of the children are;

5, 12, 11, 6, 4, 7, 8, 5, 10, 9, 13, 13, 12, 4, 3, 12, 11, 11, 12, 4.

Calculate the median age for this group?

9.5

Correct Incorrect Correct answer

9

Correct Incorrect Correct answer

10

Correct Incorrect Correct answer

10.5

Correct Incorrect Correct answer

11

Correct Incorrect Correct answer

A one-year child has presented with a new diagnosis of croup.

He currently weighs 10kg.

Please select the single most appropriate prescription.

3.75ml Dexamethasone 2mg/5ml oral solution sugar-free

Correct Incorrect Correct answer

7.5ml Dexamethasone 2mg/5ml oral solution sugar-free

Correct Incorrect Correct answer

2.5ml Dexamethasone 2mg/5ml oral solution sugar-free

Correct Incorrect Correct answer

25ml Dexamethasone 2mg/5ml oral solution sugar-free

Correct Incorrect Correct answer

37.5ml Dexamethasone 2mg/5ml oral solution sugar-free

Correct Incorrect Correct answer

An 18-month-old child has responded well to a course of antibiotics following a simple urinary tract infection. She is otherwise fit and well. This is the first time she has suffered from a urinary tract infection.

What would be the most appropriate imaging for this patient?

Ultrasound KUB

Correct Incorrect Correct answer

DMSA scan

Correct Incorrect Correct answer

Micturating cystourethrogram (MCUG)

Correct Incorrect Correct answer

CT KUB

Correct Incorrect Correct answer

No imaging required

Correct Incorrect Correct answer

An adult patient with known Attention deficit hyperactivity disorder (ADHD) is currently suffering from worsening symptoms of hyperactivity and impulsivity. Which of the following medications would be considered first-line?

Select one or more correct answers.

Methylphenidate

Correct Incorrect Correct answer

Dexamfetamine

Correct Incorrect Correct answer

Lisdexamfetamine

Correct Incorrect Correct answer

Atomoxetine

Correct Incorrect Correct answer

Melatonin

Correct Incorrect Correct answer

An adult patient with known Addisons disease has started with a new cough and fever of 38.2. She is eating and drinking well and there are no other concerning features.

How should the patient adjust their medication?

Double the patients fludrocortisone dose.

Correct Incorrect Correct answer

Double the patients hydrocortisone and fludrocortisone dose.

Correct Incorrect Correct answer

Double the hydrocortisone dose.

Correct Incorrect Correct answer

Administer 100mg hydrocortisone IM.

Correct Incorrect Correct answer

Patient should take 20mg oral hydrocortisone stat.

Correct Incorrect Correct answer

You are reviewing a poorly controlled diabetic patient who has suffered from five bouts of vaginal thrush this year.

She is poorly compliant with her metformin and refuses to engage with diabetic services.

Recent blood tests show;

Hb 140
PLT 243
WCC 7.8

Na 137
K 4.5
Urea 4.3
Creatinine 40

Bil 8
ALT 20
AST 25
GGT 30

HbA1c 92

What would be the most appropriate treatment?

Refer to endocrinology.

Correct Incorrect Correct answer

Refer to gynaecology.

Correct Incorrect Correct answer

Offer patient GLP-1 analogue.

Correct Incorrect Correct answer

Clotrimazole pessary 100mg.

Correct Incorrect Correct answer

Oral fluconazole 150mg once weekly.

Correct Incorrect Correct answer

Researchers have investigated the uptake of NHS health checks with automated prompts for clinicians.

Which of the control groups had the lowest uptake for the NHS health check?

40-44

Correct Incorrect Correct answer

45-49

Correct Incorrect Correct answer

55-59

Correct Incorrect Correct answer

60-64

Correct Incorrect Correct answer

70-74

Correct Incorrect Correct answer

A 65-year-old patient recently fractured her distal radius. The fracture was successfully repaired with an open reduction and internal fixation.

Following the fracture, she was prescribed co-codamol 30/500 two tablets four times per day.

She is otherwise fit and well and takes no other medication.

She has suffered from constipation since using opiate medication.

Which laxative would be least helpful in alleviating her constipation?

Fybogel

Correct Incorrect Correct answer

Movicol

Correct Incorrect Correct answer

Lactulose

Correct Incorrect Correct answer

Docusate

Correct Incorrect Correct answer

Senna

Correct Incorrect Correct answer

A 62-year-old patient with known COPD has complained of worsening breathlessness for several months.

On examination, he has bilateral peripheral oedema, a raised jugular venous pressure, a parasternal heave and a loud second heart sound heard best in the second intercostal space.

What is the likely diagnosis?

Mitral regurgitation

Correct Incorrect Correct answer

Pulmonary oedema

Correct Incorrect Correct answer

Pulmonary hypertension

Correct Incorrect Correct answer

Aortic stenosis

Correct Incorrect Correct answer

Mitral stenosis

Correct Incorrect Correct answer

A patient has undertaken home blood pressure monitoring.

What is the minimum number of days that they should record their readings?

4

Correct Incorrect Correct answer

7

Correct Incorrect Correct answer

5

Correct Incorrect Correct answer

10

Correct Incorrect Correct answer

14

Correct Incorrect Correct answer

Background Serious adverse events (SAE) at out-of-hours services in primary care (OHS-PC) are rare. It most often concerns missed acute coronary syndromes (ACS). Root cause analyses highlighted errors in the triage process, but these analyses are hampered by hindsight bias.

Aim To compare triage calls at the OHS-PC of missed ACS with matched controls with chest discomfort but without a missed ACS; and to assess predictors of missed ACS.

Method Cases were matched 1:8 with controls based on age and gender. Clinical, patient and call characteristics were assessed, and 15 expert GPs rated the triage safety and quality, being blinded to the final diagnosis.

Which type of study design has been used?

Root cause analysis

Correct Incorrect Correct answer

Prospective Cohort study

Correct Incorrect Correct answer

Case-control study

Correct Incorrect Correct answer

Cross-sectional survey

Correct Incorrect Correct answer

Retrospective Cohort study

Correct Incorrect Correct answer

A patient is travelling to Kenya and would like to take malaria prophylaxis.

You have decided to offer Doxycycline.

How long after returning to the U.K should the patient continue taking Doxycycline?

One week

Correct Incorrect Correct answer

Four weeks

Correct Incorrect Correct answer

Two weeks

Correct Incorrect Correct answer

Six weeks

Correct Incorrect Correct answer

Stop immediately on return

Correct Incorrect Correct answer

A patient presents to your clinic with a mild discomfort to his eye. He reports no visual loss, no eye pain and no photophobia.

What is the likely diagnosis?

Conjunctivitis

Correct Incorrect Correct answer

Scleritis

Correct Incorrect Correct answer

Anterior uveitis

Correct Incorrect Correct answer

Dry-eye syndrome

Correct Incorrect Correct answer

Episcleritis

Correct Incorrect Correct answer

A 55-year-old patient has presented with an 8-day history of worsening cough.

He is otherwise fit and well.

On examination, he has left-sided crackles on auscultation of the chest.

Observations:

RR22, HR105, T38.2, Sats 94%A, BP 125/72.

Bloods

Hb 140
PLT 350
WCC 17.9

Na 123
K 4.8
Urea 8.0
Creat 80

CRP 140

What is the likely cause for this patients hyponatraemia?

