Consulting in General Practice

Question 1

A 78-year-old patient attends with a gift following referral for an MI.
According to the NHS England Standard GMS Contract, what is the threshold at which gifts should be recorded in a register?
A. £25
B. £10
C. £250
D. £100
E. £50

Answer 1

Answer: D. £100

Justification: NHS England requires gifts ≥£100 from patients or relatives be recorded unless unconnected to service provision.

Resources:
- BMA. Receiving gifts from patients (2020)
- GMC. Good Medical Practice (2013, updated 2014, 2019)

Question 2

A 54-year-old patient has severe restless leg syndrome affecting sleep and work.
What is the SINGLE MOST appropriate management?
A. Lifestyle changes
B. Gabapentin
C. Quinine sulphate
D. Diazepam
E. Zopiclone

Answer 2

Answer: B. Gabapentin

Justification: First-line for significant RLS is alpha-2-delta ligands (gabapentin, pregabalin) or dopamine agonists.

Resource: West R. Restless legs syndrome. InnovAiT 2019; 12(12): 714–719.

Question 3

You work in a 10,000-patient practice.
What is the SINGLE MOST likely number of carers among the patient population?
A. 200
B. 600
C. 800
D. 400
E. 1000

Answer 3

Answer: E. 1000

Justification: Census data shows ~1 in 10 people are carers. Extrapolates to ~1000 in a 10,000-patient practice.

Resource: ONS. Census analysis – Provision of unpaid care in England and Wales (2011).

Question 4

A 38-year-old man with MUS and normal investigations is attending joint consultations with his family and mental health team.
What is the BEST description of this approach?
A. Collaborative care
B. Reattribution
C. CBT
D. Psychodynamic therapy
E. Brief intervention therapy

Answer 4

Answer: A. Collaborative care

Justification: Involves working with patient + family to define solutions. Effective for MUS.

Resource: GMC; NICE; InnovAiT guidance.

Question 5

Fitness to drive scenarios:
1. First seizure at work (21yo)
2. 3-hour arm weakness abroad (61yo)
3. Diet-controlled diabetic taxi driver (47yo)
What is the correct advice for each?

Answer 5

Answers:
1 → Driving must cease for at least six months
2 → Driving must cease for at least one month
3 → Need not notify DVLA

Justification: Based on DVLA Group 1 & 2 criteria for seizures, TIA, and diabetes.

Resource: DVLA. Assessing fitness to drive: guide for professionals.

Question 6

A man with leg fracture requests a fit note. He already self-certified the first week.
What is the SINGLE MOST appropriate action?
A. Issue from today, <3 months
B. Back-date to 1 week after injury, <3 months
C. Back-date to date of injury for 4 months
D. Issue today for 4 months
E. Refuse to issue

Answer 6

Answer: B. Back-date to a week from injury, <3 months

Justification: Fit note must follow some assessment or hospital documentation. Max 3 months in first 6 months.

Resource: DWP. Fit note: guidance for GPs.

Question 7

Which recommendation did the GMC make to reduce self-harm in doctors under investigation?
A. Emotional resilience training during undergraduate training
B. Mandatory OH exams
C. More health examiner reports
D. Random drug/alcohol testing
E. Weekly psychological support

Answer 7

Answer: A. Emotional resilience training

Justification: GMC recommends resilience training for students/doctors to improve coping under stress.

Resource: GMC. Doctors who commit suicide while under GMC investigation (2014).

Question 8

A 55-year-old woman post-ICU for pneumonia presents with low mood, tiredness and malaise.
What is the MOST likely diagnosis?
A. Post ICU syndrome
B. Anaemia
C. PMR
D. Delirium
E. PTSD

Answer 8

Answer: A. Post intensive care syndrome

Justification: Common post-ICU effects include fatigue, mood changes, weakness.

Resource: Karavadra M, Bell R. InnovAiT 2020; 13(9): 550–556.

Question 9

Which consultation technique improves understanding during consultations?
A. Calgary–Cambridge
B. SPIKES
C. Elicit–provide–elicit
D. Ask me three
E. Active listening

Answer 9

Answer: D. Ask me three

Justification: Encourages patients to ask: “What’s my main problem?”, “What do I need to do?”, “Why is it important?”

