Mrs A, a 34 year old woman presents at your pharmacy with a prescription for flucloxacillin 250mg qds for 10 days. She informs you that her GP prescribed the flucloxacillin for the treatment of mastitis but she is concerned about taking flucloxacillin whilst breastfeeding and asks for your advice. Mrs A takes no other medication and has no known drug allergies.

Which one of the following is the most appropriate course of action?

Mr B is a 76 year old patient weighing 65kg and requires treatment for a pulmonary embolism. You have been asked to provide advice on an appropriate dose of edoxaban to administer to Mr B.

Which of the following is the most appropriate dose to be administered to Mr B?

This question concerns Mrs C, a 52 year old lady who is a regular patient at your pharmacy and is being treated for deep vein thrombosis.

You receive a phone call from your local GP Dr T, informing you that Mrs C has been discharged from hospital after being treated with rivaroxaban for deep vein thrombosis. He tells you that Mrs C has received 7 days of rivaroxaban at the initial treatment dose of 15mg twice daily and he would like to know how many additional days of rivaroxaban he must prescribe for her at this dose.

How many additional days must you advise Dr T to prescribe for the initial treatment of deep vein thrombosis?

This question concerns Mrs C, a 52 year old lady who is a regular patient at your pharmacy and is being treated for deep vein thrombosis.

Mrs C presents at your pharmacy with a prescription for the additional rivaroxaban that the GP has prescribed for her.

Which of the following counselling points would be most appropriate for you to advise Mrs C when dispensing her prescription?

You are working as a locum pharmacist on a busy Friday afternoon and are presented with a prescription for ciclosporin 50mg capsules. The patient requests that you provide him with the Capimune brand as this is what he was given previously. You do not have that brand in stock but do have the required strength and quantity of generic ciclosporin and the Neoral brand.

Which one of the following is the most appropriate course of action?

Mrs D is a 76 year old woman who has atrial fibrillation and must be assessed for her risk of stroke using the CHA2 DS2 VASc scoring tool. Mrs D weighs 65 kg and has recently suffered a heart attack. She is currently on the following medication

• Tolbutamide 500mg od
• Ramipril 10mg od
• Donepezil 5mg nocte
• Atorvastatin 80mg od
• Bisoprolol 5mg od

Which of the following is Mrs D’s CHA2 DS2 VASc score?

You are preparing a pharmaceutical care plan for a paediatric cancer patient.

Which of the following is most likely to result in severe neurotoxicity if administered intrathecally?

This question concerns Mrs E, a regular customer whose 7 year old daughter takes desmopressin for bedwetting.

Mrs E informs you that she is travelling with her family next week. She tells you that they will be going to a beach and will be doing plenty of activities involving swimming. She asks for your advice regarding her 7 year old daughter who takes desmopressin for bedwetting. She wants to know if there are any precautions she must take while on holiday.

Which of the following is the most appropriate advice to give Mrs E in regards to her daughter while on holiday?

This question concerns Mrs E, a regular customer whose 7 year old daughter takes desmopressin for bedwetting.

Which of the following electrolyte imbalances would be of most concern if experienced by Mrs E’s daughter?

This question concerns Mrs F, a 52 year old woman who is a regular customer at your pharmacy.

Mrs F presents with a prescription for trimethoprim 200mg twice daily and she explains that the doctor has prescribed her antibiotics for a urinary tract infection. You are aware that she takes methotrexate tablets at a dose of 12.5mg weekly for rheumatoid arthritis and decide to contact the doctor to suggest an alternative antibiotic as there is an interaction between methotrexate and trimethoprim.

Which one of the following statements best describes the interaction between trimethoprim and methotrexate?

Mrs H, a 35 year old woman, presents in the pharmacy asking for your advice.  She has developed a small circle of thickened skin on the side of her small toe.  Although it is not often painful, she is rather conscious of it and would like something to help remove it as the summer is approaching and she wants to wear sandals but is worried at how her feet may look in them.

What is the most likely diagnosis of the lesion on Mrs H’s foot?

Mr G, a 26 year old man, comes into the pharmacy and asks if someone can have a look at his eye. He informs you that although his vision is not affected, his eye is causing him some irritation, is slightly watery and is sensitive to the touch.

Which of the following best describes the cause of Mr G’s condition and its management?

Mr H is 56 year old man weighing 72 kg and is currently on the following medication
• Atorvastatin 20mg tablets
• Metformin 500mg tablets
• Sertraline 50mg tablets

You are a pharmacist in a GP surgery and need to give advice on the tests required for Mr H. You note from his records that atorvastatin was only started two months ago. Mr H has recently been complaining of tiredness and constipation. He has also noticed an increase in his weight, although he has not made any dietary changes and continues with his exercise regimen.

Which one of the following tests is most necessary for Mr H?

Mr I, a 57 year old man visits your pharmacy and you hear him discussing a choice of suitable eye drops with the counter assistant. He explains that he has recently started to experience some blurred vision. You check the patient medication records and find that he is currently taking the following medication:

• Allopurinol 100mg daily
• Amiodarone 200mg daily
• Salbutamol 100mcg inhaler 2 puffs when required

The counter assistant refers Mr I to you for your advice.

What is the most appropriate course of action?

Miss J, a 27 year old lady presents you with a prescription. You proceed to legally and clinically check the prescription and subsequently explain to her that you are unable to dispense the prescription.

Which of the following is the most appropriate explanation to provide Miss J as to why you cannot dispense the prescription?

This question concerns Mrs K, a 54 year old woman that is receiving treatment for breast cancer.

Mrs K has been receiving fluorouracil as part of her treatment plan but has now started to complain about a sore mouth.

Which of the following is the most appropriate advice to give Mrs K to help manage her symptoms?

This question concerns Mrs K, a 54 year old woman that is receiving treatment for breast cancer.

Mrs K has been receiving oral morphine at a dose of 30mg every 4 hours, but she has recently started to suffer with dysphagia. Consequently, the doctor has decided to change her from oral morphine to a 24-hourly subcutaneous infusion of morphine.

Which of the following is the most suitable daily dose of morphine that Mrs K should be given by subcutaneous infusion?

This question concerns Mrs K, a 54 year old woman that is receiving treatment for breast cancer.

Mrs K starts to suffer with constipation and the doctor decides that she will benefit from taking a laxative.

Which one of the following laxatives would be most suitable as initial treatment of constipation in palliative care?

