1. A 26-year-old woman presents to the pharmacy with a 2-day history of thick white vaginal discharge and vulval itching. She has had similar symptoms before and is not pregnant. She has no pelvic pain, fever, abnormal bleeding or urinary symptoms.
Which ONE of the following is the most appropriate management?
A. Refer urgently to hospital for suspected pelvic inflammatory disease.
B. Treat as bacterial vaginosis with oral metronidazole only.
C. Consider treatment for uncomplicated vulvovaginal candidiasis and provide self-care advice.
D. Treat as uncomplicated cystitis with nitrofurantoin.
E. Advise no treatment is ever required.
2. A 28-year-old woman asks for treatment for suspected thrush. She has never had these symptoms before. She reports yellow-green offensive discharge, pelvic discomfort and bleeding after sex.
Which ONE of the following is the most appropriate pharmacist action?
A. Supply oral fluconazole immediately.
B. Supply clotrimazole pessary and advise return if not improved.
C. Recommend vaginal moisturiser only.
D. Treat as uncomplicated cystitis.
E. Refer to GP or sexual health service for assessment.
3. A 24-year-old woman attends after unprotected sex 36 hours ago. She is not using regular contraception. She has a BMI of 32 kg/m² and is taking carbamazepine for epilepsy.
Which ONE of the following is the most appropriate emergency contraception consideration?
A. Discuss copper intrauterine device as the most effective option and consider medicine interactions when advising on oral options.
B. Supply ulipristal acetate without asking about interacting medicines.
C. Reassure that emergency contraception is not useful after 24 hours.
D. Supply combined oral contraceptive as emergency contraception.
E. Advise waiting until her next period before taking action.
4. A 19-year-old woman taking a combined oral contraceptive pill reports vomiting 2 hours after taking her pill yesterday. She also had unprotected sex the same evening.
Which ONE of the following is the most appropriate pharmacist action?
A. Reassure that vomiting never affects oral contraceptive efficacy.
B. Advise stopping the pill until her next period.
C. Supply antibiotics to prevent pregnancy.
D. Assess the timing, pill type and need for additional precautions or emergency contraception using current guidance.
E. Advise taking two packs simultaneously for the next month.
5. A 35-year-old woman asks to restart the combined hormonal contraceptive pill. She has migraine with aura, smokes 15 cigarettes daily and has a BMI of 34 kg/m².
Which ONE of the following is the most appropriate advice?
A. Combined hormonal contraception is preferred because she is under 40.
B. Combined hormonal contraception is likely unsuitable and alternative contraception should be discussed.
C. Start combined hormonal contraception and add aspirin.
D. Use combined hormonal contraception only on days she has intercourse.
E. Migraine with aura is unrelated to contraceptive risk.
6. A 31-year-old woman using the progestogen-only pill reports taking one pill 16 hours later than usual. She had unprotected sex that morning.
Which ONE of the following is the most appropriate pharmacist action?
A. Reassure that progestogen-only pills have a 7-day missed pill window.
B. Advise taking emergency contraception automatically without asking pill type.
C. Stop the pill permanently.
D. Switch immediately to combined hormonal contraception without assessment.
E. Clarify the type of progestogen-only pill and follow missed-pill guidance, including emergency contraception assessment if indicated.
7. A 27-year-old woman has a copper intrauterine device fitted. Three weeks later she develops lower abdominal pain, fever, deep dyspareunia and abnormal vaginal discharge.
Which ONE of the following is the most appropriate action?
A. Arrange urgent assessment for possible pelvic inflammatory disease.
B. Reassure that pain and fever are expected for 6 months after fitting.
C. Advise removing the device herself.
D. Supply loperamide.
E. Treat as uncomplicated thrush without review.
8. A 32-year-old woman using depot medroxyprogesterone acetate asks about long-term adverse effects. She has been using it for 4 years and has risk factors for osteoporosis.
Which ONE of the following is the most appropriate pharmacist contribution?
