1. Mr A is a 45-year-old ex-smoker with a history of chronic asthma. He is a regular patient at your pharmacy. Today he brings in a prescription for erythromycin 500 mg tablets, one to be taken every 6 hours for 5 days. He explains that he has developed a bad chest infection. His patient medication record shows that he is allergic to penicillin and that he is taking the following medication:
- Salbutamol 100 mcg/dose inhaler, two puffs four times daily when required
- Seretide 250 Evohaler (fluticasone propionate 250 mcg, salmeterol xinafoate 25 mcg/metered inhalation), two puffs twice daily
- Uniphyllin Continus (theophylline) 300 mg modified release tablets, one tablet every 12 hours
You decide to contact his GP to discuss your concerns.
Which of the following points would be most important to discuss with Mr A’s GP?
| Answer or metric | Value |
|---|
| Number and % correct answers |
63% / 26 correct answers from 41 total answers received |
| A- erythromycin will decrease the plasma concentration of theophylline | 4 times selected / 10% |
| B- erythromycin will increase the plasma concentration of theophylline | 26 times selected / 63% |
| C- smoking can decrease the plasma concentration of theophylline | 1 times selected / 2% |
| D- symptoms of theophylline toxicity include bradycardia and breathlessness | 0 times selected / 0% |
| E- theophylline has a narrow therapeutic index and therefore Mr A will be at risk of a loss of therapeutic effect
| 0 times selected / 0% |
| Unanswered | 10 times selected / 24% |
2.
Questions 2 and 3 relate to Mr C, a 76-year-old man, who was admitted to hospital for an infection. Mr C was started on intravenous gentamicin at a dose of 3mg/kg daily in three divided doses. On the second day, his trough serum gentamicin level was found to be 0.5mg/L and his peak serum gentamicin level was 7mg/L (target trough level <1mg/L, target peak level 3-5mg/L).
Which of the following is the most appropriate method of dose rationalisation?
| Answer or metric | Value |
|---|
| Number and % correct answers |
46% / 19 correct answers from 41 total answers received |
| A- Increase the dose and increase the dosing interval | 1 times selected / 2% |
| B- Decrease the dose and maintain the dosing interval | 19 times selected / 46% |
| C- Maintain the same dose and increase the dosing interval | 7 times selected / 17% |
| D- Decrease the dose and increase the dosing interval | 2 times selected / 5% |
| E- Maintain the same dose and decrease the dosing interval sub-therapeutic treatment of his condition | 2 times selected / 5% |
| Unanswered | 10 times selected / 24% |
3. Questions 2 and 3 relate to Mr C, a 76-year-old man, who was admitted to hospital for an infection.
Which of the following parameters should be monitored while treating Mr C with gentamicin?
| Answer or metric | Value |
|---|
| Number and % correct answers |
61% / 25 correct answers from 41 total answers received |
| A- Neutrophils
| 4 times selected / 10% |
| B- Thyroid function | 1 times selected / 2% |
| C- Respiratory rate | 0 times selected / 0% |
| D- Serum creatinine | 25 times selected / 61% |
| E- Blood pressure | 0 times selected / 0% |
| Unanswered | 11 times selected / 27% |
4. Mr C is a 67-year-old man with type 2 diabetes mellitus, angina and hypertension. During his most recent medication review, he complains of severe throbbing headaches that have increased in frequency. You suspect that he could be experiencing an adverse drug reaction.
Which one of Mr C’s medicines is most likely to be implicated?
| Answer or metric | Value |
|---|
| Number and % correct answers |
71% / 29 correct answers from 41 total answers received |
| A- aspirin | 0 times selected / 0% |
| B- atorvastatin | 0 times selected / 0% |
| C- enalapril | 1 times selected / 2% |
| D- gliclazide | 1 times selected / 2% |
| E- isosorbide mononitrate | 29 times selected / 71% |
| Unanswered | 10 times selected / 24% |
5. Mr F is a 74-year-old man who has osteoarthritis and benign prostatic hyperplasia. At a routine appointment with the GP, Mr F asks if he can be given a stronger analgesic as the ones he is currently taking have stopped helping with the pain despite using them at the maximum recommended daily dose. Mr F is currently on the following medication:
- Tamsulosin
- Paracetamol
Which of the following analgesics is the least appropriate for Mr F to take?
| Answer or metric | Value |
|---|
| Number and % correct answers |
15% / 6 correct answers from 41 total answers received |
| A- Co-codamol | 12 times selected / 29% |
| B- Tiaprofenic acid | 6 times selected / 15% |
| C- Naproxen | 1 times selected / 2% |
| D- Topical diclofenac | 4 times selected / 10% |
| E- Celecoxib | 5 times selected / 12% |
| Unanswered | 13 times selected / 32% |
6. The extravasation of chemotherapy drugs must be managed according to the extravasation risk of each drug and the local extravasation policy using the extravasation kit.