You are working on a Saturday as a locum and the staff inform you about an error made by the regular pharmacist. You are aware that he is dealing with some personal issues at home, and the staff can smell alcohol when he works. On Friday a patient returned amlodipine 10mg tablets as she was prescribed amitriptyline 10mg tablets, two to be taken daily. She had realised the error before consuming any medication and has not come to harm from it. The staff are afraid to report their concerns as the pharmacist has had a short temper lately, however you deem it necessary to report this to the pharmacy manager.

Which of the following legislations will provide you with protection?

You are required to deliver a training session on the concept of pharmaceutical care.

Which of the following descriptions best relate to the concept of pharmaceutical care?

Mrs L, a 67 year old woman who is a regular patient at your pharmacy, asks for your advice. She has been suffering with nausea and diarrhoea and would like to purchase something to help with her symptoms. While talking to you, she compliments you on your “beautiful yellow top”. This raises concern as your top is in fact white and not yellow.

Which of the following medications is most likely be responsible for Mrs L’s symptoms?

This question concerns Mr M, a 58 year old man who is on warfarin.

Mr M has his INR checked on a regular basis. Usually his INR is within the normal range, however today it is found to be 6.5. There are no signs of bleeding.

Which one of the following is the most appropriate course of action?

This question concerns Mr M, a 58 year old man who is on warfarin.

Mr M informs you that he has been drinking a new juice lately, which you suspect could be the cause of the increased INR.

Which of the following juices is most likely responsible for Mr M’s increase in INR?

Mrs N is a 65 year old lady who is rushed into hospital. She presents with nausea, vomiting and abdominal pain and is severely dehydrated. She is also slightly confused and complains of a back ache, and tells the medical team that lately she has produced very little urine. She is taking the following medication on admission:

• Co-codamol 15/500mg
• Citalopram 20 mg
• Simvastatin 20mg
• Ramipril 5mg
• Amlodipine 5mg

Which of the following drugs is the most likely cause of Mrs N’s symptoms?

Mr O, a regular customer, rings your pharmacy distressed. He explains that his 4 year old daughter has just experienced a seizure at home for which he administered midazolam as per the instructions he was given by the doctors. He informs you that the midazolam stopped the seizure but is concerned that his daughter’s breathing has become shallow and she appears lethargic. Mr O is worried and asks for your advice.

Which one of the following is the most appropriate course of action?

Mr P is a 52 year old patient who takes medication for blood pressure and osteoporosis. Recently he has been feeling quite “light headed” but is otherwise fine. He asks if there is anything he can do to prevent this. He tells you that he has recently been started on Tamsulosin after he developed prostrate problems. His medication records show that he also takes the following medication:

• Amlodipine 5mg daily
• Ramipril 10mg daily
• Simvastatin 20mg at night
• Alendronic acid 10mg daily

What is the most appropriate course of action?

Mrs Q is a 55 year old lady weighing 72kg and presents to your pharmacy complaining of urinary problems. She complains of pain on urinating and feels the urge to go more frequently than usual, only to produce very little urine. Mrs Q would like to know if there is anything over the counter that can help. She does not suffer from any allergies and takes the following medications:

• Ramipril 5mg capsules
• Alendronic acid 70mg tablets
• Tiaprofenic acid 300mg tablets
• Salbutamol 100mcg inhaler

Which of the following is the best advice to give Mrs Q?

This question relates to Mr R, a patient who has mild renal impairment.

The nurse asks for your advice on whether Mr R’s medication requires adjusting.

Which one of the following serum creatinine levels would you most likely expect to see after Mr R’s eGFR has been measured?

This question relates to Mr R, a patient who has mild renal impairment.

The nurse on the renal ward asks you for help. She informs you that she has been reading up about renal disease and asks what the acronym MDRD stands for.

Which one of the following options best describes what MDRD stands for?

Mrs S, a 53 year old woman who has type 2 diabetes and hypertension, presents you with a prescription for her regular medication. She explains that the GP has added on a new medication for hypertension as her blood pressure is still high despite taking ramipril 10mg daily.

Which of the following is the most appropriate action to take?

Miss T presents at your pharmacy after being bitten on her hand by a cat yesterday and asks for your advice. Her hand is rather tender and she is worried about the possibility of developing an infection. You are aware that cat bites have an increased risk of infection and suggest that Miss T visits her GP as she may need antibiotics.

Considering that Miss T is allergic to penicillin, which of the following antibiotics would be the most appropriate for her to take?

You are working as a locum pharmacist. A 16 year old girl comes into the pharmacy requesting some strong painkillers. She appears to be distressed and looking around her. You invite her to the consultation room to which she agrees. From the consultation you gather that she has had female genital mutilation (FGM) and would like some strong pain killers.

What is the most appropriate course of action to take?

Mr U is 21 years old and was diagnosed with eczema 6 months ago. He has been struggling with looking after his skin as he leads quite a hectic lifestyle. He presents in the pharmacy asking you for advice concerning the spots on his face, which are increasingly becoming troublesome for him. He describes them as being red and itchy and also complains about his skin becoming painful. After examining his face you notice a few pustules. You ask him how he applies the E45 cream and he explains that he rubs it into his skin all over in circular motions. Prior to this he has had no skin issues apart from the eczema.

What is the most likely cause of Mr U’s spots on his face?

Mr V is a 27 year old male who recently had an anaphylactic shock after eating a Chinese take away, which he later discovered contained peanut oil. Consequently his GP recommended that he carries intramuscular adrenaline injection with him at all times.

Which of the following is the most appropriate dose of adrenaline that should be administered to Mr V in case of anaphylaxis?

A hospital inpatient has died from a drug overdosage due to a suspected dosing error. The chief pharmacist of the hospital has ordered the undertaking of a Root Cause Analysis (RCA) on this incident.

What is the most suitable type of investigation to be performed?

This question concerns Miss W, a 22 year old lady who has been newly prescribed Priadel 200mg prolonged release tablets for the treatment of bipolar disorder.

Miss W presents at the pharmacy to collect her prescription for Priadel 200mg tablets. She informs you that this is the first time she will be taking the tablets and asks whether there is any important information she should be aware of.

Which of the following advice is the most appropriate for you to give Miss W regarding the treatment?

This question concerns Miss W, a 22 year old lady who has been newly prescribed Priadel 200mg prolonged release tablets for the treatment of bipolar disorder.

