GP General Practitioner MCQs (Prometric)

A 30-year-old woman who is breastfeeding presents with persistent breast pain and fever despite 48 hours of appropriate oral antibiotics for mastitis. Temperature is 38.5°C, pulse is 108/min, and a tender 4-cm mass is palpable beneath an erythematous area. She is hemodynamically stable, milk drainage continues, and there is no skin necrosis or immunosuppression. Review the supplied ultrasound. What is the most appropriate next step?

A 61-year-old man with type 2 diabetes develops fever and rapidly spreading facial pain one day after a small nasal abrasion. Temperature is 39.0°C, pulse is 118/min, blood pressure is 104/66 mmHg, and glucose is 14.2 mmol/L. He has no fluctuance, crepitus, visual loss, painful eye movements, or dental symptoms. Review the supplied clinical photograph. What is the most appropriate management?

A 54-year-old man presents six hours after circumferential casting of a forearm fracture. He reports rapidly increasing pain despite opioid analgesia and numbness in the thumb and index finger. The fingers are pale, capillary refill is four seconds, and active finger movement is weak. The cast feels tight, but the radial pulse remains detectable. What is the most appropriate immediate action?

A 40-year-old man with bipolar disorder is brought after four days of vomiting while continuing lithium and taking ibuprofen for back pain. He has coarse tremor, slurred speech, unsteady gait, confusion, and generalized muscle twitching. Lithium concentration is markedly elevated, creatinine has doubled, and sodium is 148 mmol/L. He is hemodynamically stable but cannot safely walk. What is the most appropriate management?

A 54-year-old woman with type 2 diabetes and hypertension has an estimated glomerular filtration rate of 48 mL/min/1.73 m² and urine albumin-creatinine ratio of 56 mg/mmol on two samples. Blood pressure is 146/88 mmHg despite amlodipine. Potassium is 4.7 mmol/L, and she is clinically euvolemic. Lisinopril is started for renal and cardiovascular protection. She has no vomiting, diarrhea, or recent NSAID use. What monitoring plan is most appropriate after initiation?

A 29-year-old man presents with sharp central chest pain beginning three days after a viral respiratory illness. The pain worsens when supine and during deep inspiration but improves when he leans forward. Temperature is 37.6°C, pulse is 92/min, blood pressure is 122/74 mmHg, and a pericardial rub is audible. Troponin is normal, inflammatory markers are mildly elevated, and echocardiography shows no effusion or ventricular dysfunction. The ECG is shown. What is the most appropriate initial treatment?

A 72-year-old retired construction worker reports several rough scalp lesions that repeatedly crust but do not heal completely. He has extensive lifetime sun exposure and previous actinic keratoses. The appearance is shown. One lesion has become thicker and tender over three months, but there is no palpable lymphadenopathy or systemic illness. He takes apixaban for atrial fibrillation. What is the most appropriate next step?

A 7-year-old child develops gradually enlarging areas of scalp hair loss over six weeks. The patches are mildly itchy but not painful, and there is no fever or fluctuance. Two classmates have recently been treated for scalp infections. Examination shows no generalized alopecia, nail abnormalities, or cervical lymph-node enlargement. A topical corticosteroid prescribed elsewhere produced no improvement. Review the supplied photograph. What is the most appropriate management?

An 80-year-old woman with type 2 diabetes is brought with progressive confusion, profound thirst, and weakness after five days of a chest infection. She takes metformin but no insulin. Temperature is 38.2°C, pulse is 116/min, blood pressure is 96/60 mmHg, and mucous membranes are very dry. Glucose is 39 mmol/L, calculated osmolality is 338 mOsm/kg, ketones are 1.1 mmol/L, pH is 7.36, and sodium is 151 mmol/L. What is the most appropriate initial treatment?

A 50-year-old woman returns ten days after laparoscopic cholecystectomy because one port-site incision has mild redness and scant clear drainage. She is afebrile, pain is improving, and there is no fluctuance, spreading erythema, wound separation, jaundice, or abdominal tenderness. Sutures are due for removal today. What is the most appropriate wound-care plan?