Which of the following techniques is least likely to be used to prevent extravasation injury?
| Answer or metric | Value |
|---|
| Number and % correct answers |
29% / 12 correct answers from 41 total answers received |
| A- administer the drug as a bolus dose via peripheral line | 12 times selected / 29% |
| B- assess the site of injection regularly for signs of redness or swelling | 1 times selected / 2% |
| C- ensure the patient reports any signs of burning or pain during administration of drug immediately | 0 times selected / 0% |
| D- placing a glyceryl trinitrate patch distal to the cannula, which may improve the patency of the vessel in patients with small veins or in those whose veins are prone to collapse | 9 times selected / 22% |
| E- use of a central line for slow infusions of high-risk drugs | 9 times selected / 22% |
| Unanswered | 10 times selected / 24% |
7. Questions 7 and 8 relate to Mr D, a 57-year-old accountant who collects his monthly Byetta (exenatide) injection prescriptions from your hospital outpatient pharmacy. He brings in a new outpatient prescription today and you can see that his dose has been increased to 10 mcg twice daily. Mr D is also taking metformin 500 mg three times daily. He has a BMI of 34 kg/m2
Which of the following statements is most applicable regarding the correct use of Byetta prefilled pen for injection?
| Answer or metric | Value |
|---|
| Number and % correct answers |
37% / 15 correct answers from 41 total answers received |
| A- Byetta is administered by intramuscular injection | 1 times selected / 2% |
| B- Byetta is being used for the treatment of type 1 diabetes mellitus in Mr D | 0 times selected / 0% |
| C- Byetta must be taken at the same time as metformin for the morning and evening doses | 5 times selected / 12% |
| D- Byetta must be stored in the refrigerator before and after opening | 8 times selected / 20% |
| E- Byetta should be used in caution in patients receiving oral medicines that require rapid gastrointestinal absorption | 15 times selected / 37% |
| Unanswered | 12 times selected / 29% |
8. Questions 7 and 8 relate to Mr D, a 57-year-old accountant who collects his monthly Byetta (exenatide) injection prescriptions from your hospital outpatient pharmacy. He brings in a new outpatient prescription today and you can see that his dose has been increased to 10 mcg twice daily. Mr D is also taking metformin 500 mg three times daily. He has a BMI of 34 kg/m2
Excessive sweating is an undesirable side effect reported to occur in how many users of Byetta prefilled pen for injection?
| Answer or metric | Value |
|---|
| Number and % correct answers |
63% / 26 correct answers from 41 total answers received |
| A- greater than 1 in 10 | 0 times selected / 0% |
| B- 1 in 100 to 1 in 10 | 26 times selected / 63% |
| C- 1 in 1000 to 1 in 100 | 3 times selected / 7% |
| D- 1 in 10,000 to 1 in 1000 | 1 times selected / 2% |
| E- less than 1 in 10,000 | 0 times selected / 0% |
| Unanswered | 11 times selected / 27% |
9. You are a hospital medicines information pharmacist who is responding to an enquiry by a paediatric consultant on whether a new medicine is suitable for a child. You view current literature available to you for evidence-based information to assess the risks for prescribing this medicine for an unlicensed indication for this child.
Which of the following is the most robust form of evidence?
| Answer or metric | Value |
|---|
| Number and % correct answers |
49% / 20 correct answers from 41 total answers received |
| A- case-control | 1 times selected / 2% |
| B- case reports | 2 times selected / 5% |
| C- cohort studies | 7 times selected / 17% |
| D- cross sectional studies | 2 times selected / 5% |
| E- randomised controlled trials | 20 times selected / 49% |
| Unanswered | 9 times selected / 22% |
10. Mrs F contacted the GP with a 3-day history of urinary urgency and dysuria. A midstream urine sample confirmed the presence of a bacterial infection sensitive to trimethoprim, cefalexin and amoxicillin. Mrs F regularly takes methotrexate tablets at a dose of 12.5mg weekly for rheumatoid arthritis and, as such, the GP decided not to prescribe trimethoprim due to the interaction with methotrexate.
Which one of the following statements best describes the interaction between trimethorpim and methotrexate?
| Answer or metric | Value |
|---|
| Number and % correct answers |
51% / 21 correct answers from 41 total answers received |
| A- The metabolism of trimethoprim is enhanced | 0 times selected / 0% |
| B- The metabolism of methotrexate is inhibited | 2 times selected / 5% |
| C- Increased risk of Stevens Johnson | 1 times selected / 2% |
| D- Increased risk of liver toxicity Increased risk of side effects of methotrexate | 8 times selected / 20% |
| E- Trimethoprim may increase the risk of side effects of methotrexate | 21 times selected / 51% |
| Unanswered | 9 times selected / 22% |
11. Mrs N is a 56-year-old black South African lady who takes amlodipine 10mg for the management of hypertension. At a recent hypertension review, her blood pressure was measured as 162/97mmHg and it was agreed to optimise treatment. She has no known drug or other allergies nor any other medical conditions.