Miss W comes to the pharmacy with a dental prescription for metronidazole 400mg tablets. She informs you that the dentist has prescribed this for the treatment of acute gingivitis. She also asks if she can buy a bottle of chlorhexidine mouthwash.

Which of the following courses of action is the most appropriate for you to take?

This question concerns Miss W, a 22 year old lady who was prescribed, a month ago, with Priadel 200mg prolonged release tablets for the treatment of bipolar disorder.

Miss W is admitted to A&E suffering with a suspected lithium overdose. Serum levels yield a lithium concentration of 3.0mmol/L. Further tests suggest Miss W has impaired renal function.

Which of the following methods is the most appropriate to manage Miss W’s lithium overdose?

Mr X is a 27 year old man who has type 1 diabetes for which he uses NovoRapid and Lantus. You are having trouble obtaining Lantus devices and the doctor writes a prescription for Abasaglar instead.

Which of the following statements regarding biosimilar medicines is the most appropriate?

Mrs Y is a 68 year old woman who suffers with type 2 diabetes and hypertension for which she takes metformin, gliclazide and enalapril. She is admitted to hospital with generalised weakness, shortness of breath and vomiting. A blood and urine test is conducted upon admission and she is found to have an eGFR of 36ml/min/1.73m2 and an albumin:creatinine ratio of 18mg/mmol.

Which of the following is an appropriate chronic kidney disease classification for Mrs Y?

Mrs Z, a 72 year old lady presents at your pharmacy seeking advice. She has been experiencing pain in her right ear and thinks it may be due to a build- up of ear wax. She asks if you can recommend something for her to use over the counter. Her PMR shows that she is currently taking the following medication:

• Amlodpine 10mg daily
• Alendronic acid 70mg weekly
• Atorvastatin 20mg daily

Which one of the following is the most appropriate course of action?

Mr A visits your pharmacy and asks you to recommend a suitable analgesic to ease his headache that he has been experiencing over the last few days. When asked to describe the headache he tells you that it seems like a “tight band” around his head. You check the patient medication record system and see that he is currently taking:
• lithium carbonate 400mg tablets
• gliclazide 30mg tablets

Which of the following over the counter analgesics would be the most appropriate for Mr A?

Miss B is a 21 year old female who visits your pharmacy and requires emergency contraception, as she has had unprotected sexual intercourse two days ago. Upon further questioning you decide to provide her with EllaOne. Miss B informs you that she has just completed a course of amoxicillin 250mg capsules and takes salbutamol, when required, for mild asthma. She also has a 6 month old baby whom she is breast feeding.

Which one of the following is the most suitable advise to give Miss B?

This question concerns Master C, a 6 year old boy who has been taken to hospital after having ingested his mother’s iron tablets.

You are a hospital pharmacist working in the paediatric ward and have been asked by the doctor about iron poisoning. He informs you that Master C, who weighs 20 kg, has been rushed into hospital after ingesting his mother’s iron tablets which were in her handbag. Master C is showing signs of iron toxicity including vomiting and abdominal pain.

What is the minimum amount of elemental iron that the child could have ingested that could result in symptoms of toxicity?

This question concerns Master C, a 6 year old boy who has been taken to hospital after having ingested his mother’s iron tablets.

After initial assessment the doctors decide that treatment of iron overdose is necessary.

Which of the following is the most suitable approach to use when managing iron poisoning?

Mr D, a 42 year old man, presents at the pharmacy with a prescription for lansoprazole 30mg gastro resistant capsules. He explains that his GP has prescribed this to take alongside naproxen 250mg tablets which he is taking for tendinitis. The prescription is dispensed and you conduct a final check.

Which of the following information should be included on the dispensing label for lansoprazole 30mg gastro resistant capsules?

Mrs E is a 67 year old woman who visits your pharmacy seeking advice about her hay fever. She explains that although she has suffered with mild hay fever symptoms in the past, she has not taken any medication for it previously. However, this year it is particularly bothersome, and she would like you to advise on the most appropriate medication to help manage her symptoms. Mrs E informs you that she is currently taking the following regular medication:

• Co-beneldopa 200/50mg twice a day
• Citalopram 20mg daily
• Metformin 500mg three times a day

Which of the following hay fever medications would be the least appropriate to supply Mrs E?

Mrs F visits the pharmacy with her 3 year old daughter weighing 14kg, who has had a high temperature recently. The GP has advised Mrs F to administer paracetamol every four to six hours.

Which of the following doses should Mrs F administer to her child?

Mr G is a 46 year old patient who was admitted to hospital with meningitis. Following initial treatment with gentamicin, the doctors decided to switch to amikacin due to apparent resistance. Mr G was started on amikacin at a dose of 600mg twice daily. Following the administration of four doses, a serum amikacin concentration measurement yielded a pre-dose (‘trough’) amikacin level of 14mg/litre. Mr G has no known allergies.

Which of the following is the most appropriate action to take?

Mrs H is a 46 year old regular patient who has type 2 diabetes. Whilst discussing the medication with the patient you ascertain that over the last three days she has been experiencing nausea, fatigue, abdominal pain and she has also noticed that her urine is dark in colour. She informs you that, despite taking metformin 500mg three times a day regularly for the past four months, her HbA1c was found to be 68 mmol/mol and the doctor prescribed a new additional oral anti-diabetic which she has been taking for the last 10 days.

Which of the following medications would the doctor have recently prescribed for Mrs H?

Mr I, a 35 year old man, presents at the pharmacy requesting to speak to the pharmacist. He explains that he has recently been experiencing shortness of breath and often finds himself wheezing. He notices the symptoms are worse after exercise and in cold weather. You measure his weight to be 72kg and height as 1.75m, concluding that he has a healthy BMI. He does not smoke and does not have any allergies.

Which of the following Peak Expiratory Flow Rate values would be considered normal for Mr I?

After attending a CPPE workshop on inhaler techniques, you decide to undertake an audit in the pharmacy to review the information and counselling provided to patients on how to effectively use their inhalers.

Which of the following statements regarding audits is true?

Both patients and healthcare professionals are encouraged to report all suspected adverse drug reactions via the yellow card scheme to the Medicines and Healthcare products Regulator Agency (MHRA).

Which of the following adverse drug reactions would need to be reported to the MHRA?

Mr O is a 26 year old student who has recently visited the dentist and has been prescribed Colgate Duraphat 5000ppm toothpaste. He has researched about the fluoride content in his area and is curious about fluoride tablets. Mr O would like to know what the fluoride content must be before fluoride tablets or drops are considered.

