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MOH GP Competitive Appointment Exam study materials
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MOH GP Competitive Appointment Exam practice questions

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Question 1General practice clinical knowledge and patient care

A 28-year-old woman presents with a 3-day history of dysuria, urinary frequency, and suprapubic discomfort, with no fever, flank pain, or vaginal discharge. Urine dipstick shows positive nitrites and leukocyte esterase. What is the most appropriate initial management?

  1. Reassurance and analgesia alone, since uncomplicated cystitis usually resolves spontaneously
  2. Immediate referral to the emergency department for intravenous antibiotics
  3. A 7-day course of oral ciprofloxacin with a follow-up urine culture in all cases
  4. A 3-day course of oral trimethoprim or nitrofurantoin, with advice to return if symptoms persist beyond 48 hours Correct answer.

Explanation

This is classic acute uncomplicated cystitis in a non-pregnant woman, which is managed empirically with a short course of a first-line oral antibiotic such as nitrofurantoin or trimethoprim. Urine culture is not routinely required for a first uncomplicated episode, and safety-netting advice is essential.

Question 2General practice clinical knowledge and patient care

Which single measurement is used to diagnose type 2 diabetes in an asymptomatic adult according to standard diagnostic criteria?

  1. A fasting plasma glucose of 7.0 mmol/L or more on one occasion Correct answer.
  2. A fasting plasma glucose of 5.6 mmol/L
  3. A glycated haemoglobin of 40 mmol/mol (5.8%)
  4. A random plasma glucose of 9.0 mmol/L at any time

Explanation

A fasting plasma glucose of 7.0 mmol/L or above meets the diagnostic threshold for diabetes. In an asymptomatic patient, a confirmatory repeat test is normally required before the diagnosis is firmly established.

Question 3General practice clinical knowledge and patient care

A 55-year-old man with no prior cardiac history presents with central crushing chest pain of 30 minutes' duration. Which action should be taken first in the community setting?

  1. Give aspirin 300 mg chewed and arrange immediate emergency ambulance transfer Correct answer.
  2. Prescribe a nitrate spray and advise review if pain recurs
  3. Arrange an urgent same-day outpatient cardiology review
  4. Perform an ECG in the practice and review the result before calling an ambulance

Explanation

Suspected acute coronary syndrome requires immediate emergency transfer, and chewing aspirin 300 mg early improves outcomes. Delaying transfer for investigations or outpatient review is unsafe in acute chest pain.

Question 4General practice clinical knowledge and patient care

Which finding is most characteristic of a diagnosis of community-acquired pneumonia rather than an upper respiratory tract infection?

  1. A sore throat with anterior cervical lymphadenopathy
  2. Focal crackles or bronchial breathing on auscultation with fever and tachypnoea Correct answer.
  3. A dry cough with a normal chest examination and no systemic upset
  4. Bilateral clear rhinorrhoea and sneezing

Explanation

Focal auscultatory signs with fever and tachypnoea suggest lower respiratory tract involvement and support pneumonia. Upper respiratory infections typically lack focal chest signs and significant tachypnoea.

Question 5General practice clinical knowledge and patient care

A 70-year-old woman has a blood pressure of 158/94 mmHg on two separate visits, with no diabetes or kidney disease. According to standard hypertension guidance, what is the appropriate next step?

  1. Admit her to hospital for urgent blood pressure control
  2. Arrange ambulatory or home blood pressure monitoring to confirm the diagnosis Correct answer.
  3. Reassure her that this reading is normal for her age
  4. Start antihypertensive drug treatment immediately without further assessment

Explanation

Clinic readings in the stage 1 range should be confirmed with ambulatory or home monitoring before treatment is started, to exclude white-coat hypertension. This also guides the decision on whether drug therapy is needed.

Question 6General practice clinical knowledge and patient care

A 4-year-old child has a 2-day history of fever, sore throat, and tonsillar exudate, with tender anterior cervical nodes and no cough. Which feature most supports a bacterial (streptococcal) cause?

  1. Tender anterior cervical lymphadenopathy with fever and absence of cough Correct answer.
  2. Bilateral conjunctivitis
  3. Absence of tonsillar exudate
  4. Presence of a cough

Explanation

Fever, tonsillar exudate, tender anterior cervical nodes, and absence of cough are features that raise the likelihood of streptococcal pharyngitis. Cough and coryzal symptoms favour a viral cause.