Congestive cardiac failure

Correct Incorrect Correct answer

SIADH

Correct Incorrect Correct answer

Diabetes insipidus

Correct Incorrect Correct answer

Addisons disease

Correct Incorrect Correct answer

Primary polydipsia

Correct Incorrect Correct answer

You have reviewed an adult patient after an ankle injury. The patient inverted at their ankle and now complains of pain to the base of the lateral malleolus extending above this point during examination.

The patient is able to bear weight on their ankle, however, there is an antalgic gait present.

What would be the most appropriate management?

Rest, Ice, Compression and Elevation advice.

Correct Incorrect Correct answer

Trial non-steroidal anti-inflammatory.

Correct Incorrect Correct answer

Ankle X-ray.

Correct Incorrect Correct answer

Foot X-ray.

Correct Incorrect Correct answer

Foot and Ankle X-ray.

Correct Incorrect Correct answer

An 18-year-old patient presents to your clinic after having a number of recent consultations with your colleagues. He complains of abdominal discomfort associated with a chronic history of frequent loose stool. He reports no blood or mucus within his bowels. His weight has remained stable at 70kg. He reports occasional bloating when stressed.

Recent investigations;

Hb 155
WCC 9.2
PLT 230

AST 15
ALT 20
Bil 8
ALP 80

ESR 4
CRP <4

tTg-IgA negative

What would be the most appropriate next step?

Make an appropriate diagnosis of Irritable bowel syndrome.

Correct Incorrect Correct answer

Refer the patient for a routine colonoscopy.

Correct Incorrect Correct answer

Send a stool sample for culture and microscopy.

Correct Incorrect Correct answer

Refer urgently to gastroenterology.

Correct Incorrect Correct answer

Arrange to test for faecal calprotectin.

Correct Incorrect Correct answer

A study is measuring the effectiveness of Digoxin in reducing shortness of breath for patients with congestive cardiac failure.

Patients are allocated to subgroups based on their NYHA classification.

How would you best describe the NYHA classification?

Nominal scale

Correct Incorrect Correct answer

Ordinal scale

Correct Incorrect Correct answer

Discrete scale

Correct Incorrect Correct answer

Continuous scale

Correct Incorrect Correct answer

Which of the following medication doses may need increasing in patients with a declining renal function?

Aspirin

Correct Incorrect Correct answer

Bisoprolol

Correct Incorrect Correct answer

Apixaban

Correct Incorrect Correct answer

Furosemide

Correct Incorrect Correct answer

Nitrofurantoin

Correct Incorrect Correct answer

A 32-week pregnant patient has developed tonsillitis. Her FeverPAIN score is 4.

She has no past medical history.

Allergies include Penicillin.

What would be the most appropriate treatment for this patient?

Phenoxymethylpenicillin

Correct Incorrect Correct answer

Clarithromycin

Correct Incorrect Correct answer

Doxycycline

Correct Incorrect Correct answer

Amoxicillin

Correct Incorrect Correct answer

Erythromycin

Correct Incorrect Correct answer

No antibiotic prescription

Correct Incorrect Correct answer

A 55-year-old patient over ten days has developed a right-sided painful, erythematous rash, with crusting to his external ear canal.

On examination, the patient is unable to blow his right cheek and he cannot smile. However, he is able to raise both eyebrows.

Which of the following investigations would you consider first-line?

Swab for Varicella

Correct Incorrect Correct answer

MRI Brain

Correct Incorrect Correct answer

Electromyography

Correct Incorrect Correct answer

C-reactive protein

Correct Incorrect Correct answer

Varicella antibodies

Correct Incorrect Correct answer

Which cancer site made up the greatest proportion of cancers diagnosed in the microcytosis cohort?

Select the single most appropriate answer:

Colorectal

Correct Incorrect Correct answer

Lung

Correct Incorrect Correct answer

Breast

Correct Incorrect Correct answer

Lymphoma

Correct Incorrect Correct answer

Other

Correct Incorrect Correct answer

Which side-effect is most likely to occur in an infant taking regular Gaviscon?

Fever

Correct Incorrect Correct answer

Cough

Correct Incorrect Correct answer

Urticarial rash

Correct Incorrect Correct answer

Constipation

Correct Incorrect Correct answer

Angioedema

Correct Incorrect Correct answer

You are reviewing a 61-year-old patient who has presented with a one-hour history of facial weakness this morning. Her symptoms have now completely resolved and she feels well in herself.

Examination is now unremarkable.

Which of the following would be most appropriate?

Calculate the ABCD2 score and refer immediately for same-day assessment.

Correct Incorrect Correct answer

Calculate ABCD2 score and refer to be seen within 24 hours.

Correct Incorrect Correct answer

Arrange an ECG for the patient.

Correct Incorrect Correct answer

Start Aspirin 75mg once daily.

Correct Incorrect Correct answer

Refer patient to be seen within 24 hours.

Correct Incorrect Correct answer

An elderly lady has suffered from COPD for many years. She is finding that her exercise tolerance is significantly worsening. She would like to try pulmonary rehabilitation.

How would you best describe this intervention?

Secondary prevention

Correct Incorrect Correct answer

Tertiary prevention

Correct Incorrect Correct answer

Primary prevention

Correct Incorrect Correct answer

End-stage intervention

Correct Incorrect Correct answer

Early intervention

Correct Incorrect Correct answer

A patient is positive for anti-Glutamic Acid Decarboxylase (GAD).

Which of the following conditions is associated with anti-GAD?

Autoimmune hepatitis

Correct Incorrect Correct answer

Sjogren’s

Correct Incorrect Correct answer

Scleroderma

Correct Incorrect Correct answer

Type 1 Diabetes

Correct Incorrect Correct answer

Addisons disease

Correct Incorrect Correct answer

Primary biliary cholangitis

Correct Incorrect Correct answer

A patient has recently been diagnosed with iron deficiency anaemia. You have started her on ferrous sulphate as replacement.

What advice should you give her regarding the co-prescription of levothyroxine?

Take both medications at least one hour apart.

Correct Incorrect Correct answer

Take both medications at least two hours apart.

Correct Incorrect Correct answer

Take both medications together.

Correct Incorrect Correct answer

Take levothyroxine in the morning and ferrous in the evening.

Correct Incorrect Correct answer

Double the dose of levothyroxine.

Correct Incorrect Correct answer

A 76-year-old patient presents to your clinic with a four-day history of vaginal spotting. She is otherwise well in herself.

Vaginal examination is normal.

Which of the following investigations would be diagnostic?

Ultrasound pelvis

Correct Incorrect Correct answer

Hysteroscopy

Correct Incorrect Correct answer

CT Pelvis

Correct Incorrect Correct answer

MR Pelvis

Correct Incorrect Correct answer

Endometrial biopsy

Correct Incorrect Correct answer

Background Most people with acute otitis media (AOM) and acute sinusitis (AS) do not benefit from antibiotics, and GPs are under increasing pressure to reduce antibiotic prescribing. Concern about the risk of complications can drive unnecessary prescribing.

Aim To describe the incidence of serious complications following AOM and AS, and to determine whether antibiotics are protective.

Design and setting This was a study using the Clinical Practice Research Datalink database to identify patients diagnosed in general practice with AOM or AS between 1 January 1982 and 31 December 2012.

Method The incidence of brain abscess and acute mastoiditis following AOM, and of brain abscess and orbital cellulitis following AS, were calculated, as was the association between antibiotics and the development of these complications and numbers needed to treat (NNT).

Which type of study design has been used?

