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.
Skin Questions
Answers and Rationale
1. C
Flexural itchy eczema with dry inflamed skin and no infection features should be managed by optimising emollient use and using an appropriate topical corticosteroid for active inflammation. Education on regular application is essential.
2. E
Mildly weeping eczema without systemic illness does not automatically require antibiotics. Eczema treatment should be optimised, and the patient should be safety-netted for spreading redness, fever or worsening symptoms.
3. A
Facial and eyelid skin is thin and more prone to topical corticosteroid adverse effects such as atrophy, glaucoma risk around the eyes and perioral dermatitis. Potent steroids should not be used there without specialist advice.
4. D
Psoriasis can be associated with psoriatic arthritis. Joint swelling, prolonged morning stiffness and nail changes require assessment because early treatment can reduce joint damage.
5. B
Moderate acne is usually managed with consistent topical treatment first, often using combinations such as benzoyl peroxide, topical retinoid or topical antibiotic depending on suitability. Isotretinoin is specialist-only for severe or resistant disease.
6. E
Isotretinoin is highly teratogenic. Patients who can become pregnant need strict pregnancy prevention, pregnancy testing and counselling before and during treatment.
7. A
Facial flushing, persistent erythema and inflammatory papules without comedones are typical of rosacea. Triggers such as alcohol, spicy foods and heat are common.
8. C
Honey-coloured crusted lesions around the mouth are typical of impetigo. Management depends on extent and severity, with hygiene advice to reduce transmission.
9. D
A spreading hot, painful red leg with fever and shivering suggests cellulitis with systemic features. This requires urgent assessment and appropriate antimicrobial treatment.
10. B
Most leg ulcers are colonised with bacteria, but antibiotics are only indicated when there are clinical signs of infection such as spreading redness, warmth, increased pain or purulent discharge.
11. D
Scabies is highly transmissible through close contact. Treating close contacts simultaneously reduces reinfestation and ongoing spread.
12. A
Head lice treatment should generally be used when live lice are detected. Detection combing helps confirm active infestation and identify affected household contacts.
13. E
Shingles affecting the forehead or eye area may involve the ophthalmic branch of the trigeminal nerve. Eye redness or pain requires urgent assessment to prevent sight-threatening complications.
14. C
Chickenpox exposure in an immunosuppressed person requires urgent advice about immunity and post-exposure prophylaxis. Live vaccination may be contraindicated during immunosuppression.
15. B
A ring-shaped itchy rash with central clearing and a scaly active edge is typical of tinea corporis. Topical corticosteroids can mask or worsen fungal infection.
16. D
Tinea capitis usually requires systemic antifungal treatment because topical therapy alone does not penetrate the hair shaft adequately. Assessment and confirmation may be needed.
17. A
Diabetes, neuropathy and previous foot ulceration increase risk of serious foot complications. Toenail disease should be assessed before treatment, especially before systemic antifungals.
18. E
An enlarging, irregular, variably pigmented or bleeding mole is suspicious for melanoma. Urgent assessment is required.
19. C
A pearly, slowly growing lesion with telangiectasia and bleeding is characteristic of basal cell carcinoma. It requires clinical assessment, though urgency depends on features and local pathway.
20. B
Rough scaly sun-damaged lesions may be actinic keratoses. They can need treatment and monitoring because some lesions may progress or coexist with skin cancer.
21. E
A widespread painful rash with fever and mucosal involvement soon after starting lamotrigine suggests Stevens–Johnson syndrome or toxic epidermal necrolysis. The medicine should be stopped and urgent assessment arranged.
22. C
Doxycycline can cause photosensitivity. Patients should use sun protection, avoid sunbeds and limit excessive sunlight exposure during treatment.
23. A
Paraffin-based and paraffin-free emollients can soak into clothing and bedding, increasing fire risk. Patients should keep treated fabrics away from flames and wash clothing regularly.
24. B
Non-blanching redness over a pressure area suggests early pressure damage. Pressure relief, skin assessment, nutrition, continence care and repositioning should be addressed promptly.
