Clinical knowledge: general practice and primary care
What the exam asks
General practice questions test undifferentiated presentations, safety-netting and your ability to work to UK primary care guidance rather than hospital pathways.
Core rules
- Consult with a structure: set the agenda, explore ICE (ideas, concerns, expectations), examine, explain in chunks, check understanding, and always safety-net with explicit red flags and when to return.
- Cancer referral: follow NICE suspected cancer guidance. Haemoptysis with a heavy smoking history, unexplained weight loss or a new lump goes on a two-week-wait pathway.
- Hypertension: confirm with ambulatory or home readings, then treat stepwise with an ACE inhibitor or ARB (or a calcium channel blocker in Black African or Caribbean patients), adding a thiazide or CCB.
- Cardiovascular prevention: QRISK3 of 10% or more over 10 years triggers a statin discussion; discuss absolute risk, not relative risk.
- Antimicrobial stewardship: no antibiotic for uncomplicated URTI; consider delayed or back-up prescriptions.
- Polypharmacy: review with STOPP/START, deprescribe where benefit is unclear, and check renal function with every dose change.
Worked example
A 58-year-old smoker reports a cough for six weeks and one episode of haemoptysis. He is otherwise well and afebrile. Rather than a trial of antibiotics, arrange an urgent chest X-ray on the two-week-wait suspected lung cancer pathway and document the safety-net: return immediately if breathless or bleeding increases.
Traps
Reassuring without a plan for review; prescribing antibiotics for a viral illness to be safe; missing safeguarding in frequent attenders; forgetting that a normal examination does not exclude serious pathology when the history is high risk.