Infectious Travel1. A 67-year-old man with a presumed urinary infection is mottled, hypotensive and newly confused in the waiting room. What is the most appropriate immediate action in UK general practice?A. Call 999 for emergency transfer for suspected red-flag sepsis (NICE NG51)B. Give a delayed 7-day oral antibiotic script and review next Friday for this presentationC. Book routine bloods and a telephone review in 48 hoursD. Reassure that community sepsis is never managed via 999Check
Infectious Travel2. A 19-year-old student has fever, neck stiffness and a spreading non-blanching purpuric rash. An ambulance is en route. He has no penicillin anaphylaxis. What should the GP do before transfer if possible?A. Withhold all antibiotics until hospital blood cultures are guaranteedB. Give benzylpenicillin intramuscularly or intravenously before transferC. Give oral phenoxymethylpenicillin and wait 2 hours at the surgeryD. Give intramuscular gentamicin as first-line community meningococcal treatmentCheck
Infectious Travel3. A 44-year-old woman has typical unilateral lower-leg cellulitis without penicillin allergy, bite, or orbital signs. What is first-line oral antibiotic therapy in NICE NG141? Select TWO correct statements.Select all that apply.A. Most appropriate: FlucloxacillinB. The following is not the most appropriate next step: Oral ciprofloxacin as routine first-line for all cellulitisC. Most appropriate: Metronidazole monotherapy in this clinical contextD. Most appropriate: Intravenous vancomycin started in every GP surgeryCheck
Infectious Travel4. A well 8-year-old had an attached UK garden tick removed today. There is no rash and he is asymptomatic. What is the most appropriate antibiotic plan? Select TWO correct statements.Select all that apply.A. Most appropriate: No routine prophylactic antibiotic; safety-net for erythema migrans and flu-like illnessB. The following is not the most appropriate next step: Immediate 3-week doxycycline for every UK tick bite just in case for this presentation in this NHS general-practice settingC. Most appropriate: Lifelong amoxicillin after any tick exposure in this NHS general-practice settingD. Most appropriate: IV ceftriaxone in the surgery for all paediatric tick bitesCheck
Infectious Travel5. A 34-year-old returned from rural West Africa 10 days ago with fever, headache and myalgia. What is the most appropriate investigation timing?A. Reassure and review in a week if still feverish in this NHS general-practice settingB. Book routine serology in 6 weeks before any film in this NHS general-practice settingC. Same-day malaria blood films (and related urgent tropical work-up), not delayed reviewD. Treat empirically with oseltamivir only and discharge for this presentation in this NHS general-practice settingCheck
Infectious Travel6. A practice nurse sustains a needlestick from a known HIV-positive source at 18:00 on Friday. Occupational health is closed until Monday. What is the most appropriate action? The most appropriate action is: Seek urgent PEP assessment tonight (ED/occupational pathway); do not wait until MondayTRUE. TrueFALSE. FalseCheck
Infectious Travel7. A 35-year-old has 3 weeks of paroxysmal cough with whoop and post-tussive vomiting. What is an appropriate GP action besides clinical care?A. Reassure that adult pertussis never needs notificationB. Give oral flucloxacillin as first-line for BordetellaC. Notify suspected whooping cough and treat with a recommended macrolide to reduce transmission if within the treatment windowD. Start high-dose inhaled corticosteroid as disease-modifying cure for this presentation in this NHS general-practice setting in this NHS general-practice settingCheck
Infectious Travel8. An eligible high-risk adult is offered nirmatrelvir/ritonavir (Paxlovid) for COVID-19. He takes simvastatin. What is the key prescribing concern if this remains UK policy in the stem?A. Ritonavir has no clinically important interactions in primary care for this presentation in this NHS general-practice setting in this NHS general-practice settingB. Simvastatin doses should always be doubled during PaxlovidC. Paxlovid inactivates all vaccines so MMR must be repeatedD. Ritonavir has major drug interactions (including some statins); interacting medicines may need holding or an alternative COVID pathwayCheck
Infectious Travel9. A 50-year-old with typical leg cellulitis has a documented anaphylaxis to penicillin. Which class of oral option does NICE NG141 include as an alternative? The most appropriate action is: Flucloxacillin despite anaphylaxis because cellulitis is staphylococcal for this presentationTRUE. TrueFALSE. FalseCheck
Infectious Travel10. A 62-year-old on chemotherapy for lymphoma has a fever of 38.2 °C but says he 'looks fine'. Neutrophils last week were 0.3 × 10⁹/L. What is the most appropriate action? Select TWO correct statements.Select all that apply.A. Most appropriate: Same-day oncology/neutropenic-sepsis pathway even if he appears relatively wellB. The following is not the most appropriate next step: Oral amoxicillin and review after the weekendC. Most appropriate: Reassure that a recent low neutrophil count is irrelevant if he is talking for this presentationD. Most appropriate: Start community G-CSF in the GP fridge as first-lineCheck