A. Reassure that depot contraception has no bone-related considerations.
B. Advise taking it every week to improve bone health.
C. Stop immediately and use no contraception.
D. Recommend review of ongoing suitability, bone health risk and alternative methods if appropriate.
E. Add long-term oral corticosteroids.
9. A 17-year-old requests emergency contraception. She is accompanied by an older partner who answers most questions for her and refuses to leave the consultation room.
Which ONE of the following is the most appropriate pharmacist action?
A. Refuse all care because she is under 18.
B. Ensure a private consultation where possible and assess safeguarding, consent and Fraser competence.
C. Provide contraception without asking any questions.
D. Discuss her details openly with her partner.
E. Advise emergency contraception is unavailable to under-18s.
10. A 46-year-old woman reports heavy menstrual bleeding for 8 months with flooding and clots. She is tired and has known fibroids. She has no possibility of pregnancy.
Which ONE of the following is the most appropriate initial pharmacist contribution?
A. Reassure that heavy bleeding is always normal before menopause.
B. Recommend long-term oral iron without further assessment.
C. Advise clinical review to assess bleeding cause, anaemia and treatment options.
D. Start oral antibiotics.
E. Treat as uncomplicated thrush.
11. A 29-year-old woman has severe dysmenorrhoea, deep dyspareunia and pelvic pain that is worse before menstruation. Symptoms have gradually worsened over 2 years.
Which ONE of the following condition should be considered?
A. Uncomplicated cystitis.
B. Bacterial vaginosis.
C. Acute pyelonephritis.
D. Endometriosis.
E. Hyperemesis gravidarum.
12. A 33-year-old woman has irregular periods, acne and hirsutism. She has gained weight over several years and has difficulty conceiving.
Which ONE of the following is the most likely diagnosis?
A. Polycystic ovary syndrome.
B. Acute pelvic inflammatory disease.
C. Ovarian torsion in all cases.
D. Uncomplicated vulvovaginal candidiasis.
E. Stress urinary incontinence.
13. A 42-year-old woman has sudden severe unilateral pelvic pain, nausea and vomiting. She has a known ovarian cyst.
Which ONE of the following is the most appropriate action?
A. Treat as period pain with ibuprofen only.
B. Recommend vaginal antifungal treatment.
C. Advise routine GP review in 4 weeks.
D. Treat as uncomplicated cystitis.
E. Arrange urgent assessment for possible ovarian torsion.
14. A 55-year-old woman has postmenopausal bleeding 18 months after her last period. She is not taking hormone replacement therapy.
Which ONE of the following is the most appropriate management?
A. Reassure because bleeding is expected after menopause.
B. Supply tranexamic acid without review.
C. Refer for urgent assessment of postmenopausal bleeding.
D. Treat as vaginal thrush.
E. Advise waiting for three further episodes before seeking care.
15. A 53-year-old woman has hot flushes, night sweats and vaginal dryness affecting sleep and quality of life. She has no history of breast cancer, venous thromboembolism or unexplained vaginal bleeding.
Which ONE of the following is the most appropriate pharmacist contribution?
A. Advise HRT is never used for menopausal symptoms.
B. Discuss lifestyle measures and advise clinical review to consider HRT or non-hormonal options based on individual risk.
C. Start long-term antibiotics.
D. Treat symptoms as urinary tract infection.
E. Recommend stopping all vaginal moisturisers.
16. A 60-year-old woman with vaginal dryness, soreness and pain during sex asks about local treatment. She has no unexplained bleeding and no symptoms of infection.
Which ONE of the following is the most appropriate option to discuss?
A. Oral ciprofloxacin.
B. High-dose oral corticosteroids.
C. Long-term oral fluconazole.
D. Vaginal moisturisers, lubricants and possible local vaginal oestrogen after appropriate assessment.
E. Emergency contraception.
17. A 30-year-old woman is 8 weeks pregnant and has unilateral pelvic pain, shoulder tip pain and light vaginal bleeding. She feels dizzy.