Question 7General practice clinical knowledge and patient care

Which advice is correct for a woman starting a combined oral contraceptive pill for the first time?

  1. She must use condoms for three months regardless of when she starts
  2. She needs no additional contraception from the first day of the packet if started on day 1 of menstruation Correct answer.
  3. She should start only on the first day of her period and never at another time
  4. She requires a pregnancy test before every packet

Explanation

When the combined pill is started on day 1 of menstruation, contraceptive protection is immediate. Starting at other times usually requires additional barrier contraception for the first seven days.

Question 8General practice clinical knowledge and patient care

A 65-year-old man reports new-onset exertional breathlessness and ankle swelling. Which initial investigation is most appropriate in primary care?

  1. A resting 12-lead ECG and serum natriuretic peptide measurement Correct answer.
  2. Routine spirometry before any other test
  3. An exercise stress test
  4. A chest radiograph alone

Explanation

Suspected heart failure is initially assessed with a resting ECG and natriuretic peptide testing, which guide the need for echocardiography. This pathway distinguishes cardiac from non-cardiac causes of breathlessness.

Question 9General practice clinical knowledge and patient care

A 45-year-old woman has a 6-week history of low mood, anhedonia, poor sleep, and reduced concentration affecting her work. She has no suicidal ideation. What is the most appropriate initial approach?

  1. Watchful waiting for six months before offering any treatment
  2. Immediate referral to a psychiatrist for all cases of depression
  3. Offer a structured psychological therapy or an antidepressant, with active monitoring and safety-netting Correct answer.
  4. Prescribe a benzodiazepine nightly for sleep

Explanation

Moderate depression is managed with a high-intensity psychological intervention or an antidepressant, with regular review and safety-netting. Watchful waiting is reserved for mild, recent symptoms.

Question 10General practice clinical knowledge and patient care

A 60-year-old man with type 2 diabetes has an eGFR of 40 mL/min/1.73m² and an albumin-to-creatinine ratio of 45 mg/mmol. Which medication class offers renal and cardiovascular protection in addition to glycaemic control?

  1. An SGLT2 inhibitor Correct answer.
  2. A dipeptidyl peptidase-4 inhibitor
  3. A thiazolidinedione
  4. A sulfonylurea

Explanation

SGLT2 inhibitors reduce progression of chronic kidney disease and cardiovascular events in people with type 2 diabetes and albuminuria, independent of glucose lowering. They are recommended in this setting alongside renin-angiotensin blockade.

Question 11General practice clinical knowledge and patient care

A 30-year-old woman has a 2-day history of unilateral throbbing headache with photophobia and nausea, worsened by routine activity. What is the most appropriate acute treatment?

  1. Prophylactic propranolol started during the attack
  2. Regular paracetamol four times daily for two weeks
  3. An opioid combination analgesic
  4. An oral triptan plus a simple analgesic or antiemetic, taken early in the attack Correct answer.

Explanation

Acute migraine is treated early with a triptan and a simple analgesic or antiemetic. Prophylaxis is considered separately when attacks are frequent or disabling, not as acute therapy.

Question 12General practice clinical knowledge and patient care

A 72-year-old woman has a fall with a painful, shortened, externally rotated right leg. She is haemodynamically stable. What is the most appropriate immediate action?

  1. Arrange urgent hospital assessment with analgesia and immobilisation in transit Correct answer.
  2. Attempt to reduce the deformity in the practice
  3. Advise bed rest and review in one week
  4. Order an outpatient radiograph for the following day

Explanation

A displaced hip fracture is a clinical diagnosis requiring urgent hospital assessment, analgesia, and immobilisation during transfer. Delay increases morbidity and mortality.

Question 13General practice clinical knowledge and patient care

A 25-year-old man has a painless penile ulcer with a clean base and bilateral inguinal lymphadenopathy. Which diagnosis is most likely?

  1. Chancroid
  2. Herpes simplex infection
  3. Primary syphilis Correct answer.
  4. Genital warts

Explanation

A painless, indurated ulcer with a clean base and non-tender lymphadenopathy is typical of primary syphilis. Herpes lesions are usually painful and vesicular.

Question 14General practice clinical knowledge and patient care

A 50-year-old woman reports 3 months of fatigue, weight gain, cold intolerance, and constipation. Which initial test best confirms the suspected diagnosis?