Which one of the following is the most appropriate anti-hypertensive medication to add on for Mrs Ns treatment?
| Answer or metric | Value |
|---|
| Number and % correct answers |
34% / 14 correct answers from 41 total answers received |
| A- Atenolol | 1 times selected / 2% |
| B- Indapamide | 5 times selected / 12% |
| C- Lercanidipine hydrochloride | 1 times selected / 2% |
| D- losartan | 14 times selected / 34% |
| E- ramipril | 11 times selected / 27% |
| Unanswered | 9 times selected / 22% |
12. Questions 12, 13 and 14 relate to Mrs F who is 45 years old and has rheumatoid arthritis. Since her diagnosis she has tried a number of anti-inflammatory drugs, which have been unsuccessful in controlling her condition. As a result, she now takes oral prednisolone 7.5 mg once daily and naproxen 500 mg twice daily, which control her condition well.
Mrs F’s GP asks for your advice. He wants to start Mrs F on treatment to prevent NSAID-associated ulceration as she is considered to be at a high risk of developing gastro-intestinal complications whilst taking an NSAID.
Which of the following puts Mrs F at a greater risk of developing gastro-intestinal complications while taking an NSAID?
| Answer or metric | Value |
|---|
| Number and % correct answers |
78% / 32 correct answers from 41 total answers received |
| A- Mrs F's age | 0 times selected / 0% |
| B- Having rheumatoid arthritis | 0 times selected / 0% |
| C- her father developed a gastric ulcer at age 62 years | 0 times selected / 0% |
| D- having a BMI greater than 25kg/m2 | 0 times selected / 0% |
| E- concomitant use of prednisolone | 32 times selected / 78% |
| Unanswered | 9 times selected / 22% |
13. Questions 12, 13 and 14 relate to Mrs F who is 45 years old and has rheumatoid arthritis. Since her diagnosis she has tried a number of anti-inflammatory drugs, which have been unsuccessful in controlling her condition. As a result, she now takes oral prednisolone 7.5 mg once daily and naproxen 500 mg twice daily, which control her condition well.
Two months later Mrs F is admitted to hospital for major surgery under general anaesthesia. Her dose of prednisolone was increased 4 weeks earlier due to a flare up in her rheumatoid arthritis, and on admission is 12.5 mg daily.
Which one of the following is the most suitable regimen for corticosteroid replacement for Mrs F during surgery?
| Answer or metric | Value |
|---|
| Number and % correct answers |
54% / 22 correct answers from 41 total answers received |
| A- 20 mg oral prednisolone daily for 7 days, followed by 12.5 mg oral prednisolone daily thereafter | 0 times selected / 0% |
| B- 25 mg intravenous hydrocortisone at induction, followed by 12.5 mg oral prednisolone daily thereafter | 9 times selected / 22% |
| C- 100 mg intravenous hydrocortisone at induction, followed by 12.5 mg oral prednisolone daily thereafter | 0 times selected / 0% |
| D- 12.5 mg oral prednisolone on the morning of surgery and 25 mg intravenous hydrocortisone at induction, followed by intravenous hydrocortisone 25 mg three times daily for 48 hours, then 12.5 mg oral prednisolone daily thereafter | 22 times selected / 54% |
| E- 3x100 mg doses of intravenous hydrocortisone on the day of surgery, followed by 20 mg oral prednisolone daily for 7 days, then 12.5 mg oral prednisolone daily thereafter | 0 times selected / 0% |
| Unanswered | 10 times selected / 24% |
14. Questions 12, 13 and 14 relate to Mrs F who is 45 years old and has rheumatoid arthritis. Since her diagnosis she has tried a number of anti-inflammatory drugs, which have been unsuccessful in controlling her condition. As a result, she now takes oral prednisolone 7.5 mg once daily and naproxen 500 mg twice daily, which control her condition well.
Six months later, Mrs F’s GP has decided to stop her prednisolone, and asks for your advice on the current recommendations.
A gradual withdrawal of systemic corticosteroids should be considered in those patients whose disease is unlikely to relapse as well as which of the following?
| Answer or metric | Value |
|---|
| Number and % correct answers |
17% / 7 correct answers from 41 total answers received |
| A- have other possible causes of adrenal suppression | 7 times selected / 17% |
| B- received a single repeat dose in the evening as a ‘one-off’ during the course of treatment | 0 times selected / 0% |
| C- received 3 weeks’ treatment | 12 times selected / 29% |
| D- received more than 20 mg daily prednisolone (or equivalent) for one week | 7 times selected / 17% |
| E- taken a short course within 1-3 years of stopping long-term therapy | 4 times selected / 10% |
| Unanswered | 11 times selected / 27% |
15. You are a hospital pharmacist and you receive a prescription for a 7-year-old child weighing 23kg who has been prescribed alfacalcidol at the maximum recommended dose for the prevention of vitamin D deficiency in liver disease.