What is the most suitable advise to give Mr O?

This question concerns Mr P, a 32 year old man, who has depression.

Mr P presents in the pharmacy with a prescription for tranylcypromine 10mg twice daily and explains that this is a new medication that the doctor has prescribed for him.

Which of the following foods should you advise Mr P to avoid?

This question concerns Mr P, a 32 year old man, who has depression.

Whilst counselling Mr P you highlight possible side effects of the new medication.

Which one of the following symptoms would warrant urgent referral?

Mr Q, a 35 year old man who is visiting the UK from Germany, presents you with a prescription for diazepam tablets. He explains that his doctor in Germany prescribed them for him for the management of muscle spasms. He further informs you that he was unable to obtain the medication in Germany due to his travels and asks whether you could dispense the prescription for him. You manage to confirm the registration status of the prescriber by checking their registration number online.

Which of the following is the most appropriate action for you to take?

Mr R is a 56 year old male who visits your pharmacy for the first time and asks for Gaviscon as he thinks he may have indigestion after eating his lunch in a hurry. He explains that sometimes he has chest pain when he exerts himself but feels better after resting and taking the medication the GP prescribed him. Mr R has a BMI of 28 kg/m2 and you ask him to indicate where he feels the pain, to which he points towards his chest area. Mr R also complains of jaw pain and asks if you could look at his left arm since he is experiencing unexplainable pain.

What is the most appropriate course of action?

Mr S is a 60 year old man on the orthopaedic ward after having undergone hip replacement surgery. He has developed osteomyelitis and the doctors have prescribed fusidic acid at a dose of 500mg three times a day. You are screening his drug chart and notice that in addition to analgesics taken when required, he is also on the following regular medication:
• Enalapril 10mg
• Simvastatin 40mg

Which of the following advice is appropriate for you to provide to the medical team responsible for Mr S’s care?

Mr T is a 32 year old patient who visits your pharmacy seeking advice. He informs you that he had a tingling sensation in his lip yesterday and woke up this morning with a blister.

Which of the following situations would require you to refer MR T to the GP?

Mrs U has been a regular patient at your pharmacy for 5 years. She presents in your pharmacy on a busy Friday afternoon requesting that you provide her with a copy of her patient medication record (PMR) that she requires for  personal use. All patient medication records in your pharmacy are completely held on computer.

Under the provisions of the Data Protection Act 1998, which of the following would be the best course of action for you to take?

Mrs V is a 28 year old female who presents at the pharmacy to collect her husband’s prescription for isotretinoin. She informs you that she is 3 weeks pregnant and would like to purchase folic acid tablets.

Which of the following advice is the most appropriate to give Mrs V?

You are training a new healthcare assistant and want to ensure she knows when it is appropriate to supply Maloff Protect 250mg/100mg tablets (atovaquone with proguanil hydrochloride) as a pharmacy only (P) medicine.

Which of the following patients would it be appropriate to supply with Maloff Protect tablets?

This question concerns Mr B a 55 year old patient with a BMI of 29 kg/m2 and is starting to feel concerned with his weight.

Mr B comes to the pharmacy seeking advice about how he can lose weight and explains that he was worried about developing further medical conditions if he does not. He currently takes the following medication:
• amlodipine 10mg
• atorvastatin 20mg at night

At which stage of the behavioural change cycle is Mr B currently at?

This question concerns Mr B a 55 year old patient with a BMI of 29 kg/m2 and is starting to feel concerned with his weight.

After visiting his GP Mr B returns with a prescription for orlistat 120mg, one to be taken three times a day. As he plans on dieting, the doctor has advised him to take vitamin supplements. He asks if you can recommend some multivitamins and seeks your assurance as to whether it would be suitable to take them whilst taking orlistat.

Which one of the following is the most appropriate course of action?

Mr C visits your pharmacy and presents you with a prescription for 7 tablets of temazepam 10mg once daily.

Using the table above, select the most appropriate option which reflects the correct legal procedures concerning temazepam.

This question concerns Mr D, a 57 year old lorry driver weighing 69kg.

Mr D comes to the pharmacy to collect his repeat prescription and asks you to dispense a prescription for levofloxacin 500mg tablets that his GP has prescribed for the treatment of acute sinusitis.

Which of the following counselling points would be most appropriate for you to give Mr D when dispensing his prescription?

This question concerns Mr D, a 57 year old lorry driver weighing 69kg.

Four days later, Mr D returns to the pharmacy complaining of severe pain in his right shoulder and asks you to recommend a suitable pain killer. He explains that the pain started yesterday morning and is increasing in severity. He does not remember doing anything that may have caused injury to his shoulder and has not taken any pain killers for it.

Which of the following is the best course of action?

Mr E, a 66 year old man has been stabilised on Oramorph concentrated oral solution (morphine sulphate 100mg/5ml) for the past six months. The consultant doctor decides to switch him onto Durogesic DTrans (fentanyl) patches as his pain is under control. He currently takes 2mL every four hours.

Which of the following Durogesic DTrans patches should the doctor prescribe for use every 72 hours to provide an equivalent effect to Mr E’s current daily dose from Oramorph concentrated oral solution?

Mr F is a 44 year old male who presents at the hospital with facial flushing, a throbbing headache, vomiting and a pulse rate of 115 beats per minute. Mr F smokes 3 cigarettes a day and has wine with his evening meals. He has no known allergies.

Which of the following drugs is the most likely cause of Mr F’s symptoms?

Mrs G is in the initial phase of treatment for tuberculosis and is currently being treated with the following medications:

• Isoniazid 300mg daily
• Rifampicin 600mg daily
• Pyrazinamide 2.5g three times a week
• Ethambutol 1.2g three times a week

Which one of the following can be administered to prevent isoniazid induced peripheral neuropathy?

Mr H presents you with a veterinary prescription for his cat, Fluffy. He tells you that she has been quite poorly recently and not her usual self. The Vet doctor believes she has a respiratory tract infection.

Which of the following would be the most appropriate course of action?

Mr I presents at the pharmacy concerned about his 3 year old daughter who has been suffering with perianal itching. After asking the relevant questions you decide to supply Mr I with mebendazole 100mg tablets. In addition to his daughter, Mr I also lives with his wife and his 7 year old son. He asks whether the condition his daughter has is contagious.

What is the most appropriate advice to give to Mr I?

