GPH Flashcards
(20 cards)
A 35-year-old woman has noticed increasing weakness and numbness in her legs and
arms over the past few days. Today she is feeling short of breath on exertion.
Six weeks ago, she had diarrhoea and stool culture confirmed infection with
Campylobacter jejuni. She was treated with ciprofloxacin and recovered fully.
Which is the single most likely diagnosis? Select one option only.
A. Drug-induced neuropathy
B. Guillain-Barré syndrome
C. Multiple sclerosis
D. Myasthenia gravis
E. Transverse myelitis
Guillain-Barré syndrome is an acute ascending polyneuropathy which usually occurs
following an infection. It can eventually affect the respiratory muscles
A 26-year-old woman is day 8 of a 28-day cycle and had unprotected sexual intercourse
12 hours ago. This was the first occasion within this cycle.
She requests levonorgestrel 1.5 mg emergency contraception but also wants to quick-
start the combined hormonal contraceptive pill (CHC).
Having started the CHC, which is the single most appropriate length of time that she
needs to take extra contraceptive precautions, if any? Select one option only.
A. 24 hours
B. 5 days
C. 7 days
D. 14 days
E. No additional precautions needed
When a woman quick-starts the combined hormonal contraceptive (CHC) after unprotected sexual intercourse (UPSI), she needs to take additional contraceptive precautions (e.g. condoms) for 7 days. This is because the CHC is not immediately effective in preventing ovulation if started mid-cycle or after UPSI
A 50-year-old man has become increasingly tired and lethargic over the past six months
and has developed erectile dysfunction. His wife comments that he looks tanned even
in the winter months.
His blood results are as follows:
Normal range
Haemoglobin (g/L) 140
Ferritin (µg/L) 1200 30-400
Transferrin saturation (%) 84 <50
Which is the single most likely diagnosis? Select one option only.
A. Addison’s disease
B. Chronic active hepatitis
C. Haemochromatosis
D. Hypothyroidism
E. Type 2 diabetes
Answer C. (Haemochromatosis)
Haemochromatosis is an inherited disorder which increases absorption of dietary iron.
This accumulates gradually in the liver, pancreas, skin, joints, heart or endocrine
glands causing serious tissue damage and is associated with erectile dysfunction.
Ferritin and transferrin are raised.
A. Alendronic acid
B. Allopurinol
C. Diclofenac
D. Etoricoxib
E. Febuxostat
F. Hydroxychloroquine
G. Infliximab
H. Methotrexate
RETINOPATHY
Although retinopathy is rare, people taking long-term hydroxychloroquine should have
an annual vision check.
pneumonitis
A. Alendronic acid
B. Allopurinol
C. Diclofenac
D. Etoricoxib
E. Febuxostat
F. Hydroxychloroquine
G. Infliximab
H. Methotrexat
Lung disease is a well-recognised manifestation of rheumatoid arthritis, including
pulmonary nodules and pleural effusions. Methotrexate-induced pneumonitis is a rare
but life-threatening adverse drug reaction.
A 65-year-old retired man had an elective coronary artery angioplasty and stent
insertion one week ago. He is now well and asymptomatic. He asks you for advice
about driving his car.
According to DVLA guidance, which is the single most appropriate advice? Select one
option only.
A. He may resume driving immediately
B. He may resume driving after a further week
C. He may resume driving one month after the angioplasty
D. He may resume driving six months after the angioplasty
E. He must inform the DVLA and await their decision before resuming driving
DVLA guidance is to stop driving for one week after the procedure. Candidates are
not expected to know all the guidance for all medical conditions but it is important to
be aware of common restrictions and legal requirements to give patient accurate
advice, including when to check the current guidance.
Remember there is a difference in guidance between car drivers, and goods and
public service vehicle drivers.
A 43-year-old woman with persistent dyspepsia for six weeks has a positive H. pylori
stool antigen result. She is treated with a one-week course of triple therapy. She is
reviewed four weeks later and is symptom free.
Which is the single most appropriate next management option? Select one option
only.