Which of the following is the correct number of alfacalcidol 250ng capsules would this child have received after three months of treatment? Assume no dose adjustment has occurred.
| Answer or metric | Value |
|---|
| Number and % correct answers |
49% / 20 correct answers from 41 total answers received |
| A- 56 capsules | 1 times selected / 2% |
| B- 84 capsules | 3 times selected / 7% |
| C- 90 capsules | 2 times selected / 5% |
| D- 168 capsules | 20 times selected / 49% |
| E- 180 capsules | 5 times selected / 12% |
| Unanswered | 10 times selected / 24% |
16. A 40-year-old man who is a regular patient at your pharmacy requests for your advice on a suitable treatment for his mouth ulcers. On further questioning, he informs you that he also has a sore throat. You view his patient medication record and see that he currently takes the following medication:
• Ipocol (mesalazine) 400 mg enteric coated tablets
• lansoprazole 30 mg capsules
• Gaviscon oral suspension
Which of the following would be the most appropriate course of action?
| Answer or metric | Value |
|---|
| Number and % correct answers |
24% / 10 correct answers from 41 total answers received |
| A- advise him to see his GP as soon as possible | 22 times selected / 54% |
| B- advise him to use Bonjela oral gel | 0 times selected / 0% |
| C- advise him to use Difflam oromucosal spray | 0 times selected / 0% |
| D- advise him to go to A&E | 10 times selected / 24% |
| E- reassure him that the condition will improve without any treatment | 0 times selected / 0% |
| Unanswered | 9 times selected / 22% |
17. Mrs B is 6 months pregnant and comes into the pharmacy seeking your advice on what she can take to help with her constipation. She explains that she is aware that constipation is common in pregnancy but tells you that it is becoming increasingly problematic and has started to cause her much discomfort. Mrs B further explains that she has tried to increase her fluid intake and the fibre in her diet, but this has not helped.
Which of the following is the most suitable for you to recommend to Mrs B?
| Answer or metric | Value |
|---|
| Number and % correct answers |
66% / 27 correct answers from 41 total answers received |
| A- Senna | 0 times selected / 0% |
| B- Ispaghula Husk | 27 times selected / 66% |
| C- Bisacodyl | 0 times selected / 0% |
| D- Fleet Phospho-soda | 1 times selected / 2% |
| E-There is no suitable laxative over the counter and you should refer her to the GP | 4 times selected / 10% |
| Unanswered | 9 times selected / 22% |
18. A 6-year-old child has been diagnosed with attention deficit hyperactivity disorder (ADHD) by a specialist doctor and has been initiated on methylphenidate hydrochloride (Concerta XL) tablets 18 mg once daily in the morning. The mother is quite concerned and asks you several questions about her child’s new medication.
Which of the following would be the best advice to give to the mother?
| Answer or metric | Value |
|---|
| Number and % correct answers |
63% / 26 correct answers from 41 total answers received |
| A- methylphenidate affects the growth of all children taking it; your doctor will monitor your child’s growth regularly | 4 times selected / 10% |
| B- the tablet can be crushed and mixed with a small amount of soft food such as yogurt, honey or jam; make sure your child swallows it all straight away, without chewing | 0 times selected / 0% |
| C- this medicine will help to reduce the symptoms of hyperactivity and impulsive behaviour; it will also help to increase attention and concentration span; it is used as part of a comprehensive treatment programme for ADHD | 26 times selected / 63% |
| D- your child may have problems sleeping; this can be helped by taking the dose at bedtime | 0 times selected / 0% |
| E- your child may become irritable, aggressive, tearful or depressed; these effects can be permanent; you should contact your specialist or doctor as soon as possible; if you are worried, do not give any more doses of methylphenidate until you have talked to your doctor | 1 times selected / 2% |
| Unanswered | 10 times selected / 24% |
19. Mrs L has been admitted into hospital for the management of breast cancer. An oncologist is preparing a treatment plan for Mrs L. She has no family history of cancer but was previously taking hormone replacement therapy for the management of post-menopausal symptoms. The oncologist wants to ensure that Mrs L’s treatment plan does not include a drug that causes bone marrow suppression.
Which of the following cytotoxic drugs would be the most suitable choice?
| Answer or metric | Value |
|---|
| Number and % correct answers |
34% / 14 correct answers from 41 total answers received |
| A- Epirubicin | 2 times selected / 5% |
| B- Fluorouracil | 10 times selected / 24% |
| C- Treosulfan | 5 times selected / 12% |
| D- Vinblastine | 1 times selected / 2% |
| E- Vincristine | 14 times selected / 34% |
| Unanswered | 9 times selected / 22% |
20. Miss L presents at the pharmacy to ask you about medication she has found whilst clearing out her medication cupboard. She shows you a box of Morphine sulphate 100mg tablets, which are expired. She asks you for your advice about how to safely dispose of the medication.
