Clinical1. A 52-year-old with rheumatoid arthritis collects a methotrexate prescription. Which prescribing feature is the key safety requirement in UK primary care?A. Once-weekly dosing using 2.5 mg tablets onlyB. Once-daily dosing of 10 mg tablets to improve adherenceC. Combining methotrexate with trimethoprim long term for UTI prophylaxisD. Stopping folic acid because it reduces methotrexate efficacyCheck
Clinical2. A 67-year-old with a 40 pack-year history has exertional breathlessness and a chronic productive cough. Which investigation finding best supports a diagnosis of COPD?A. Post-bronchodilator FEV1/FVC ratio below 0.7 with compatible symptomsB. A single peak-flow reading of 80 percent predictedC. A chest X-ray showing hyperinflation aloneD. A raised blood eosinophil countCheck
Clinical3. A 58-year-old van-free car driver had a 20-minute episode of left-arm weakness yesterday. Symptoms have fully resolved. TIA clinic starts antiplatelet therapy today. He asks when he may drive his private car. According to GOV.UK Assessing fitness to drive (neurological disorders page, content fetched 8 September 2026; medical professionals' PDF dated November 2025), what should you advise for a Group 1 licence?A. Stop driving for 1 month and do not notify DVLA if recovery is completeB. Notify DVLA immediately and stop driving for 12 monthsC. Continue driving if the residual NIHSS score is zero todayD. Surrender the licence and reapply after a 24-hour HolterCheck
Clinical4. A 12-year-old boy who has recently gained weight attends with a 10-day left knee ache and a limp. The knee looks normal. Internal rotation of the hip is limited and painful. He is otherwise well, afebrile, and walking with an antalgic gait. What is the most appropriate next action?A. Urgent orthopaedic assessment the same day, non-weight-bearingB. Reassure that this is Osgood-Schlatter disease and review in 6 weeksC. Routine paediatric rheumatology for possible oligoarticular JIAD. Start oral flucloxacillin for presumed osteomyelitisCheck
Clinical5. A 28-year-old with newly confirmed asthma (compatible history plus raised FeNO and variable peak flow) has mild daytime wheeze only. According to NICE NG245 (BTS/NICE/SIGN 2024), what is first-line inhaled treatment?A. As-needed low-dose ICS/formoterol (AIR therapy)B. Salbutamol metered-dose inhaler only as requiredC. Regular high-dose ICS plus oral montelukast from day oneD. Nebulised salbutamol to keep at homeCheck
Clinical6. A 41-year-old care-home night worker has intense nocturnal itch and burrows in the finger webs. You diagnose classical scabies. Which management step is essential?A. Treat the patient and all household and close contacts even if they have no itchB. Treat only those with visible burrows to avoid unnecessary insecticideC. Advise that a single wash of bed linen without insecticide is sufficientD. Start oral flucloxacillin as primary treatment of the miteCheck