Set 1: For each patient, select the most appropriate management option.
A. Supply oral fluconazole
B. Same-day urgent assessment for possible peritonsillar abscess
C. Start intranasal corticosteroid
D. Refer urgently for possible oral cancer
E. Supply topical antibiotic ear drops
F. Self-care advice, analgesia and safety-netting
G. Start oral co-amoxiclav for all sore throats
H. Emergency assessment for airway compromise
1. A 20-year-old student has sore throat, coryza, dry cough and hoarse voice for 2 days. He is afebrile, has no tonsillar exudate, no cervical lymphadenopathy and is drinking normally.
Which option is most appropriate?
2. A 23-year-old woman has severe unilateral throat pain, fever, muffled “hot potato” voice, drooling and difficulty opening her mouth. The uvula appears deviated away from the painful side.
Which option is most appropriate?
Set 2: For each patient, select the most appropriate action.
A. Same-day urgent referral for sudden sensorineural hearing loss
B. Supply sodium bicarbonate ear drops only
C. Treat as allergic rhinitis
D. Urgent assessment for possible mastoiditis
E. Start oral fluconazole
F. Reassure and review in 3 months
G. Supply loperamide
H. Start topical fusidic acid
3. A 5-year-old child has had acute otitis media for several days. He now has fever, worsening ear pain, swelling and redness behind the ear, and the ear appears pushed forwards.
Which option is most appropriate?
4. A 62-year-old man wakes with sudden hearing loss in one ear. There is no wax obstruction, no discharge, no pain and no recent trauma. He also reports new tinnitus.
Which option is most appropriate?
Set 3: For each patient, select the most appropriate option.
A. Stop or reduce topical nasal decongestant and manage rebound congestion appropriately
B. Supply oral prednisolone for all nasal congestion
C. Emergency assessment for possible orbital or intracranial complication of sinusitis
D. Supply chloramphenicol eye drops
E. Treat as uncomplicated hay fever with long-term antibiotics
F. Start oral iron
G. Intranasal corticosteroid and allergen-avoidance advice if suitable
H. Reassure because facial swelling is normal in sinusitis
5. A 35-year-old woman has sneezing, itchy nose, clear rhinorrhoea and nasal blockage every spring. She has no fever, facial pain, purulent discharge or red-flag symptoms. Oral antihistamines only partly help.
Which option is most appropriate?
6. A 42-year-old man has used xylometazoline nasal spray several times daily for 5 weeks. His congestion improves briefly after each dose but is now worse than before. He has no fever or facial swelling.
Which option is most appropriate?
Set 4: For each patient, select the most appropriate management option.
A. Supply topical nasal decongestant
B. Reassure because oral ulcers lasting over 3 weeks are normal
C. Supply loperamide
D. Counsel on inhaler technique and mouth rinsing; treat suspected oral candidiasis if appropriate
E. Refer urgently for possible oral cancer
F. Start regular ibuprofen and review in 6 months
G. Treat as uncomplicated otitis externa
H. Start oral antibiotics for all mouth ulcers
7. A 58-year-old man uses a high-dose inhaled corticosteroid. He reports a sore mouth, altered taste and removable white plaques on the tongue and buccal mucosa. He rarely rinses after using his inhaler.
Which option is most appropriate?
8. A 61-year-old smoker has an unexplained ulcer on the side of his tongue that has persisted for 5 weeks. It is indurated and occasionally bleeds. He has no history of trauma from dentures.
Which option is most appropriate?
Set 5: For each patient, select the most appropriate option.
A. Sit upright, lean forward, pinch the soft part of the nose and review bleeding risk if recurrent or prolonged
B. Start oral phenoxymethylpenicillin
C. Reassure and advise lying flat with head tilted back
D. Start long-term oral steroids
E. Supply oral fluconazole
F. Delay treatment until hearing loss develops
G. Start loperamide
H. Treat likely otitis externa with appropriate topical therapy and advise keeping the ear dry if suitable
9. A 48-year-old man has a spontaneous nosebleed after blowing his nose. He is haemodynamically stable, bleeding is mild and from the front of the nose. He takes no anticoagulants and has no trauma.
Which option is most appropriate?
10. A 30-year-old swimmer has itchy ear canal pain, tenderness when the tragus is pressed and scant discharge. The tympanic membrane is intact and he is systemically well.
Which option is most appropriate?
Answers and Rationale
1. F
Coryza, dry cough, hoarse voice and absence of fever, exudate or tender lymph nodes suggest viral upper respiratory infection. Analgesia, fluids, self-care and safety-netting are more appropriate than routine antibiotics.
2. B
Severe unilateral throat pain, fever, trismus, drooling, muffled voice and uvula deviation suggest peritonsillar abscess. This needs same-day urgent assessment because drainage and antibiotics may be required.
3. D
Post-auricular redness, swelling, fever, worsening ear pain and protrusion of the ear after otitis media suggest mastoiditis. This is a serious complication requiring urgent assessment.
4. A
Sudden unilateral hearing loss without an obvious conductive cause is concerning for sudden sensorineural hearing loss. Prompt referral is needed because early treatment can improve outcomes.
5. G
Seasonal sneezing, itchy nose and clear rhinorrhoea suggest allergic rhinitis. Intranasal corticosteroid treatment can be appropriate when symptoms are persistent or not controlled by antihistamines alone.
6. A
Frequent topical nasal decongestant use for several weeks can cause rebound congestion. The spray should be stopped or reduced with supportive management, rather than continued indefinitely.
7. D
Removable white plaques, sore mouth and altered taste in a patient using high-dose inhaled corticosteroid suggest oral candidiasis. Mouth rinsing and inhaler technique should be reviewed, and antifungal treatment considered.
8. E
An unexplained oral ulcer persisting for more than 3 weeks, especially in a smoker and with induration or bleeding, is suspicious for oral cancer. Urgent referral is needed.
9. A
Most mild anterior nosebleeds can initially be managed by sitting upright, leaning forward and pinching the soft part of the nose. Recurrent, prolonged, heavy bleeding or anticoagulant use needs further assessment.
10. H
Tragus tenderness, ear canal itch/pain and discharge after swimming are typical of otitis externa. If the tympanic membrane is intact and the patient is well, appropriate topical therapy and keeping the ear dry are suitable.
Here are 10 extended matching questions designed to mimic the GPHC exam itself. At the bottom of the page you will find answers and rationale for each question.