MIC – April – 2026 – MCQs

Case Study 1: Neurology

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.

(Choose ONE best option)

A. Brain tumour

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B. Cluster headache

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C. Tension headache

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D. Migraine without aura

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E. Migraine with aura

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Case Study 2a: Analgesia and Musculoskeletal

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

(Choose ONE best option)

A. Paracetamol or ibuprofen

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B. Paracetamol and ibuprofen

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C. Co-codmaol 30/500

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D. Amitriptyline

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E. Topical analgesic

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Case Study 2b: Analgesia and Musculoskeletal

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 can do her everyday activities. However, the pai hasn not 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?

(Choose ONE best option)

A. Referred pain from the neck and physiotherapy

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B. Likely osteoarthritis of the shoulder and shoulder x-ray

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C. Shoulder impingement syndrome and ultrasound of the shoulder

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D. Rotator cuff tear and steroid injection

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Case Study 3: Prescribing

(Choose TWO best options)

A. Patients on risperidone should have an annual ECG

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B. A patient wants his diazepam prn re-authorised. He uses it when he goes on business trips as he has a phobia for flying. Although this is unlicensed use of diazepam it is a NICE recommended strategy and you should re-authorise it

Correct Incorrect Correct answer

C. An 11 year old is on an sodium valproate epilepsy. You notice he hasn’t had his dose adjusted for > 1 year. His is very heavy for his age and dose according to his weight in the BNF exceeds the maximum recommended dose. The dose in accordance to his weight should be adjusted down

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D. Children should always be prescribed liquid medication as opposed to tablets up to the age of 8

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E. An anxious patient wants to know why there is a “black triangle” ˅ or one of his medications. Does it mean that there are some known recognised safety issues with the drug?

Correct Incorrect Correct answer

Case Study 4a: ENT

(Choose TWO best options)

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.

A. Cough

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B. Tonsillar exudate / purulence (white spots)

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C. Enlarged anterior cervical lymph nodes

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D. Worse on lying flat

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E. Coryza

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Case Study 4b: ENT

(Choose ONE best option)

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.

A. Doxycycline

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B. Erythromyci

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C. Amoxicillin

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D. Phenoxymethylpenicillin

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E. Clarithromycin

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Case Study 4c: ENT

(Choose TWO best options)

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.

A. 2 episodes of tonsillitis in 1 month

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B. 5 episodes of tonsillitis per year for 2 consecutive years

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C. 3 episodes of tonsillitis in 18 months

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D. 3 episodes of tonsillitis per year for 3 years

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E. 5 episodes of tonsillitis in one year

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Case Study 5: ENT

(Choose ONE best option)

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

A. Redness and tenderness behind the ear

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B. Temperature 38.60C

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C. Purulent ear discharge

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D. Associated sore throat

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E. Perforated tympanic membrane

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Case Study 6: Dermatology

(Choose ONE best option)

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.

A. Eumovate

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B. Hydrocortisone 2.5%

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C. Dermovate

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D. Betnovate

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E. Elocon

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Case Study 7: Dermatology

(Choose THREE best options)

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 two similar spots on one of his buttocks

A. Oral antibiotics

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B. Any contact who has been pregnant should be assessed

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C. Soft diet eg yoghurt

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D. The symptoms should resolve in 7-10 days

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E. Analgesia

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Case Study 8: Musculoskeletal

(Choose TWO best options)

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

A. History confirming she landed on her outstretched hand

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B. Pain over her ulnar styloid (little finger side of wrist)

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C. Tenderness when pressing on the anatomical snuffbox

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D. Unable to make a fist

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Case Study 9a: Musculoskeletal

(Choose ONE best option)

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

A. De Quervain’s tenosynovitis

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B. Carpal tunnel syndrome

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C. Rheumatoid arthritis of hand

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D. Osteoarthritis of hand

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Case Study 9b: Musculoskeletal

(Choose ONE best option)

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

A. Pain and numbness/pins & needles in the little finger and ring finger

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B. Pain and numbness/pins & needles in the middle finger only

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C. Pain and numbness/pins & needles in the thumb, index and middle fingers

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Case Study 10: Psychiatry

(Choose ONE best option)

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.

A. Recommend St John’s Wort

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B. Use venlafaxine as a 1st line agent

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C. Review 1 week after initiation of antidepressant

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D. Advise that antidepressant should be continued for 6 months following remission

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E. Advise that antidepressant medications should always be reduced gradually as they are addictive

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Case Study 11: Chaperone Policy and Record Keeping

(Choose ONE best option)

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

A. You don’t need to offer a chaperone if you are a female HCP

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B. Your receptionist would be an acceptable chaperone

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C. You don’t need to document if a chaperone was offered but declined

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D. You can defer examination if you wish to have a chaperone but the patient does not

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E. You can successfully claim that the patient was afebrile and had no signs of an abscess (eg fluctuant swelling) even though you did not document it as you only documented the positive findings

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Case Study 12: Men’s Health

(Choose ONE best option)

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.

A. Tamsulosin 400 mcg od

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B. Tadalafil 5mg od

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C. Finasteride 5mg od

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D. Solifenacin 5mg od

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E. Dutasteride 500mcg od

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Case Study 13: Gastroenterology

(Choose ONE best option)

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 quite well. Her FBC shows a very mild anaemia and normal TFTs. She has no other symptoms and abdominal examination was unremarkable.

A. Stool culture

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B. Trial of loperamide

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C. Treat as irritable bowel syndrome

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D.H. Pylori testing

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E. 2 week wait referral for suspected colorectal cancer

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Case Study 14: Urology

(Choose ONE best option)

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.

A. Nitrofurantoin 100mg MR bd for 3 days

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B. Trimethoprim 200mg bd for 5 days

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C. Nitrofurantoin 100mg MR bd for 5 days

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D. Trimethoprim 200mg bd for 5 days

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E. Nitrofurantoin 100mg MR bd for 7 days

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Case Study 15: Respiratory

(Choose TWO best options)

A. Reassure that the most likely cause is viral and safety net with “worsening advice”

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B. Offer antibiotics as his cough has lingered for > 2 weeks

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C. Advise OTC cough remedies

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D. Advise that acute coughs can take up to 4 weeks to settle

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E. Offer antiviral treatment

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Case Study 16: Women’s Health

(Choose Best Two 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.

A. Advise avoid irritants such as bubble bath and try an emollient as a soap substitute

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B. Offer metronidazole 400mg bd for 7 days

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C. Offer fluconazole 150mg as a single dose

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D. High vaginal swab before deciding on any treatment

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E. Hydrocortisone cream prn for vaginal itchiness

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Case Study 17: Women’s Health

(Choose ONE best option)

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

A. Double her microgynon dose until the diarrhoea and vomiting settles

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B. Use additional barrier contraception (eg condoms) until at least 7 days after the diarrhoea and vomiting settles

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C. Don’t advise anything and assume she will not have intercourse whilst she has diarrhoea and vomiting

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D. Advise that the microgynon will still be absorbed normally as long as she does not vomit within 2 hours of taking a tablet

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E. Persistent diarrhoea without vomiting does not affect efficacy of the COCP

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Case Study 18: Fever and Sepsis

(Choose FOUR best options)

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

A. < 1 year old

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B. Temp ≥ 390C in a baby < 6 months

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C. Temp ≥ 390C in a 2 year old who does not have any other worrying features

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D. Temp ≤ 360C

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E. Blue lips

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