Root cause analysis

Correct Incorrect Correct answer

Prospective Cohort study

Correct Incorrect Correct answer

Case-control study

Correct Incorrect Correct answer

Cross-sectional survey

Correct Incorrect Correct answer

Retrospective Cohort study

Correct Incorrect Correct answer

A case-control study has identified 280 subjects who have a rare neurodegenerative condition. They are matched to 250 control subjects.

The researcher would like to know whether or not there is a link between head trauma and this rare condition.

140 participants in the exposure group recall having had a head injury.

125 participants in the control group recall having had a head injury.

Calculate the odds ratio

1

Correct Incorrect Correct answer

0.7

Correct Incorrect Correct answer

0.9

Correct Incorrect Correct answer

0.2

Correct Incorrect Correct answer

4

Correct Incorrect Correct answer

You are reviewing a 65-year-old patient with cervical spondylosis. She has suffered from shooting pain in her neck radiating down her right arm. She has tried an old course of amitriptyline which has helped her symptoms.

Which of the following comorbidities would present a caution for the use of amitriptyline?

Select the single most appropriate answer.

Asthma

Correct Incorrect Correct answer

COPD

Correct Incorrect Correct answer

Insomnia

Correct Incorrect Correct answer

Atrial flutter

Correct Incorrect Correct answer

Hypothyroidism

Correct Incorrect Correct answer

A 75-year-old patient has started with chronic ear pain and worsening deafness in her right ear.

She is otherwise well in herself.

Her prescribed medications include;

Aspirin
Clopidogrel
Gliclazide
Metformin
Furosemide
Alendronic acid

Which of the following medications is likely to have contributed to her symptoms?

Aspirin

Correct Incorrect Correct answer

Clopidogrel

Correct Incorrect Correct answer

Gliclazide

Correct Incorrect Correct answer

Metformin

Correct Incorrect Correct answer

Furosemide

Correct Incorrect Correct answer

Alendronic acid

Correct Incorrect Correct answer

A fifty-five-year-old patient has been diagnosed with type 2 diabetes. He was commenced on metformin 500mg TDS. He reports to you complaining of a two-week history of loose stool with abdominal cramping.

What would be the most appropriate next step?

Refer patient on a cancer referral to lower GI.

Correct Incorrect Correct answer

Switch metformin to modified-release metformin.

Correct Incorrect Correct answer

Switch metformin to Sitagliptin.

Correct Incorrect Correct answer

Send stool sample for culture.

Correct Incorrect Correct answer

Offer trial of loperamide for two weeks.

Correct Incorrect Correct answer

An elderly patient with dementia has a fungating tumour to her chin extending up towards her cheek. The patient is in considerable discomfort and there is regular bleeding present from the tumour. You are anticipating that the patient may suffer from a massive terminal haemorrhage.

Which of the following medications should be prescribed prophylactically?

Midazolam 10mg IV

Correct Incorrect Correct answer

Tranexamic acid 1g PO

Correct Incorrect Correct answer

Temazepam 10mg PO

Correct Incorrect Correct answer

Midazolam 10mg Sublingual

Correct Incorrect Correct answer

Which of the following supplements would you offer to a patient taking Orlistat?

Vitamin A

Correct Incorrect Correct answer

Vitamin D

Correct Incorrect Correct answer

Vitamin K

Correct Incorrect Correct answer

Vitamin E

Correct Incorrect Correct answer

Which of the following treatments would be considered first-line in a cluster headache?

Oral Sumatriptan

Correct Incorrect Correct answer

Intranasal Sumatriptan

Correct Incorrect Correct answer

Paracetamol

Correct Incorrect Correct answer

Aspirin

Correct Incorrect Correct answer

Short-burst 100% Oxygen therapy

Correct Incorrect Correct answer

When should you routinely screen for dementia in patients with downs syndrome?

50 years old

Correct Incorrect Correct answer

60 years old

Correct Incorrect Correct answer

30 years old

Correct Incorrect Correct answer

70 years old

Correct Incorrect Correct answer

If displaying symptoms

Correct Incorrect Correct answer

A 55-year-old patient presents to you complaining of intermittent tingling to his fingertips. He also reports that his fingers are changing colour, they are often white or red in the cold. This is affecting his work as he currently works in construction breaking concrete.

Selected the single most likely diagnosis;

Carpal tunnel syndrome

Correct Incorrect Correct answer

Osteoarthritis

Correct Incorrect Correct answer

Cervical radiculopathy

Correct Incorrect Correct answer

De Quervains tenosynovitis

Correct Incorrect Correct answer

Inflammatory arthritis

Correct Incorrect Correct answer

Trigger finger

Correct Incorrect Correct answer

Hand-arm vibration

Correct Incorrect Correct answer

Peripheral neuropathy

Correct Incorrect Correct answer

Cubital tunnel syndrome

Correct Incorrect Correct answer

Raynauds phenomenon

Correct Incorrect Correct answer

A 70-year-old patient has complained of back pain for several weeks.

The patient is found to have leukopenia on his blood results.

What would be the most appropriate next step?

Refer on a two-week wait referral to orthopaedics

Correct Incorrect Correct answer

Arrange serum protein electrophoresis

Correct Incorrect Correct answer

Repeat full blood count in six weeks

Correct Incorrect Correct answer

Arrange ESR

Correct Incorrect Correct answer

Request urgent spinal x-ray films

Correct Incorrect Correct answer

You review a patient who has complained of new hair loss from her scalp. You notice that there is hair across multiple locations of the scalp. There are multiple hairs that appear broken at varying lengths.

What is the likely diagnosis?

Tinea capitis

Correct Incorrect Correct answer

Scarring alopecia

Correct Incorrect Correct answer

Telogen effluvium

Correct Incorrect Correct answer

Trichotillomania

Correct Incorrect Correct answer

Secondary syphillis

Correct Incorrect Correct answer

Which of the following gait abnormalities would you expect in a patient with peroneal nerve palsy?

Hemiplegic gait

Correct Incorrect Correct answer

Diplegic gait

Correct Incorrect Correct answer

High-step gait

Correct Incorrect Correct answer

Waddling gait

Correct Incorrect Correct answer

Choreiform gait

Correct Incorrect Correct answer

Ataxic gait

Correct Incorrect Correct answer

Parkinsonian gait

Correct Incorrect Correct answer

You are reviewing routine investigations for a patient with known chronic kidney disease.

Serum eGFR 35 (mL/min/1.73 m2)
Urinary ACR 22 (mg/mmol)

How many times in a year should you monitor the eGFR?

1

Correct Incorrect Correct answer

2

Correct Incorrect Correct answer

3

Correct Incorrect Correct answer

4

Correct Incorrect Correct answer

5

Correct Incorrect Correct answer

A patient would like to request access to his medical records via his solicitor. Which of the following statements is correct?

The medical records should be provided within 6 weeks.

Correct Incorrect Correct answer

The solicitor should not be able to access the patients medical records.

Correct Incorrect Correct answer

The patient is unable to access their medical records if a verbal request is made.

Correct Incorrect Correct answer

The solicitor should not be charged by the practice for making this request.

Correct Incorrect Correct answer

What would be the most appropriate follow up for a patient with Barrett’s oesophagus?

Yearly follow up with a repeat upper GI endoscopy.

Correct Incorrect Correct answer

Repeat barium swallow every five years.

Correct Incorrect Correct answer

No routine follow up is required unless symptomatic.

Correct Incorrect Correct answer

Repeat upper GI endoscopy every three years.