25. D
A red, hot, swollen diabetic foot ulcer with systemic symptoms and spreading cellulitis is urgent. Diabetic foot infection can progress rapidly and requires specialist assessment.
26. A
Isolated acute urticaria without airway, breathing or circulation symptoms can often be managed with a non-sedating antihistamine. Safety-netting for anaphylaxis symptoms is essential.
27. E
Urticaria with lip swelling, wheeze and dizziness after allergen exposure suggests anaphylaxis. Intramuscular adrenaline and emergency help are required.
28. B
Wet work and irritant exposure causing hand eczema that improves away from work is typical of irritant contact dermatitis. Barrier measures and occupational advice may be needed.
29. D
Topical calcineurin inhibitors may be considered for suitable patients with eczema in sensitive areas such as the face when steroid-related adverse effects are a concern. This requires clinical review.
30. C
Oral antibiotics for acne are usually combined with appropriate topical therapy to improve efficacy and reduce resistance. Treatment duration should be reviewed rather than continued indefinitely.
31. A
Emollients should be used regularly and generously as maintenance treatment, not only during flares. Regular use helps restore the skin barrier and reduce flare frequency.
32. D
Methotrexate can cause bone marrow suppression and liver toxicity. Regular blood monitoring is required to detect adverse effects early.
33. B
Biologic treatments can increase infection risk. Fever, productive cough and breathlessness should prompt clinical advice, and treatment may need to be delayed during significant infection.
34. C
Recurrent painful nodules, abscesses, discharge and scarring in the axillae and groin are typical of hidradenitis suppurativa. Smoking and raised BMI are common associated factors.
35. D
Cellulitis can take time to resolve visually. Early improvement in fever and pain is encouraging, but ongoing review and safety-netting are needed because deterioration requires reassessment.
36. B
Severe pain out of proportion to skin signs with confusion and hypotension is concerning for necrotising fasciitis or severe soft tissue infection. Emergency assessment is required.
37. A
Eczema herpeticum presents with rapidly worsening painful clustered blisters or punched-out erosions, often with fever. It is an emergency requiring urgent antiviral treatment.
38. D
Post-scabetic itch can persist for several weeks after successful treatment. New burrows or untreated contacts may suggest reinfestation or treatment failure.
39. C
Nits alone do not confirm active head lice infestation. Treatment is generally recommended when live lice are found.
40. E
A local reaction to an insect sting can be managed symptomatically if there are no features of anaphylaxis or infection. Safety-netting is important for worsening swelling, fever or systemic symptoms.
41. C
Salicylic acid can be used for suitable verrucae, but it requires careful regular application over weeks. It should be avoided or used with caution in some patients, such as those with diabetes or poor circulation.
42. E
Genital warts should be assessed through sexual health services for diagnosis, treatment and STI screening. Partner notification and safer sex advice may also be needed.
43. A
Greasy scaling around the scalp, eyebrows and nasolabial folds is typical of seborrhoeic dermatitis. Antifungal shampoos or topical treatments may be used depending on site and severity.
44. D
Nodular acne with scarring and poor response to standard treatment warrants specialist assessment. Isotretinoin may be considered under specialist supervision.
45. B
Prolonged potent topical corticosteroid use, especially on thin skin, can cause atrophy, bruising, telangiectasia and striae. Treatment potency and duration should be reviewed.
46. C
Bullous pemphigoid commonly affects older adults and presents with widespread itchy tense blisters. Diagnosis and management require clinical assessment.
47. A
Small pearly umbilicated papules in a well child are typical of molluscum contagiosum. It is often self-limiting, but inflamed, extensive or immunosuppressed cases may need review.
48. B
Burns involving the hand or crossing joints may affect function and may need specialist assessment. Blisters should not routinely be burst in the pharmacy.
49. D
Increasing pain, warmth, redness, purulent discharge and fever after surgery suggest surgical site infection. Clinical assessment is needed to decide on wound care and antibiotics.
50. E
Vulval lichen sclerosus can cause intense itching, soreness, white plaques and fragile skin. Persistent symptoms despite antifungal treatment require clinical assessment and appropriate high-potency steroid treatment under supervision.
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.