Set 1: For each patient, select the most appropriate contraception-related option.
A. Start a combined oral contraceptive immediately and provide no emergency contraception
B. Reassure because emergency contraception is only needed within 24 hours
C. Supply ulipristal and advise immediate restart of hormonal contraception on the same day
D. Offer copper IUD as preferred emergency contraception; if unsuitable or declined, discuss oral emergency contraception considering enzyme induction
E. Supply progesterone-only pill only as emergency contraception
F. Supply fluconazole
G. Offer copper IUD as the most effective emergency contraception and possible ongoing contraception if suitable
H. Supply levonorgestrel only after 5 days have passed
1. A 26-year-old woman had unprotected sex 4 days ago. She is not using contraception and says she would also like a reliable long-term method. She has no symptoms of infection and no contraindication to intrauterine contraception.
Which option is most appropriate?
2. A 31-year-old woman taking carbamazepine for epilepsy had unprotected sex 48 hours ago. She is not using regular contraception and wants emergency contraception. She has no symptoms of pregnancy or infection.
Which option is most appropriate?
Set 2: For each patient, select the most appropriate action.
A. Same-day urgent maternity assessment for possible pre-eclampsia
B. Start ibuprofen regularly and review in 1 week
C. Reassure because ankle swelling makes pre-eclampsia unlikely
D. Supply sodium bicarbonate urinary alkalinising sachets
E. Supply emergency contraception
F. Start ramipril for pregnancy-related hypertension
G. Treat as uncomplicated morning sickness
H. Urgent assessment for possible ectopic pregnancy
3. A 34-year-old woman who is 32 weeks pregnant has a severe frontal headache, visual disturbance and right upper quadrant pain. Her blood pressure is 164/104 mmHg and urine dipstick shows protein.
Which option is most appropriate?
4. A 29-year-old woman is 7 weeks pregnant. She has unilateral pelvic pain, light vaginal bleeding, shoulder-tip pain and feels faint. She has not yet had an ultrasound scan.
Which option is most appropriate?
Set 3: For each patient, select the most appropriate management option.
A. Supply fluconazole for first-ever atypical discharge
B. Urgent assessment and treatment for possible pelvic inflammatory disease, with STI testing and partner notification
C. Treat as uncomplicated lower UTI only
D. Reassure because STIs are always asymptomatic
E. Supply hydrocortisone cream
F. Refer to sexual health service for STI testing, treatment and partner notification
G. Supply oral flucloxacillin
H. Supply intranasal corticosteroid
5. A 24-year-old man has dysuria and urethral discharge after unprotected sex with a new partner. He has no flank pain, fever or testicular pain.
Which option is most appropriate?
6. A 29-year-old woman has lower abdominal pain, fever, abnormal vaginal discharge and deep dyspareunia. Cervical motion tenderness has been documented by a clinician.
Which option is most appropriate?
Set 4: For each patient, select the most appropriate option.
A. Treat as uncomplicated cystitis with no pregnancy considerations
B. Supply oral fluconazole
C. Urgent same-day assessment for possible pyelonephritis in pregnancy
D. Recommend cranberry capsules only
E. Treat lower UTI in pregnancy with a pregnancy-appropriate antibiotic and send urine culture according to local guidance
F. Supply ciprofloxacin first-line in pregnancy
G. Reassure that symptomatic UTI in pregnancy does not need treatment
H. Treat as asymptomatic bacteriuria in a non-pregnant adult
7. A 25-year-old woman who is 20 weeks pregnant has dysuria and urinary frequency. She is systemically well, with no fever, vomiting, flank pain or visible haematuria. She has no known allergies.
Which option is most appropriate?
8. A 32-year-old woman who is 28 weeks pregnant has fever, loin pain, vomiting and urinary symptoms. She feels weak and cannot keep fluids down.
Which option is most appropriate?
Set 5: For each patient, select the most appropriate option.
A. Urgent assessment or referral for postmenopausal bleeding
B. Start combined hormonal contraception
C. Reassure because postmenopausal bleeding is expected for several years
D. Stop all HRT permanently without review
E. Supply antibiotics for all menopausal urinary symptoms
F. Start systemic oestrogen alone in a person with an intact uterus
G. Treat vasomotor symptoms with vaginal moisturiser only
H. Offer vaginal oestrogen for genitourinary symptoms if suitable, with review and counselling
9. A 64-year-old woman has vaginal dryness, superficial dyspareunia and recurrent urinary symptoms since menopause. She has no vaginal bleeding and is not taking systemic HRT.