Resource: Reilly J. Health literacy. InnovAiT 2020; 13(8): 490–494.

Question 10

A hairdresser with work-related dermatitis from dyes asks about managing her condition and work.
What is the BEST consultation technique?
A. Catalytic intervention
B. Cathartic intervention
C. Housekeeping
D. Safety netting
E. Shared management plan

Answer 10

Answer: E. Shared management plan

Justification: Essential to involve patient in decisions, especially for chronic/occupational conditions.

Resource: RCGP. Curriculum Topic Guide: consulting in general practice (2019).

Question 11

42-year-old man with PHQ-9 score of 6 post-diabetic review. No psych history.
What is the SINGLE MOST appropriate management?
A. Amitriptyline
B. St John’s wort
C. Psychiatry referral
D. Fluoxetine
E. Computerised CBT

Answer 11

Answer: E. Computerised cognitive behavioural therapy (CCBT)

Justification: PHQ-9 score of 6 = mild depression. NICE advises low-intensity psychological interventions.

Resource: NICE CG91 – Depression (amended guidance).

Question 12

25-year-old woman with 1-week tiredness. Normal exam. No mood issues.
What is the MOST appropriate initial approach?
A. Reassure and advise watchful waiting
B. Routine blood tests
C. Express diagnostic uncertainty
D. Further testing + depression screen
E. See another GP

Answer 12

Answer: A. Reassure and advise watchful waiting

Justification: Serious causes unlikely with short symptom duration and no red flags. Reassurance appropriate.

Resource: BMJ; NICE – Fatigue in primary care.

Question 13

Which of these decisions may be INAPPROPRIATE when managing uncertainty?
A. Refer symptomatic gallstones for surgery
B. Menopause labs in 52yo with 2y amenorrhoea
C. Reassure 35yo with rectal bleeding after normal tests
D. Ask colleague to review skin lesion
E. Discuss smoking cessation with COPD patient

Answer 13

Answer: B. Menopause labs in 52yo with 2y amenorrhoea

Justification: Manage based on clinical picture rather than testing in clear menopausal scenarios.

Resource: GMC. Managing Uncertainty; RCGP guidance.

Question 14

31yo woman with 6-week tiredness. Normal tests. Later reveals poor sleep, low mood.
What is the SINGLE MOST appropriate next step?
A. Hepatitis serology
B. Depression screen
C. Abdo US
D. Reassure
E. Glandular fever test

Answer 14

Answer: B. Depression screen

Justification: Depression common in persistent fatigue. Screen after ruling out physical causes.

Resource: Hamilton W, Watson J. BMJ 2010; 341: c4259.

Question 15

Which is CORRECT about using interpreters in consultations?
A. Professional interpreters don’t affect outcomes
B. Declining professional interpreters → stop consult
C. Record interpreter use in notes
D. Family members best for context
E. Interpreter responsibility lies with patient

Answer 15

Answer: C. Record interpreter use in notes

Justification: NHS must provide interpreters; patients may refuse, but documentation is essential.

Resource: NICE; RCGP; GMC – Interpreting guidance.

Question 16

During the ‘golden minute’ of a consultation, what is MOST important?
A. Detailed questioning
B. Rapport with personal anecdotes
C. Check understanding
D. Open questioning + active listening
E. Structured condition-based Qs

Answer 16

Answer: D. Open questioning + active listening

Justification: Encourages disclosure of patient’s concerns and priorities early.

Resource: Moss B, Moss S. InnovAiT 2018; 12(1): 18–22.

Question 17

Patient with mitral valve prolapse seeks advice re antibiotics before dental filling.
What is the MOST appropriate response?
A. Prescribe phenoxymethylpenicillin
B. Prescribe cefalexin
C. Prescribe erythromycin
D. Reassure – antibiotics not required
E. Prescribe amoxicillin

Answer 17

Answer: D. Reassure – antibiotics not required

Justification: NICE CG64 advises against routine prophylaxis for dental work.

Resource: NICE CG64 (2008, updated 2016).