Which ONE of the following is the most appropriate action?
A. Arrange emergency assessment for possible ectopic pregnancy.
B. Reassure and advise routine antenatal booking.
C. Supply mefenamic acid and review in one week.
D. Treat as uncomplicated cystitis.
E. Advise waiting for a home pregnancy test in 2 weeks.
18. A 24-year-old woman is 10 weeks pregnant and has persistent vomiting, inability to keep fluids down, weight loss and ketones in her urine.
Which ONE of the following is the most appropriate action?
A. Reassure because vomiting in pregnancy never needs treatment.
B. Recommend stopping all fluids.
C. Supply loperamide.
D. Treat as uncomplicated reflux only.
E. Arrange medical assessment for possible hyperemesis gravidarum and dehydration.
19. A 36-year-old woman who is 32 weeks pregnant has severe headache, visual disturbance and swelling of her face and hands. Her blood pressure at a community check is 162/104 mmHg.
Which ONE of the following is the most appropriate action?
A. Advise rest and routine midwife review next month.
B. Supply ibuprofen.
C. Arrange urgent maternity assessment for possible pre-eclampsia.
D. Treat as migraine without further assessment.
E. Advise increasing salt intake.
20. A pregnant woman at 29 weeks reports regular painful contractions, pelvic pressure and fluid leaking from the vagina.
Which ONE of the following is the most appropriate advice?
A. Reassure because labour cannot occur before 37 weeks.
B. Arrange urgent maternity assessment for possible preterm labour or membrane rupture.
C. Recommend pelvic floor exercises only.
D. Supply antifungal treatment.
E. Advise waiting until the next routine antenatal appointment.
21. A 28-year-old pregnant woman asks to buy ibuprofen for back pain at 30 weeks’ gestation. She has no red flags.
Which ONE of the following is the most appropriate pharmacist action?
A. Supply ibuprofen because it is preferred in late pregnancy.
B. Recommend doubling paracetamol dose.
C. Supply aspirin for pain relief.
D. Recommend naproxen instead.
E. Avoid OTC ibuprofen in the third trimester and advise safer analgesia or clinical advice.
22. A 37-year-old woman with epilepsy is planning pregnancy. She takes sodium valproate and asks whether she can continue it because she has been seizure-free for years.
Which ONE of the following is the most appropriate pharmacist action?
A. Reassure that valproate has no pregnancy-related risks.
B. Advise stopping valproate immediately without specialist input.
C. Urgently signpost to specialist review because valproate has major pregnancy safety concerns.
D. Replace valproate with folic acid only.
E. Advise pregnancy is contraindicated forever.
23. A 31-year-old woman is breastfeeding and asks for pain relief after an uncomplicated vaginal delivery. She has no contraindications and the baby is healthy.
Which ONE of the following is the most appropriate first-line analgesic option?
A. Paracetamol, with ibuprofen also commonly suitable if there are no contraindications.
B. Codeine as first-line in all breastfeeding patients.
C. Aspirin at high dose.
D. Methotrexate.
E. Sodium valproate.
24. A breastfeeding woman has a painful, red, swollen area of the breast with fever and flu-like symptoms. She is worried she must stop feeding.
Which ONE of the following is the most appropriate advice?
A. Stop breastfeeding permanently.
B. Seek clinical assessment for mastitis and continue milk removal if possible.
C. Apply topical steroid only and avoid assessment.
D. Treat as vaginal candidiasis.
E. Take loperamide.
25. A 34-year-old woman develops low mood, loss of interest, guilt and poor sleep 6 weeks after delivery. She reports thoughts that her family would be better off without her.
Which ONE of the following is the most appropriate action?
A. Reassure that all postnatal mood symptoms resolve without review.
B. Recommend herbal treatment only.
C. Delay assessment until the 6-month baby check.
D. Arrange urgent assessment of postnatal depression and suicide risk.
E. Advise stopping breastfeeding immediately.
26. A 25-year-old pregnant woman has dysuria and urinary frequency. A urine test suggests lower urinary tract infection. She is systemically well with no flank pain or fever.
