Paper021. A 51-year-old woman with an intact uterus wants HRT for frequent night sweats. She has no history of VTE, breast cancer or undiagnosed bleeding. What endometrial protection is required if oestrogen is used?A. Unopposed oral oestrogen indefinitely is acceptable with a uterus, which is not the safest next step in NHS general practiceB. Combined HRT, or oestrogen plus a separate progestogen (or LNG-IUD) to protect the endometriumC. Testosterone gel as sole HRT, which is not the safest next step in NHS general practice and this would delay appropriate UK-guideline careD. Vaginal oestrogen alone always treats night sweats, which is not the safest next step in NHS general practice and this would delay appropriate UK-guideline careCheck
Paper022. A 27-year-old has cyclical pelvic pain, dyspareunia and dyschezia. Examination is normal. Pregnancy test negative. What is an appropriate first-line GP approach (NICE NG73)? The most appropriate action is: Long-term high-dose opioids as first-line, which is not the safest next step in NHS general practice and this would delay appropriate UK-guideline care despite sounding plausible in a hospital protocolTRUE. TrueFALSE. FalseCheck
Paper023. A 33-year-old at 20 weeks’ gestation with known fibroids has acute localised uterine pain and low-grade fever. She is haemodynamically stable. What is the most likely diagnosis?A. Appendicitis that never occurs in pregnancyB. Red degeneration of a fibroidC. Ectopic pregnancy at 20 weeks, which is not the safest next step in NHS general practiceD. Placental abruption as the only possibilityCheck
Paper024. A 31-year-old with a copper IUD has 6 weeks’ amenorrhoea, spotting and left iliac fossa pain. Pregnancy test is positive. What is the most appropriate action?A. Reassure that IUDs prevent all pregnancies including ectopic, which is not the safest next step in NHS general practiceB. Same-day EPAU/ectopic pathway; IUD pregnancies have a higher proportion of ectopicsC. Pull the IUD in GP and send her home without a scan, which is not the safest next step in NHS general practiceD. Give methotrexate 50 mg in the treatment room, which is not the safest next step in NHS general practice and this would delay appropriate UK-guideline careCheck
Paper025. A 29-year-old with a confirmed incomplete miscarriage is stable, rhesus-D negative, bleeding like a period. She prefers to avoid surgery. What is an appropriate option after EPAU counselling?A. Expectant management is an option for incomplete miscarriage if she is stable (NICE NG126)B. Warfarin to reduce bleeding, which is not the safest next step in NHS general practice and this would delay appropriate UK-guideline careC. Combined pill to 'restart' the pregnancy, which is not the safest next step in NHS general practice and this would delay appropriate UK-guideline careD. Forced immediate hysterectomy, which is not the safest next step in NHS general practice and this would delay appropriate UK-guideline careCheck
Paper026. A 30-year-old primip at 28 weeks has booking BP 118/70 mmHg and today 148/96 mmHg, no proteinuria, no headache. What is the most appropriate action? Select TWO correct statements.Select all that apply.A. Most appropriate: Refer the same day to maternity for gestational hypertension assessment (NICE NG133)B. The following is not the most appropriate next step: Advise extra liquorice to raise potassium, which is not the safest next step in NHS general practice and this would delay appropriate UK-guideline careC. Most appropriate: Start ramipril in GP, which is not the safest next step in NHS general practice and this would delay appropriate UK-guideline careD. Most appropriate: Wait until 36 weeks because BP always rises then, which is not the safest next step in NHS general practiceCheck
Paper027. A 28-year-old at booking had a DVT after a tibial fracture 6 years ago, no thrombophilia, BMI 24 kg/m². What is the most appropriate VTE plan?A. Warfarin throughout pregnancy, which is not the safest next step in NHS general practice and this would delay appropriate UK-guideline care despite sounding plausible in a hospital protocolB. Obstetric haematology/clinic risk assessment; many provoked VTEs still need postnatal LMWH and some need antenatal LMWH (RCOG GT37a)C. Aspirin 300 mg replaces LMWH, which is not the safest next step in NHS general practice and this would delay appropriate UK-guideline care despite sounding plausible in a hospital protocolD. No VTE discussion is required, which is not the safest next step in NHS general practice and this would delay appropriate UK-guideline care despite sounding plausible in a hospital protocolCheck
Paper028. A 33-year-old with BMI 36 kg/m² has a 26-week 75 g OGTT: fasting 5.8 mmol/L, 2-hour 8.9 mmol/L. What is the diagnosis using typical NICE NG3 thresholds?A. Gestational diabetes (fasting ≥5.6 mmol/L or 2-hour ≥7.8 mmol/L)B. Type 1 diabetes diagnosed at booking by definition, which is not the safest next step in NHS general practiceC. Impaired fasting glucose that can be ignored until postnatal, which is not the safest next step in NHS general practiceD. Normal glucose tolerance, which is not the safest next step in NHS general practice and this would delay appropriate UK-guideline careCheck
Paper029. An 8-week pregnant woman has ketonuria, cannot keep fluids down, and has lost 6% of pre-pregnancy weight. What is the most appropriate action? Select TWO correct statements.Select all that apply.A. Most appropriate: Urgent maternity/EPAU assessment for hyperemesis with dehydrationB. The following is not the most appropriate next step: IV 3% saline in the GP treatment room as routine, which is not the safest next step in NHS general practiceC. Most appropriate: Oral ginger only and review in 3 weeks, which is not the safest next step in NHS general practiceD. Most appropriate: Methotrexate for nausea, which is not the safest next step in NHS general practice and this would delay appropriate UK-guideline careCheck
Paper0210. A 29-year-old with migraine with typical scintillating scotoma requests the combined transdermal patch. What is the UKMEC category?A. UKMEC 1, which is not the safest next step in NHS general practice and this would delay appropriate UK-guideline careB. UKMEC 4 for all combined hormonal contraception, including the patchC. UKMEC 2 so the patch is preferred, which is not the safest next step in NHS general practiceD. Aura only matters for tablets, not the patch, which is not the safest next step in NHS general practiceCheck