Membership of the Royal College of General Practitioners (MRCGP) Life-Stage and Population Health Care Syllabus

In the NICE traffic-light system for the unwell child, name three 'red' (high-risk) features suggesting serious illness.

Pale/mottled/blue skin, no response to social cues or appears ill to a professional, weak/high-pitched/continuous cry, grunting, tachypnoea >60/min, moderate-severe chest indrawing, reduced skin turgor, bulging fontanelle, non-blanching rash, neck stiffness, or temperature ≥38°C in an infant under 3 months.

What temperature threshold in an infant under 3 months mandates urgent referral, and what does a fever ≥39°C in a 3-6 month old indicate?

Any temperature ≥38°C in an infant <3 months is a red feature requiring urgent assessment. In a 3-6 month old, temperature ≥39°C is an amber (intermediate-risk) feature.

What is the recognised dosing approach for intramuscular benzylpenicillin in suspected meningococcal disease before hospital transfer?

Give IM/IV benzylpenicillin immediately in primary care for a non-blanching rash with suspected meningococcal sepsis: under 1 year 300 mg, 1-9 years 600 mg, 10 years and over 1200 mg (do not delay transfer).

Distinguish the rashes of measles, rubella and scarlet fever by their characteristic features.

Measles: maculopapular rash starting behind the ears spreading to body, with Koplik spots and high fever/coryza. Rubella: pink maculopapular rash starting on the face, with suboccipital/postauricular lymphadenopathy. Scarlet fever: 'sandpaper' rough rash with circumoral pallor and strawberry tongue (group A strep).

What causes slapped-cheek disease (erythema infectiosum), and why is it significant in pregnancy?

Parvovirus B19. In pregnancy it can cause fetal anaemia and hydrops fetalis (especially before 20 weeks) due to suppression of fetal erythropoiesis, requiring monitoring.

What are the three core symptom domains used to diagnose ADHD, and what is the minimum duration and number of settings required?

Inattention, hyperactivity, and impulsivity. Symptoms must be present for at least 6 months, have started before age 12, occur in two or more settings (e.g. home and school), and cause functional impairment.

Name the core triad of features used to diagnose autism spectrum disorder.

Persistent deficits in social communication and social interaction, plus restricted/repetitive patterns of behaviour, interests or activities. Onset is in the early developmental period and features cause functional impairment.

Under Fraser guidelines, what conditions must be met to provide contraceptive advice/treatment to an under-16 without parental consent?

The young person understands the advice; cannot be persuaded to inform parents or allow the doctor to; is likely to have sex with or without treatment; their physical/mental health is likely to suffer without it; and it is in their best interests to receive it. (Gillick competence assesses general capacity to consent.)

What are the domains assessed in a Comprehensive Geriatric Assessment (CGA)?

Medical (comorbidities, medications, nutrition), functional (ADLs, mobility, falls), psychological (cognition, mood), and social/environmental (support, finances, living situation). It is a multidimensional, multidisciplinary assessment to create a coordinated care plan.

Name two validated tools/measures used to identify frailty in primary care.

The electronic Frailty Index (eFI), the Clinical Frailty Scale (Rockwood, 1-9), gait speed (walking 4 m slower than 5 seconds), the timed-up-and-go test (>12 seconds), and the PRISMA-7 questionnaire.

What does the FRAX tool calculate, and how does it guide bisphosphonate treatment decisions?

FRAX estimates the 10-year probability of a major osteoporotic fracture and hip fracture. Results are mapped against NOGG thresholds; high-risk patients are treated, intermediate-risk are offered a DEXA scan to refine the decision.

What is the first-line drug treatment for osteoporosis and the key counselling point on how to take it?

Oral bisphosphonate, e.g. alendronate 70 mg once weekly. Take on an empty stomach with plenty of water, while sitting/standing upright, and remain upright and fasting for at least 30 minutes to reduce oesophageal irritation. Ensure adequate calcium and vitamin D.

After an older person presents having fallen, name four key components of a multifactorial falls assessment.

Gait and balance assessment, vision, medication review (especially sedatives/antihypertensives - polypharmacy), lying/standing blood pressure (postural hypotension), cardiovascular exam, cognition, continence, footwear, and home hazards.

What is the first-line pharmacological treatment for mild-to-moderate Alzheimer's disease, and what is added/used for severe disease?

Acetylcholinesterase inhibitors (donepezil, rivastigmine, galantamine) for mild-to-moderate Alzheimer's. Memantine (NMDA antagonist) is used for severe disease, or for moderate disease intolerant of/contraindicated to cholinesterase inhibitors.

Which type of dementia is characterised by fluctuating cognition, visual hallucinations and parkinsonism, and which medication class must be avoided?

Dementia with Lewy bodies. Antipsychotics (especially typical/conventional ones) must be avoided as they can cause severe neuroleptic sensitivity reactions.

In palliative care, what is the standard first-line strong opioid for cancer pain and how is breakthrough (PRN) dosing calculated?