Which ONE of the following is the most appropriate management principle?
A. Treat and follow pregnancy-specific guidance because UTIs in pregnancy require active management.
B. Reassure that UTIs in pregnancy never require antibiotics.
C. Use trimethoprim automatically in the first trimester without considering folate status.
D. Treat with ciprofloxacin as first-line.
E. Delay treatment until after delivery.
27. A 44-year-old woman has dysuria and frequency. She also has fever, rigors, loin pain and nausea.
Which ONE of the following is the most appropriate action?
A. Treat as uncomplicated lower UTI with self-care only.
B. Supply vaginal antifungal treatment.
C. Recommend cranberry capsules only.
D. Give delayed antibiotics and review in 2 weeks.
E. Arrange urgent clinical assessment for possible pyelonephritis.
28. A 68-year-old postmenopausal woman has recurrent UTIs and symptoms of vaginal dryness and soreness. She asks whether anything other than repeated antibiotics may help.
Which ONE of the following is the most appropriate consideration?
A. Avoid discussing vaginal symptoms.
B. Recommend long-term ciprofloxacin without review.
C. Consider assessment for genitourinary syndrome of menopause and possible vaginal oestrogen if appropriate.
D. Stop all fluid intake.
E. Treat with oral fluconazole indefinitely.
29. A 72-year-old man presents with new painless visible haematuria. He has no dysuria or fever and is an ex-smoker.
Which ONE of the following is the most appropriate action?
A. Reassure because visible haematuria is common with ageing.
B. Supply nitrofurantoin without assessment.
C. Recommend prostate supplements.
D. Refer urgently for assessment of possible urinary tract malignancy.
E. Advise drinking cranberry juice only.
30. A 66-year-old man has lower urinary tract symptoms with nocturia, weak stream and hesitancy. He also reports new bone pain and unexplained weight loss.
Which ONE of the following is the most appropriate pharmacist action?
A. Treat as uncomplicated benign prostatic enlargement only.
B. Refer for medical assessment because red flags may suggest prostate cancer.
C. Supply a decongestant.
D. Advise fluid restriction during the whole day.
E. Recommend OTC testosterone.
31. A 70-year-old man with benign prostatic enlargement starts tamsulosin. He asks what adverse effect he should be aware of when standing up.
Which ONE of the following is the most appropriate counselling point?
A. It may cause postural dizziness or hypotension, especially when starting treatment.
B. It commonly causes severe hyperglycaemia.
C. It prevents all falls.
D. It must be taken with sildenafil without review.
E. It causes permanent urinary retention in all patients.
32. A 76-year-old man with nocturia and urinary frequency is prescribed oxybutynin. He has dementia and chronic constipation.
Which ONE of the following is the most appropriate pharmacist action?
A. Recommend increasing oxybutynin dose.
B. Reassure that anticholinergic effects do not occur in older adults.
C. Add another antimuscarinic.
D. Review suitability because anticholinergic effects may worsen cognition and constipation.
E. Stop all bladder treatment permanently without review.
33. A 69-year-old woman reports urinary leakage when she coughs, laughs or lifts shopping. She has no urgency, dysuria, haematuria or recurrent infections.
Which ONE of the following is the most appropriate initial management advice?
A. Supervised pelvic floor muscle training should be considered.
B. Long-term antibiotics are first-line.
C. Fluid restriction to 250 mL/day is recommended.
D. Oxybutynin is always first-line for stress incontinence.
E. Urgent cancer referral is needed in all cases.
34. A 58-year-old woman has urgency, frequency and urge incontinence. She has tried bladder training but remains symptomatic. Oxybutynin is being considered.
Which ONE of the following should be reviewed before treatment?