What would be the most appropriate course of action?
| Answer or metric | Value |
|---|
| Number and % correct answers |
32% / 13 correct answers from 41 total answers received |
| A- Take the medication and dispose of it in the disposal bins. | 0 times selected / 0% |
| B- Take the medication and store them in the CD cupboard, away from the pharmacy stock, and clearly marked as patient returned CDs. Denature them in the presence of a member of pharmacy staff | 13 times selected / 32% |
| C- Take the medication and store them in the CD cupboard, away from the pharmacy stock, and clearly marked as patient returned CDs. Wait for an authorised witness to be available before denaturing the medication. | 18 times selected / 44% |
| D- Take the medication and store them in the CD cupboard, away from the pharmacy stock, and clearly marked as patient returned CDs. Denature at your earliest convenience | 0 times selected / 0% |
| E- Refuse to accept the medication as you cannot dispose of them in community pharmacy. | 0 times selected / 0% |
| Unanswered | 10 times selected / 24% |
21. Mrs H and her 7-year-old daughter Miss H visit your pharmacy requesting for advice about a skin rash that has developed recently on Miss H. Mrs H explains that the rash initially appeared as red itchy spots which have now developed into fluid-filled blisters that are intensely itchy. She further informs you that Miss h has spots on her face, chest, abdomen and limbs. She has no other symptoms and does not suffer from any other medical conditions.
Which of the following is the most likely cause of Miss H’s symptoms?
| Answer or metric | Value |
|---|
| Number and % correct answers |
73% / 30 correct answers from 41 total answers received |
| A- an allergic reaction | 0 times selected / 0% |
| B- cytomegalovirus | 1 times selected / 2% |
| C- measles virus | 0 times selected / 0% |
| D- tinea corporis | 0 times selected / 0% |
| E- varicella-zoster virus | 30 times selected / 73% |
| Unanswered | 10 times selected / 24% |
22. A GP orders some routine tests for a 29-year-old female patient following a consultation.
Which of the following test results will most likely require further action to be taken?
| Answer or metric | Value |
|---|
| Number and % correct answers |
44% / 18 correct answers from 41 total answers received |
| A- total cholesterol - 5 mmol/L | 5 times selected / 12% |
| B- fasting blood glucose - 5.5 mmol/L | 1 times selected / 2% |
| C- blood pressure - 122/80 mmHg | 2 times selected / 5% |
| D- ferritin -12mg/L | 18 times selected / 44% |
| E- White Blood Cells (WBCs) – 5 x 10^9
/L | 6 times selected / 15% |
| Unanswered | 9 times selected / 22% |
23. Mr I visits the pharmacy and asks you about the smoking cessation service the pharmacy offers. You invite him to the consultation room and inform him about the service and further explain to him the benefits of quitting smoking. By the end of your consultation, he informs you that after he celebrates his 40th birthday the following week, he will return to the pharmacy and sign up to the service.
At which stage of the ‘Stages-of-Change Model’ is Mr I at?
| Answer or metric | Value |
|---|
| Number and % correct answers |
51% / 21 correct answers from 41 total answers received |
| A- action | 0 times selected / 0% |
| B- contemplation | 10 times selected / 24% |
| C- maintenance | 0 times selected / 0% |
| D- pre-contemplation | 1 times selected / 2% |
| E- preparation | 21 times selected / 51% |
| Unanswered | 9 times selected / 22% |
24. Mr J is a 65-year-old man who underwent an elective knee replacement surgery two weeks ago. He has a history of hypertension, which is treated with amlodipine 5mg once daily and lisinopril 10mg once daily. There have been complications due to an infection and Mr J has been readmitted to hospital.
Which of the following drugs started in hospital is most likely to have caused Mr J’s abnormal laboratory results?
| Answer or metric | Value |
|---|
| Number and % correct answers |
51% / 21 correct answers from 41 total answers received |
| A- ampicillin | 8 times selected / 20% |
| B- ibuprofen | 21 times selected / 51% |
| C- lactulose | 0 times selected / 0% |
| D- paracetamol | 0 times selected / 0% |
| E- tramadol | 2 times selected / 5% |
| Unanswered | 10 times selected / 24% |
25. Mr A, is a 42-year-old male who has been diagnosed with type 2 diabetes. The doctor informs him that it is important to achieve optimal levels of blood-glucose control and avoid or minimise hypoglycemia. Mr A has no co-morbidities.