  1. Serum cortisol
  2. Thyroid function tests Correct answer.
  3. Full blood count alone
  4. Serum calcium

Explanation

The symptoms suggest hypothyroidism, which is confirmed by thyroid function tests showing a raised TSH with a low free T4. Other tests would not address this likely diagnosis.

Question 15General practice clinical knowledge and patient care

A 68-year-old man with atrial fibrillation has a CHA2DS2-VASc score of 3. What is the most appropriate management?

  1. Clopidogrel alone
  2. No antithrombotic therapy
  3. Aspirin alone
  4. An oral anticoagulant, with assessment of bleeding risk Correct answer.

Explanation

A score of 2 or more in men indicates sufficient stroke risk to recommend oral anticoagulation, after assessing bleeding risk with a tool such as HAS-BLED. Antiplatelet monotherapy is not an adequate substitute.

Question 16General practice clinical knowledge and patient care

A 3-month-old infant is brought with a 1-day history of fever of 38.5°C, poor feeding, and irritability. What is the most appropriate action?

  1. Advise the parents to give paracetamol and return if the fever persists for 3 days
  2. Prescribe oral amoxicillin and review in one week
  3. Same-day urgent paediatric assessment for possible serious bacterial infection Correct answer.
  4. Reassurance and review in 48 hours

Explanation

Fever in an infant under 3 months is a red flag for serious bacterial infection and requires urgent paediatric assessment, often including blood and urine tests and possible admission. Delay is unsafe.

Question 17General practice clinical knowledge and patient care

A 40-year-old woman has a 2-week history of a painful, swollen calf after a long-haul flight. Which is the most appropriate investigation to confirm suspected deep vein thrombosis?

  1. D-dimer testing regardless of clinical probability
  2. Compression ultrasound of the leg Correct answer.
  3. Ankle-brachial pressure index
  4. Serum electrolytes

Explanation

Compression ultrasound is the imaging test of choice to confirm or exclude a proximal deep vein thrombosis. D-dimer is used mainly to exclude DVT when clinical probability is low.

Question 18General practice clinical knowledge and patient care

A 35-year-old man with a BMI of 32 has persistent epigastric pain, and you suspect gastro-oesophageal reflux disease. Which initial measure is most appropriate alongside lifestyle advice?

  1. Long-term H2 receptor antagonist therapy without trial
  2. Immediate referral for endoscopy regardless of symptoms
  3. A 4-week trial of a proton pump inhibitor Correct answer.
  4. A course of antibiotics for Helicobacter pylori without testing

Explanation

A trial of a proton pump inhibitor for four weeks is appropriate for typical reflux symptoms without alarm features. Referral for endoscopy is reserved for alarm symptoms or inadequate response.

Question 19General practice clinical knowledge and patient care

A 58-year-old woman with a history of asthma presents with acute breathlessness and wheeze after a respiratory infection. On examination she is speaking in sentences, with a peak flow of 60% of predicted. How should this be classified?

  1. Mild acute asthma
  2. Moderate acute asthma Correct answer.
  3. Life-threatening acute asthma
  4. Chronic obstructive pulmonary disease exacerbation

Explanation

A peak flow of 50-75% of predicted with the ability to speak in sentences indicates a moderate acute asthma attack. Life-threatening features include silent chest, exhaustion, and peak flow below 33%.

Question 20General practice clinical knowledge and patient care

A 70-year-old man on warfarin for atrial fibrillation has an INR of 8.0 with no bleeding. What is the most appropriate management?

  1. Withhold warfarin and give oral vitamin K, then recheck the INR Correct answer.
  2. Double the next warfarin dose to stabilise the level
  3. Continue warfarin at the same dose and recheck in one week
  4. Give intravenous vitamin K and fresh frozen plasma immediately

Explanation

An INR of 8.0 without bleeding is managed by stopping warfarin and giving low-dose oral vitamin K, with repeat INR monitoring. Intravenous vitamin K and prothrombin complex are reserved for major bleeding or very high INR with bleeding risk.

Question 21General practice clinical knowledge and patient care

A 45-year-old woman has a breast lump that is hard, fixed, and associated with skin dimpling. What is the most appropriate next step?

  1. Arrange a repeat examination in three months
  2. Prescribe antibiotics for mastitis
  3. Reassure her that fibroadenomas are common at this age
  4. Refer urgently to a breast clinic for triple assessment Correct answer.