Question 18

Which statement aligns with Michael Balint’s consulting theory?
A. Communication = sender/receiver interpretation
B. Patients = drugs without side effects
C. Doctor behaviour/personality affects relationship
D. Illness = psychosocial perspective
E. Consult = game of social exchange

Answer 18

Answer: C. Doctor behaviour/personality affects relationship

Justification: Balint proposed the idea of the doctor as a therapeutic agent.

Resource: Neighbour R. InnovAiT 2018; 12(1): 24–29.

Question 19

52-year-old with bladder carcinoma in situ post-TURBT.
What is the MOST likely additional treatment?
A. No further treatment
B. Brachytherapy
C. Intravesical BCG
D. Annual monitoring
E. Radiotherapy

Answer 19

Answer: C. Intravesical BCG

Justification: CIS is high risk; BCG reduces recurrence and progression.

Resource: NICE NG2. Bladder cancer: diagnosis and management (2015).

Question 20

Tired GP ends a long consultation early without addressing all concerns.
What is the MOST appropriate action?
A. Bring patient back soon to address needs
B. Refer to specialists
C. Ask patient to see another GP
D. Leave note for next time
E. Assume patient will return if needed

Answer 20

Answer: A. Bring patient back soon to address needs

Justification: Recognising HALT states (Hungry, Angry, Late, Tired) protects patient care and safety.

Resource: Papanikitas A. InnovAiT 2017; 10(8): 452–457.

Question 21

A 37-year-old patient is asking for advice regarding fitness to fly. She has just broken her ankle and was put in a full plaster cast. She is due to fly to Egypt on holiday. The duration of the flight to Egypt is about 4–5 hours.
Which SINGLE option is MOST appropriate?
A. The patient can fly straight away without restriction
B. The patient can fly straight away provided she starts oral aspirin
C. The patient should delay flying by 48 hours
D. The patient can fly straight away provided she starts an oral anticoagulant
E. The patient should delay flying by 24 hours

Answer 21

Answer: C. The patient should delay flying by 48 hours

Justification: If a full plaster cast has been applied, the traveller should avoid flying for 48 hours for flights longer than two hours due to the risk of circulatory compromise from tissue swelling. Risk may be reduced by a bivalve cast or back slab.

Resource: Godden A. Passenger fitness to fly. InnovAiT 2021; 14(9): 540–545.

Question 22

Which ONE of the following statements regarding treatment of young people is true?
A. A 15-year-old girl wishing to commence the oral contraceptive should always have parental consent
B. Once a child is deemed to be Gillick competent this competence applies to all future forms of medical treatment
C. The parents of an 18-year-old girl with severe anorexia nervosa have the right to override her decision to refuse feeding even though she is deemed competent
D. A 15-year-old deemed Gillick competent has the right to accept treatment
E. Gillick competence only applies to contraceptive issues

Answer 22

Answer: D. A 15-year-old deemed Gillick competent has the right to accept treatment

Justification: Gillick competence gives a young person the right to accept treatment, though not necessarily to refuse it. Fraser guidelines specifically relate to contraception.

Resource: GMC. Consent. 0–18 years: guidance for all doctors. 2018.

Question 23

Which of the following consultation models introduced and described the concept of ‘housekeeping’?
A. Calgary–Cambridge
B. Neighbour
C. Tait
D. Helmann Folk
E. Pendleton

Answer 23

Answer: B. Neighbour

Justification: Roger Neighbour’s five tasks include connecting, summarising, handing over, safety netting, and housekeeping.

Resource: Harmon M, Ellender M, Draper R. Innovative new ways of consulting. InnovAiT 2018; 11(9): 483–488.

Question 24

You see a 55-year-old man who is troubled by involuntary movements of his legs during sleep. This has caused him to be increasingly tired during the day and is affecting his daily activities.
Which of the following deficiencies is the MOST likely cause?
A. Iron
B. Vitamin B12
C. Thiamine
D. Folate
E. Vitamin D

Answer 24

Answer: A. Iron

Justification: Restless leg syndrome can be caused by iron deficiency, anaemia and diabetes mellitus.

Resource: Strickland SR. Sleep disorders. InnovAiT 2023; 16(1): 27–33.