Which option is most appropriate?
10. A 59-year-old woman has new vaginal bleeding 3 years after her last menstrual period. She is not taking HRT and has no symptoms of UTI.
Which option is most appropriate?
Set 6: For each patient, select the most appropriate action.
A. Treat visible haematuria as cystitis without review
B. Reassure because prostate cancer cannot occur with urinary symptoms
C. Supply nitrofurantoin only
D. Refer urgently for possible urological cancer due to visible haematuria
E. Start tamsulosin without assessment
F. Supply oral fluconazole
G. Urgent assessment or referral for possible testicular cancer
H. Reassure that painless testicular lumps are usually harmless in young adults
11. A 58-year-old man has two episodes of painless visible haematuria. He has no dysuria, frequency, flank pain or fever. He smoked for 25 years.
Which option is most appropriate?
12. A 24-year-old man finds a painless lump in one testicle with a dragging sensation. He has no dysuria, fever or urethral discharge.
Which option is most appropriate?
Set 7: For each patient, select the most appropriate management option.
A. Start oxybutynin without checking anticholinergic burden or cognition
B. Same-day urgent assessment for acute urinary retention
C. Treat as stress incontinence with pelvic floor exercises only
D. Start a loop diuretic for nocturia
E. Reassure because inability to pass urine is not urgent
F. Assess for overactive bladder and consider bladder training and medicine options after excluding red flags
G. Treat nocturia with regular NSAIDs
H. Supply antibiotics for all urinary frequency without infection features
13. A 73-year-old man has not passed urine for 14 hours. He has severe suprapubic pain, a distended bladder and increasing agitation. He takes amitriptyline and tramadol.
Which option is most appropriate?
14. A 55-year-old woman has urgency, frequency and nocturia for several months. She has no dysuria, fever, haematuria, pelvic pain or vaginal bleeding. Urine dipstick is negative. Symptoms are affecting work and sleep.
Which option is most appropriate?
Set 8: For each patient, select the most appropriate action.
A. Stop breastfeeding immediately for all breast pain
B. Recommend codeine as preferred first-line analgesia during breastfeeding
C. Urgent mental health assessment for possible postpartum psychosis or severe postnatal mental illness
D. Avoid paracetamol and ibuprofen in breastfeeding
E. Continue breastfeeding or expressing and manage mastitis; assess need for antibiotics if systemic or not improving
F. Supply cabergoline over the counter
G. Treat as hay fever
H. Reassure that thoughts of harming the baby are normal and need no assessment
15. A woman 2 weeks postpartum tells you she has not slept for 3 nights, believes the baby is possessed and has heard voices telling her to harm herself. Her partner says her behaviour is very unlike her.
Which option is most appropriate?
16. A woman 4 weeks postpartum has a painful red area on one breast, fever and flu-like symptoms. She is worried breastfeeding will harm the baby and has started skipping feeds.
Which option is most appropriate?
Set 9: For each patient, select the most appropriate option.
A. Consider levonorgestrel intrauterine system for heavy menstrual bleeding if suitable after assessment
B. Reassure that flooding and anaemia are always normal
C. Avoid all NSAIDs in heavy menstrual bleeding regardless of circumstances
D. Assess or refer for suspected endometriosis
E. Supply oral fluconazole
F. Start warfarin
G. Refer all fibroids for same-day emergency surgery
H. Start metformin as first-line for heavy menstrual bleeding
17. A 43-year-old woman has heavy menstrual bleeding affecting quality of life. She also wants reliable contraception. She has no intermenstrual bleeding, postcoital bleeding, pelvic mass symptoms or contraindication to intrauterine contraception.
Which option is most appropriate?
18. A 33-year-old woman has cyclical pelvic pain, deep dyspareunia, painful bowel symptoms during menstruation and difficulty conceiving. Symptoms have been present for over a year.
Which option is most appropriate?
Set 10: For each patient, select the most appropriate medicine-safety option.