Explanation

A hard, fixed lump with skin dimpling is suspicious for malignancy and warrants urgent referral for triple assessment (clinical examination, imaging, and biopsy). Delay in referral is unsafe.

Question 22General practice clinical knowledge and patient care

A 55-year-old man has a 3-month history of early satiety, unintentional weight loss, and iron-deficiency anaemia. What is the most appropriate investigation?

  1. Trial of a proton pump inhibitor for 8 weeks
  2. Abdominal ultrasound
  3. Urgent referral for upper gastrointestinal endoscopy Correct answer.
  4. Reassurance and dietary advice

Explanation

Dyspepsia with weight loss and iron-deficiency anaemia are alarm features that mandate urgent endoscopy to exclude oesophageal or gastric malignancy. Empirical acid suppression would delay diagnosis.

Question 23General practice clinical knowledge and patient care

A 30-year-old woman with a BMI of 31 has irregular periods and clinical signs of hyperandrogenism. Which set of investigations best supports a diagnosis of polycystic ovary syndrome after excluding other causes?

  1. Total testosterone, LH, and pelvic ultrasound Correct answer.
  2. Thyroid function and prolactin only
  3. Serum cortisol and ACTH
  4. Serum oestradiol and progesterone on day 21

Explanation

PCOS is diagnosed using the Rotterdam criteria of oligo-ovulation, hyperandrogenism, and polycystic ovarian morphology, supported by testosterone, LH, and ultrasound after excluding thyroid, prolactin, and adrenal causes.

Question 24General practice clinical knowledge and patient care

A 65-year-old man has sudden painless loss of vision in one eye described as a curtain descending. What is the most appropriate immediate action?

  1. Reassure him that floaters are benign
  2. Prescribe lubricating eye drops and review in one week
  3. Arrange routine optometry follow-up
  4. Same-day referral to an ophthalmology unit for suspected retinal artery occlusion Correct answer.

Explanation

A curtain-like painless visual loss suggests retinal detachment or vascular occlusion, both ophthalmic emergencies requiring same-day specialist assessment. Delay risks permanent visual loss.

Question 25General practice clinical knowledge and patient care

A 40-year-old woman presents with a 2-day history of fever, headache, neck stiffness, and photophobia. What is the most appropriate immediate action?

  1. Advise rest and analgesia at home
  2. Arrange urgent hospital admission for suspected meningitis and give parenteral antibiotics without delay Correct answer.
  3. Prescribe oral antibiotics and review in 24 hours
  4. Arrange an outpatient lumbar puncture in one week

Explanation

Fever with neck stiffness and photophobia suggests bacterial meningitis, a medical emergency requiring immediate transfer and parenteral antibiotics without waiting for investigations.

Question 26General practice clinical knowledge and patient care

A 28-year-old woman presents with a 3-day history of dysuria, urinary frequency, and suprapubic discomfort. She is afebrile and has no flank pain. What is the most appropriate initial management?

  1. Immediate referral for intravenous antibiotics
  2. A 3-day course of oral trimethoprim Correct answer.
  3. A single dose of oral fosfomycin
  4. A 7-day course of oral amoxicillin

Explanation

Uncomplicated cystitis in a non-pregnant woman is usually treated with a short course of an oral antibiotic such as trimethoprim or nitrofurantoin, after considering local resistance. Amoxicillin is not first-line because of high resistance rates, and intravenous therapy is reserved for pyelonephritis or systemic illness.

Question 27General practice clinical knowledge and patient care

A 55-year-old man with a BMI of 34 has a 6-month history of fatigue, polyuria, and polydipsia. His fasting plasma glucose is 8.9 mmol/L. What is the most appropriate initial pharmacological treatment?

  1. Gliclazide
  2. Metformin Correct answer.
  3. Pioglitazone
  4. Basal insulin

Explanation

Metformin is first-line for type 2 diabetes in overweight or obese patients unless contraindicated. It is effective, weight-neutral, and has a low risk of hypoglycaemia. Sulfonylureas and insulin are usually reserved for later stages or specific circumstances.

Question 28General practice clinical knowledge and patient care

A 70-year-old woman presents with a 2-day history of a painful, blistering rash in a dermatomal distribution on her right chest. What is the most appropriate treatment to reduce the risk of postherpetic neuralgia?

