091. A 58-year-old woman develops a drooping right eyelid while staking beans on her allotment. The right pupil is larger than the left and reacts poorly to light. The globe sits down and out. She has a mild right temporal headache. Blood glucose is 6.1 mmol/L. What is the most appropriate next action?A. Urgent same-day medical admission to exclude a compressive third-nerve palsy (posterior communicating artery aneurysm until proven otherwise)B. Trial of pyridostigmine in primary care for presumed myastheniaC. Reassure that diabetic microvascular III palsy is certain and review in 8 weeksD. Start high-dose prednisolone for giant cell arteritis and review if no better in a monthE. Routine community optometry for new reading glassesCheck
092. A 27-year-old man with newly confirmed asthma (spirometry + FeNO) asks for ‘just a blue inhaler like my brother had’. He is 12 or over, not pregnant, and has infrequent symptoms. According to current national guidance, what is the most appropriate prescribing principle?A. Nebulised salbutamol to take home for all new asthmaB. Do not prescribe SABA-only treatment; offer an inhaled corticosteroid-containing reliever pathway (anti-inflammatory reliever / MART as indicated for his age)C. Salbutamol MDI 2 puffs as required is first-line as a single agentD. Oral montelukast monotherapy replaces any inhalerCheck
093. A 12-year-old boy who has recently gained weight attends with a 3-week limp and pain in the left knee. The knee looks normal. Internal rotation of the left hip is limited and the hip is irritable. Select TWO correct statements.Select all that apply.A. Slipped upper femoral epiphysis (SUFE) can present with referred knee pain and a deceptively normal knee examinationB. He should be kept non-weight-bearing and referred urgently for orthopaedic assessment (frog-lateral imaging in secondary care)C. Reassurance and a 6-week wait for ‘growing pains’ is appropriate because the knee is not swollenD. A trial of oral dexamethasone in primary care should precede any imagingCheck
094. Registered medical practitioners must notify suspected measles to the local health protection team urgently and must not wait for laboratory confirmation.TRUE. TrueFALSE. FalseCheck
095. A 41-year-old man has 10 days of worse headache on straining, transient visual obscurations, and horizontal diplopia. Examination: he cannot abduct the right eye; fundi show blurred disc margins. What is the most likely cranial-nerve lesion and the safest GP action?A. Right trochlear (IV) palsy — community prism glasses onlyB. Left hypoglossal (XII) palsy — start community aspirinC. Right abducens (VI) palsy as a false localising sign of raised intracranial pressure — same-day emergency assessmentD. Right oculomotor (III) palsy — book routine neurology in 3 monthsCheck
096. A 34-year-old man recalls a tick after walking in long grass. Seven days later he has an expanding, painless, non-itchy circular rash with central clearing on the thigh, diameter 8 cm, no fever. What is the most appropriate action?A. Withhold antibiotics until Lyme serology returns in 2 weeksB. Incise and drain the rash as an abscessC. Potent topical corticosteroid as first-line for presumed ringwormD. Start oral doxycycline for erythema migrans without waiting for serologyCheck
097. A 62-year-old 40-pack-year smoker has slowly progressive exertional breathlessness, winter bronchitis, and little day-to-day variability. Spirometry: FEV1/FVC 0.58 after bronchodilator, FEV1 62% predicted, little reversibility. Select TWO correct statements.Select all that apply.A. The picture is more consistent with COPD than with late-onset variable asthmaB. Offer smoking cessation and vaccinations as core COPD care, not only an inhalerC. A normal peak-flow diary would exclude COPDD. Start a SABA-only asthma pathway because he wheezed onceCheck
098. A 71-year-old woman with hypertension has new ECG-confirmed atrial fibrillation, rate 88/min at rest, no heart failure symptoms. CHA2DS2-VASc is 3. What is the most appropriate stroke-prevention principle?A. Offer anticoagulation (DOAC first-line unless contraindicated); do not use aspirin monotherapy for stroke prevention in AFB. Aspirin 75 mg daily is sufficient because her rate is controlledC. No antithrombotic is needed until she has a strokeD. Immediate DC cardioversion in GP without anticoagulation planningCheck
099. A new Horner syndrome (ptosis, miosis, apparent enophthalmos) in a smoker with shoulder-tip pain should prompt urgent investigation for apical lung cancer rather than reassurance as ‘simple ptosis of ageing’.TRUE. TrueFALSE. FalseCheck
0910. A 64-year-old with type 2 diabetes on empagliflozin has gastroenteritis with poor oral intake. Capillary glucose 8.4 mmol/L, no ketones when last checked, eGFR 62. What is the most appropriate immediate prescribing advice?A. Continue SGLT2i and add a thiazide diuretic for ‘protection’B. Withhold the SGLT2 inhibitor during acute dehydrating illness (sick-day rules) and restart when eating and drinking normallyC. Double the empagliflozin to cover the illnessD. Add pioglitazone today as sick-day coverCheck