Practice · MRCGP AKT

MSK Derm Eyes ENT

2. A GP suspects cauda equina syndrome. The local community MRI slot is in 11 days. What is the most appropriate next step?

A. Hold the referral until the community MRI result is available — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice
B. Refer the same day to the emergency spinal/CES pathway without waiting for a GP-organised MRI for this person in today's UK general practice consultation for this person in today's UK general practice consultation for this person in today's UK general practice consultation for this person in today's UK general practice consultation
C. Request a routine outpatient neurosurgery letter — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice
D. Arrange GP bed rest until imaging — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice

MSK Derm Eyes ENT

6. A 71-year-old has a classic GCA story including scalp pain. The practice cannot process ESR until tomorrow. What is the most appropriate plan? Select TWO correct statements.

Select all that apply.

A. Most appropriate: Start high-dose prednisolone today and arrange same-day/urgent specialist review; do not wait for ESR or CRP for this person in today's UK general practice consultation for this person in today's UK general practice consultation for this person in today's UK general practice consultation for this person in today's UK general practice consultation for this person in today's UK general practice consultation for this person in today's UK general practice consultation for this person in today's UK general practice consultation
B. The following is not the most appropriate next step: Delay all treatment until ESR is >50 mm/h — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice
C. Most appropriate: Order CRP only and review after the weekend — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice
D. Most appropriate: Give aspirin 75 mg alone until labs return — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice

MSK Derm Eyes ENT

7. Which feature scores 2 points as a major item on the NG12 weighted 7-point melanoma checklist? Select TWO correct statements.

Select all that apply.

A. Most appropriate: Change in size for this person in today's UK general practice consultation for this person in today's UK general practice consultation for this person in today's UK general practice consultation for this person in today's UK general practice consultation for this person in today's UK general practice consultation for this person in today's UK general practice consultation for this person in today's UK general practice consultation
B. The following is not the most appropriate next step: Oozing or crusting only — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice
C. Most appropriate: Inflammation only — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice
D. Most appropriate: Change in sensation only — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice

MSK Derm Eyes ENT

10. A 68-year-old with hypermetropia has severe unilateral eye pain, vomiting, seeing haloes, a mid-dilated oval pupil and a rock-hard globe. What is the most appropriate action? Select TWO correct statements.

Select all that apply.

A. Most appropriate: Same-day emergency ophthalmology for suspected acute angle-closure glaucoma for this person in today's UK general practice consultation for this person in today's UK general practice consultation for this person in today's UK general practice consultation for this person in today's UK general practice consultation for this person in today's UK general practice consultation for this person in today's UK general practice consultation for this person in today's UK general practice consultation for this person in today's UK general practice consultation
B. The following is not the most appropriate next step: Routine glaucoma clinic in 3 months — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice
C. Most appropriate: Start atropine drops in the surgery — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice
D. Most appropriate: Treat as migraine because of nausea — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice — a commonly chosen but incorrect alternative in UK general practice

Ten-minute consult

1. A 46-year-old warehouse worker with acute lumbar disc pain reports new numbness between the buttocks when wiping. Legs are strong. What is the most appropriate action?

2. A GP suspects cauda equina syndrome. The local community MRI slot is in 11 days. What is the most appropriate next step?

4. A 29-year-old with acute non-specific low back pain has no NSAID contraindications and no red flags. What is the most appropriate pharmacological option? The most appropriate action is: Consider an oral NSAID (for example ibuprofen) at the lowest effective dose for the shortest possible time

5. A 74-year-old with new temporal headache and jaw ache notices transient visual blurring in one eye. What is the most appropriate referral?

6. A 71-year-old has a classic GCA story including scalp pain. The practice cannot process ESR until tomorrow. What is the most appropriate plan? Select TWO correct statements.

7. Which feature scores 2 points as a major item on the NG12 weighted 7-point melanoma checklist? Select TWO correct statements.

8. A 61-year-old notices two colours in a previously uniform mole. Which NG12 statement is correct? Select TWO correct statements.

9. A 22-year-old swimmer has painful itchy otitis externa, canal swollen but pinna not displaced, afebrile, no diabetes. What is the most appropriate first-line treatment?

10. A 68-year-old with hypermetropia has severe unilateral eye pain, vomiting, seeing haloes, a mid-dilated oval pupil and a rock-hard globe. What is the most appropriate action? Select TWO correct statements.