Set 1: For each patient, select the most appropriate management option.
A. Immediate doxycycline
B. Immediate phenoxymethylpenicillin
C. Immediate co-amoxiclav
D. Emergency assessment for possible sepsis or airway compromise
E. Immediate oseltamivir
F. Self-care advice only, with safety-netting
G. Immediate oral fluconazole
H. Back-up antibiotic prescription strategy
1. A 21-year-old student has sore throat, dry cough, coryza and hoarse voice for 2 days. He is afebrile, has no tonsillar exudate and no cervical lymphadenopathy. He is drinking normally and has no breathing difficulty.
Which option is most appropriate?
2. A 19-year-old woman has a sore throat that started suddenly yesterday. She has fever, purulent tonsillar exudate, tender anterior cervical lymph nodes and no cough. She is systemically well, swallowing fluids and has no airway symptoms.
Which option is most appropriate?
Set 2: For each patient, select the most appropriate option.
A. Oral nitrofurantoin
B. Oral fluconazole
C. Nebulised salbutamol only
D. Urgent hospital assessment
E. Immediate oseltamivir
F. Oral co-amoxiclav
G. No antibiotic; manage as likely acute bronchitis with safety-netting
H. Oral amoxicillin
3. A 42-year-old man has a cough for 5 days after a cold. He has yellow sputum but no breathlessness, normal observations, no chest signs and no significant comorbidities. He asks for antibiotics.
Which option is most appropriate?
4. A 79-year-old woman has fever, confusion, respiratory rate 30/min, oxygen saturations 90% on air and right basal crackles. She lives alone and has chronic kidney disease.
Which option is most appropriate?
Set 3: For each patient, select the most appropriate management option.
A. Oral fluconazole
B. Ciprofloxacin first-line for all lower UTIs
C. Treat as UTI in pregnancy and send urine culture according to local guidance
D. Reassure and advise that antibiotics are never used for urinary symptoms
E. Oral aciclovir
F. Nitrofurantoin regardless of renal function or infection site
G. Treat as catheter-associated asymptomatic bacteriuria
H. Nitrofurantoin, if renal function and clinical situation are suitable
5. A 34-year-old non-pregnant woman has dysuria and urinary frequency. She has no vaginal discharge, fever, flank pain or haematuria. Her eGFR is 78 mL/min/1.73 m² and she has no drug allergies.
Which option is most appropriate?
6. A 28-year-old woman who is 22 weeks pregnant has dysuria and urinary frequency. She is systemically well with no flank pain or fever. She has no known drug allergies.
Which option is most appropriate?
Set 4: For each patient, select the most appropriate option.
A. Do not treat cloudy urine alone in a well catheterised patient; assess for symptoms and safety-net
B. Vaginal antifungal treatment
C. Oral loperamide
D. Methenamine as acute treatment only
E. Urgent clinical assessment for possible pyelonephritis or complicated UTI
F. Delayed antibiotic after 2 weeks
G. Treat as uncomplicated lower UTI
H. Topical hydrocortisone
7. A 45-year-old woman has dysuria and frequency with fever, rigors, loin pain and vomiting. She feels light-headed and cannot keep fluids down.
Which option is most appropriate?
8. A 72-year-old man with an indwelling catheter has cloudy urine but no fever, suprapubic pain, flank pain, rigors or acute confusion. He is otherwise well.
Which option is most appropriate?
Set 5: For each patient, select the most appropriate management option.
A. Oral aciclovir
B. Oral metronidazole alone
C. Oral nitrofurantoin
D. Topical antifungal treatment
E. Reassurance only for all red legs
F. Urgent assessment for severe infection or necrotising fasciitis
G. Oral flucloxacillin if suitable
H. Antibiotics not routinely indicated if no clinical signs of infection
9. A 66-year-old man has a unilateral hot, red, tender lower leg with spreading erythema. He is systemically well, has no abscess and can take oral medicines. He has no penicillin allergy.