Correct Incorrect Correct answer

Oesophageal ablation.

Correct Incorrect Correct answer

A retired quarry labourer has recently had spirometry for ongoing shortness of breath.

His spirometry results are;

FEV1 0.48
FVC 0.52

FEV1/FVC 0.92

What is the likely cause of symptoms?

Silicosis

Correct Incorrect Correct answer

Asbestosis

Correct Incorrect Correct answer

Aspergillosis

Correct Incorrect Correct answer

COPD

Correct Incorrect Correct answer

Extrinsic allergic alveolitis

Correct Incorrect Correct answer

You are treating a patient for a lower-respiratory tract infection.

He is taking the following medication;

Aspirin
Warfarin
Atorvastatin
Lisinopril
Doxycycline

After how many days after starting the antibiotics would you repeat the INR?

2 days

Correct Incorrect Correct answer

4 days

Correct Incorrect Correct answer

3 days

Correct Incorrect Correct answer

Repeat is not required

Correct Incorrect Correct answer

10 days

Correct Incorrect Correct answer

A patient with known eczema presents to you with a recent flare. He reports dry skin to both forearms with frequent itching. On examination, both forearms are red with excoriation marks.

Which of the following options would be most appropriate?

Betamethasone 0.1%

Correct Incorrect Correct answer

Hydrocortisone 1%

Correct Incorrect Correct answer

Trimovate

Correct Incorrect Correct answer

Clobetasol 0.05%

Correct Incorrect Correct answer

Fucidin H

Correct Incorrect Correct answer

A 42-year-old patient is found to have a total cholesterol of 9.0. You suspect familial hyperlipidemia.

Which of the following causes would require exclusion before a diagnosis is made?

Select one or more answers that apply.

Addisons disease

Correct Incorrect Correct answer

Alcohol excess

Correct Incorrect Correct answer

Hypothyroidism

Correct Incorrect Correct answer

Diabetes mellitus

Correct Incorrect Correct answer

Medication-induced

Correct Incorrect Correct answer

In which of the following scripts is a prescribing error present?

Clopidogrel 75mg once daily.

Correct Incorrect Correct answer

Doxycycline 100mg twice daily.

Correct Incorrect Correct answer

Alendronic acid 70mg once daily.

Correct Incorrect Correct answer

Omeprazole 20mg once daily.

Correct Incorrect Correct answer

Atorvastatin 20mg once daily.

Correct Incorrect Correct answer

Which of the following suspensions would you administer to an adult in anaphylactic shock?

0.5 ml 1:1000 adrenaline

Correct Incorrect Correct answer

1.0 ml 1:1000 adrenaline

Correct Incorrect Correct answer

10 ml 1:10 000 adrenaline

Correct Incorrect Correct answer

5 ml 1: 10 000 adrenaline

Correct Incorrect Correct answer

300mg IV Amiodarone

Correct Incorrect Correct answer

6mg IV Adenosine

Correct Incorrect Correct answer

500mcg IV Atropine

Correct Incorrect Correct answer

Which of the following screening tests is offered to all newborns?

Automated otoacoustic emission test

Correct Incorrect Correct answer

Automated auditory brainstem response

Correct Incorrect Correct answer

Play audiometry

Correct Incorrect Correct answer

Tympanometry

Correct Incorrect Correct answer

Pure tone audiometry

Correct Incorrect Correct answer

You are the duty doctor and a patient is demanding to see you with an urgent prescription request. The patient was issued with oramorph 10mg/5ml two weeks ago, he was advised to take 5ml four times daily. The patient was prescribed a 500ml bottle.

The patient informs you that he did not dispense the initial prescription. He took the prescription to the pharmacy this morning and they rejected it as the prescription has now expired.

How would you best manage this scenario?

Issue the patient with a repeat prescription of oramorph.

Correct Incorrect Correct answer

Change the patient to Zomorph 20mg BD.

Correct Incorrect Correct answer

Refuse to issue the prescription as this patient is abusing his medication.

Correct Incorrect Correct answer

Advise the patient that the prescription is still valid for a total of six months.

Correct Incorrect Correct answer

Remove the patient from your practice list.

Correct Incorrect Correct answer

You have issued a fit note for a patient with a newly diagnosed lumbar fracture. This is his first request for a fit note.

Please select the maximum duration of this fit note.

Twelve months

Correct Incorrect Correct answer

Three months

Correct Incorrect Correct answer

Six months

Correct Incorrect Correct answer

One month

Correct Incorrect Correct answer

Two months

Correct Incorrect Correct answer

Primary breast cancer is least likely to metastasise to;

Kidney

Correct Incorrect Correct answer

Brain

Correct Incorrect Correct answer

Bone

Correct Incorrect Correct answer

Lung

Correct Incorrect Correct answer

Liver

Correct Incorrect Correct answer

A patient who is 3-weeks postpartum presents to your clinic with a painful wedge-shaped swelling in the lower quadrant of her right breast. She is currently breastfeeding and remains apyrexial.

There are no obvious skin changes present.

The patient is breastfeeding her infant and despite trying effective milk removal for 24 hours the symptoms have not improved.

What is the likely diagnosis?

Breast abscess

Correct Incorrect Correct answer

Mastitis

Correct Incorrect Correct answer

Blocked milk duct

Correct Incorrect Correct answer

Breast neoplasm

Correct Incorrect Correct answer

Fibrocystic breast change

Correct Incorrect Correct answer

A patient with known pulmonary tuberculosis is ten weeks into their treatment.

Which of the following medications is the patient likely to be taking?

Select the correct answers that apply.

Isoniazid

Correct Incorrect Correct answer

Rifampicin

Correct Incorrect Correct answer

Pyrazinamide

Correct Incorrect Correct answer

Ethambutol

Correct Incorrect Correct answer

Infliximab

Correct Incorrect Correct answer

A toddler has suffered from recent fainting episodes. All episodes have occurred when the child has been upset and crying.

Which of the following conditions may be associated with the diagnosis?

Brugada syndrome

Correct Incorrect Correct answer

Iron deficiency anaemia

Correct Incorrect Correct answer

Vasovagal syncope

Correct Incorrect Correct answer

Epilepsy

Correct Incorrect Correct answer

Infantile spasms

Correct Incorrect Correct answer

An elderly patient presents with a painful red right eye. He has an associated headache and is repeatedly vomiting. On examination there is a semi-dilated and fixed pupil on the right side. Select the most appropriate diagnostic investigation.

Tonometry

Correct Incorrect Correct answer

MRI brain

Correct Incorrect Correct answer

CT brain

Correct Incorrect Correct answer

Lumbar puncture

Correct Incorrect Correct answer

Electromyography

Correct Incorrect Correct answer

Which of the following treatments would not be considered first-line in the management of irritable bowel syndrome (IBS)?

Ispaghula husk

Correct Incorrect Correct answer

Probiotics

Correct Incorrect Correct answer

Loperamide

Correct Incorrect Correct answer

Buscopan

Correct Incorrect Correct answer

Amitriptyline

Correct Incorrect Correct answer

A 55-year-old patient has recently been discharged from hospital following an acute coronary syndrome. The patient was treated with percutaneous coronary intervention. Two days following the event he was diagnosed with atrial fibrillation.

The patient has been commenced on apixaban.

Which of the following medications should be initiated in addition to the Apixaban?