Which of the following is the target HbA1c concentration should Mr A aim for?
| Answer or metric | Value |
|---|
| Number and % correct answers |
68% / 28 correct answers from 41 total answers received |
| A- 42mmol/mol (6%) or lower | 0 times selected / 0% |
| B- 48mmol/mol (6.5%) or lower | 28 times selected / 68% |
| C- 53mmol/mol (7%) or lower | 1 times selected / 2% |
| D- 58mmol/mol (7.5%) or lower | 1 times selected / 2% |
| E- 47mmol/mol (8%) or lower | 1 times selected / 2% |
| Unanswered | 10 times selected / 24% |
26. Following a review with the neurologist, Mrs L has been initiated on sodium valproate to take in addition to lamotrigine for the management of epilepsy. Whilst collecting the prescription, Mrs L enquires about suitable dietary supplements to boost her nutritional intake as she is hoping to start a family in the near future. Mrs L has no known allergies and does not take any other medication.
Which of the following would be the most appropriate course of action?
| Answer or metric | Value |
|---|
| Number and % correct answers |
68% / 28 correct answers from 41 total answers received |
| A- contact the prescriber and recommend an alternative antiepileptic drug with fewer drug interactions | 1 times selected / 2% |
| B- contact the prescriber and request for the prescription to be amended to state a specific brand of sodium valproate | 0 times selected / 0% |
| C- advise Mrs L to see her GP as soon as possible and in the meantime to use alternative methods of contraception to avoid an unplanned pregnancy | 28 times selected / 68% |
| D- supply the sodium valproate and advise Mrs L to take a folic acid supplement whilst on anti-epileptic medication | 0 times selected / 0% |
| E- supply the sodium valproate and advise Mrs L to visit a family planning clinic for further information and advice on planning a pregnancy | 3 times selected / 7% |
| Unanswered | 9 times selected / 22% |
27. Mr M is a 47 year old man who takes ramipril 10mg for hypertension. He has a BMI of 28kg/m2 and a calculated QRisk of 13.5%. He was recently started atorvastatin 20 mg once daily as primary prevention for cardiovascular disease. He manages a small vineyard in the countryside and enjoys drinking wine as well as locally produced spirits. He drinks a glass of fresh fruit or vegetable juice every morning and eats a balanced vegetarian diet. He has no known allergies and does not take any other medication.
Which of the following is the most appropriate counselling advice to give to Mr M regarding atorvastatin?
| Answer or metric | Value |
|---|
| Number and % correct answers |
46% / 19 correct answers from 41 total answers received |
| A- advise Mr M not to take more than one or two glasses of grapefruit juice per day | 19 times selected / 46% |
| B-advise Mr M that it is safe to drink alcohol with this medicine | 4 times selected / 10% |
| C-advise Mr M that this medicine increases his risk of developing diabetes | 0 times selected / 0% |
| D- Mr M should avoid dark green leafy vegetables e.g. broccoli and spinach in his diet as they contain vitamin K which can interact with this medicine | 0 times selected / 0% |
| E- Mr M should take atorvastatin in the evening | 9 times selected / 22% |
| Unanswered | 9 times selected / 22% |
28. A 1-year-old child has been diagnosed with gastro-oesophageal reflux disease. He is formula fed. His mother trialled smaller but frequent feeds for 2 weeks, but symptoms have not improved. She then trialled thickened feeds, but symptoms have also not improved.
Which of the following is the most appropriate course of action?
| Answer or metric | Value |
|---|
| Number and % correct answers |
41% / 17 correct answers from 41 total answers received |
| A- Continue with the thickened formula alongside a trial of alginic acid for 1–2 weeks | 15 times selected / 37% |
| B- Consider prescribing a 1-2-week trial of metoclopramide hydrochloride day | 0 times selected / 0% |
| C- Consider prescribing a 4-week trial of a proton pump inhibitor, such as omeprazole suspension | 17 times selected / 41% |
| D- Consider prescribing a 4-week trial of domperidone | 0 times selected / 0% |
| E- Consider prescribing a 1-2-week trial of erythromycin | 0 times selected / 0% |
| Unanswered | 9 times selected / 22% |
29.
Mrs M is a 67 year old woman who suffers with hypertension, osteoporosis and asthma for which she takes the following medication:
• Lisinopril 30mg od
• Amlodipine 10mg od
• Alendronic acid 70mg weekly
• Calcichew D3, two tablets daily
• Salbutamol 100mcg inhaler, two puffs up to four times a day when required
• Seretide 125 evohaler, two puffs twice daily
Mrs M presents at the pharmacy requesting medication for diarrhoea. She informs you that this is the second day that she has been experiencing diarrhoea and vomiting and that she vomited three times yesterday and has lost count of the number of times she has been to the toilet with very loose stools.