A. Combined hormonal contraception is suitable in migraine with aura
B. Avoid pregnancy and arrange specialist review because current medicine is teratogenic or needs pre-conception planning
C. Start combined hormonal contraception after previous VTE without review
D. Reassure that rifampicin has no effect on contraception
E. Stop tamoxifen immediately because contraception is needed
F. Use levonorgestrel emergency contraception as the only long-term method
G. Avoid combined hormonal contraception because of migraine with aura and discuss safer alternatives
H. No contraception is needed with teratogenic medicines if today’s pregnancy test is negative
19. A 30-year-old woman wants to start the combined oral contraceptive pill. She has migraine with visual aura twice per month. She has no other medical conditions and does not smoke.
Which option is most appropriate?
20. A 29-year-old woman takes methotrexate for inflammatory arthritis and wants to start trying for pregnancy next month. She has not spoken to her specialist and is still taking weekly methotrexate.
Which option is most appropriate?
Answers and Rationale
1. G
The copper IUD is the most effective emergency contraception and can also provide ongoing contraception. At 4 days after unprotected sex, it should be offered if suitable.
2. D
Carbamazepine is an enzyme inducer and can reduce effectiveness of oral emergency contraception. The copper IUD is preferred; if declined or unsuitable, oral options need specialist consideration.
3. A
Severe headache, visual disturbance, right upper quadrant pain, hypertension and proteinuria suggest pre-eclampsia. This requires urgent maternity assessment.
4. H
Early pregnancy with unilateral pelvic pain, vaginal bleeding, shoulder-tip pain and faintness suggests ectopic pregnancy with possible intra-abdominal bleeding. Urgent assessment is required.
5. F
Urethral discharge after unprotected sex suggests STI such as chlamydia or gonorrhoea. Sexual health assessment enables testing, treatment and partner notification.
6. B
Lower abdominal pain, fever, discharge, dyspareunia and cervical motion tenderness suggest pelvic inflammatory disease. Prompt treatment and STI management reduce complications.
7. E
Symptomatic UTI in pregnancy should be treated with a pregnancy-appropriate antibiotic and urine culture, even if the patient is systemically well.
8. C
Fever, loin pain, vomiting and urinary symptoms in pregnancy suggest pyelonephritis. This requires urgent assessment because of maternal and fetal risks.
9. H
Vaginal dryness, dyspareunia and recurrent urinary symptoms after menopause are consistent with genitourinary syndrome of menopause. Vaginal oestrogen can be considered if suitable, with counselling and review.
10. A
Bleeding after menopause is an alarm symptom that needs urgent assessment or referral to exclude endometrial or other gynaecological cancer.
11. D
Painless visible haematuria in an older adult, especially with smoking history, is a red flag for urological cancer and requires urgent referral.
12. G
A painless testicular lump with heaviness should be treated as possible testicular cancer until assessed. Urgent clinical assessment or referral is needed.
13. B
Inability to pass urine with suprapubic pain and bladder distension suggests acute urinary retention. Anticholinergic and opioid medicines can contribute, but same-day assessment is the priority.
14. F
Urgency, frequency and nocturia without infection or red flags suggests overactive bladder. Management includes assessment, bladder training and considering medicine options while reviewing anticholinergic risks.
15. C
Delusions, hallucinations, severe insomnia and thoughts of harm postpartum suggest postpartum psychosis or severe postnatal mental illness. This is an emergency requiring urgent mental health assessment.
16. E
Mastitis management includes continuing breastfeeding or expressing to prevent milk stasis. Antibiotics may be needed if systemic symptoms are present or symptoms do not improve.
17. A
For heavy menstrual bleeding where contraception is also wanted and no red flags are present, a levonorgestrel intrauterine system is a suitable option after assessment.
18. D
Cyclical pelvic pain, deep dyspareunia, bowel symptoms during menstruation and subfertility suggest endometriosis. Assessment or referral is appropriate.
19. G
Migraine with aura is a contraindication to combined hormonal contraception because of increased stroke risk. Safer alternatives should be discussed.
20. B
Methotrexate is teratogenic and requires pre-conception planning. Pregnancy should be avoided until specialist advice confirms safe discontinuation timing and alternative disease control.
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.