A. Whether she has ever had hay fever.
B. Whether symptoms improve after exercise only.
C. Whether she can take it with antibiotics.
D. Whether she has normal vitamin D level.
E. Anticholinergic burden, constipation, glaucoma risk and cognitive effects.
35. A 78-year-old man presents to the pharmacy with severe suprapubic pain and inability to pass urine for 10 hours. He has known benign prostatic enlargement.
Which ONE of the following is the most appropriate action?
A. Supply tamsulosin and advise review in 1 month.
B. Recommend cranberry capsules.
C. Arrange urgent medical assessment for acute urinary retention.
D. Advise restricting fluids for 24 hours.
E. Treat as uncomplicated cystitis.
36. A 23-year-old man presents with sudden severe testicular pain, nausea and a high-riding testicle. Symptoms started 2 hours ago.
Which ONE of the following is the most appropriate action?
A. Treat as uncomplicated epididymitis and review in 1 week.
B. Recommend simple analgesia only.
C. Supply antibiotics for 3 days.
D. Arrange emergency assessment for possible testicular torsion.
E. Reassure if pain improves slightly.
37. A 29-year-old man has testicular pain, dysuria and urethral discharge. Symptoms developed gradually over 3 days. He has had a new sexual partner.
Which ONE of the following is the most appropriate management?
A. Diagnose torsion without assessment.
B. Refer to sexual health or urgent clinical assessment for suspected epididymo-orchitis or STI.
C. Recommend antifungal cream only.
D. Advise no partner notification is needed.
E. Treat with loperamide.
38. A 27-year-old woman is diagnosed with chlamydia. She asks whether her partner needs treatment if he has no symptoms.
Which ONE of the following is the most appropriate advice?
A. Asymptomatic partners do not need assessment.
B. Partner notification and treatment are important to prevent reinfection and onward transmission.
C. Only female partners require testing.
D. Symptoms must be present before treatment.
E. Barrier contraception has no role after diagnosis.
39. A 30-year-old woman has lower abdominal pain, fever, deep dyspareunia and cervical motion tenderness. Pelvic inflammatory disease is suspected.
Which ONE of the following is the most appropriate action?
A. Supply thrush treatment only.
B. Reassure if discharge is absent.
C. Delay assessment until her next cervical screening appointment.
D. Treat as uncomplicated cystitis.
E. Arrange urgent sexual health or medical assessment and appropriate antibiotic treatment.
40. A 52-year-old woman reports thin grey-white vaginal discharge with a fishy odour, especially after sex. She has no vulval itching, pelvic pain or fever.
Which ONE of the following is the most likely diagnosis?
A. Vulvovaginal candidiasis.
B. Bacterial vaginosis.
C. Acute pyelonephritis.
D. Endometriosis.
E. Ectopic pregnancy.
41. A 40-year-old woman has recurrent heavy menstrual bleeding. She is already using a copper intrauterine device and has become iron deficient. She asks about longer-term options.
Which ONE of the following may be considered after assessment?
A. Levonorgestrel-releasing intrauterine system if suitable.
B. Long-term oral antibiotics.
C. Emergency contraception monthly.
D. Oxybutynin.
E. Tamsulosin.
42. A 47-year-old woman has irregular heavy bleeding between periods and bleeding after sex. Her cervical screening is overdue.
Which ONE of the following is the most appropriate action?
A. Treat as normal perimenopause without assessment.
B. Supply tranexamic acid only.
C. Arrange clinical assessment because intermenstrual and postcoital bleeding require review.
D. Recommend emergency contraception.
E. Treat as uncomplicated UTI.
43. A 56-year-old woman taking systemic HRT has new unexplained vaginal bleeding after previously being stable on treatment.
Which ONE of the following is the most appropriate pharmacist advice?
A. Ignore bleeding if she is taking HRT.
B. Stop all medicines and avoid medical review.
C. Treat as thrush.
D. Increase the oestrogen dose.
E. Seek clinical review because new or persistent bleeding on HRT requires assessment.
44. A 36-year-old woman using tamoxifen after breast cancer treatment asks to buy a combined hormonal contraceptive pill.
