Applied professional knowledge and skills
Applied professional knowledge and skills
This domain covers clinical reasoning, evidence-based practice, prescribing safety and chronic disease management in general practice. Questions test whether you can move from a presenting problem to a defensible plan, using pre-test probability rather than reflexive test ordering.
Rules that generate marks
- Probabilistic reasoning: estimate pre-test probability from age, sex and risk factors before ordering a test; a result shifts probability, it does not create certainty.
- Evidence-based practice: check the guideline applies to your patient's subgroup; convert trial results into absolute risk reduction and number needed to treat.
- Prescribing safety: renal and hepatic dose adjustment, anticholinergic burden, QT prolongation, serotonin syndrome, and the “triple whammy” (ACE inhibitor or ARB + diuretic + NSAID).
- Antimicrobial stewardship: no antibiotic for viral upper respiratory infection; use delayed scripts and safety-netting; follow local resistance data and therapeutic guidelines.
- Chronic disease: structured GP Management Plan and Team Care Arrangements, recall systems, and targeted allied health referral.
Worked example
A 74-year-old on perindopril 5 mg and frusemide 40 mg daily starts ibuprofen 400 mg three times daily for knee osteoarthritis. Two weeks later creatinine has risen from 90 to 180 micromol/L and BP is 98/60.
Reasoning: the NSAID blocks prostaglandin-mediated afferent vasodilatation, the ACE inhibitor dilates the efferent arteriole, and the diuretic depletes volume - acute kidney injury. Best immediate action: stop the NSAID and the diuretic, hold the ACE inhibitor, rehydrate, and repeat electrolytes and creatinine within 48–72 hours. Longer-term analgesia for osteoarthritis is topical NSAID or paracetamol plus exercise.
Traps that cost marks
- Ordering imaging or referral before a focused examination.
- Prescribing an antibiotic because the patient “expects” one.
- Failing to recognise that a newly started drug is the cause of a new symptom.