Which one of Mrs M’s medication should be temporarily withheld until she recovers from the diarrhoea and vomiting?
| Answer or metric | Value |
|---|
| Number and % correct answers |
46% / 19 correct answers from 41 total answers received |
| A- Lisinopril | 19 times selected / 46% |
| B- Amlodipine | 1 times selected / 2% |
| C- Alendronic acid | 6 times selected / 15% |
| D- Calcichew D3 | 5 times selected / 12% |
| E- Seretide 125 Evohaler | 0 times selected / 0% |
| Unanswered | 10 times selected / 24% |
30. Mr N is a 37-year-old asthmatic who has been regularly prescribed the following medication:
• Flixotide Accuhaler (fluticasone propionate) 100 mcg/blister, 100 mcg twice daily
• Ventolin Accuhaler (salbutamol sulfate) 200 mcg/blister, 200 mcg up to four times daily when required
During a medicines’ review with Mr N, you discover that he is regularly needing to use the Ventolin Accuhaler 3 to 4 times a week to relieve bouts of breathlessness. You confirm that Mr N uses the Flixotide Accuhaler as prescribed and note that he has a satisfactory inhaler technique. Since you have come to the conclusion that Mr N’s asthma does not appear to be under control, you recommend that is medication stepped up.
Using the British Thoracic Society’s guidelines, which of the following treatment regimens would best correspond to a step up in treatment from Mr N’s current medication?
| Answer or metric | Value |
|---|
| Number and % correct answers |
12% / 5 correct answers from 41 total answers received |
| A- A. Flixotide Accuhaler (fluticasone propionate) 250 mcg/blister, 250 mcg twice daily Ventolin Accuhaler, 200 mcg up to four times daily when required montelukast 10 mg once daily at night | 11 times selected / 27% |
| B- Relvar Ellipta 184 mcg/22mcg (fluticasone furoate 184 mcg, vilanterol trifenatate 22 mcg), one inhalation once daily
Ventolin Accuhaler, 200 mcg up to four times daily when required
montelukast 10 mg once daily at night | 1 times selected / 2% |
| C- Fostair Nexthaler 100/6 (100 micrograms of beclometasone dipropionate anhydrous and 6 micrograms of formoterol fumarate dihydrate) 1 puff BD (as a MART regime). | 5 times selected / 12% |
| D- Fostair (beclometasone dipropionate 100 micrograms, formoterol fumarate 6 micrograms/ metered inhalation), two puffs twice daily
Ventolin Accuhaler, 200 mcg up to four times daily when required
montelukast 10 mg once daily at night prednisolone tablets 10 mg once daily in the morning | 2 times selected / 5% |
| E- Flutiform 125 mcg/5 mcg (fluticasone propionate 125 mcg, formoterol fumarate 5 mcg/ metered inhalation), two puffs twice daily
Ventolin Accuhaler, 200 mcg up to four times daily when required | 11 times selected / 27% |
| Unanswered | 11 times selected / 27% |
31. A 10-year-old boy has type 1 diabetes mellitus. Previous attempts to achieve optimal glycaemic control with multiple-injection regimens for him have failed and resulted in repeated hypoglycaemic episodes. Multiple injection regimens have proven to be impractical as there is not always a suitably trained member of staff to administer the insulin to him whilst he is at school. He is of average body weight for his age and has no known allergies.
Which of the following would be the most suitable treatment option for him?
| Answer or metric | Value |
|---|
| Number and % correct answers |
44% / 18 correct answers from 41 total answers received |
| A- continuous subcutaneous insulin infusion | 18 times selected / 44% |
| B- insulin glargine | 9 times selected / 22% |
| C- insulin aspart | 0 times selected / 0% |
| D- insulin aspart and insulin glargine dual-therapy regimen | 3 times selected / 7% |
| E- insulin lispro | 1 times selected / 2% |
| Unanswered | 10 times selected / 24% |
32. Ms Y, a 30-year-old female, with type 1 diabetes, presents at the pharmacy sweating and appears pale and anxious. She tells you that she feels dizzy and needs to sit down. Ms Y is worried as it is the first time, she is experiencing such symptoms and is rather confused
Which of the following is the most appropriate action for you to take to help Ms Y with her symptoms?
| Answer or metric | Value |
|---|
| Number and % correct answers |
15% / 6 correct answers from 41 total answers received |
| A- Give Ms Y 2 teaspoonfuls of sugar dissolved in 80ml of warm water | 3 times selected / 7% |
| B- Give Ms Y 200ml of pure apple juice | 6 times selected / 15% |
| C- Give Ms Y 100ml of Lucozade Energy Original | 20 times selected / 49% |
| D- Administer glucagon injection | 1 times selected / 2% |
| E- Give Ms Y two chocolate biscuits | 0 times selected / 0% |
| Unanswered | 11 times selected / 27% |
33. You are the Responsible Pharmacist working at a community pharmacy and receive a veterinary prescription for phenobarbital 30 mg tablets for Dolly the cat.
