Minor Illness Assessment – London, February 2024

• A 32 year old male patient complains of daily headaches for the past 2 weeks. They come on suddenly without warning over 1-2 mins and are centred around his left eye. The eye often waters. The pain is so severe that he has to stop whatever he is doing and goes to a quiet room before the pain resolves completely and spontaneously after about 20 minutes. He recalls having a similar series of headaches about a year ago

Q1. What is the diagnosis?

• 48 year old woman
• Developed gradual onset left sided neck and shoulder pain during a bank holiday weekend which she spent decorating the house
• She has full range of movement and is able to do her normal activities. However the pain been constant and has persisted now for more than 3 months
• The patient is keen for analgesia

Q2a. What are the best options for this patient?

• 48 year old woman
• Developed gradual onset left sided neck and shoulder pain during a bank holiday weekend which she spent decorating the house
• She has full range of movement and is able to do her normal activities. However the pain been constant and has persisted now for more than 3 months
• On examination you notice her shoulder pain only occurs in a limited arc between 60 and 120 degrees?

Q2b. Which of the following are correct in terms of the likely diagnosis and correct management?

Q3. You are doing a whole morning of medication reviews. Which of the following are correct?

• A 6 year old boy with a sore throat is brought to see you by her mum. She insists that you prescribe antibiotics for tonsillitis and refer him for a tonsillectomy as this is the 3rd time he has had this problem in the past 18 months

Q4a. Which of the following are criteria that should influence positively whether you would prescribe antibiotics for his sore throat?

• A 6 year old boy with a sore throat is brought to see you by her mum. She insists that you prescribe antibiotics for tonsillitis and refer him for a tonsillectomy as this is the 3rd time he has had this problem in the past 18 months.

Q4b. If antibiotics are indicated what is the recommended first line agent?

• A 6 year old boy with a sore throat is brought to see you by her mum. She insists that you prescribe antibiotics for tonsillitis and refer him for a tonsillectomy as this is the 3rd time he has had this problem in the past 18 months.

Q4c. Which patients should be referred for consideration of tonsillectomy?

• You are assessing a 6 year old child with a suspected ear infection

Q5. What one finding should alert you that this patient has an extensive middle ear infection that needs same day hospital assessment?

• You see a child with a flare up of atopic eczema, mainly affecting his elbows and behind his knees. He has been using regular emollient treatment and so you decide to add a topical steroid cream.

Q6. Which one of these creams is the most potent steroid?

• A 5 year old child is brought to the surgery with a 3 day history of temperature, reduced appetite and red spots on his hands and feet. You also notice 2 similar spots on one of his buttocks

Q8. What should you be advising in terms of management assuming you find no other positive findings?

• A 40 year old woman is complaining of pain in her wrist after tripping in her bathroom 2 days ago.

Q9. Which factors would favour a referral for suspected scaphoid fracture?

• A 35 year old pregnant woman is experiencing pain in her left hand at night, affecting her sleep. She finds that shaking her hand gives her some relief

Q10a. Just from that history what is the likely diagnosis?

• A 35 year old pregnant woman is experiencing pain in her left hand at night, affecting her sleep. She finds that shaking her hand gives her some relief

Q10b. What features are classic of carpal tunnel syndrome?

• You are reviewing a 29 year old patient with who has had a recurrent episode of moderate depression (PHQ-9 score of 10). He is keen to start an antidepressant in addition to counselling and CBT which he has already commenced through work. He has no suicidal ideation. He recalls a similar depressive episode 2 years ago.

Q12. What is/are appropriate management options?

• Unfortunately a patient has filed a written complaint to the practice about a consultation she had with you 2 months ago. She was breastfeeding at the time and had come to see you as she had been experiencing localised pain and tenderness in her right breast which was stopping her breast feeding
• You examined her and diagnosed mastitis and recommended analgesia and regular expressing of her breast milk
• 5 days later she presented to A&E with a fever and marked swelling of her right breast. She was diagnosed with a breast abscess and admitted for IV Abx and drainage of her abscess.
• Her complaints are that firstly you examined her inappropriately and secondly you missed her abscess

Q14. Which of the following are correct in relation to this case?

• A 68 year old man complains of a 6 month history of worsening urinary symptoms. He has to go urinate frequently and wakes up at night 3 times to urinate. He also notices his stream is not as strong as it used to be and he sometimes finds it difficult to initiate micturition. His PSA and HbA1c were normal and PR examination by one of your GP colleagues revealed a smoothly enlarged prostate. He reports no other symptoms. His symptoms have persisted despite conservative measures of reducing caffeine and alcohol intake.

Q14. What is the most appropriate pharmacological treatment to consider?

• A 60 year old woman has made an appointment because of a 7 week history of opening her bowels more frequently and she has also noticed that her stools are a little looser. She’s not sure if she has lost weight but does mention when you ask her that her trousers are a bit looser than usual and she uses a tighter belt notch. She has not noticed any blood in her stool and feels otherwise quite well. Her FBC shows a very mild anaemia and normal TFTs. She has no other symptoms and abdominal examination was unremarkable

Q16. What is the most appropriate management?

• A 28 year old non pregnant woman has symptoms of a lower UTI (2 day history of dysuria, frequency and urgency). She is well and afebrile with no loin pain or tenderness. You decide to treat her with antibiotics.

Q17. What is the most appropriate management?

• A 28 year old patient attends because he has had a dry cough for 2 weeks. A recent COVID PCR test was negative. He has no fever or breathlessness. His SpO2 was 98% and chest examination was normal.

Q18. What are appropriate management options?:

• A 28 year old female comes to see you to discuss a 1 week history of vaginal itchiness and a white creamy discharge. The discharge is not offensive smelling. Just over 4 weeks ago she was given antibiotics for a sore throat. She is well and afebrile.

Q19. What are the 2 most appropriate management options?

• An 18 year old female comes to see you as she has a 4 day history of diarrhoea and vomiting which she says her partner had the week before.

Q20. Whilst assessing her likely viral induced gastroenteritis, what should you advise with regard to contraception (she is on microgynon) (COCP))? What is the most appropriate management option?

• You are assessing a child < 5 years old with a 2 day history of unexplained high temperature.

Q21. Which of the following are high risk factors or red flags for developing potential sepsis?