Which option is most appropriate?
10. A 58-year-old woman has rapidly worsening leg pain. The pain is severe and disproportionate to the visible redness. She is febrile, confused and hypotensive.
Which option is most appropriate?
Set 6: For each patient, select the most appropriate immediate action.
A. Routine GP appointment within 1 week
B. Self-care and fluids only
C. Emergency assessment and empirical treatment for suspected meningitis or meningococcal disease
D. Oral phenoxymethylpenicillin and discharge
E. Topical chloramphenicol
F. Delayed antibiotic prescription
G. Oral loperamide
H. Immediate assessment for possible neutropenic sepsis
11. A 20-year-old student has fever, severe headache, neck stiffness, photophobia and a non-blanching rash. He is drowsy and difficult to keep awake.
Which option is most appropriate?
12. A 63-year-old woman received chemotherapy for breast cancer 9 days ago. She has a temperature of 38.2°C, chills and feels generally unwell. She has no obvious localising symptoms.
Which option is most appropriate?
Set 7: For each patient, select the most appropriate option.
A. Triple therapy for H. pylori if confirmed or strongly indicated
B. Oral loperamide as sole treatment for bloody diarrhoea
C. Oral ciprofloxacin for all diarrhoea after travel
D. Reassure and provide no hydration advice
E. Stop unnecessary antibiotics and assess for Clostridioides difficile infection
F. Oral fluconazole
G. Oral nitrofurantoin
H. Topical fusidic acid
13. An 82-year-old woman develops watery diarrhoea 6 times daily after a recent course of co-amoxiclav. She has abdominal cramps and a raised white cell count.
Which option is most appropriate?
14. A 47-year-old man has confirmed H. pylori-associated dyspepsia. He has no penicillin allergy and is not taking interacting medicines.
Which option is most appropriate?
Set 8: For each patient, select the most appropriate option.
A. Treat as uncomplicated lower UTI only
B. Urgent assessment for possible pelvic inflammatory disease
C. Reassure because sexually transmitted infections are always symptomatic
D. Refer to sexual health service for testing, treatment and partner notification
E. Treat as uncomplicated thrush
F. Oral flucloxacillin
G. Oral nitrofurantoin
H. Intranasal corticosteroid
15. A 24-year-old man has dysuria and urethral discharge after unprotected sex with a new partner. He has no flank pain or fever.
Which option is most appropriate?
16. A 29-year-old woman has lower abdominal pain, fever, deep dyspareunia and abnormal vaginal discharge. Cervical motion tenderness has been documented by a clinician.
Which option is most appropriate?
Set 9: For each patient, select the most clinically important medicine-related issue.
A. Reduced levothyroxine absorption
B. Lithium toxicity from NSAID use
C. Reduced contraceptive efficacy from enzyme induction
D. Serotonin syndrome
E. QT prolongation risk
F. Warfarin interaction increasing INR and bleeding risk
G. Statin interaction increasing myopathy or rhabdomyolysis risk
H. Hyperkalaemia risk
17. A 70-year-old man taking warfarin is prescribed metronidazole for dental infection. His INR has been stable for months.
Which option is most relevant?
18. A 61-year-old man taking simvastatin 40 mg nightly is prescribed clarithromycin for community-acquired pneumonia. He has previously reported statin-related muscle pain.
Which option is most relevant?
Set 10: For each patient, select the most appropriate pharmacist action.
A. Stop all antibiotics permanently
B. Ignore levels if infection is improving
C. Continue aminoglycoside unchanged despite rising creatinine
D. Review gentamicin level timing, renal function and ototoxicity risk before further dosing
E. Review vancomycin levels, renal function and dose before further dosing
F. Switch oral vancomycin to IV for C. difficile infection automatically
G. Give aminoglycoside with loop diuretic routinely
H. Treat tinnitus with earwax drops only
19. A 73-year-old man receiving gentamicin for Gram-negative sepsis develops rising creatinine. He also reports new tinnitus and dizziness. The gentamicin level was taken at the wrong time.
