An everyday GP decision can turn on a detail that is easy to overlook: a symptom returning after treatment, a medicine affecting a test, the timing of a change or a patient's preference about care.
This general-practice quiz contains ten original questions with a separate answer key. The cases are fictional and use UK guidance checked on 18 October 2026. Each asks for the most appropriate decision within the information supplied, rather than a complete consultation plan.
Choose your answer before reading the explanation. Then identify the detail that makes another plausible action less appropriate. For a practice meeting, a three-question version appears after the answer key.
The questions
1. Visible haematuria returns after treatment
A 56-year-old woman recently completed appropriate treatment for a culture-confirmed lower UTI. Dysuria and frequency resolved. Visible haematuria has now recurred without urinary symptoms. She is clinically stable, without clot retention or another acute complication.
What is the most appropriate next step?
A. Wait for two further episodes before considering referral.
B. Arrange a routine ultrasound first and refer only if it is abnormal.
C. Repeat antibiotics automatically without assessing the recurrent bleeding.
D. Refer through the suspected urological cancer pathway while completing appropriate assessment.
2. The H. pylori test requested during PPI treatment
A 39-year-old has dyspepsia without alarm features after clinical assessment. You are arranging an H. pylori stool antigen test. They currently take a proton pump inhibitor and have not used antibiotics in the preceding four weeks. A temporary PPI interruption is clinically appropriate.
Which instruction best preserves the test's usefulness?
A. Withhold only the morning PPI dose on the day of the sample.
B. Allow a two-week PPI washout before testing.
C. Substitute a breath test without changing PPI exposure, because it is assumed to avoid the issue.
D. Treat a negative result obtained during PPI use as definitive regardless of the circumstances.
3. An uncomplicated acute cough
A previously well 34-year-old has a cough for nine days after an upper respiratory illness. Temperature, respiratory rate and oxygen saturation are normal. They are not systemically unwell, have no focal chest findings or significant breathlessness, and have no relevant condition increasing complication risk. Your assessment supports uncomplicated acute bronchitis.
Which approach is most appropriate?
A. Explain the expected course, offer symptom advice and safety-netting, without routine antibiotics.
B. Prescribe antibiotics because a cough has lasted more than seven days.
C. Arrange chest imaging routinely once a cough reaches one week, even with this assessment.
D. Issue a back-up antibiotic solely because the cough has lasted nine days, without another indication.
4. Unilateral acute otitis media in a well child
A four-year-old has two days of ear pain. Examination supports unilateral acute otitis media. The child is drinking, is not systemically very unwell and has no otorrhoea, mastoid swelling or relevant high-risk medical condition.
Which plan is most consistent with the stated presentation?
A. Prescribe immediately on the basis of the otoscopic diagnosis alone.
B. Prescribe immediately because the pain has lasted 48 hours, without considering the rest of the presentation.
C. Offer appropriate analgesia and consider no antibiotic or a back-up prescription, with clear review advice.
D. Give a back-up prescription but instruct the family to begin it immediately regardless of symptom progression.
5. Less severe depression and an informed treatment preference
A 29-year-old has a new episode of less severe depression following a full assessment. There is no history suggesting mania, no psychosis and no immediate safety concern identified, although risk and support have been discussed. The patient prefers a supported psychological or guided self-help approach and does not currently want an antidepressant.
What is the most appropriate response?
A. Start an antidepressant before offering psychological options because the symptoms have persisted.
B. Discuss suitable treatment options consistent with the person's needs and preference, agree support and arrange review.
C. Provide a leaflet only and leave review entirely open-ended because the episode is less severe.
D. Repeat a questionnaire in several months before discussing any treatment.
6. A persistent discrete breast lump at 34
A 34-year-old woman reports a new breast lump that has persisted. Examination confirms a discrete, unexplained lump. There are no signs of acute infection. She asks whether being younger than the screening population means it can simply be observed.
What should happen next?
A. Arrange routine rather than suspected cancer assessment because she is under 40.
B. Re-examine after three months before considering referral because there is no pain.
C. Wait for routine screening to become available rather than use a symptomatic pathway.
D. Arrange a suspected cancer pathway referral for specialist breast assessment.
7. A serum urate result during a flare
A 58-year-old is assessed during an acute first-metatarsophalangeal joint flare. The history and examination make gout a strong possibility; infection and other urgent causes have been considered in the assessment. Serum urate during the flare is 320 micromol/L.
What is the best interpretation and follow-up decision?
A. The result permanently excludes gout.
B. Repeat the urate the next morning and use that value alone to settle the diagnosis.
C. If gout remains strongly suspected, repeat serum urate at least two weeks after the flare has settled.
D. Diagnose gout solely from the location of pain, regardless of the assessment.
8. The first eGFR below 60
A 63-year-old has an incidental eGFR of 55 mL/min/1.73 m2. There is no previous renal result available. They are clinically well, potassium is normal and the assessment identifies no current emergency feature or obvious acute illness.
What is the most useful next step?