Which ONE of the following is the most appropriate pharmacist action?
A. Supply because tamoxifen improves contraceptive safety.
B. Advise clinical review for suitable non-oestrogen contraception.
C. Recommend combined hormonal contraception as first-line.
D. Advise no contraception is needed.
E. Suggest emergency contraception as routine contraception.
45. A 31-year-old woman takes rifampicin for tuberculosis. She uses combined oral contraception and asks whether it still works.
Which ONE of the following is the most appropriate advice?
A. Rifampicin has no effect on hormonal contraception.
B. Take the pill at night to avoid interaction.
C. Double the combined pill dose without review.
D. Rifampicin can reduce hormonal contraceptive efficacy; discuss reliable alternative contraception.
E. Stop tuberculosis treatment.
46. A 65-year-old man asks for sildenafil for erectile dysfunction. He uses glyceryl trinitrate spray for angina.
Which ONE of the following is the most appropriate pharmacist action?
A. Supply sildenafil and advise using extra GTN if dizzy.
B. Recommend taking sildenafil at the same time as GTN.
C. Do not supply and refer for clinical advice because nitrates and sildenafil can cause severe hypotension.
D. Supply tadalafil instead because it has no interaction.
E. Advise stopping GTN permanently.
47. A 22-year-old woman has dysuria and urinary frequency. She has also noticed vaginal discharge and pelvic discomfort after unprotected sex with a new partner.
Which ONE of the following is the most appropriate action?
A. Refer to sexual health or GP assessment because STI or PID should be considered.
B. Treat as uncomplicated lower UTI without asking about sexual health.
C. Supply sodium citrate only.
D. Recommend no treatment or review.
E. Diagnose overactive bladder.
48. A 70-year-old man with urinary symptoms is taking pseudoephedrine for a cold. He reports worsening hesitancy and reduced urinary flow since starting it.
Which ONE of the following is the most appropriate pharmacist contribution?
A. Increase pseudoephedrine dose.
B. Review pseudoephedrine use because sympathomimetics can worsen urinary retention in susceptible men.
C. Add oxybutynin.
D. Reassure that decongestants improve urine flow.
E. Recommend fluid restriction for one week.
49. A 64-year-old woman has recurrent urinary urgency and frequency. She has visible blood in the urine but no pain or fever.
Which ONE of the following is the most appropriate action?
A. Treat as overactive bladder without investigation.
B. Supply oxybutynin immediately.
C. Recommend pelvic floor exercises only.
D. Refer for assessment because visible haematuria requires investigation.
E. Reassure if symptoms are intermittent.
50. A 29-year-old woman asks for emergency contraception after unprotected sex 4 days ago. She is breastfeeding and wants the most effective method.
Which ONE of the following is the most appropriate advice?
A. No emergency contraception is available after 72 hours.
B. Use combined oral contraception as emergency contraception.
C. Wait for the next period.
D. Use vaginal antifungal treatment.
E. Discuss copper intrauterine device as the most effective option and assess suitability for oral methods.
Obstetrics, Gynaecology and Genito-Urinary Questions
Answers and Rationale
1. C
Thick white discharge with vulval itching, no red flags and previous similar episodes is consistent with uncomplicated vulvovaginal candidiasis. Treatment can be considered with counselling on correct use and when to seek review.
2. E
First presentation, yellow-green discharge, pelvic discomfort and postcoital bleeding are not typical uncomplicated thrush features. STI, cervicitis or pelvic inflammatory disease should be considered, so clinical assessment is needed.
3. A
The copper intrauterine device is the most effective emergency contraception and is not affected by enzyme-inducing medicines. Carbamazepine can reduce effectiveness of some oral emergency contraception options, so this must be considered.
4. D
Vomiting soon after taking an oral contraceptive pill may reduce absorption. The timing, pill type, missed pill rules and whether emergency contraception is needed should be assessed using current contraception guidance.