You are working in the hospital pharmacy dispensary and a nurse from the mental health unit contacts you late on a Friday evening asking whether you have risperidone depot injection in stock as she requires it for Mr J. She informs you that he usually takes haloperidol tablets 5mg twice a day. The nurse confirms that the dose of haloperidol decanoate to be administered is 50mg every 4 weeks.

What would be the most likely reason behind Mr J’s change of formulation?

You want to obtain information on the European Community guidelines on Good Manufacturing Practice.

Which of the following is the most important reference source to consult for this
information?

Miss N suffers from eczema and has been prescribed 3 x 500g of Balneum Plus Cream (Urea 5%, Lauromacrogols 3%) to use whilst she is away on holiday for two months.

Which of the following provides the correct weight of active ingredients in the total amount of cream prescribed?

Ms L is a 42 year old woman visiting the UK from France who presents at your pharmacy and asks if you can provide her with a supply of medication that she usually takes for Ménière’s disease. She explains that she left France for the UK in a hurry to attend a conference and forgot her medication in the process. She further explains that she has enough to last her for two days but is staying for a week and will need more. The medication she is requesting is not one that you are familiar with and upon searching, you discover that it is used in countries in Europe but is not licensed in the UK.

Which of the following is the most appropriate action to take?

You are a locum pharmacist working in a busy pharmacy on a Friday evening. You are approached by a patient requesting an emergency supply of his medication. He explains that he has run out of his medicine and that he is in pain and needs his pain killers and sedatives.

Which of the following medications can be supplied in an emergency request on behalf of the patient?

Mrs M is a 65 year old woman who has developed a severe skin infection associated with methicillin resistant staphylococcus aureus (MRSA). She has been initiated on medication via the intravenous route in order to treat the infection, however she has now developed a temperature of 39.2oC and her torso, face and neck is of a prominent red colour. She also is experiencing a rash and itching.

Which of the following antibiotics is responsible for Mrs M’s symptoms?

Miss N is 24 years old and has been admitted to hospital following a paracetamol overdose. She weighs 55kg and her mother informs you that she ingested the paracetamol six hours ago. She has no known allergies and has given up alcoholic beverages over a month ago. She has been vomiting over the last two hours. Miss N’s plasma-paracetamol concentration is 75mg/L.

Which of the following is the most appropriate course of action?

Mr S, a 36 year old man has been stopped by police on the M25 motorway for dangerous driving. The police question Mr S and he denies taking any drugs that may have impaired his driving. The police decide to use a drug screening device to establish whether Mr S has taken any drugs by testing his saliva.

Which of the following licensed drugs can be identified on a roadside drug screening device?

Whilst working as a pharmacist in an inpatient hospital pharmacy, you receive a delivery of controlled drugs which you are required to store appropriately on the pharmacy premises.

Under the Misuse of Drugs (Safe Custody) Regulations 1973, which of the following medicines is exempt from being kept under safe custody?

Mrs O is a 27 year old woman who recently gave birth and is currently breast feeding. She presents you with a new prescription for phenytoin. You deem it pertinent to check her patient medication records which show that last week she collected a prescription for the following medication:
• ferrous sulphate 200mg twice a a day
• Co-codamol 8/500mg when required
• Sumatriptan 50mg when required
• Lactulose 15ml twice a day

Which of the following medications that Mrs O is taking would cause you the most concern?

Mr P is a 55 year old patient who has been diagnosed with moderate rheumatoid arthritis. He has been started on prednisolone at an initial dose of 60mg daily which will be tapered to 7.5mg daily over 6 weeks and reviewed.

Which of the following is the most appropriate statement?

This question relates to Mr Q, a 64 year old man who has been recently prescribed Trulicity (dulaglutide) 1.5 mg solution for injection as an add-on therapy for his diabetes at a dose of 1.5mg weekly, which he usually takes on Wednesdays. He is also on atorvastatin, metformin, gliclazide and ramipril. He has no known drug allergies and has a BMI of 28.2kg/m2.

Mr Q contacts you in the pharmacy on a Saturday morning. He explains that he has forgotten to take his regular dose this week and asks for your advice.

Which of the following is the most appropriate advice to give Mr Q regarding his missed dose?

This question relates to Mr Q, a 64 year old man who has been recently prescribed Trulicity (dulaglutide) 1.5 mg solution for injection as an add-on therapy for his diabetes at a dose of 1.5mg weekly, which he usually takes on Wednesdays. He is also on atorvastatin, metformin, gliclazide and ramipril. He has no known drug allergies and has a BMI of 28.2kg/m2.

Mr Q visits the pharmacy experiencing constipation and flatulence.

Constipation and flatulence are undesirable effects reported to occur in how many users of dulaglutide?

This question relates to Mr Q, a 64 year old man who has been recently prescribed Trulicity (dulaglutide) 1.5 mg solution for injection as an add-on therapy for his diabetes at a dose of 1.5mg weekly, which he usually takes on Wednesdays. He is also on atorvastatin, metformin, gliclazide and ramipril. He has no known drug allergies and has a BMI of 28.2kg/m2.

Mr Q is concerned about his weight and is attempting some lifestyle changes to help with weight loss. He asks whether dulaglutide will help reduce his weight.

Over a 52 week period, what change in Mr Q’s weight could be attributed to Trulicity?

Mr R visits his GP and is diagnosed with type 2 diabetes mellitus. He is prescribed a biguanide.

Which of the following cautionary labels must be present on the dispensing label?

You are working as the Responsible Pharmacist at a community pharmacy and the superintendent pharmacist has asked you to dispose of some Controlled Drugs (CDs).

For which of the following would it be most important to arrange for an authorised
witness to be present whilst you denature the CDs?

Miss S, a 36 year old patient comes to the pharmacy with a prescription for Norgeston 30mcg, one to be taken daily. While dispensing the prescription, you notice from her Patient Medicine Records that she is also taking phenobarbital 30mg.

Which of the following is the best advice regarding Miss S’s medication?

This is an extended matching question:

For each question in this section select one answer from the list of nine options.

Miss S is 16 years old. She presents in the pharmacy requesting some pain relief as her dysmenorrhoea is becoming troublesome. Miss S explains that she takes paracetamol at the maximum recommended dose and the pain is usually alleviated, however now it doesn’t seem to be as effective.

This is an extended matching question:

For each question in this section select one answer from the list of nine options. 