Aspirin and Ticagrelor

Correct Incorrect Correct answer

Aspirin and Clopidogrel

Correct Incorrect Correct answer

Clopidogrel

Correct Incorrect Correct answer

Aspirin

Correct Incorrect Correct answer

Ticagrelor

Correct Incorrect Correct answer

Which of the following anti-parkinsonian drugs are most likely to cause dyskinesia?

Co-beneldopa

Correct Incorrect Correct answer

Selegiline

Correct Incorrect Correct answer

Pramipexole

Correct Incorrect Correct answer

Pergolide

Correct Incorrect Correct answer

Ropinirole

Correct Incorrect Correct answer

A 35-year-old patient has been diagnosed with metastatic brain cancer. He is currently bed-bound and entirely reliant on his partner for personal care. She would like to apply for financial support during his terminal illness.

Which of the following benefits may the patient be eligible for?

Select one or more answers that apply.

Attendance allowance

Correct Incorrect Correct answer

Personal Independence Payment (PIP)

Correct Incorrect Correct answer

Employment and Support Allowance (ESA)

Correct Incorrect Correct answer

Universal Credit

Correct Incorrect Correct answer

DS1500

Correct Incorrect Correct answer

Which of the following conditions are not screened for within pregnancy?

Thalassaemia

Correct Incorrect Correct answer

Edward’s syndrome

Correct Incorrect Correct answer

Down’s syndrome

Correct Incorrect Correct answer

Syphilis

Correct Incorrect Correct answer

Hepatitis C

Correct Incorrect Correct answer

A 62-year-old was recently diagnosed with bipolar affective disorder. He is not happy with his current medication regime and would like to know about other options that are available?

Which of the following medications is least appropriate for this patient?

Sodium valproate

Correct Incorrect Correct answer

Clozapine

Correct Incorrect Correct answer

Lithium

Correct Incorrect Correct answer

Olanzapine

Correct Incorrect Correct answer

Lamotrigine

Correct Incorrect Correct answer

A patient complains of pain to the base of his thumb which is exacerbated by the use of his phone. Finkelstein’s test is positive.

Select the single most likely diagnosis;

Carpal tunnel syndrome

Correct Incorrect Correct answer

Osteoarthritis

Correct Incorrect Correct answer

Cervical radiculopathy

Correct Incorrect Correct answer

De Quervains tenosynovitis

Correct Incorrect Correct answer

Inflammatory arthritis

Correct Incorrect Correct answer

Trigger finger

Correct Incorrect Correct answer

Hand-arm vibration

Correct Incorrect Correct answer

Peripheral neuropathy

Correct Incorrect Correct answer

Cubital tunnel syndrome

Correct Incorrect Correct answer

Raynauds phenomenon

Correct Incorrect Correct answer

Select the most likely diagnosis;

Image reference Primary Care Dermatology Soceity

Seborrheic keratosis

Correct Incorrect Correct answer

Eczema

Correct Incorrect Correct answer

Squamous cell carcinoma

Correct Incorrect Correct answer

Bowens disease

Correct Incorrect Correct answer

Actinic keratosis

Correct Incorrect Correct answer

A 32-year-old patient has recently been discharged from hospital following a life-threatening asthma exacerbation. She has been discharged with long term glucocorticoid therapy. She is currently mid-cycle and had unprotected intercourse four days ago.

Which of the following options would be the single most suitable option as emergency contraception?

Ulipristal acetate 30mg (EllaOne)

Correct Incorrect Correct answer

Levonorgestrel 1.5mg

Correct Incorrect Correct answer

Copper intrauterine device (Cu-IUD)

Correct Incorrect Correct answer

Levonorgestrel 3mg

Correct Incorrect Correct answer

Emergency contraception is not indicated

Correct Incorrect Correct answer

You are reviewing a 70-year-old male patient who has presented with a twelve-month history of worsening breathlessness. He is waking up during the night feeling breathless and often has to use several pillows to fall asleep.

On examination, you find that the patient has bilateral chest crackles and lower limb swelling to both ankles.

You have arranged a number of initial investigations;

FBC, UE, LFTs, Bone profile, TSH – No abnormality detected

NT-proBNP – 750 ng/l

Spirometry – FEV1/FVC 0.85

Urine dipstick – Normal

What would be the most appropriate management for this patient?

Request an immediate ECG

Correct Incorrect Correct answer

Arrange an urgent chest x-ray

Correct Incorrect Correct answer

Refer the patient to cardiology for a review within six weeks

Correct Incorrect Correct answer

Refer the patient to cardiology for a review within two weeks

Correct Incorrect Correct answer

Arrange an echocardiogram to be performed within six weeks

Correct Incorrect Correct answer

Which of the following tools would not help in assessing the risk of advanced liver fibrosis?

ELF test

Correct Incorrect Correct answer

NAFLD fibrosis score

Correct Incorrect Correct answer

FIB-4 score

Correct Incorrect Correct answer

Ultrasound Liver

Correct Incorrect Correct answer

Liver function tests

Correct Incorrect Correct answer

An 85-year-old patient with known type 2 diabetes is suffering from repeated episodes of hypoglycemia. She has little awareness of the hypoglycemic episodes and is often found to be confused by her carers.

Which of the following medications would you consider stopping?

Select one or more that apply.

Gliclazide

Correct Incorrect Correct answer

Metformin

Correct Incorrect Correct answer

Candesartan

Correct Incorrect Correct answer

Aspirin

Correct Incorrect Correct answer

Atenolol

Correct Incorrect Correct answer

A known patient with paroxysmal atrial fibrillation has experienced low mood for several months. He reports suffering from poor sleep and often finds little pleasure in his daily activities. Over the last two weeks, he has experienced fleeting suicidal thoughts.

He currently takes; Atorvastatin and Flecainide.

Which of the following medications would be least suitable for this patient?

Sertraline

Correct Incorrect Correct answer

Citalopram

Correct Incorrect Correct answer

Fluoxetine

Correct Incorrect Correct answer

Mirtazapine

Correct Incorrect Correct answer

Paroxetine

Correct Incorrect Correct answer

An 85-year-old gentleman has palliative oesophageal cancer, he is no longer able to tolerate oral medications.

His medications include;

Paracetamol 1g QDS
Omeprazole 20mg BD
Salbutamol 2 puffs QDS
Fostair 100/6 2 puffs BD
Furosemide 20mg OD
Codeine 60mg QDS

You decide to convert the patient to buprenorphine patches.

Which of the following would you prescribe?

Buprenorphine 5micrograms/hour

Correct Incorrect Correct answer

Buprenorphine 2.5micrograms/hour

Correct Incorrect Correct answer

Buprenorphine 10micrograms/hour

Correct Incorrect Correct answer

Buprenorphine 35micrograms/hour

Correct Incorrect Correct answer

Buprenorphine 52.5micrograms/hour

Correct Incorrect Correct answer

A 32-week pregnant patient has presented to your clinic with a concerning rash to both cheeks. The patient has noted hyperpigmented patches on both cheeks.

What is the most likely diagnosis?

Polymorphic eruption of pregnancy

Correct Incorrect Correct answer

Intrahepatic cholestasis

Correct Incorrect Correct answer

Atopic eczema

Correct Incorrect Correct answer

Melasma

Correct Incorrect Correct answer

Systemic lupus erythematosus

Correct Incorrect Correct answer

You are treating a patient for Chlamydia.

How long following a course of Doxycycline should a person abstain from sexual intercourse?