5. B
Migraine with aura is an important contraindication to combined hormonal contraception because of stroke risk. Smoking and obesity add further cardiovascular risk, so safer alternatives should be discussed.
6. E
Missed-pill advice depends on the specific progestogen-only pill and timing. The pharmacist should clarify the preparation and assess whether additional precautions or emergency contraception are needed.
7. A
Pelvic pain, fever, dyspareunia and abnormal discharge after intrauterine device fitting may indicate pelvic inflammatory disease. Prompt clinical assessment is needed to reduce complications.
8. D
Depot medroxyprogesterone acetate can be associated with reduced bone mineral density, especially with longer-term use or additional risk factors. Ongoing suitability should be reviewed.
9. B
A young person requesting contraception should be offered a private consultation where possible. Consent, competence, safeguarding and possible coercion should be assessed sensitively.
10. C
Heavy menstrual bleeding with clots and fatigue can cause iron deficiency anaemia and may be related to fibroids or other pathology. Clinical review is needed to assess cause and treatment options.
11. D
Progressive pelvic pain, severe dysmenorrhoea and deep dyspareunia are typical features of endometriosis. Symptoms often develop over time and can significantly affect quality of life.
12. A
Irregular periods, acne, hirsutism, weight gain and subfertility are consistent with polycystic ovary syndrome. Diagnosis requires clinical assessment and exclusion of other causes.
13. E
Sudden severe unilateral pelvic pain with nausea and a known ovarian cyst raises concern for ovarian torsion. This is a gynaecological emergency requiring urgent assessment.
14. C
Postmenopausal bleeding requires urgent assessment because it can be a symptom of endometrial cancer or other significant pathology. It should not be managed with empirical OTC treatment alone.
15. B
Menopausal vasomotor symptoms and vaginal dryness can significantly affect quality of life. HRT may be appropriate for some patients after individualised assessment of risks, benefits and preferences.
16. D
Genitourinary symptoms of menopause can cause vaginal dryness, soreness and dyspareunia. Vaginal moisturisers, lubricants and local vaginal oestrogen may be considered after appropriate assessment.
17. A
Unilateral pelvic pain, shoulder tip pain, bleeding and dizziness in early pregnancy suggest possible ectopic pregnancy with internal bleeding. Emergency assessment is required.
18. E
Persistent vomiting, weight loss, dehydration and ketonuria suggest hyperemesis gravidarum. Medical assessment is needed to manage hydration, electrolytes and antiemetic treatment.
19. C
Severe headache, visual symptoms, swelling and blood pressure above 160/100 mmHg in pregnancy are concerning for pre-eclampsia. Urgent maternity assessment is required.
20. B
Regular painful contractions and leaking fluid before 37 weeks may indicate preterm labour or ruptured membranes. Urgent maternity assessment is needed.
21. E
Ibuprofen and other NSAIDs are generally avoided in the third trimester because of fetal and neonatal risks. Safer analgesia or clinical advice should be recommended.
22. C
Valproate has major pregnancy safety risks and is subject to strict prescribing controls. Patients planning pregnancy should be urgently referred to their specialist rather than stopping abruptly.
23. A
Paracetamol is generally suitable during breastfeeding, and ibuprofen is also commonly suitable if there are no contraindications. Codeine is generally avoided because of infant safety concerns.
24. B
Breast pain, redness, fever and flu-like symptoms suggest mastitis. Clinical assessment may be needed, but continuing milk removal where possible helps relieve symptoms and prevent complications.
25. D
Postnatal depression can present with low mood, guilt, sleep disturbance and suicidal thoughts. Thoughts that the family would be better off without her require urgent risk assessment.
26. A
UTIs in pregnancy require active management because untreated infection can progress and may affect pregnancy outcomes. Antibiotic choice should follow pregnancy-specific guidance.
27. E
Fever, rigors, loin pain and nausea suggest pyelonephritis rather than uncomplicated lower UTI. This requires urgent clinical assessment and appropriate antimicrobial treatment.