Miss T is a 26 year old dance student who sprained her ankle yesterday and is suffering with mild-moderate pain. After being examined by the university nurse, Miss T is advised to purchase pain relief over the counter. Her ankle appears to be slightly swollen and she has informed you that she is not taking any medication.

This is an extended matching question:

For each question in this section select one answer from the list of nine options.

Mr U is a 75 year old palliative patient with end stage lung cancer. He is currently taking modified release oxycodone at a dose of 80mg twice a day.  Recently he has been suffering with a cough which makes it difficult for him to rest, and administration of oral medication has also become difficult. He requires treatment to alleviate his symptoms.

This is an extended matching question:

For each question in this section select one answer from the list of nine options.

Mrs V is 55 years old who slipped on ice while on her way to work and hit her head on the edge of the pavement. She also broke her nose in the process. She is suffering with moderate pain and has been brought to hospital for assessment. Apart from asthma, which is well managed with the inhalers she currently uses, Mrs V is otherwise well and has no known allergies.

This is an extended matching question:

For each question in this section select one answer from the list of nine options.

Mr W is a 57 year old male who was diagnosed with type 2 diabetes a few years ago. His blood glucose is currently managed with metformin and pioglitazone. Despite appropriate lifestyle interventions, he continues to have an average blood pressure reading of 140/90 mmHg and the GP would like to initiate an appropriate antihypertensive.

This is an extended matching question:

For each question in this section select one answer from the list of nine options.

Mrs X is a 42 year old woman who has type 2 diabetes. After making a number of lifestyle changes, her blood pressure remains above the target recommended for type 2 diabetics. While discussing possible treatment measures with her GP, she mentions that she is currently trying to conceive.

This is an extended matching question:

For each question in this section select one answer from the list of nine options.

Mr Y is a 42 year old man who presents in the clinic complaining of recurrent headaches. Two consecutive blood pressure measurements taken in the clinic yield an average reading of 149/92mmHg. Mr Y explains that he has been under a considerable amount of stress lately exacerbated by the fact that his father has recently had a heart attack.

This is an extended matching question:

For each question in this section select one answer from the list of nine options.

Mrs Z visits your pharmacy worried about her 4 month old daughter. She has noticed greasy yellow scaly patches on her daughter’s scalp. She has not tried anything yet and her daughter is otherwise well.

This is an extended matching question:

For each question in this section select one answer from the list of nine options.

Miss A has brought her 6 year old niece to the pharmacy seeking your advice.  She tells you that her niece has been complaining of intense itching of the scalp, especially behind the ears and back of the neck. Miss A further informs you that she has looked at her scalp but did not see anything other than tiny brown specks. Miss A’s niece has no known allergies and uses a salbutamol inhaler when needed.

This is an extended matching question:

For each question in this section select one answer from the list of nine options.

Mr B visits your pharmacy worried about his 3 month old son who is crying and is noticeably red in the face. He explains that his son is usually quiet, however he has been crying constantly for several hours over the past few days. You notice that whilst the baby is crying, his back is arched and the knees are drawn up. Mr B is particularly worried as the baby is clenching his fists.

This is an extended matching question:

For each question in this section select one answer from the list of nine options.

Mr C presents to your pharmacy with a prescription for his 12 year old daughter for penicillin V 250mg tablets at a dose of one tablet four times a day for 10 days. While waiting for the prescription, Mr C asks to purchase paracetamol tablets for his daughter. He explains that he took her to the GP this morning as she has had a sore throat and high temperature and developed a rash on her abdomen yesterday which was quite rough to the touch, like sand paper.

This is an extended matching question:

For each question in this section select one answer from the list of nine options.

Mr D is a 29 year old builder who recently broke his arm after falling off a ladder. He was prescribed codeine phosphate tablets to help with the pain and used them at the maximum recommended dose in addition to co-codamol. He is rushed into hospital with pinpoint pupils and is starting to suffer from respiratory depression.

This is an extended matching question:

For each question in this section select one answer from the list of nine options.

Mr E, a 34 year old man, calls the ambulance and explains that he has come home to find his wife, who is 31 years old, collapsed on the floor and breathing rapidly. After further questioning, the paramedics arrive at the house and find that Mrs E has a pulse rate of 127 beats per minute. Mr E explains that other than flu like symptoms and nausea that him and his wife have recently been suffering with, Mrs E is generally in good health. The paramedics suspect carbon monoxide poisoning and transfer Mrs E to the hospital.

This is an extended matching question:

For each question in this section select one answer from the list of nine options.

Miss G is 27 years old and has been managed for epilepsy since the age of 15.  She has discovered that she is pregnant and the doctor is considering reviewing her antiepileptic medication.

This is an extended matching question:

For each question in this section select one answer from the list of nine options.

Master H is an 8 year old child who was diagnosed with focal seizures nine months ago. Despite treatment with carbamazepine, Master H continues to have seizures and the neurologist decides to add on a second anti-epileptic medication. Master H participates in several sporting activities both inside and outside of school, especially during the current summer months.

This is an extended matching question:

For each question in this section select one answer from the list of nine options.

Mrs I is a 64 year old patient who was recently diagnosed with valvular atrial fibrillation and initiated on warfarin. She presents at the pharmacy requesting to purchase Daktarin oral gel which she explains is to treat oral thrush caused by her beclometasone inhaler. She further informs you that she used the Daktarin oral gel 18 months ago when she suffered with similar symptoms and it helped resolve the condition.

This is an extended matching question:

For each question in this section select one answer from the list of nine options.

Mr J is a 56 year old male who takes venlafaxine 75mg tablets once daily for social anxiety disorder. He visits your pharmacy today with a headache and requests to purchase Anadin Extra tablets (aspirin, paracetamol and caffeine) which have been recommended to him by a friend.

This is an extended matching question:

For each question in this section select one answer from the list of nine options.

Mr K is a 67 year old male who suffers with depression for which he takes citalopram 20mg once daily. He visits the GP complaining of a burning sensation when urinating, as well as fever. The GP collects a urine specimen and prescribes trimethoprim 200mg twice daily to be taken by Mr K until the culture results are obtained.

This is an extended matching question:

For each question in this section select one answer from the list of nine options.

Mr L is a 55 year old taxi driver weighing 98kg, who has had a productive cough over the last 6 months. He stopped smoking 18 months ago after his father passed away from lung cancer; prior to which he smoked up to 30 cigarettes a day. Mr L visited his GP 2 months ago after noticing that he was becoming increasingly breathless whilst loading customer suitcases into the taxi and that the breathlessness had become more persistent causing him to use the salbutamol inhaler more frequently. During the consultation his FEV₁ was measured to be 51% predicted.