A. Check eradication with H pylori stool antigen test
B. Check eradication with H. pylori breath test
C. Continue proton-pump inhibitor therapy for further four weeks
D. Maintenance low-dose proton-pump inhibitor therapy
E. No further treatment necessary
Answer E. (No further treatment necessary)
Current guidance is that no follow-up is required after triple therapy if the patient is
symptom free.
According to UKMEC 2016 guidance, for which one of the following conditions is the
risk of DMPA most likely to outweigh the benefit? Select one option only.
A. Diabetes mellitus
B. Breast cancer
C. Previous ovarian cysts
D. Previous ectopic pregnancy
E. Current smoke
Answer B. (Breast cancer)
Depo-Provera should not be used within 5 years of a diagnosis of breast cancer and,
even after that, should only be used if non-hormonal methods are unacceptable and
there is no evidence of disease recurrence.
Because parental progestogen contraceptives inhibit ovulation, they are protective
against ovarian cysts and ectopic pregnancy.
A 50-year-old woman has painful knees. She feels tired and her memory is poor. She
has recently lost her appetite, feels nauseated and is constipated. Urinalysis is normal.
Which is the single most likely diagnosis? Select one option only.
A. Addison’s disease
B. Chronic renal failure
C. Conn’s syndrome
D. Cushing’s syndrome
E. Hyperparathyroidism
Answer E. (Hyperparathyroidism)
The patient is most likely to have hyperparathyroidism. causing hypercalcaemia -
such as bone and joint pain, loss of appetite, nausea, tiredness and psychological
symptoms.
A 67-year-old man with known long QT interval has a chest infection that requires
antibiotic treatment.
According to the BNF, which single antibiotic is most important to avoid in this
situation? Select one option only.
A. Amoxicillin
B. Ciprofloxacin
C. Clarithromycin
D. Co-amoxiclav
E. Doxycycline
All macrolides, clarithromycin, azithromycin, erythromycin predispose to QT interval
prolongation.
A 34-year-old woman has had a sore throat for two days. She has ulcerative colitis
which is well controlled with maintenance oral mesalazine.
She has a mild fever of 37.8 oC and has pus on her tonsils.
Which is the single most appropriate initial investigation? Select one option only.
A. ASO titre
B. FBC
C. Liver function tests
D. Throat swab
E. Urine for culture
Answer B. (FBC)
All aminosalicylates can cause rare but serious blood disorders, including
agranulocytosis, aplastic anaemia, leukopenia, methaemoglobinaemia, neutropenia,
and thrombocytopenia. Patients should be warned to report fever, sore throat or
abnormal bleeding in order to ensure an urgent blood count is performed.
Which is the single most appropriate antidepressant to prescribe to a breastfeeding
mother with postnatal depression? Select one option only.
A. Duloxetine
B. Escitalopram
C. Fluoxetine
D. Mirtazapine
E. Sertraline
Answer E. (Sertraline)
Antidepressants can be used by breastfeeding women if drug therapy benefits are
thought to outweigh the risks. Sertraline is thought to be the safest on the list given
due to low expression in breast milk whereas the others are advised to be avoided.
A 45-year-old man has cluster headaches which have failed to respond to sumatriptan.
He has attended a specialist headache clinic for further advice.
According to current national guidance, which is the single most appropriate next
treatment for his acute episodes? Select one option only.
A. Fentanyl patch
B. GTN spray
C. High flow oxygen
D. Nasal nicotine
E. Sublingual buprenorphine
Answer C. (High flow oxygen)
High flow oxygen is a specialist treatment for cluster headaches that do not respond
to a triptan. It is important to be aware of what other options are available from
secondary care. Opiates should be avoided for cluster headaches.
62-year-old man has heart failure due to left ventricular dysfunction. He is seen for
annual routine review.
His pulse is 96/min and irregular and his blood pressure is 135/72.
An ECG confirms a new diagnosis of atrial fibrillation.
Which is the single most appropriate initial medication, if any, to control his heart
rate? Select one option only.