Five days after starting treatment

Correct Incorrect Correct answer

Seven days after starting treatment

Correct Incorrect Correct answer

Fourteen days after starting treatment

Correct Incorrect Correct answer

No need to abstain

Correct Incorrect Correct answer

Until retesting occurs at 3 to 6 months

Correct Incorrect Correct answer

A patient with known angina has developed chest pain following exertion. He has taken two sprays of his sublingual GTN to nil effect. He has repeated the GTN dose and the pain remains present.

What would be the most appropriate advice?

Dial 999 for immediate medical support

Correct Incorrect Correct answer

Take four sprays of GTN immediately

Correct Incorrect Correct answer

Repeat a further dose at 5 minutes

Correct Incorrect Correct answer

Take Aspirin 300mg

Correct Incorrect Correct answer

Take oral isosorbide mononitrate

Correct Incorrect Correct answer

You have reviewed a patient in the Emergency Department with sudden onset pain to his left ankle. He is unable to plantarflex at the ankle. On examination, the patient has a positive Simmonds test.

What is the likely cause of this injury?

Clindamycin

Correct Incorrect Correct answer

Atorvastatin

Correct Incorrect Correct answer

Ciprofloxacin

Correct Incorrect Correct answer

Aspirin

Correct Incorrect Correct answer

Apixaban

Correct Incorrect Correct answer

Your colleague has commenced a patient on a trial of topical betamethasone 0.1% for Alopecia Areata of the scalp.

The patient has used the steroid for two weeks and would like to know how long it will take for hair regrowth?

Six weeks

Correct Incorrect Correct answer

Six months

Correct Incorrect Correct answer

Four weeks

Correct Incorrect Correct answer

Twelve months

Correct Incorrect Correct answer

Three months

Correct Incorrect Correct answer

Which of the following haemorrhoidal preparations would be considered first-line in pregnancy?

Anodesyn

Correct Incorrect Correct answer

Germoloids

Correct Incorrect Correct answer

Proctosedyl

Correct Incorrect Correct answer

Anusol

Correct Incorrect Correct answer

Anugesic-HC

Correct Incorrect Correct answer

A newly-appointed practice nurse is having his pre-employment health screen at your practice. During this consultation, you note that the nurse has no clear recollection of suffering from chickenpox.

What would be the most appropriate action to take?

No further action is required at this stage.

Correct Incorrect Correct answer

The nurse should be offered a vaccine unless there is a clear contraindication to the vaccine.

Correct Incorrect Correct answer

The nurse should be offered intramuscular immunoglobulin.

Correct Incorrect Correct answer

The nurse should be serologically tested for VZV.

Correct Incorrect Correct answer

An elderly female patient reports an increase in cough and shortness of breath.

Her past medical history includes; Hypertension, Peripheral venous disease, Type 2 Diabetes and recurring urinary tract infections.

Medication list

Metformin
Sitagliptin
Amlodipine
Ramipril
Nitrofurantoin

Which medication is likely to contribute to her symptoms?

Metformin

Correct Incorrect Correct answer

Sitagliptin

Correct Incorrect Correct answer

Amlodipine

Correct Incorrect Correct answer

Ramipril

Correct Incorrect Correct answer

Nitrofurantoin

Correct Incorrect Correct answer

What was the leading cause of death in July 2021?

Chronic lower respiratory disease

Correct Incorrect Correct answer

Ischaemic heart disease

Correct Incorrect Correct answer

Influenza

Correct Incorrect Correct answer

Cerebrovascular disease

Correct Incorrect Correct answer

Dementia and Alzheimer disease

Correct Incorrect Correct answer

A 62-year-old patient has presented with a two-month history of breathlessness. He reports an associated headache, which is worse on leaning forward. On examination, there is facial swelling with dilated neck and chest veins.

What would be the most suitable immediate management for this patient?

Prednisolone

Correct Incorrect Correct answer

Dexamethasone

Correct Incorrect Correct answer

Morphine

Correct Incorrect Correct answer

Endovascular stenting

Correct Incorrect Correct answer

Thrombectomy

Correct Incorrect Correct answer

A research group has completed three phases of the Delphi method. They are unable to reach a consensus above the specified percentage.

How should the team approach this?

The study should be abandoned.

Correct Incorrect Correct answer

The researchers who chose not to change their consensus should be excluded.

Correct Incorrect Correct answer

The senior-most participant should decide on the group consensus.

Correct Incorrect Correct answer

The Delphi should be recreated from phase one.

Correct Incorrect Correct answer

A further phase can be applied to allow for a consensus to be formulated.

Correct Incorrect Correct answer

A four-year-old child has recently recovered from a viral illness. She has developed a non-blanching rash on her forearms and ankles.

Physical examination is otherwise normal.

The child appears well.

What would be the single most appropriate investigation?

Full blood count

Correct Incorrect Correct answer

Urea and electrolytes

Correct Incorrect Correct answer

Liver function tests

Correct Incorrect Correct answer

Coagulation screen

Correct Incorrect Correct answer

Urine dipstick

Correct Incorrect Correct answer

You are reviewing a teenage boy with gynecomastia. On examination, he is of tall stature, with sparse body hair. He has a high pitched voice and is embarrassed that he sounds different when compared to his peers.

The patient reports having small testicles.

What is the likely diagnosis?

Noonan’s syndrome

Correct Incorrect Correct answer

Edwards syndrome

Correct Incorrect Correct answer

Klinefelter syndrome

Correct Incorrect Correct answer

Turners syndrome

Correct Incorrect Correct answer

Downs syndrome

Correct Incorrect Correct answer

Image reference Primary Care Dermatology Society

A teenage girl has presented to you with a rash affecting her upper arms on both sides. She reports no symptoms from the rash.

What is the likely diagnosis?

Eczema

Correct Incorrect Correct answer

Folliculitis

Correct Incorrect Correct answer

Keratosis pilaris

Correct Incorrect Correct answer

Pustular dermatosis

Correct Incorrect Correct answer

Tinea

Correct Incorrect Correct answer

An 80-year-old patient with known prostate cancer has complained of a one-week history of feeling tired.

You receive a home visit request from his daughter informing you that he is feeling nauseous and appears confused.

The examination is unremarkable.

Which of the following investigations would be most appropriate?

Bone profile

Correct Incorrect Correct answer

Liver function test

Correct Incorrect Correct answer

Full blood count

Correct Incorrect Correct answer

CRP

Correct Incorrect Correct answer

Lumbar puncture

Correct Incorrect Correct answer

A study is measuring the efficacy of anti-IL-5 treatments in preventing severe exacerbations of Asthma.

Which of the following statements is correct?

The experimental event rate is 60%

Correct Incorrect Correct answer

The control event rate is 43%

Correct Incorrect Correct answer

The absolute risk reduction is 40%

Correct Incorrect Correct answer

Patients taking Anti IL-5 are statistically more likely to experience an exacerbation of Asthma.

Correct Incorrect Correct answer

Six additional people need to be treated with anti-IL-5 to prevent an additional patient from experiencing an exacerbation of asthma.

Correct Incorrect Correct answer

You are reviewing a 52-year-old patient who was commenced on Semaglutide six months ago.

His bodyweight is 85kg.

During his last review, he weighed 92kg.

What would be the minimum expected weight loss to continue with Semaglutide?

4%

Correct Incorrect Correct answer

8%

Correct Incorrect Correct answer

7%

Correct Incorrect Correct answer

3%

Correct Incorrect Correct answer

10%

Correct Incorrect Correct answer

You have received the following MSU result for a 45-year-old patient.