Question 25

Uncertainty about a patient’s diagnosis or management can be frustrating for GPs. Which of the following management strategies is MOST effective? A. Eliminate serious conditions, explain the plan and arrange an appropriate review B. Ask the patient to see a GP colleague as you are uncertain of the diagnosis C. Suggest repeating the normal blood tests from three weeks ago to buy time D. Refer the patient for further investigation to help with the uncertain diagnosis E. Treat the patient's anxiety which is likely to be the underlying cause of the symptoms

Answer 25

Answer: A. Eliminate serious conditions, explain the plan and arrange an appropriate review Justification: Best practice includes ruling out serious causes, sharing uncertainty, and planning safe follow-up. Resource: Danczak A. The psychology of uncertainty in difficult decisions. InnovAiT 2017; 10(8): 466–472.

Question 26

You see a teenage boy with severe acne. He has not responded to treatment with topical lotions or oral antibiotics. You discuss with him a referral to a dermatologist to consider oral isotretinoin. From what age is it presumed that a young person is able to consent to their own treatment? A. 13 years B. 17 years C. 12 years D. 18 years E. 16 years

Answer 26

Answer: E. 16 years Justification: Young people aged 16 or over are presumed competent unless proven otherwise. Resources: GMC. 0–18 years: guidance for all doctors (2018); NHS. Consent to treatment for children (2022).

Question 27

Educational tools for learning aims: 1. Identifying learning styles (activists, reflectors etc) 2. Understanding team personality types for team dynamics 3. Improving communication via video review of consultations Which tools apply?

Answer 27

Answers: 1 → Honey and Mumford Questionnaire 2 → The Belbin Inventory 3 → Calgary–Cambridge Observation Guide Justification: Each tool fits the scenario described and is used in educational settings for development. Resource: RCGP. Curriculum Topic Guides: consulting in general practice. 2019.

Question 28

A 21-year-old jockey has dry skin, low mood, constipation, and dizziness. He uses large doses of laxatives. BMI 17, pulse 48, orthostatic hypotension. Which is the SINGLE MOST likely diagnosis? A. Bulimia nervosa B. Obsessive-compulsive disorder C. Addison's disease D. Anorexia nervosa E. Hypothyroidism

Answer 28

Answer: D. Anorexia nervosa Justification: Classic signs include low BMI, bradycardia, hypotension, laxative misuse, fear of weight gain. Resource: WHO ICD-11 – Feeding or Eating Disorders. 2024.

Question 29

A 31-year-old woman complains of tiredness for six weeks. All investigations are normal. Months later, she reveals poor sleep and low mood. What is the SINGLE MOST appropriate next step? A. Test for glandular fever B. Commence antidepressant medication C. Offer sleeping tablets D. Reassure patient E. Screen for underlying depression

Answer 29

Answer: E. Screen for underlying depression Justification: Depression is found in ~17% of patients with persistent fatigue and normal tests. Resource: Hamilton W, Watson J. BMJ 2010; 341: c4259.

Question 30

Which consultation model uses an evidence-based structure including information gathering, building relationships, and explanation/planning? A. Pendleton’s model B. Cambridge–Calgary model C. Stott and Davies’ model D. Murtagh’s model E. Roger Neighbour’s model

Answer 30

Answer: B. Cambridge–Calgary model Justification: It emphasises consultation structure and effective communication tasks. Resource: RCGP Learning and Consultation Models.

Question 31

Which of the following statements regarding consent is TRUE? A. Potential complications of a procedure do not need to be mentioned if it is thought that it may frighten the patient B. Consent is not required for physical examinations C. Rare but serious side-effects of a procedure should be explained to patients D. Consent is not required for routine health screening such as cervical smears E. Written consent is the same as informed consent

Answer 31

Answer: C. Rare but serious side-effects of a procedure should be explained to patients Justification: Valid consent includes explaining all common minor and rare serious risks. Resource: GMC. Decision making and consent. 2020.

Question 32

Which of the following statements is TRUE regarding the definition of young carers? A. Under 16 years B. Under 25 years C. Under 21 years D. Under 18 years E. Under 20 years

Answer 32

Answer: D. Under 18 years Justification: Young carers are defined as children and young people under 18 who care for someone with disability or illness. Resource: Simon C, Slatcher C. Young carers. InnovAiT 2011; 4(8): 458–463.

