Msk1. A 44-year-old develops bilateral sciatica, new urinary retention and saddle numbness. What is the most appropriate next step? The most appropriate action is: Emergency same-day hospital assessment for suspected cauda equina syndromeTRUE. TrueFALSE. FalseCheck
Msk2. A 52-year-old man with no CKD or ulcer history has acute first MTP gout. What is an appropriate first-line anti-inflammatory option?A. Immediate IV antibiotics for septic arthritis without assessmentB. Allopurinol 300 mg as the sole acute treatment with no anti-inflammatory for this presentationC. Lifelong high-dose codeine only in this NHS general-practice settingD. A short course of NSAID (or colchicine or corticosteroid by comorbidity)Check
Msk3. A 48-year-old woman has 8 weeks of early-morning stiffness and bilateral MCP synovitis. RF is pending. What is the most appropriate action?A. Urgent rheumatology referral for suspected RA without waiting for serologyB. Wait 12 months for RF before any referralC. Start methotrexate 15 mg weekly in GP todayD. Reassure that seronegative synovitis cannot be RA for this presentation in this NHS general-practice settingCheck
Msk4. A 76-year-old with new headache, jaw claudication and fleeting visual loss attends. What is the most appropriate action? Select TWO correct statements.Select all that apply.A. Most appropriate: Same-day specialist assessment and start high-dose corticosteroid without delaying for biopsyB. The following is not the most appropriate next step: Routine rheumatology in 3 months in this NHS general-practice settingC. Most appropriate: Prednisolone 5 mg for presumed PMR only in this NHS general-practice settingD. Most appropriate: Reassure that visual symptoms in GCA can wait for ESR for this presentation in this NHS general-practice settingCheck
Msk5. A 68-year-old with knee osteoarthritis and no red flags. Core exercise advice is given. What is first-line topical drug treatment (NG226)?A. Oral morphine MR as first-lineB. Glucosamine on the NHS as first-lineC. Long-term oral ketoprofen without considering topicalD. Topical NSAIDCheck
Msk6. A 72-year-old woman has a low-trauma wrist fracture. DEXA confirms osteoporosis. eGFR is 70. What is a usual first-line oral treatment?A. Alendronate (plus calcium/vitamin D if diet deficient)B. Unsupervised high-dose oral calcitriol onlyC. Immediate total hip replacement for the wrist fracture for this presentationD. Prednisolone 30 mg to 'strengthen bone'Check
Msk7. A 45-year-old with fibromyalgia/chronic primary pain asks for modified-release oxycodone. What is NICE-aligned advice?A. Start high-dose oxycodone as first-line in this NHS general-practice settingB. Do not initiate opioids for chronic primary pain; offer non-pharmacological approachesC. Mandatory gabapentin for all fibromyalgia in this NHS general-practice settingD. Long-term benzodiazepines as core treatment for this presentation in this NHS general-practice settingCheck
Msk8. A 54-year-old diabetic has 4 months of shoulder pain with global restriction, especially external rotation, and a normal X-ray. What is the most likely diagnosis?A. Acute anterior dislocation still presentB. Uncomplicated AC joint sprain from last week onlyC. Frozen shoulder (adhesive capsulitis)D. Polymyalgia rheumatica confined to one shoulder without stiffness elsewhereCheck
Msk9. A 13-year-old boy who is overweight has a limp and knee pain. Knee examination is normal; internal rotation of the hip is limited and painful. What must not be missed? The most appropriate action is: Osgood–Schlatter as the only diagnosis without examining the hipTRUE. TrueFALSE. FalseCheck
Msk10. A 67-year-old has an acutely hot, exquisitely painful knee with fever. What is the most appropriate GP action?A. Same-day hospital assessment for suspected septic arthritis; do not inject steroidB. Intra-articular triamcinolone in the treatment room today for this presentation in this NHS general-practice settingC. Oral flucloxacillin and review in 2 weeksD. Reassure as 'flare of OA' without assessmentCheck