Co-morbidities

Asthma
Chronic Kidney Disease Stage Four
Hypertension
Type 2 Diabetes

Medications

Ramipril
Sitagliptin
Salbutamol

Allergy

Penicillin causing anaphylaxis

MSU

WCC 1,200
RCC 250

Growth E.coli

Nitrofurantoin S
Cefalexin S
Amoxicillin R
Trimethoprim R

What would be the most appropriate antibiotic treatment?

Nitrofurantoin

Correct Incorrect Correct answer

Cefalexin

Correct Incorrect Correct answer

Pivmecillinam

Correct Incorrect Correct answer

Trimethoprim

Correct Incorrect Correct answer

Fosfomycin

Correct Incorrect Correct answer

A newly diagnosed 82-year-old patient has been diagnosed with heart failure with a reduced ejection fraction.

The patient has recently experienced postural dizziness.

On examination you find the patient to have the following findings;

HS12 + ejection systolic murmur.
Chest – fine bilateral crackles.
Bilateral pitting oedema to both ankles.

Blood pressure: 150/85
Heart rate: 85bpm regular

Which of the following medications would be most appropriate for this patient?

Ramipril

Correct Incorrect Correct answer

Spironolactone

Correct Incorrect Correct answer

Bisoprolol

Correct Incorrect Correct answer

Digoxin

Correct Incorrect Correct answer

Ivabradine

Correct Incorrect Correct answer

Isosorbide Mononitrate

Correct Incorrect Correct answer

A patient is noted to have a wide-based gait, with staggering of their body from left to right. The patient is unable to walk in a straight line.

Select the single most likely diagnosis;

Hemiplegic gait

Correct Incorrect Correct answer

Diplegic gait

Correct Incorrect Correct answer

High-step gait

Correct Incorrect Correct answer

Waddling gait

Correct Incorrect Correct answer

Choreiform gait

Correct Incorrect Correct answer

Ataxic gait

Correct Incorrect Correct answer

Parkinsonian gait

Correct Incorrect Correct answer

Image reference – Life in the fast lane

This patient has developed sudden visual loss.

What is the likely diagnosis?

Central retinal artery occlusion

Correct Incorrect Correct answer

Branch retinal vein occlusion

Correct Incorrect Correct answer

Diabetic retinopathy

Correct Incorrect Correct answer

Central retinal vein occlusion

Correct Incorrect Correct answer

Macular degeneration

Correct Incorrect Correct answer

You are reviewing a couple who have struggled to conceive for two years. The female partner has regular periods which occur at 35-day intervals.

You arrange for a mid-luteal progesterone test to take place.

When should the sample be taken?

14 days into her cycle

Correct Incorrect Correct answer

21 days into her cycle

Correct Incorrect Correct answer

7 days into her cycle

Correct Incorrect Correct answer

28 days into her cycle

Correct Incorrect Correct answer

Mid-luteal progesterone should not be offered

Correct Incorrect Correct answer

How many patients were diagnosed with chlamydia in 2012 at a rate per 10 000?

3900 patients per 10 000

Correct Incorrect Correct answer

39 patients per 10 000

Correct Incorrect Correct answer

390 patients per 100 000

Correct Incorrect Correct answer

36 patients per 10 000

Correct Incorrect Correct answer

50 patients 100 000

Correct Incorrect Correct answer

Which of the following would you administer in an asystole arrest?

Select the single most likely answer.

0.5 ml 1:1000 adrenaline

Correct Incorrect Correct answer

1.0 ml 1:1000 adrenaline

Correct Incorrect Correct answer

10 ml 1:10 000 adrenaline

Correct Incorrect Correct answer

5 ml 1: 10 000 adrenaline

Correct Incorrect Correct answer

300mg IV Amiodarone

Correct Incorrect Correct answer

6mg IV Adenosine

Correct Incorrect Correct answer

500mcg IV Atropine

Correct Incorrect Correct answer

Which of the following conditions would not be an indication for circumcision?

Select the single most appropriate answer.

Phimosis

Correct Incorrect Correct answer

Paraphimosis

Correct Incorrect Correct answer

Balanitis

Correct Incorrect Correct answer

Penile cancer

Correct Incorrect Correct answer

STI prevention

Correct Incorrect Correct answer

You have a four-month-old infant who has suffered from regurgitating feeds since they were four weeks old. The infant currently has 110ml of formula every 3 hours. The parents have tried to give the child more regular feeds and smaller quantities but this has not made a difference.

The infant examines normally and weighs 6kg.

What would be the most appropriate next step?

Reduce the feeds to 90ml every 3 hours.

Correct Incorrect Correct answer

Switch to a hypoallergenic formula.

Correct Incorrect Correct answer

Add in a thickened formula.

Correct Incorrect Correct answer

Refer to the paediatric team.

Correct Incorrect Correct answer

Add in alginate therapy.

Correct Incorrect Correct answer

Encourage mum to feed hourly.

Correct Incorrect Correct answer

A newborn baby is discharged from the hospital at 6 hours following delivery.

The baby has no risk factors for sepsis. Mum has called you at 18 hours post-delivery concerned that the baby is very sleepy and is no longer breastfeeding.

She also reports that the babies skin appears yellow.

What is the likely cause of this babies symptoms?

Breastfeeding jaundice

Correct Incorrect Correct answer

G6PD deficiency

Correct Incorrect Correct answer

Biliary atresia

Correct Incorrect Correct answer

Blood group incompatibility

Correct Incorrect Correct answer

Hypothyroidism

Correct Incorrect Correct answer

You are reviewing a 16-year-old female patient who has yet to start menstruating. On examination, she is of short stature, with a short neck and broad chest, with widely spaced nipples.

What is the likely diagnosis?

Klinefelter’s syndrome

Correct Incorrect Correct answer

Becker’s muscular dystrophy

Correct Incorrect Correct answer

Turner’s syndrome

Correct Incorrect Correct answer

Down’s syndrome

Correct Incorrect Correct answer

Noonan’s syndrome

Correct Incorrect Correct answer

Which of the following tools can be used to assess the severity of sleep apnoea?

Select one or more answers that apply.

Epworth sleepiness scale

Correct Incorrect Correct answer

STOP-Bang questionnaire

Correct Incorrect Correct answer

NIH scale

Correct Incorrect Correct answer

CHADSvasc

Correct Incorrect Correct answer

ABCD2 score

Correct Incorrect Correct answer

An 81-year-old patient has complained of vaginal pain for five months. She has never experienced such pain before. She is very distressed by her symptoms and despite repeated courses of antifungal medication, there is no improvement in her symptoms.

On examination, there is an ivory-white discolouration around the clitoris, with areas of telangiectasia.

There is marked atrophy present during the examination.

What would be the most appropriate treatment?

Topical oestrogen

Correct Incorrect Correct answer

Topical lidocaine 2%

Correct Incorrect Correct answer

Topical Clobetasol

Correct Incorrect Correct answer

Routine referral to gynaecology

Correct Incorrect Correct answer

Refer on a two-week wait to gynaecology

Correct Incorrect Correct answer

A patient is walking with his right arm flexed and internally rotated. On the same side, he is swinging his leg in a semi-circular motion.

Select the single most appropriate diagnosis.

Hemiplegic gait

Correct Incorrect Correct answer

Diplegic gait

Correct Incorrect Correct answer

High-step gait

Correct Incorrect Correct answer

Waddling gait

Correct Incorrect Correct answer

Choreiform gait

Correct Incorrect Correct answer

Ataxic gait

Correct Incorrect Correct answer

Parkinsonian gait

Correct Incorrect Correct answer

A patient is taking Alendronate weekly.