Question 33

A 45-year-old man asks for a further fit note. He self-certified the first week. He fractured his leg two weeks ago. What is the SINGLE MOST appropriate action? A. Issue from today for <3 months B. Issue from today for 4 months C. Back-date to a week from injury for <3 months D. Back-date to injury for 4 months E. Refuse to issue

Answer 33

Answer: C. Back-date to a week from injury for <3 months Justification: Fit note must follow assessment and within first 6 months max duration is 3 months. Resource: DWP. Fit note: guidance for GPs.

Question 34

A man with back pain and normal investigations attends collaborative consultations with mental health and family. What is the BEST description of this approach? A. Collaborative care B. Reattribution C. Psychodynamic therapy D. Brief intervention therapy E. Cognitive behavioural therapy

Answer 34

Answer: A. Collaborative care Justification: Collaborative care involves patient and family to find solutions. Effective for MUS. Resource: InnovAiT guidance on MUS and care models.

Question 35

8-year-old boy with ADHD and insomnia despite behavioural efforts. Which SINGLE medication is preferred? A. Chlorphenamine B. Zopiclone C. Promethazine D. Melatonin E. Diazepam

Answer 35

Answer: D. Melatonin Justification: Melatonin is first-line for insomnia in ADHD after behavioural approaches. Resource: Strickland SR. Sleep disorders. InnovAiT 2023; 16(1): 27–33.

Question 36

61-year-old man with 4-week hoarseness, 30 cig/day, 40 units alcohol/week, normal chest X-ray. What is the MOST appropriate INITIAL management? A. Chest CT B. Urgent head and neck referral C. Observe and review D. Erythromycin E. Respiratory referral

Answer 36

Answer: B. Urgent head and neck referral Justification: Persistent unexplained hoarseness over 3 weeks in smokers/alcohol users requires 2WW ENT referral. Resource: NICE NG12. Suspected Cancer (updated 2023).

Question 37

42-year-old man with PHQ-9 score of 6 after diabetes review. No prior mental illness. What is the SINGLE MOST appropriate management? A. Counselling B. Guided self-help C. SSRI medication D. Amitriptyline E. St John’s Wort

Answer 37

Answer: B. Guided self-help Justification: NICE NG222 recommends guided self-help as first-line for less severe depression. Resource: NICE NG222. Depression in adults. 2022.

Question 38

Which statement is CORRECT when using an interpreter during a consultation? A. Interpreter use doesn’t improve outcomes B. Patient must arrange interpreter C. Family members are preferred interpreters D. Record interpreter use in patient notes E. Do not proceed if patient insists on friend/family interpreter

Answer 38

Answer: D. Record interpreter use in patient notes Justification: Use of professional interpreters improves care; documentation is key. Resource: GMC, NICE, RCGP – Interpreting in primary care.

Question 39

6-year-old girl had car accident 1 week ago. Now subdued, has nightmares, and plays accident with toys. What is the MOST appropriate INITIAL management? A. Review in 3 weeks if persists B. Sedate with antihistamine C. Refer for EMDR D. Refer for CBT E. Review in 1 week

Answer 39

Answer: A. Review in 3 weeks if persists Justification: Early PTSD signs should be monitored. Active treatment generally delayed until 1 month. Resource: NICE PTSD guidance (children).

Question 40

52-year-old woman diagnosed with bladder CIS post-TURBT. What is the SINGLE MOST likely further treatment? A. No further treatment B. Brachytherapy C. Annual monitoring D. Intravesical BCG E. Radiotherapy

Answer 40

Answer: D. Intravesical BCG Justification: BCG is used in high-risk non-muscle invasive bladder cancer to reduce progression. Resource: NICE NG2. Bladder cancer: diagnosis and management. Updated 2020.

Question 41

According to current DVLA rules, after a first unprovoked seizure, what is the minimum time a person must not drive? A. Six months B. Three months C. Three years D. 12 months E. Five years

Answer 41

Answer: A. Six months Justification: The DVLA requires people to stop driving for 6 months after a first unprovoked seizure. If risk of recurrence is high, this extends to 12 months. Resource: DVLA. Assessing Fitness to Drive: a guide for medical professionals. 2016.