This is an extended matching question:

For each question in this section select one answer from the list of nine options.

You are conducting an asthma review for Master M, a 4 year old child, who has with asthma for which he uses Clenil modulite 50mcg inhaler (beclomethasone dipropionate) two puffs twice a day and salbutamol 100mcg inhaler two puffs when required.   During the review, his mother explains that over the past three weeks, Master M has been using the salbutamol inhaler almost every day and she often notices that he wheezes at night.

This is an extended matching question:

For each question in this section select one answer from the list of nine options.

Miss N is a 25 year old female who has chronic asthma. She visits her GP as she continues to use her salbutamol inhaler at least once a day despite using Clenil Modulite 100mcg inhaler (beclomethasone dipropionate) at a dose of two puffs twice a day for the past two months.

This is an extended matching question:

For each question in this section select one answer from the list of nine options.

Mrs O is a 64 year old woman who has asthma and osteoarthritis. Her son presents at the pharmacy with a prescription for his mother and explains that she has recently had a review with the GP who has made some changes to her medication.

This is an extended matching question:

For each question in this section select one answer from the list of nine options.

Mr P is a 59 year old man who has type 2 diabetes, hypertension, angina and ischaemic heart disease. He visits the pharmacy informing you that a prescription should have been sent to you electronically from his GP for medication he has run out of.

This is an extended matching question:

For each question in this section select one answer from the list of nine options.

Mrs Q is a 36 year old lady who is 11 weeks pregnant. She explains that the doctor has prescribed some antibiotics as she has a urinary tract infection. She asks you for advice on any steps she can be taken to prevent her developing a urinary tract infection again as it is extremely painful and she would rather not take any medication whilst pregnant. Mrs Q further tells you that she has been taking Pregnacare since she discovered she was pregnant.

This is an extended matching question:

For each question in this section select one answer from the list of nine options.

Mr R, an 80 year old man, calls the pharmacy and asks if you could dispense and deliver his prescription that was collected from the GP surgery earlier today.

This is an extended matching question:

For each question in this section select one answer from the list of nine options.

Mr S presents at the pharmacy with a prescription for his 4 month old son. He explains that the GP prescribed this gel for his son who has developed white patches on his tongue and inner cheeks. He asks you for instructions on how best to apply the gel.

This is an extended matching question:

For each question in this section select one answer from the list of nine options.

Mrs T is a 46 year old female who has type 2 diabetes and hypertension. Recently her kidney function has started to deteriorate. She is currently taking metformin, pioglitazone and gliclazide in addition to Lantus Solostar (insulin glargine 100units/ml) at a dose of 28 units every morning. However, Mrs T is finding the Lantus painful and the endocrinologist decides to start her on Tresiba.

This is an extended matching question:

For each question in this section select one answer from the list of nine options.

Mr U is a 36 year old man who has type 1 diabetes. Despite taking NovoRapid FlexPen (insulin aspart 100units/ml) at a dose of 8 units before meals and Levemir FlexPen (insulin detemir 100units/ml) at a dose of 15 units once daily, he continues to have raised glucose levels on waking. It is decided that Mr U should start using Tresiba as it has been shown to be longer acting and may provide him with better glycaemic control.

This is an extended matching question:

For each question in this section select one answer from the list of nine options.

Mr V is a 62 year old man who has type 2 diabetes for which he takes metformin, pioglitazone and Tresiba at a dose of 18 units daily. However, despite taking his medication as prescribed, his diabetes continues to be uncontrolled. His doctor decides to initiate exenatide in addition to his existing medication.

This is an extended matching question:

For each question in this section select one answer from the list of nine options.

Mr F is 73 years old and has had epilepsy since childhood. He has recently visited his GP and has now been diagnosed with Parkinson’s disease.

Mr A is 45 years old. He smokes 15 cigarettes and drinks 2 to 3 units of alcohol per day. His BMI is 27 and he has an unhealthy diet. He has been prescribed atorvastatin 40 mg once daily for the treatment of familial hypercholesterolemia, which he has been taking for the past 3 months.

In addition to serum cholesterol, which of the following parameters is most important to monitor at this stage?

Mr B, a 52-year-old man, comes into the pharmacy seeking advice about a symptom that he has experienced for the past 2 days. He has not yet attempted to take any treatment to relieve the symptom but he takes the following long-term prescribed medication:

• carbimazole 15mg once daily
• omeprazole 20mg once daily
• alendronic acid 70mg once weekly

Which of the following symptoms would most likely require an urgent referral to his doctor?

This question concerns Mr C, a 62-year-old man who has just been diagnosed with non-valvular atrial fibrillation. He does not take any regular medication and has no known allergies.

Mr C asks for your advice on stroke prevention as he tells you his doctor had informed him that he is at a higher risk of developing a stroke.

Which of the following assessment tools is most suitable for assessing stroke risk in patients with atrial fibrillation?

This question concerns Mr C, a 62-year-old man who has just been diagnosed with non-valvular atrial fibrillation. He does not take any regular medication and has no known allergies.

Which of the following drugs is least likely to be prescribed for stroke prevention for Mr C?

Mr D is a 72-year-old man who presents with diffuse pain in his arms and legs. He is of South Asian origin and has been residing in the United Kingdom for 45 years. Upon questioning, he informs you that he rarely leaves the house for fear of falling and he eats a vegetarian diet. You have access to his most recent blood test results.

With respect to Mr D’s blood test results, what is the best course of action?

You have been appointed as the lead for pharmaceutical care within your hospital trust. You are preparing a training session for pharmacists as well as other health and social care professionals to raise awareness of pharmaceutical care.

Which of the following descriptions would best describe the principles of pharmaceutical care?

Whilst working as the Responsible Pharmacist at a community pharmacy premises you plan to dispose of some Controlled Drugs (CDs).

For which of the following would it be most important to arrange for an authorised witness to be present whilst you denature the CDs?

Mr E, a 65-year-old man with no history of alcohol misuse, was admitted to hospital with jaundice after feeling unwell for three weeks with nausea, vomiting, tiredness and abdominal pain. Three months before, his GP had changed his gliclazide to pioglitazone. He had also taken lercanidipine, metformin and bendroflumethiazide for some years, and recently a cephalosporin antibiotic for a few days. He developed encephalopathy 36 hours after admission and doctors transferred him to intensive care. Blood tests were conducted to assist in the diagnosis.

