General practice clinical knowledge and patient care
This domain tests whether you can take an undifferentiated symptom, build a ranked differential that fits Singapore's epidemiology, exclude the dangerous alternatives using only what a GP clinic has, and act inside a short consultation. Marks are lost less often through ignorance of rare disease than through unstructured assessment and missing safety-netting.
Core rules
- Vital signs first: temperature, pulse, BP, SpO2, capillary glucose. They shift your differential more than any test you can order.
- Rank by "must not miss" before "most likely": chest pain brings acute coronary syndrome, dissection and pulmonary embolism; abdominal pain in a woman of childbearing age demands a urine pregnancy test for ectopic; headache brings subarachnoid haemorrhage, meningitis and acute glaucoma.
- Local epidemiology sets pretest probability: dengue in a febrile patient from a cluster, hand-foot-mouth disease in a childcare case, tuberculosis in a chronic cougher, melioidosis in a diabetic with soil exposure.
- Antibiotic stewardship: most acute respiratory infection is viral. Use McIsaac/Centor to decide throat swabbing and penicillin; avoid fluoroquinolones for uncomplicated UTI where local resistance is high.
- Write the safety net into the notes: what to return for, when, and how.
Worked example
A 34-year-old man has three days of fever to 39°C, headache and myalgia, and lives in a dengue cluster. Reasoning: dengue leads the differential; NS1 antigen is most sensitive in the first five days, IgM later. Order dengue NS1 and a full blood count. Normal platelets and haematocrit with no warning signs means home with paracetamol, oral fluids and daily review. Platelets under 100 ×10⁹/L with rising haematocrit, abdominal pain, vomiting or drowsiness means same-day hospital assessment. Avoid NSAIDs and aspirin.
Traps
- Reassuring "viral illness" without a dengue test in an endemic area.
- Treating one normal platelet count as exclusion; deterioration often comes at defervescence.
- Prescribing NSAIDs in possible dengue.
- No documented return criteria.