  1. Oral aciclovir Correct answer.
  2. Topical corticosteroid
  3. Oral antifungal
  4. Oral antibiotic

Explanation

Herpes zoster is caused by reactivation of varicella-zoster virus. Early antiviral therapy with aciclovir, valaciclovir, or famciclovir reduces the duration and severity of the rash and may reduce the risk of postherpetic neuralgia. Topical steroids, antibiotics, and antifungals are ineffective.

Question 29General practice clinical knowledge and patient care

A 30-year-old woman is diagnosed with iron-deficiency anaemia. She has no gastrointestinal symptoms and no family history of colorectal cancer. What is the most appropriate next step in management?

  1. Start oral iron therapy and reassess in 4 weeks Correct answer.
  2. Start vitamin B12 injections
  3. Arrange urgent colonoscopy
  4. Refer for bone marrow biopsy

Explanation

In a young woman with iron-deficiency anaemia and no alarm symptoms, the most likely cause is menstrual blood loss. A trial of oral iron with reassessment is appropriate. Colonoscopy is indicated for older patients or those with gastrointestinal symptoms.

Question 30General practice clinical knowledge and patient care

A 45-year-old man presents with a 3-day history of a painful, red, swollen right leg. He has a temperature of 38.5°C. What is the most appropriate initial management?

  1. Compression bandaging
  2. Topical corticosteroid
  3. Oral flucloxacillin Correct answer.
  4. Oral antihistamine

Explanation

Cellulitis is usually caused by beta-haemolytic streptococci or Staphylococcus aureus. Flucloxacillin is first-line for non-purulent cellulitis in the UK. Compression and antihistamines are not treatments for infection.

Question 31General practice clinical knowledge and patient care

A 60-year-old man with chronic obstructive pulmonary disease has an exacerbation with increased breathlessness and purulent sputum. He is not hypoxic. What is the most appropriate treatment?

  1. Oral theophylline
  2. Inhaled salbutamol alone
  3. Oral corticosteroid and oral antibiotic Correct answer.
  4. Intravenous diuretic

Explanation

Exacerbations of COPD with purulent sputum are usually treated with a short course of oral corticosteroids and antibiotics. Inhaled bronchodilators are used for symptom relief but are insufficient alone. Theophylline and diuretics are not indicated.

Question 32General practice clinical knowledge and patient care

A 25-year-old woman presents with a 2-day history of a painful, vesicular rash on her lips. What is the most appropriate management?

  1. Oral flucloxacillin
  2. Topical corticosteroid
  3. Topical aciclovir Correct answer.
  4. Oral antifungal

Explanation

Herpes labialis is caused by herpes simplex virus. Topical aciclovir can reduce symptoms if started early. Antibiotics, steroids, and antifungals are ineffective against viral infections.

Question 33General practice clinical knowledge and patient care

A 50-year-old woman presents with a 3-month history of heartburn and regurgitation. She has no alarm symptoms. What is the most appropriate initial management?

  1. Oral antibiotic for Helicobacter pylori
  2. Lifestyle advice alone
  3. Immediate endoscopy
  4. A trial of a proton pump inhibitor Correct answer.

Explanation

For typical gastro-oesophageal reflux disease without alarm symptoms, a trial of a proton pump inhibitor is first-line. Endoscopy is reserved for alarm symptoms or failure to respond. H. pylori testing is considered if symptoms persist.

Question 34General practice clinical knowledge and patient care

A 65-year-old man with atrial fibrillation is at moderate risk of stroke. He has no history of bleeding. Which anticoagulant is most appropriate for long-term thromboprophylaxis?

  1. Dipyridamole
  2. Apixaban Correct answer.
  3. Aspirin
  4. Clopidogrel

Explanation

Direct oral anticoagulants such as apixaban are recommended for stroke prevention in non-valvular atrial fibrillation when anticoagulation is indicated. Antiplatelet agents are less effective and are not recommended for thromboprophylaxis in AF.

Question 35General practice clinical knowledge and patient care

A 40-year-old woman presents with a 6-week history of fatigue, weight gain, and cold intolerance. Her TSH is elevated and free T4 is low. What is the most appropriate treatment?

  1. Carbimazole
  2. Radioiodine
  3. Liothyronine
  4. Levothyroxine Correct answer.

Explanation

Primary hypothyroidism is treated with levothyroxine replacement therapy, titrated to TSH. Carbimazole and radioiodine are used for hyperthyroidism. Liothyronine is not first-line.