Which option is most appropriate?
20. A 59-year-old woman receiving IV vancomycin for MRSA bacteraemia has a high trough concentration and worsening renal function. She is also receiving piperacillin/tazobactam.
Which option is most appropriate?
Infection Questions
Answers and Rationale
1. F
Cough, coryza, hoarseness and absence of fever, exudate or tender nodes suggest viral upper respiratory tract infection. Antibiotics are unlikely to help, so self-care and safety-netting are most appropriate.
2. B
This patient has several features suggesting streptococcal sore throat. If antibiotic treatment is justified, phenoxymethylpenicillin is a standard first-line option when there is no penicillin allergy.
3. G
Acute bronchitis after a viral illness is usually self-limiting. Yellow sputum alone does not prove bacterial infection, and unnecessary antibiotics increase adverse effects and resistance.
4. D
Confusion, tachypnoea, hypoxia, fever and chest signs in an older patient suggest severe pneumonia or sepsis risk. Hospital assessment is more appropriate than community oral antibiotics.
5. H
This is consistent with uncomplicated lower UTI in a non-pregnant woman. Nitrofurantoin is commonly appropriate if renal function is adequate and there are no signs of upper UTI.
6. C
UTI in pregnancy should be actively managed because of maternal and fetal risks. Urine culture and pregnancy-appropriate antibiotic selection are needed rather than non-pregnancy empirical management alone.
7. E
Fever, rigors, loin pain, vomiting and inability to maintain fluids suggest pyelonephritis or complicated UTI. Urgent assessment is required.
8. A
Cloudy urine alone in a catheterised patient does not necessarily indicate infection. Treating asymptomatic bacteriuria promotes antimicrobial resistance and is usually inappropriate unless specific circumstances apply.
9. G
A unilateral hot, tender, spreading red leg in a systemically well patient is consistent with cellulitis suitable for oral therapy. Flucloxacillin is a typical first-line choice if there is no penicillin allergy.
10. F
Pain out of proportion, fever, confusion and hypotension suggest severe soft tissue infection such as necrotising fasciitis. This is an emergency requiring urgent assessment.
11. C
Fever, headache, neck stiffness, photophobia, drowsiness and non-blanching rash suggest meningitis or meningococcal sepsis. Emergency treatment and transfer are required.
12. H
Fever within days of chemotherapy should be treated as possible neutropenic sepsis. This is an oncology emergency even without localising symptoms.
13. E
Recent broad-spectrum antibiotic use followed by watery diarrhoea and raised white cell count suggests possible C. difficile infection. Unnecessary antibiotics should be stopped and assessment arranged.
14. A
Confirmed H. pylori infection is treated with eradication therapy, commonly a PPI with two antibiotics depending on allergy, resistance risk and local guidance.
15. D
Urethral discharge after unprotected sex suggests STI such as gonorrhoea or chlamydia. Sexual health assessment, testing, treatment and partner notification are needed.
16. B
Lower abdominal pain, fever, dyspareunia, discharge and cervical motion tenderness suggest pelvic inflammatory disease. Prompt assessment and antibiotic treatment reduce complications.
17. F
Metronidazole can increase warfarin effect and raise INR, increasing bleeding risk. INR monitoring and anticoagulation review are needed.
18. G
Clarithromycin can increase simvastatin exposure and increase myopathy or rhabdomyolysis risk. This is especially relevant with previous statin muscle symptoms.
19. D
Gentamicin has nephrotoxicity and ototoxicity risks. Rising creatinine, tinnitus and dizziness require urgent review, and an incorrectly timed level cannot be interpreted safely for dosing.
20. E
High vancomycin levels and worsening renal function increase nephrotoxicity risk. Dosing should be reviewed with levels, timing, renal function and other nephrotoxic medicines considered before further doses.
Here are 20 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.