A. Repeat renal testing within two weeks, assess the context and investigate appropriately rather than diagnosing chronicity from one result.
B. Label established chronic kidney disease solely from this single measurement.
C. Defer a repeat for at least three months because that is the interval used to establish chronicity.
D. Arrange an annual renal check without first obtaining a prompt comparison.
9. An irregular pulse without symptoms
During a routine consultation, you detect an irregular pulse in a 72-year-old. The pulse rate is approximately 88/min. They are haemodynamically stable and deny chest pain, breathlessness, syncope or other acute symptoms. Atrial fibrillation is suspected but has not been documented.
What should you arrange to establish the diagnosis?
A. Repeat pulse palpation in three months and investigate only if symptoms appear.
B. A 12-lead ECG.
C. An echocardiogram instead of any rhythm recording to establish atrial fibrillation.
D. A formal diagnosis based only on the irregular pulse, followed by treatment selection.
10. Sudden hearing loss and a normal-looking ear canal
A 47-year-old developed marked hearing loss in one ear yesterday over a few hours. Examination does not identify wax, an external-ear problem or a middle-ear cause. There are no additional focal neurological symptoms suggesting a stroke presentation.
Which referral approach is appropriate?
A. Routine audiology in several months, because there is no ear pain.
B. Arrange audiometry in two weeks before deciding whether urgent referral is necessary.
C. Wait four weeks to establish whether it becomes chronic.
D. Immediate referral to ENT or an emergency department, to be seen within 24 hours.
Answers and explanations
1. D: recurrent visible haematuria after successful UTI treatment needs referral
NICE CKS guidance on UTI with haematuria in women identifies recurrent or persistent visible haematuria after successful infection treatment in people aged 45 and over as a reason for suspected cancer pathway referral.
The decisive detail is not simply that the urine was once infected. It is that the infection symptoms resolved and visible bleeding returned. Repeating antibiotics without an appropriate indication would not address that change.
This does not diagnose cancer. It identifies the investigation pathway required for an unexplained symptom in the stated age group. Acute complications would require additional immediate management; the question explicitly excludes them so that the referral decision remains clear.
For more questions about the next appropriate action, stat offers a separate daily set of mixed UK-context clinical decisions.
2. B: allow a two-week washout from the PPI
NICE's H. pylori testing quality statement specifies a two-week washout from proton pump inhibitors before a breath or stool antigen test. It also addresses avoiding antibiotics in the four weeks before testing.
The case has already excluded recent antibiotic exposure and established that temporary interruption is appropriate. The practical task is to arrange testing under suitable conditions and explain the reason to the patient, rather than place an unqualified request on the system.
A negative result needs interpretation in the circumstances in which the sample was obtained. This is a test-preparation question, not a reason to postpone assessment of alarm features or leave significant symptoms without an appropriate plan.
3. A: avoid routine antibiotics and explain the expected course
NICE NG120 advises against routine antibiotics for uncomplicated acute bronchitis in someone who is not systemically very unwell or at higher risk of complications. An acute cough can take three to four weeks to improve.
Nine days of coughing does not, by itself, establish a need for an antibiotic. The rest of the vignette matters: observations, examination, general condition and risk factors support the stated uncomplicated presentation.
Useful management includes explaining that course and agreeing when reassessment is needed, particularly with significant worsening or new concerns. The preferred answer is not "do nothing". It is a positive clinical plan without an unnecessary prescription, while remaining open to a different diagnosis if the presentation changes.
4. C: provide analgesia and choose an appropriate no-antibiotic or back-up strategy
For children fitting this scenario, NICE NG91 supports considering no antibiotic or a back-up prescription, alongside advice and pain management. Most children improve within around three days, although symptoms can last longer.
The age, unilateral disease, absence of discharge and lack of systemic illness are deliberately specified. Children who are systemically very unwell, have complications or fall into groups more likely to benefit need a different discussion.
Explain how to manage pain, what to expect and when to seek review. Where a back-up prescription is chosen, provide clear instructions on when to use it rather than handing over an ambiguous prescription. The two reasonable strategies are combined in one option because the question should not falsely imply that only one is acceptable in every such consultation.
5. B: make a shared treatment plan rather than prescribing automatically
NICE NG222 advises against routinely offering antidepressants as first-line treatment for less severe depression unless that is the person's informed preference. It describes a range of psychological and psychosocial options, including guided self-help.
The patient in this example prefers a suitable supported approach. Explore that preference, agree an accessible option and arrange follow-up that also addresses safety and support. Less severe symptoms do not mean that care or review is unnecessary.
The opposite overstatement would also be wrong: this recommendation does not mean antidepressants are forbidden for every person with less severe depression. The assessed presentation, previous experience, informed preference and wider circumstances remain relevant. A severity score contributes information but does not replace that discussion.
6. D: refer for specialist assessment rather than waiting for screening
NICE NG12 recommends suspected cancer pathway referral for an unexplained breast lump, with or without pain, in people aged 30 and over.
