Question 1

How do you assess fever in an adult in primary care?

Accepted Answer

Assess fever systematically: (1) Confirm temperature ≥38°C. (2) Check for haemodynamic instability (BP <90/60, HR >120, SpO2 <94%) — if present, activate sepsis protocol immediately. (3) Duration: <7 days → focused history for localising source (cough, dysuria, rash); >7 days → full investigations (CBC, ESR, CRP, blood culture, urine, CXR, malaria RDT, typhoid serology). (4) Common causes: viral URTI (most common), UTI, pneumonia, typhoid, malaria. Treat the specific cause. Paracetamol 1g TDS for symptomatic relief. Refer immediately if sepsis criteria are met.

Question 2

What is the Centor score and when should a GP prescribe antibiotics for sore throat?

Accepted Answer

The Centor score (modified McIsaac) predicts Group A Streptococcal (GAS) pharyngitis. Score 1 point each for: tonsillar exudate, tender anterior cervical lymphadenopathy, fever >38°C, absence of cough; subtract 1 point if age ≥45. Score 0–1: very low probability of GAS — no antibiotics, reassure. Score 2–3: moderate probability — throat swab if available; consider antibiotics only if GAS confirmed. Score ≥4: high probability — prescribe Amoxicillin 500 mg TDS × 10 days (or Phenoxymethylpenicillin). Penicillin-allergic: Azithromycin 500 mg OD × 5 days. Most sore throats are viral — antibiotic stewardship is essential.

Question 3

What is the CURB-65 score and how does it guide pneumonia management?

Accepted Answer

CURB-65 assesses severity of community-acquired pneumonia (CAP). Score 1 point each for: Confusion (new), Urea >7 mmol/L, Respiratory rate ≥30/min, Blood pressure systolic <90 or diastolic ≤60 mmHg, Age ≥65. Interpretation: Score 0–1: low severity — outpatient treatment with Amoxicillin 500 mg TDS × 5 days (add Azithromycin if atypical organism suspected). Score 2: moderate severity — consider hospital admission; Amoxicillin + Clarithromycin. Score ≥3: severe — hospital admission required; IV antibiotics. Score 4–5: consider ICU. CURB-65 is simple and validated for GP use — always correlate with clinical judgement.

Question 4

When should a GP refer a patient with chest pain as a medical emergency?

Accepted Answer

Refer immediately (call 999/ambulance) for any of: crushing or heavy central chest pain with radiation to arm, jaw, or back; associated diaphoresis, breathlessness, or presyncope; ECG showing ST elevation or new LBBB; ST depression or T-wave inversion with ongoing pain; suspected aortic dissection (tearing pain radiating to back with BP difference between arms); haemodynamic instability (BP <90/60, SpO2 <94%). While waiting: Aspirin 300 mg chewable, sublingual GTN if SBP >90 mmHg, high-flow O2 if SpO2 <94%, IV access, 12-lead ECG and transmit to receiving centre. Do NOT delay transfer to investigate further in primary care.

Question 5

How should a GP manage uncomplicated UTI in a woman?

Accepted Answer

For uncomplicated UTI in a non-pregnant woman (dysuria, frequency, urgency without systemic features): urine dipstick showing nitrites and/or leucocytes supports clinical diagnosis. First-line treatment: Nitrofurantoin 100 mg modified-release BD × 5 days (avoid if eGFR <45). Alternative: Trimethoprim 200 mg BD × 7 days (avoid if local resistance >20% or if used in last 3 months). For complicated UTI (male, pregnant, systemically unwell, recurrent, upper tract symptoms): send mid-stream urine for culture before starting antibiotics. Treat for 7 days. If pyelonephritis suspected (fever, loin pain, rigors): urine and blood cultures, start Ciprofloxacin 500 mg BD × 7–14 days or Cephalexin 500 mg QID × 7–14 days, and consider hospital admission.

Question 6

What are the red flag signs requiring immediate hospital referral in a febrile child?

Accepted Answer

Immediate emergency referral for a febrile child if any of: age <3 months with any fever (all require hospital admission — sepsis risk); non-blanching petechial or purpuric rash (meningococcal septicaemia until proven otherwise — give IV/IM Ceftriaxone 50 mg/kg before transfer); bulging fontanelle, neck stiffness, photophobia, high-pitched cry, or Kernig's/Brudzinski's sign (meningitis); altered consciousness, seizures, or inconsolable irritability; SpO2 <92% or respiratory distress with grunting; signs of severe dehydration (sunken eyes, reduced skin turgor, unable to drink, no urine output). Act immediately — do not delay for investigations in primary care.

Clinical Algorithms

Fever Workup

Chest Pain Triage

Hypertension Management

Diabetes Management

Acute Diarrhea

Asthma Step Therapy

UTI Management

Pediatric Fever