Question 42

A 22-year-old man with mumps asks how long to remain off work. A. 24 hours after resolution B. 3 days from onset C. 7 days from diagnosis D. 9 days from onset E. 5 days from onset

Answer 42

Answer: E. 5 days from onset Justification: Patients are infectious 3 days before and up to 7 days after parotitis. NICE advises staying off school/work for 5 days from onset. Resource: NICE CKS. Mumps. 2018.

Question 43

A 69-year-old with restless leg symptoms at night. Already tried lifestyle changes. Which is the MOST appropriate management? A. Sodium valproate B. Pramipexole C. Carbamazepine D. Ibuprofen E. Melatonin

Answer 43

Answer: B. Pramipexole Justification: Dopamine agonists like pramipexole are effective for restless leg syndrome when non-drug measures fail. Resource: Strickland SR. Sleep disorders. InnovAiT 2023; 16(1): 27–33.

Question 44

51-year-old with bloating, weight loss, appetite loss, urinary urgency. What is the MOST likely diagnosis? A. Ovarian cancer B. Diabetes mellitus C. IBS D. Hyperthyroidism E. UTI

Answer 44

Answer: A. Ovarian cancer Justification: Vague symptoms like bloating, satiety, urinary symptoms and weight loss are red flags for ovarian cancer. Resource: Maxwell SS et al. Ovarian cancer in primary care. InnovAiT 2022; 15(9): 525–531.

Question 45

8-year-old with ADHD and insomnia unresponsive to behavioural strategies. Which medication would a specialist recommend? A. Promethazine B. Melatonin C. Zopiclone D. Chlorphenamine E. Diazepam

Answer 45

Answer: B. Melatonin Justification: Melatonin is recommended in children with ADHD and persistent insomnia, on specialist advice. Resource: Strickland SR. Sleep disorders. InnovAiT 2023; 16(1): 27–33.

Question 46

Female patient, distressed after adverse events. No mental illness or suicide risk. Which is the MOST appropriate medium-term management? A. Benzodiazepine B. Reassure and discharge C. Written dos/don’ts D. Always make yourself available E. Encourage self-help and review

Answer 46

Answer: E. Encourage self-help and review Justification: Encouraging autonomy and supporting coping strategies is better than overreliance or pharmacological treatment. Resource: RCGP Curriculum – Consulting in GP.

Question 47

38-year-old woman with mitral valve prolapse needs dental filling. What is the MOST appropriate action? A. Amoxicillin B. Reassure – no antibiotics needed C. Penicillin V D. Erythromycin E. Cefalexin

Answer 47

Answer: B. Reassure – no antibiotics needed Justification: NICE CG64 advises against routine prophylaxis for dental work. Resource: NICE CG64. Prophylaxis against infective endocarditis. 2016.

Question 48

Consulting with a patient with medically unexplained symptoms. What is the BEST initial strategy? A. Simplify explanation to one event B. Focus on diagnosis C. Repeat tests D. Acknowledge concerns E. Reassure symptoms are normal

Answer 48

Answer: D. Acknowledge concerns Justification: Validating the patient’s experience builds trust and supports shared management. Resource: RCGP – MUS consultation strategies.

Question 49

28-year-old with a superficial human bite on hand. No signs of infection. What is the MOST appropriate treatment? A. Clarithromycin B. No treatment C. Amoxicillin D. Flucloxacillin E. Co-amoxiclav

Answer 49

Answer: E. Co-amoxiclav Justification: Human bites require prophylaxis if skin is broken, especially in high-risk areas like hands. Resource: NICE CKS – Human and animal bites (2022).

Question 50

Which patient automatically qualifies for a Blue Badge without assessment? A. 19-year-old with cerebral palsy B. 71-year-old with heart failure C. 67-year-old with attendance allowance D. 37-year-old with incapacity benefit E. 69-year-old with War Pensioner’s Mobility Supplement

Answer 50

Answer: E. 69-year-old with War Pensioner’s Mobility Supplement Justification: This is an automatic qualifying criterion for a Blue Badge. Resource: Department for Transport. Blue Badge scheme (2023).