Oral morphine (modified-release for background plus immediate-release for breakthrough). The breakthrough dose is one-sixth (1/6) of the total 24-hour background dose, given as needed.

How do you convert oral morphine to subcutaneous morphine and to subcutaneous diamorphine in palliative care?

Oral morphine to subcutaneous morphine: divide by 2. Oral morphine to subcutaneous diamorphine: divide by 3. (e.g. 30 mg oral morphine/24h = 15 mg SC morphine = 10 mg SC diamorphine.)

Which anticipatory ('just in case') medications are commonly prescribed for the dying patient, by indication?

Morphine/diamorphine (pain or breathlessness), midazolam (agitation/terminal restlessness/seizures), haloperidol or levomepromazine (nausea/agitation), and hyoscine butylbromide or glycopyrronium (respiratory secretions/'death rattle').

What is first-line management of overactive bladder (urge urinary incontinence) versus stress urinary incontinence?

Urge incontinence/OAB: bladder training (≥6 weeks) first, then antimuscarinics (e.g. oxybutynin, but avoid in frail elderly) or mirabegron. Stress incontinence: pelvic floor muscle training (≥3 months), then consider duloxetine or surgery.

What PHQ-9 score ranges correspond to mild, moderate, moderately severe and severe depression?

PHQ-9: 5-9 mild, 10-14 moderate, 15-19 moderately severe, 20-27 severe. (0-4 = none/minimal.) Scores guide stepped-care management intensity.

According to NICE stepped care, what is the first-line treatment for a new episode of moderate depression?

Either a high-intensity psychological intervention (e.g. CBT or interpersonal therapy) or an antidepressant (SSRI first line). Combination is offered for severe depression. Antidepressants are not first line for subthreshold/mild depression.

What is the first-line drug treatment for generalised anxiety disorder (GAD) after psychological measures, and which screening tool quantifies severity?

An SSRI (e.g. sertraline) is first-line drug treatment; if ineffective, switch to another SSRI or an SNRI. The GAD-7 questionnaire quantifies severity (scores 5/10/15 = mild/moderate/severe). Avoid long-term benzodiazepines.

Name key high-risk factors increasing suicide risk that should be elicited in a self-harm/suicide risk assessment.

Male sex, older age, previous self-harm/attempts, mental illness (depression, psychosis), substance misuse, planning (final acts, note, precautions against discovery), violent/lethal method, hopelessness, chronic illness/pain, social isolation, and recent loss. The SAD PERSONS items capture many of these.

In a patient with established schizophrenia in primary care, what annual physical health monitoring is required due to antipsychotic use?

Annual monitoring of weight/BMI/waist circumference, blood pressure, HbA1c/fasting glucose, lipid profile, and prolactin. Also assess cardiovascular risk, smoking, and adherence/side effects. Antipsychotics carry metabolic and cardiovascular risks.

What scoring tool is used to assess alcohol dependence severity, and what AUDIT score indicates harmful drinking/possible dependence?

AUDIT (Alcohol Use Disorders Identification Test). Score 8-15 = increasing/hazardous risk, 16-19 = higher/harmful risk, and ≥20 = possible dependence (refer for specialist assessment). AUDIT-C is a shorter screening version.

Which medication is used for assisted alcohol withdrawal and which vitamin must be given to prevent Wernicke's encephalopathy?

A reducing regimen of chlordiazepoxide (a benzodiazepine) for withdrawal symptoms. Parenteral then oral thiamine (Pabrinex/B vitamins) is given to prevent Wernicke's encephalopathy.

What are the diagnostic features distinguishing anorexia nervosa, and what is a commonly used screening questionnaire?

Restriction of intake leading to significantly low body weight, intense fear of weight gain, and disturbance in body image. (DSM-5 removed the BMI 17.5 and amenorrhoea criteria.) The SCOFF questionnaire screens for eating disorders (≥2 positive answers suggests a likely disorder).

What are the UK weekly alcohol limits and the recommended pattern of consumption per the Chief Medical Officers?

No more than 14 units per week for both men and women, spread evenly over 3 or more days, with several drink-free days, and not 'saving up' units. Pregnant women are advised the safest option is no alcohol at all.

Outline the 'very brief' smoking cessation intervention model used in UK primary care.

The 'Ask, Advise, Act' (3 As) model (formerly Ask-Advise-Assist-Arrange). Ask and record smoking status, Advise on the best way to quit (referral to local stop-smoking services plus pharmacotherapy is the most effective), and Act by offering support/referral and treatment such as varenicline, NRT or bupropion.

Define the difference between health equality and health equity, and name two 'social determinants of health'.

Equality means giving everyone the same resources; equity means allocating resources according to need to achieve fair outcomes. Social determinants include income/poverty, education, housing, employment/working conditions, and access to healthcare (the 'causes of the causes'). The inverse care law states good medical care varies inversely with the need of the population served.