Which of the following drugs that Mr E has taken is most likely to have caused his abnormal laboratory results?

Mr F is a 38-year-old man who has been experiencing muscle cramps in his arms and a fine tremor in his hands for the past two weeks.

Below is a list of Mr F’s regular medication. Which one of these drugs is most likely to have caused Mr F’s symptoms?

Mrs G is a 45-year-old woman who takes the following regular medication:

• ramipril 5 mg once daily
• simvastatin 40 mg once daily at night

She has recently been to see her GP with symptoms of a severe chest infection and her doctor has issued a prescription for clarithromycin 500 mg twice daily for 2 weeks.

Which of the following would be the most appropriate course of action for you to take?

Mrs H is a regular customer to your pharmacy. She has presented you with a new prescription for lansoprazole 15 mg gastro-resistant capsules. Mrs H explains that she has been prescribed a 4-week course of lansoprazole for the treatment of dyspepsia, which failed to respond to the antacids she was previously advised to take.

Which of the following statements would be the most important factor for you to consider when dispensing Mrs H’s prescription?  

Mr I has just attended his annual medication review with his GP. After completing the review and assessing Mr I’s blood pressure, the GP has decided to change Mr I’s current anti-hypertensive to Coversyl Arginine Plus (perindopril arginine 5 mg, indapamide 1.25 mg).

Which of the following cautionary and advisory labels would be most suitable for the new drug?

You are on the committee appointed by your hospital that is responsible for writing the antibacterial policy to support ‘antimicrobial stewardship’.

Which one of the following statements would be least likely to be included in the ‘antimicrobial stewardship’ policy?

Mrs J, a 70-year-old woman, has been admitted to hospital after having breathing problems. She has been feeling very weak and numb lately but is otherwise an active person. She takes the following medication:

• bumetanide
• fluoxetine
• omeprazole
• prednisolone
• ramipril

Her most recent biochemistry test results are shown below.

Which one of her drugs is the most likely cause of her abnormal test results?

Mrs K is 53 years old. She recently had a hysterectomy. Her doctor has prescribed Climaval for her menopausal symptoms.

Which of the following statements would be of most concern to you regarding Mrs K’s treatment?

Mr L is 67 years old and has recently been initiated on isosorbide mononitrate 40 mg twice daily by his GP following recommendation by a hospital specialist. When Mr L comes to your pharmacy to collect his repeat prescription, he tells you that he takes the medicine as prescribed but has recently been experiencing occasional throbbing headaches.

What would be the most appropriate advice for you to give to Mr L?

You are a regular locum at a community pharmacy. Lately, you have noticed that the superintendent pharmacist has been coming into work smelling of alcohol. He has also developed a bad temper, he frequently shouts at the rest of the pharmacy team and he has been making dispensing errors more frequently.

Which of the following would be the most appropriate course of action?

Mrs M is a 57-year-old lady of South Asian origin who no longer has a menstrual bleed. She has been complaining of lethargy for the past 6 months despite not suffering from any sleep disturbance and despite eating a balanced vegetarian diet. She takes enalapril 5 mg once daily and furosemide 20 mg once daily for hypertension. Her GP recently sent her for a blood test to investigate a number of parameters.

In light of her symptoms and blood test results, which of the following points would it be most appropriate to inform Mrs M?

A patient asks you why his multidose bottle of timolol eye drops contains benzalkonium chloride.

Which one of the following is the most appropriate response to give this patient?

A hospital inpatient has died from a drug overdosage due to a suspected dosing error. The chief pharmacist of the hospital has ordered the undertaking of a Root Cause Analysis (RCA) on this incident.

What is the most suitable type of investigation to be performed?

Mrs N is a 50-year-old black South African lady who has just been diagnosed with stage 2 hypertension. Her blood pressure was last measured as 164/91 mmHg. She has no known drug or other allergies nor any other medical conditions.

Which one of the following is the most appropriate first line antihypertensive for Mrs N?

Mrs O is an 80-year-old female with a history of Parkinson’s disease and osteoporosis. She takes her Parkinson’s medication in a ‘dosette box’ and takes the following:

• Co-beneldopa (Madopar) 62.5 mg, one capsule once daily in the morning 9am
• Co-careldopa 50/200 modified release (Sinemet CR), one tablet once daily at night at 8pm
• Stalevo 100/25/200 (levodopa 100 mg, carbidopa 25 mg, entacapone 200 mg), one tablet three times daily at 9am, 2pm and 8pm

She has been admitted to hospital for a fall. Her daughter is concerned as she feels her mother is not coping well at home. You inspect her ‘dosette box’ and can see that there are tablets which have not been taken by Mrs O.

Which of the following counselling points is most appropriate for you give to Mrs O and her daughter?

Mr P is a 55-year-old man who presents at your pharmacy with the following prescription from his GP:

• amlodipine 10 mg once daily
• simvastatin 40 mg once daily at night

Mr P has not collected medicines from your pharmacy before but informs you that he has taken the prescribed medication for 2 months already.

Which of the following would be the most appropriate course of action?

Miss Q is a 32-year-old accountant who was diagnosed with type 1 diabetes mellitus 12 years ago. She tests her glucose when she feels unwell and uses multiple injections of insulin. Her HbA_1c is 64 mmol/mol (8.0%).

She has a passion for rowing and every morning at 6:30 am she rows for up to one hour on the River Thames. She is planning to participate in a coastal race in the summer to raise funds for a campaign to increase awareness of the sport amongst the youth in her local community. She has a high-calorie diet to give her energy in the morning and help her get through the day.

What is the most suitable number of blood glucose tests Miss Q should be advised to take at this stage?

Mr R is a 45-year-old man who does not take any regular medication and has no known allergies with the exception of being hypersensitive to NSAIDs. He tells you he has just seen his GP regarding an acute attack of gout and asks you to check if the prescription he has been given will help to treat his existing pain.

Which one of the following would be the most suitable treatment for Mr R’s acute attack of gout?

This question relates to Miss S, an 8-year-old girl who has been admitted to the A&E unit at her hospital with moderate severity community-acquired pneumonia.

The doctor has ordered a culture sensitivity test, but due to the severity of her infection he wants to start antibiotic treatment immediately. Miss S has a documented penicillin allergy.

Which of the following would be the most suitable empiric antibiotic treatment for her infection?