Question 51

31-year-old woman with 6-week fatigue, no red flags. Normal vitals and exam. What is the MOST appropriate next step? A. Further investigations in primary care B. Review in 2–3 weeks C. Ask her to return in a month D. Reassure and do not investigate E. Refer to chronic fatigue specialist

Answer 51

Answer: A. Further investigations in primary care Justification: Investigations should be done after 4+ weeks fatigue with no clear cause, to rule out underlying illness. Resource: NICE NG206. ME/CFS diagnosis and management. 2021.

Question 52

78-year-old brings a gift after MI referral. At what value must gifts be registered per NHS GMS contract? A. £10 B. £100 C. £50 D. £25 E. £500

Answer 52

Answer: B. £100 Justification: NHS GMS contract requires recording gifts ≥£100 unless unrelated to care. Resources: BMA. Receiving gifts (2020); GMC. Good Medical Practice (2024).

Question 53

Chronic pain patient on gabapentin, tramadol, naproxen, paracetamol. What is the MOST appropriate approach to med review? A. Avoid discussing evidence gaps B. Stop immediately – no evidence base C. Assess harms/benefits and agree plan D. Maintain current meds due to long use E. Taper all over next few weeks

Answer 53

Answer: C. Assess harms/benefits and agree plan Justification: Shared decision-making helps patients reduce medication burden where appropriate. Resource: NICE. Chronic pain in over 16s (NG193).

Question 54

Best method for giving structured feedback per Pendleton’s rules? A. Focus on body language B. Emphasise poor performance C. Encourage by highlighting positives D. State what went well, then suggest improvements E. Highlight clinical knowledge

Answer 54

Answer: D. State what went well, then suggest improvements Justification: Pendleton’s rules emphasise balance: strengths first, then constructive critique. Resource: Pendleton D. Consultation models in GP training.

Question 55

38-year-old post-viral illness with fatigue, brain fog, normal tests. Suspected COVID, negative test. What is the MOST likely diagnosis? A. Post COVID-19 syndrome B. Depression C. Hypothyroidism D. Anxiety E. Menopause

Answer 55

Answer: A. Post COVID-19 syndrome Justification: Can occur without confirmed infection. Diagnosis of exclusion after 12+ weeks of symptoms. Resource: Allsopp G, Blythe J. InnovAiT 2022; 15(7): 383–387.

Question 56

54-year-old with severe restless legs affecting sleep/work. Which is the MOST appropriate management? A. Zopiclone B. Ropinirole C. Diazepam D. Quinine sulphate E. Codeine sulphate

Answer 56

Answer: B. Ropinirole Justification: First-line includes dopamine agonists like ropinirole or gabapentinoids. Resources: NICE CKS RLS (2022); West R. InnovAiT 2019; 12(12).

Question 57

Which system is an online clinical decision support tool specifically for GPs? A. OMNI B. CKS C. NeLH D. SystemOne E. MEDLINE

Answer 57

Answer: B. CKS Justification: Clinical Knowledge Summaries provide evidence-based GP guidance. Resource: NICE. Clinical Knowledge Summaries (CKS).

Question 58

You are called to verify a 51-year-old woman found dead at home. Last GP review 6 months ago. What is the MOST appropriate next step? A. Call social worker B. Call funeral director C. Call ambulance D. Notify coroner via police E. Contact the coroner directly

Answer 58

Answer: D. Notify coroner via police Justification: Unexpected deaths should be reported via police who notify coroner out of hours. Resource: NICE. Death verification and notification guidance.

Question 59

24-year-old asks about becoming an organ donor. Which is TRUE? A. Diabetes is an absolute contraindication B. Organs only donated post-death C. Max age for donors is 70 D. Human Tissue Authority regulates living donation E. NHS pays for donor funerals

Answer 59

Answer: D. Human Tissue Authority regulates living donation Justification: Living donations (e.g. kidney, liver segment) are regulated by the HTA in the UK. Resource: NHS Blood and Transplant; HTA UK.

Question 60

19-year-old repeatedly requesting antibiotics for viral pharyngitis. What is the MOST appropriate consultation model? A. Cambridge–Calgary B. Transactional Analysis C. FRAYED D. DR SAMOSA E. Helman–Folk

Answer 60

Answer: C. FRAYED Justification: FRAYED helps manage unreasonable requests in challenging consultations. Resource: Mirza D. InnovAiT 2018; 12(1): 33–37.