After how long should you review the use of Alendronate?

1 year

Correct Incorrect Correct answer

3 years

Correct Incorrect Correct answer

10 years

Correct Incorrect Correct answer

8 years

Correct Incorrect Correct answer

5 years

Correct Incorrect Correct answer

A 21-year-old female patient suffers from acute migraine. She currently takes a combination of paracetamol and metoclopramide. She would like a repeat prescription.

What is the maximum duration for a single course of metoclopramide?

14 days

Correct Incorrect Correct answer

7 days

Correct Incorrect Correct answer

5 days

Correct Incorrect Correct answer

28 days

Correct Incorrect Correct answer

10 days

Correct Incorrect Correct answer

Botox injections are not a treatment option in which of the following conditions?

Blepharospasm

Correct Incorrect Correct answer

Bladder dysfunction

Correct Incorrect Correct answer

Tardive dyskinesia

Correct Incorrect Correct answer

Hyperhidrosis

Correct Incorrect Correct answer

Migraine prophylaxis

Correct Incorrect Correct answer

A 45-year-old patient has recently had an unprovoked DVT. On examination, there is no abnormality to be found. She reports no other symptoms.

Which of the following tests would you consider in this patient?

Mammogram

Correct Incorrect Correct answer

Antiphospholipid antibodies

Correct Incorrect Correct answer

CT thorax, abdomen, pelvis

Correct Incorrect Correct answer

US pelvis

Correct Incorrect Correct answer

MR brain

Correct Incorrect Correct answer

Researchers have developed a new depression screening tool. The tool is made up of ten questions. Nine of the questions focus on quantifying suicidal ideation.

Which of the following domains is lacking?

Select the single most likely answer.

Test-retest

Correct Incorrect Correct answer

Interrater

Correct Incorrect Correct answer

Criterion validity

Correct Incorrect Correct answer

Reliability

Correct Incorrect Correct answer

Content validity

Correct Incorrect Correct answer

A patient with known diabetes is currently taking standard release metformin 1g BD.

Her up to date renal function is;

eGFR 40

What would be the most appropriate action?

Stop metformin

Correct Incorrect Correct answer

Reduce metformin dose by 25%

Correct Incorrect Correct answer

Reduce metformin dose by 50%

Correct Incorrect Correct answer

Switch patient to modified-release metformin

Correct Incorrect Correct answer

Continue with the same dose

Correct Incorrect Correct answer

A 62-year-old patient has presented to you with a four-month history of bilateral shoulder discomfort which is affecting her sleep. She often finds that after sitting down she will experiencing stiffness in her hips which will last for at least one hour.

What would be the most appropriate first-line investigation?

Anti-cyclic citrullinated peptide (anti-CCP)

Correct Incorrect Correct answer

Creatine kinase

Correct Incorrect Correct answer

Urinary Bence Jones protein

Correct Incorrect Correct answer

C-reactive protein

Correct Incorrect Correct answer

CT Thorax, Abdomen, Pelvis

Correct Incorrect Correct answer

You are concerned with the professional conduct of an advanced paramedic practitioner working within your General Practice.

Which of the following agencies would you escalate your concerns to?

The Professional Standards Authority

Correct Incorrect Correct answer

Health and Care Professions Council

Correct Incorrect Correct answer

The Nursing and Midwifery Council

Correct Incorrect Correct answer

General Medical Council

Correct Incorrect Correct answer

General Pharmaceutical Council

Correct Incorrect Correct answer

An elderly patient with known depression has a significant history of multiple overdoses. He is currently on daily prescriptions.

He has attended your clinic with an acute ankle sprain and would like to be prescribed co-codamol 30/500 for two weeks.

You have agreed to do the script. However, you are unwilling to give the patient a two-week supply of the medication.

Which of the following ethical principles is likely to be upheld in this scenario?

Autonomy

Correct Incorrect Correct answer

Beneficence

Correct Incorrect Correct answer

Non-maleficence

Correct Incorrect Correct answer

Justice

Correct Incorrect Correct answer

A 52-year-old patient has presented to your clinic concerned that she is now menopausal. She has a Mirena coil in situ which was inserted when she was 46 years old as a contraceptive measure.

She would like the Mirena coil to be removed as she no longer feels it is required for contraceptive cover despite being sexually active.

She has had two FSH measurements taken;

FSH 25 IU/L

FSH 24 IU/L

What would be the most appropriate next step?

Remove the existing Mirena coil and replace it with a new Mirena coil

Correct Incorrect Correct answer

Remove the Mirena after one more year

Correct Incorrect Correct answer

Remove the existing Mirena coil and offer no further contraception

Correct Incorrect Correct answer

Continue with the current Mirena coil and recheck the FSH in one year

Correct Incorrect Correct answer

Switch the patient over to hormone replacement therapy

Correct Incorrect Correct answer

A 28-year-old patient was initiated on lithium two years ago. The lithium was initially prescribed by the local mental health team and was then transferred to primary care six months later.

The patient has requested his repeat medication including his lithium. The patient has requested a two month supply of his medication. His last blood tests were taken six months ago and they were normal.

What is the most appropriate management?

Deprescribe the patients lithium.

Correct Incorrect Correct answer

Issue a prescription for one month and request a blood test.

Correct Incorrect Correct answer

Refer back to secondary care.

Correct Incorrect Correct answer

Prescribe the two months script and request a blood test.

Correct Incorrect Correct answer

Prescribe a one month script.

Correct Incorrect Correct answer

Refuse to prescribe lithium.

Correct Incorrect Correct answer

A 50-year-old patient who recognises themselves as non-binary would like to know more about the cervical screen programme. They are registered as female on their medical records.

The patient has female reproductive organs.

What would be the most appropriate advice for this patient?

The NHS Cervical Screening Programme (NHSCSP) will call the patient for their cervical smear.

Correct Incorrect Correct answer

The patient will be called for their smear every 3 years.

Correct Incorrect Correct answer

The GP practice will take responsibility to invite the patient for a 5-yearly smear.

Correct Incorrect Correct answer

The patient will not require a cervical smear.

Correct Incorrect Correct answer

The patient will need a smear via colposcopy.

Correct Incorrect Correct answer

A newborn baby is screened for hip examination at birth. The infant was delivered at 39 weeks without any complications. During pregnancy, mum had a successful external cephalic version (ECV) at 36+2.

On examination, there are no abnormalities to find.

What would be the most appropriate step?

Refer for hip ultrasonography.

Correct Incorrect Correct answer

Repeat hip screen at six weeks.

Correct Incorrect Correct answer

Repeat Ortolani and Barlow at two weeks.

Correct Incorrect Correct answer

No further follow up is required.

Correct Incorrect Correct answer

Specialist orthopaedic input before two weeks.

Correct Incorrect Correct answer

An adult patient has routine blood tests taken which show an incidental finding;

Adjusted Calcium 2.80

The bone profile is repeated;

Adjusted Calcium 2.82

What would be the next line of investigation?

Bone profile

Correct Incorrect Correct answer

Parathyroid hormone

Correct Incorrect Correct answer

24-hour urinary calcium

Correct Incorrect Correct answer

Vitamin D

Correct Incorrect Correct answer

Bone profile and Parathyroid hormone

Correct Incorrect Correct answer

Parathyroid hormone and Vitamin D

Correct Incorrect Correct answer

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