Question 36General practice clinical knowledge and patient care

A 55-year-old man presents with a 2-day history of a painful, red, swollen right knee. He is febrile. Joint aspiration shows a white cell count of 50,000/µL with 90% neutrophils. What is the most appropriate initial management?

  1. Intra-articular corticosteroid injection
  2. Intravenous antibiotics and joint drainage Correct answer.
  3. Oral non-steroidal anti-inflammatory drugs
  4. Rest and elevation alone

Explanation

Septic arthritis is a medical emergency requiring prompt intravenous antibiotics and joint drainage. NSAIDs, steroids, and rest alone are inadequate and may worsen the infection.

Question 37General practice clinical knowledge and patient care

A 35-year-old woman presents with a 3-day history of severe unilateral headache with ptosis and miosis on the same side. What is the most likely diagnosis?

  1. Tension-type headache
  2. Giant cell arteritis
  3. Cluster headache Correct answer.
  4. Migraine

Explanation

Cluster headache is characterised by severe unilateral periorbital pain with ipsilateral autonomic features such as ptosis, miosis, and lacrimation. Migraine typically has photophobia and nausea without these features. Tension-type headache is bilateral and non-disabling.

Question 38General practice clinical knowledge and patient care

A 70-year-old woman presents with a 2-week history of pain and stiffness in the shoulders and hips, worse in the morning. Her ESR is 80 mm/h. What is the most appropriate initial treatment?

  1. Methotrexate
  2. Physiotherapy alone
  3. Oral prednisolone Correct answer.
  4. Hydroxychloroquine

Explanation

Polymyalgia rheumatica is characterised by proximal muscle pain and stiffness with raised inflammatory markers. Low-dose oral corticosteroids are the treatment of choice and usually produce rapid improvement. Methotrexate and hydroxychloroquine are not first-line.

Question 39General practice clinical knowledge and patient care

A 28-year-old woman has a 6-month history of recurrent episodes of palpitations, sweating, and tremor. She has lost weight despite a good appetite. Her TSH is suppressed and free T4 is elevated. What is the most appropriate initial treatment?

  1. Thyroidectomy
  2. Carbimazole Correct answer.
  3. Radioiodine
  4. Levothyroxine

Explanation

Graves' disease is the most common cause of hyperthyroidism. Antithyroid drugs such as carbimazole are first-line, especially in younger patients. Radioiodine and surgery are alternative options after failed medical therapy or in specific circumstances.

Question 40General practice clinical knowledge and patient care

A 60-year-old man presents with a 3-month history of progressive dysphagia for solids and weight loss. What is the most appropriate initial investigation?

  1. Barium swallow
  2. Oesophageal manometry
  3. Abdominal ultrasound
  4. Upper gastrointestinal endoscopy Correct answer.

Explanation

Progressive dysphagia with weight loss is a red flag for oesophageal cancer. Urgent upper gastrointestinal endoscopy allows direct visualisation and biopsy. Barium swallow and manometry are not first-line.

Question 41General practice clinical knowledge and patient care

A 45-year-old woman presents with a 2-day history of fever, flank pain, and dysuria. Urinalysis shows nitrites and leukocytes. What is the most appropriate management?

  1. Intravenous fluids alone
  2. Oral ciprofloxacin Correct answer.
  3. Topical antifungal
  4. Oral trimethoprim

Explanation

Acute pyelonephritis requires antibiotics with good renal tissue penetration, such as ciprofloxacin, guided by local resistance. Trimethoprim is less effective for pyelonephritis. Intravenous fluids alone are insufficient.

Question 42General practice clinical knowledge and patient care

A 30-year-old man presents with a 4-week history of low mood, anhedonia, and insomnia. He has no suicidal ideation. What is the most appropriate initial management?

  1. Lithium
  2. Cognitive behavioural therapy Correct answer.
  3. Electroconvulsive therapy
  4. Fluoxetine

Explanation

For mild to moderate depression, psychological therapies such as CBT are first-line. Antidepressants are considered for more severe depression or if psychological therapy is unavailable. ECT and lithium are reserved for severe or treatment-resistant cases.

Question 43General practice clinical knowledge and patient care

A 55-year-old woman presents with a 2-day history of a painful, red, swollen right eye with reduced vision. She wears contact lenses. What is the most appropriate immediate action?

