Set 1: For each patient, select the most appropriate management option.
A. Use regular emollients, avoid triggers and use a short course of appropriate-potency topical corticosteroid for flare areas
B. Start oral flucloxacillin immediately for all eczema flares
C. Apply potent topical steroid to eyelids for 4 weeks
D. Stop all emollients because they worsen eczema
E. Urgent clinical assessment for possible eczema herpeticum
F. Treat as scabies without examination
G. Start oral isotretinoin
H. Reassure because painful vesicles are normal in eczema
1. A 7-year-old child has worsening flexural eczema with dry itchy patches behind the knees and elbows. There is no fever, no weeping, no honey-coloured crusting and no painful blisters. The parent has been applying emollient only once every few days.
Which option is most appropriate?
2. A 19-year-old woman with atopic eczema develops rapidly worsening painful punched-out erosions and clustered blisters on her face. She feels feverish and unwell. The lesions are much more painful than her usual eczema.
Which option is most appropriate?
Set 2: For each patient, select the most appropriate action.
A. Treat as uncomplicated fungal infection
B. Urgent emergency assessment for possible necrotising fasciitis or sepsis
C. Topical fusidic acid only
D. Oral flucloxacillin if suitable, with safety-netting and review
E. Reassure because red legs are always inflammatory
F. Start oral aciclovir
G. Supply hydrocortisone 1% cream
H. Delay treatment until a swab result returns
3. A 62-year-old man has a unilateral hot, red, swollen, tender lower leg with spreading erythema. He is systemically well, has no abscess, no necrosis and no severe pain out of proportion. He has no penicillin allergy.
Which option is most appropriate?
4. A 58-year-old woman has rapidly worsening leg pain after a small graze. The pain is severe and disproportionate to the skin changes. She is febrile, confused and hypotensive, and the skin has dusky patches.
Which option is most appropriate?
Set 3: For each patient, select the most appropriate pharmacist intervention.
A. Increase methotrexate dose without blood tests
B. Stop all psoriasis medicines permanently
C. Urgent review for possible methotrexate toxicity and bone marrow suppression
D. Start live vaccine immediately during biologic therapy
E. Treat as uncomplicated eczema
F. Withhold biologic and arrange urgent review for possible serious infection
G. Reassure because sore throat is expected with methotrexate
H. Add ibuprofen without assessing renal or GI risk
5. A 47-year-old man with severe psoriasis takes methotrexate 15 mg once weekly. He accidentally took it daily for 5 days and now has mouth ulcers, bruising and a sore throat.
Which option is most appropriate?
6. A 51-year-old woman taking adalimumab for psoriasis develops fever, productive cough, pleuritic chest pain and oxygen saturation of 92% on air.
Which option is most appropriate?
Set 4: For each patient, select the most appropriate option.
A. Treat as impetigo
B. Refer urgently for suspected melanoma
C. Supply antifungal cream
D. Reassure and review in 6 months
E. Supply topical corticosteroid only
F. Urgent same-day assessment for possible ophthalmic shingles
G. Start oral iron
H. Treat as acne
7. A 69-year-old man has a painful vesicular rash on the right forehead and scalp. There are lesions on the tip of the nose, and his right eye is red and painful.
Which option is most appropriate?
8. A 42-year-old woman reports a pigmented mole on her back that has changed shape and colour over 4 months. It is asymmetric, has an irregular border and has bled twice.
Which option is most appropriate?
Set 5: For each patient, select the most appropriate management option.
A. Treat patient and close contacts for scabies at the same time and repeat treatment as directed
B. Urgent assessment for possible diabetic foot infection
C. Supply topical hydrocortisone only
D. Reassure because itching at night excludes infestation
E. Treat with oral fluconazole
F. Start long-term oral prednisolone
G. Use antiseptic wash only for all impetigo
H. Treat localised impetigo with topical hydrogen peroxide or topical antibiotic if appropriate, considering local guidance and extent
9. A 34-year-old man has intense itching worse at night. Several household members are also itching. Examination shows burrows between the fingers and excoriated papules on the wrists.
Which option is most appropriate?
10. A 66-year-old man with type 2 diabetes has a painful ulcer on the sole of his foot with surrounding erythema, warmth and swelling. He feels generally unwell and his glucose readings are higher than usual.
Which option is most appropriate?
Answers and Rationale
1. A
This is an uncomplicated eczema flare without signs of bacterial or viral infection. Optimising emollient use and using an appropriate-potency topical corticosteroid for flare areas is more suitable than antibiotics or potent steroid use on sensitive areas.
2. E
Painful punched-out erosions, clustered blisters and systemic symptoms in eczema suggest eczema herpeticum. This is a dermatological emergency because herpes simplex infection can spread rapidly and may threaten vision if facial/ocular involvement develops.
3. D
A unilateral hot, red, swollen, tender leg is consistent with cellulitis. If systemically well and no severe features are present, oral flucloxacillin may be appropriate if no allergy, with review and clear safety-netting.
4. B
Pain out of proportion, rapid progression, hypotension, confusion and dusky skin changes suggest necrotising fasciitis or severe soft tissue infection. This requires emergency assessment and treatment.
5. C
Daily methotrexate dosing is a serious medication error. Mouth ulcers, bruising and sore throat suggest mucositis and possible bone marrow suppression, requiring urgent review and blood tests.
6. F
Biologic therapy increases infection risk. Fever, pleuritic chest pain, productive cough and reduced oxygen saturation suggest serious infection, so the biologic should be withheld and urgent review arranged.
7. F
Shingles affecting the ophthalmic distribution, especially with lesions on the nose and a red painful eye, needs same-day assessment because of the risk of ocular complications.
8. B
A changing pigmented lesion with asymmetry, irregular border, colour change and bleeding is suspicious for melanoma. Urgent suspected-cancer referral is appropriate.
9. A
Nocturnal itch, burrows and multiple affected household members strongly suggest scabies. The patient and close contacts should be treated at the same time, with repeat treatment as directed and environmental advice.
10. B
A diabetic foot ulcer with surrounding erythema, warmth, swelling, pain, systemic symptoms and worsening glucose control suggests infection. Diabetic foot infection requires urgent assessment to reduce risk of deterioration.
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.