Routine screening and investigation of a symptom are different pathways. Being younger than the routine screening population is not a reason to leave a persistent, discrete lump unassessed. Equally, absence of pain does not provide reassurance sufficient to cancel the referral.
Explain that the purpose is to determine the cause, not that cancer has been diagnosed. Document the findings and referral arrangement, and ensure the patient knows what to do if the expected contact does not occur. The case is about the threshold for symptomatic assessment, not a prediction of the eventual diagnosis.
7. C: repeat the urate after the flare if clinical suspicion remains
NICE NG219 recommends repeating serum urate at least two weeks after a flare has settled when the result during the flare is below 360 micromol/L and gout remains strongly suspected.
The result is therefore not a reliable shortcut to permanent exclusion in the scenario provided. Conversely, the correct location of pain alone does not establish the diagnosis. Further assessment, including aspiration or imaging where appropriate, may be required when uncertainty remains.
The explicit consideration of infection is important. A hot, painful joint requiring assessment for septic arthritis must not be left waiting for a later urate test. The repeat-testing recommendation applies to the unresolved gout question after the immediate clinical assessment, not instead of that assessment.
8. A: obtain a prompt comparison and assess whether the change is acute or persistent
NICE NG203 advises confirming a newly identified eGFR below 60 by repeating testing within two weeks. The wider assessment should consider previous results, medicines, possible acute causes and relevant urine testing.
The UK Kidney Association's CKD staging guidance distinguishes a single low result from abnormalities established over more than three months. That longer interval defines chronicity; it is not an instruction to ignore a new abnormal result until then.
The patient in this question is clinically well with normal potassium. A more concerning clinical situation could need earlier or urgent reassessment. The preferred answer is therefore not a universal two-week waiting rule, but the appropriate initial approach under the facts given.
9. B: confirm the suspected rhythm with a 12-lead ECG
NICE NG196 recommends a 12-lead ECG when an irregular pulse raises suspicion of atrial fibrillation, whether or not the person has symptoms.
The irregular pulse prompts investigation; it does not identify every feature of the rhythm. A patient without palpitations can still need that assessment, and the absence of symptoms should not become a reason to leave the finding uninvestigated.
The question stops at confirmation because treatment decisions require more information. Rate, symptoms, stroke risk, bleeding considerations and the wider cardiac context would matter after assessment. An unstable patient would require an immediate emergency response, but the scenario explicitly describes a stable consultation rather than that situation.
10. D: sudden unexplained hearing loss needs immediate referral
NICE's quality statement on sudden-onset hearing loss specifies immediate referral, to be seen within 24 hours, when hearing loss developed over three days or less within the preceding 30 days and is not explained by an external- or middle-ear cause.
The timescale is the decisive feature: the loss began yesterday over hours. A normal-looking canal does not make a routine wait appropriate when the hearing change remains unexplained.
The exact receiving route should follow local arrangements, but the urgency should survive that administrative choice. New facial weakness or other neurological findings would change the emergency assessment. This case is not asking the GP to finish a specialist diagnostic work-up before making a time-sensitive referral.
A three-question version for a practice meeting
For a short discussion, use questions 2, 8 and 10. They provide three different decisions: preparing a diagnostic test, interpreting the chronology of a laboratory result and recognising a time-sensitive symptom.
Ask each participant to choose an answer independently, then identify the one detail they considered decisive. Reveal the explanation only after the group has discussed its reasoning.
A suggested follow-up is to change one condition. What happens when interrupting the PPI is unsuitable? How does new systemic illness alter the renal-result response? Why would a gradual hearing change have a different referral discussion from the sudden loss described here?
The objective is to understand when the answer changes, not simply remember the original option letter. Suggested discussion timings are an organiser's choice, not evidence that every question can be assessed safely in a fixed number of seconds.
Turn one uncertain answer into focused learning
Choose the question whose explanation changed your thinking. Write a precise learning prompt, such as "When should a PPI be paused before H. pylori testing?" or "How do I distinguish confirmation of a new renal result from establishing chronicity?"
That is more useful than deciding you need to revise all gastroenterology or all renal medicine. Follow the linked source, establish the boundary of the recommendation and revisit a different case later.
The free daily stat game can provide another decision to attempt, but it does not promise a GP-only edition every day or repeat the same subject. The ten questions above deliver this article's primary-care quiz; the game is a separate next challenge rather than a replacement for the promised content.
Frequently asked questions
Is this GP quiz suitable for qualified doctors as well as trainees?
It is written for clinicians who want to discuss everyday primary-care decisions. The cases can be used individually or in teaching, but the score is not a validated assessment of professional competence.
Why do some answers allow more than one reasonable management option?
A good question should preserve legitimate clinical choice. For example, the otitis-media answer includes both no-antibiotic and back-up approaches where the guidance supports considering either, rather than creating an artificial certainty.
Will today's stat edition contain these general-practice topics?
Not necessarily. These are original article questions. stat provides separate mixed UK-context decisions about priorities, next actions and changes to a plan.