  1. Urgent ophthalmology referral Correct answer.
  2. Warm compresses
  3. Topical antibiotic drops
  4. Oral antihistamine

Explanation

Contact lens wear with a painful red eye and reduced vision raises suspicion of microbial keratitis, which is sight-threatening. Urgent ophthalmology assessment is required for corneal scraping and appropriate treatment. Topical antibiotics may be started but should not delay referral.

Question 44General practice clinical knowledge and patient care

A 40-year-old man presents with a 3-day history of a painful, swollen scrotum and fever. Ultrasound shows increased blood flow to the right testis. What is the most appropriate management?

  1. Oral antibiotics Correct answer.
  2. Oral antifungal
  3. Scrotal support alone
  4. Immediate surgical exploration

Explanation

Epididymitis is suggested by increased blood flow on ultrasound, distinguishing it from testicular torsion which shows reduced flow. Antibiotics are the mainstay of treatment. Surgical exploration is for torsion.

Question 45General practice clinical knowledge and patient care

A 65-year-old man presents with a 6-month history of progressive exertional dyspnoea and ankle swelling. He has a history of hypertension. Examination reveals raised JVP and bibasal crackles. What is the most appropriate initial investigation?

  1. D-dimer
  2. Echocardiography Correct answer.
  3. Chest X-ray
  4. Spirometry

Explanation

Heart failure is suspected based on symptoms and signs. Echocardiography is the key investigation to assess cardiac structure and function. Chest X-ray may show cardiomegaly or pulmonary oedema but is less specific.

Question 46General practice clinical knowledge and patient care

A 25-year-old woman presents with a 2-day history of a painful, vesicular rash on the vulva. She has had similar episodes before. What is the most appropriate management?

  1. Topical corticosteroid
  2. Oral aciclovir Correct answer.
  3. Topical antibiotic
  4. Oral fluconazole

Explanation

Genital herpes is caused by herpes simplex virus. Oral aciclovir or valaciclovir is effective for acute episodes and can be used for suppression. Topical steroids, antifungals, and antibiotics are not effective.

Question 47General practice clinical knowledge and patient care

A 70-year-old man presents with a 3-month history of progressive weakness and sensory loss in the hands and feet. He has a history of type 2 diabetes. What is the most appropriate initial investigation?

  1. Muscle biopsy
  2. MRI spine
  3. Nerve conduction studies Correct answer.
  4. Lumbar puncture

Explanation

Diabetic peripheral neuropathy is a common cause of symmetrical distal sensory loss. Nerve conduction studies can confirm the diagnosis and exclude other causes. MRI and lumbar puncture are not first-line.

Question 48General practice clinical knowledge and patient care

A 50-year-old man presents with a 2-day history of a painful, red, swollen right calf. He has a history of recent long-haul travel. What is the most appropriate initial investigation?

  1. X-ray
  2. MRI
  3. D-dimer Correct answer.
  4. Doppler ultrasound

Explanation

Deep vein thrombosis is suspected based on unilateral calf swelling and risk factors. D-dimer is used as a rule-out test in low-risk patients, but Doppler ultrasound is the definitive diagnostic test. MRI and X-ray are not first-line.

Question 49General practice clinical knowledge and patient care

A 35-year-old woman presents with a 3-week history of a painless, enlarging ulcer on her vulva. She has no other symptoms. What is the most appropriate initial investigation?

  1. Swab for herpes simplex virus Correct answer.
  2. Biopsy
  3. Urine culture
  4. Serology for syphilis

Explanation

A painless vulvar ulcer raises suspicion of primary syphilis, but herpes can also present atypically. Swab for HSV PCR is important, and syphilis serology should also be sent. However, biopsy is reserved for non-healing ulcers after infection is excluded.

Question 50General practice clinical knowledge and patient care

A 60-year-old man with a history of alcohol excess presents with confusion, ataxia, and ophthalmoplegia. What is the most appropriate immediate treatment?

  1. Intravenous glucose
  2. Intravenous antibiotics
  3. Oral multivitamins
  4. Intravenous thiamine Correct answer.

Explanation

Wernicke's encephalopathy is a medical emergency caused by thiamine deficiency. Immediate intravenous thiamine is required to prevent irreversible neurological damage. Glucose should be given after thiamine to avoid precipitating the condition.