28. C
Postmenopausal recurrent UTIs with vaginal dryness may reflect genitourinary syndrome of menopause. Vaginal oestrogen can be considered for suitable patients after assessment.
29. D
Painless visible haematuria, especially in an older ex-smoker, requires urgent assessment for possible urinary tract malignancy. It should not be treated empirically without review.
30. B
Lower urinary tract symptoms may be benign, but bone pain and unexplained weight loss are red flags for possible prostate cancer or metastatic disease. Medical assessment is required.
31. A
Tamsulosin is an alpha-blocker and can cause postural dizziness or hypotension, particularly when treatment is started or doses change. Falls risk counselling is important.
32. D
Oxybutynin has anticholinergic effects that can worsen constipation, cognition and urinary retention risk. These issues are particularly important in older adults and people with dementia.
33. A
Leakage on coughing, laughing or lifting is typical of stress urinary incontinence. Supervised pelvic floor muscle training is an appropriate initial management option.
34. E
Antimuscarinics for overactive bladder can cause dry mouth, constipation, blurred vision and cognitive effects. Anticholinergic burden and glaucoma or retention risks should be reviewed.
35. C
Inability to pass urine with suprapubic pain suggests acute urinary retention. This requires urgent medical assessment and usually catheterisation.
36. D
Sudden severe testicular pain with nausea and a high-riding testicle suggests testicular torsion. This is a surgical emergency where time-critical assessment is needed.
37. B
Gradual testicular pain with dysuria, urethral discharge and sexual risk suggests epididymo-orchitis or STI. Sexual health or urgent clinical assessment is appropriate.
38. B
Chlamydia is often asymptomatic in partners. Partner notification, testing and treatment reduce reinfection risk and onward transmission.
39. E
Lower abdominal pain, fever, deep dyspareunia and cervical motion tenderness suggest pelvic inflammatory disease. Prompt assessment and antibiotics reduce the risk of infertility and chronic pelvic pain.
40. B
Thin grey-white discharge with fishy odour, especially after sex, is typical of bacterial vaginosis. It differs from candidiasis, which more often causes itching and thick white discharge.
41. A
The levonorgestrel-releasing intrauterine system can reduce heavy menstrual bleeding and provide contraception. Suitability should be assessed, especially if fibroids are present.
42. C
Intermenstrual bleeding and postcoital bleeding require clinical assessment to exclude cervical, endometrial or other pathology. Being perimenopausal does not remove the need for review.
43. E
New or persistent vaginal bleeding while taking HRT should be assessed, particularly if it occurs after a stable pattern. This helps exclude endometrial pathology and optimise HRT use.
44. B
A history of breast cancer treatment and tamoxifen use means combined hormonal contraception is usually unsuitable. Non-oestrogen options should be discussed with an appropriate clinician.
45. D
Rifampicin is a potent enzyme inducer and can reduce hormonal contraceptive effectiveness. Reliable alternative contraception, such as copper intrauterine contraception, should be discussed.
46. C
Sildenafil and nitrates can cause severe hypotension when combined. Sildenafil should not be supplied without clinical review in a patient using glyceryl trinitrate.
47. A
Dysuria with vaginal discharge, pelvic discomfort and recent unprotected sex should prompt assessment for STI or pelvic inflammatory disease, rather than treating as uncomplicated UTI alone.
48. B
Pseudoephedrine can worsen urinary hesitancy or retention in susceptible men, particularly those with benign prostatic enlargement. Use should be reviewed.
49. D
Visible haematuria requires clinical assessment even without pain or fever. It may indicate urinary tract malignancy, stones or other significant pathology.
50. E
At 4 days after unprotected sex, the copper intrauterine device remains the most effective emergency contraception option. Oral options require assessment of timing, breastfeeding, interactions and suitability.
Here are 50 multiple-choice questions designed to mimic the GPHC exam itself. At the bottom of the page you will find answers and rationale for each question.