A. Bisoprolol
B. Digoxin
C. Sotalol
D. Verapamil
E. No rate-control treatment required
Answer A. (Bisoprolol)
Rate-controlling treatment should be offered first-line aiming for a resting heart rate of
60-80 beats per minute. A beta blocker (with the exception of sotalol) or rate-limiting
calcium channel blocker should be offered. However, the latter is contraindicated in
heart failure, making bisoprolol a more appropriate choice for this patient. Digoxin
should only be considered in sedentary people.
A 92-year-old woman who lives alone and cares for herself, has long-standing
constipation. She has no rectal bleeding or pain, her weight is steady, abdominal and
rectal examinations are normal and she is otherwise well.
Which is the single most likely cause of her constipation? Select one option only.
A. Alzheimer’s disease
B. Carcinoma of the colon
C. Diverticular disease
D. Hypothyroidism
E. Poor fibre intake
The most likely cause of this patient’s constipation is dietary, and there are no
indicators of more serious disease in her history and examination.
A 67-year-old man has nocturia and post-micturition dribbling which is interfering with
his sleep. He has an International Prostate Symptom Score of 9, which is in the
moderate range (8 to 19).
Clinical examination and investigations are in keeping with benign prostatic hyperplasia
with a minor degree of prostate enlargement.
Which is the single most appropriate initial treatment? Select one option only.
A. Duloxetine
B. Finasteride
C. Oxybutynin
D. Solifenacin
E. Tamsulosin
Answer E. (Tamsulosin)
NICE guidance recommends that if a man has moderate-to-severe voiding
symptoms (which would correspond to an International Prostate Symptom Score of 8
or more), the first-line treatment is an alpha-blocker (alfuzosin, doxazosin, tamsulosin,
or terazosin).
A 64-year-old woman with CKD3 and hypertension has an annual review. Her average
BP on home monitoring is 143/84. She is currently taking amlodipine 5 mg and
atorvastatin 20 mg daily.
Her renal function is stable with an eGFR of 54 ml/min and her urinary
albumin:creatinine ratio is 45 mg/mmol (normal range < 3 mg/mmol).
Which is the single most appropriate additional drug treatment, if any? Select one
option only.
A. Aspirin
B. Clopidogrel
C. Indapamide
D. No additional drug therapy indicated
E. Ramipril
Answer E. (Ramipril)
NICE suggest a low-cost renin-angiotensin system antagonist for people with
hypertension and an ACR > 30 mg/mmol as well as suggesting a target BP of lower
than 140/90.
An 84-year-old man has just undergone mitral valve replacement with a mechanical
valve.
Which is the single most appropriate anticoagulant? Select one option only.
A. Apixaban
B. Aspirin
C. Clopidogrel
D. Dabigatran
E. Warfarin
A mechanical valve replacement requires lifelong anticoagulation with warfarin and
the direct-acting oral anticoagulants (DOACs) are not licensed for this indication.
A 45-year-old woman is admitted to hospital with an acute depressive episode. She is
started on medication. She suddenly develops shivering, sweating, diarrhoea and
confusion.
Which is the single most likely drug to have been started? Select one option only.
A. Fluoxetine
B. Lithium
C. Mirtazapine
D. Trazodone
E. Valproate
This is serotonin syndrome. Fluoxetine is the only SSRI on the list. Serotonin
syndrome is a severe illness which tends to develop over hours and requires
cessation of the causative medication plus supportive care which may include
admission to hospital for fluids.
Features of serotonin syndrome include confusion, delirium, shivering, sweating,
changes in blood pressure and myoclonus
According to the current BNF, which is the single most appropriate anti-emetic to use
in a syringe driver with diamorphine? Select one option only.
A. Domperidone
B. Glycopyrronium bromide
C. Levomepromazine
D. Ondansetron
E. Prochlorperazine
Answer C. (Levomepromazine)
Haloperidol and cyclizine can also be used as an anti-emetic in a syringe driver with
diamorphine but unlike levopromazine, are associated with a risk of precipitation.