Which of the following would be the most appropriate course of action?
| Answer or metric | Value |
|---|
| Number and % correct answers |
54% / 22 correct answers from 41 total answers received |
| A- do not dispense this prescription as it is not legally valid and advise Ms P to see another veterinary surgeon | 5 times selected / 12% |
| B- dispense this prescription and supply the medication to Ms P | 1 times selected / 2% |
| C- contact the prescriber and advise them to make an indelible amendment to include a statement that the medicine is prescribed under the veterinary cascade | 22 times selected / 54% |
| D- contact the prescriber and advise them to make an indelible amendment to include the number repeats of the prescription | 0 times selected / 0% |
| E- Amend the prescription indelibly to include the professional registration number of the veterinary surgeon before dispensing this prescription | 2 times selected / 5% |
| Unanswered | 11 times selected / 27% |
34. Mr Q 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 Q 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?
| Answer or metric | Value |
|---|
| Number and % correct answers |
56% / 23 correct answers from 41 total answers received |
| A- contact the GP and advise him/her to reduce the dose of amlodipine to 5 mg | 2 times selected / 5% |
| B- contact the GP and advise him/her to reduce the dose of simvastatin to 20 mg or less | 23 times selected / 56% |
| C- dispense the prescription exactly as prescribed and advise Mr Q to contact his GP for a review of his medicines at his earliest convenience | 1 times selected / 2% |
| D- dispense the prescription exactly as prescribed and advise Mr Q to continue taking his medicines as prescribed and inform his GP straight away if he experiences any adverse effects | 4 times selected / 10% |
| E- politely refuse to dispense the prescription and ask Mr Q to return to the pharmacy he has used in the past | 0 times selected / 0% |
| Unanswered | 11 times selected / 27% |
35. Mr G is a 57-year-old man with bipolar disorder. He takes the following medication:
- Olanzapine 10mg once daily
- Lithium carbonate (Priadel) 400 mg prolonged release tablet, one tablet once daily
- Procyclidine 5mg three times daily
Mr G calls the pharmacy sounding distressed; he has forgotten to take his medication for the past three days. He has taken olanzapine and procyclidine this morning but would like your advice regarding the missed lithium doses.
What would be the most suitable action to take in response to the missed lithium doses?
| Answer or metric | Value |
|---|
| Number and % correct answers |
17% / 7 correct answers from 41 total answers received |
| A- Mr G should have his serum lithium levels checked prior to recommencing treatment | 19 times selected / 46% |
| B- Mr G should re-start the usual dose of lithium as soon as possible
| 7 times selected / 17% |
| C- Mr G should restart his medication at half his usual dose for two weeks and have a serum lithium measured prior to increasing the dose
| 4 times selected / 10% |
| D- Mr G should take a double dose when the next dose is due then continue on the normal dose | 0 times selected / 0% |
| E- Mr G should take all missed doses for three days, and then continue on the normal dose | 0 times selected / 0% |
| Unanswered | 11 times selected / 27% |
36. Mr R is a 40 year old man with type 1 diabetes mellitus.
He is using a basal-bolus insulin regimen to control his blood glucose and monitors his blood glucose regularly.
He has recently changed occupation and started working as a part-time lorry driver for a transport company. Each job usually involves long distance travel. On an average day, he completes two jobs and travels up to 350 miles a day. He usually has a rest stop every 70 miles at a minimum.
What is the most suitable number of blood glucose tests Mr R should be advised to take at this stage?
| Answer or metric | Value |
|---|
| Number and % correct answers |
66% / 27 correct answers from 41 total answers received |
| A- once a day | 0 times selected / 0% |
| B- up to twice a day | 0 times selected / 0% |
| C- up to three times a day | 0 times selected / 0% |
| D- up to four times a day | 3 times selected / 7% |
| E- up to ten times a day | 27 times selected / 66% |
| Unanswered | 11 times selected / 27% |
37. You have been unable to source Fresubin 1000 Complete to supply to your local care homes for the past week. You receive a call from the matron at one of the care homes asking for your recommendation of the most similar product to Fresubin 1000 Complete so that they can ask the doctor to prescribe this alternative product.
Which of the following would be the closest substitute?
| Answer or metric | Value |
|---|
| Number and % correct answers |
34% / 14 correct answers from 41 total answers received |
| A- Ensure Twocal | 0 times selected / 0% |
| B- Fresubin Energy | 3 times selected / 7% |
| C- Jevity Promote | 14 times selected / 34% |
| D- Novasource GI Forte | 0 times selected / 0% |
| E- Nutrison MCT | 13 times selected / 32% |
| Unanswered | 11 times selected / 27% |
38. A 35-year-old male patient presented to A&E with vomiting and abdominal pain. He had a 2-week history of polyuria and polydipsia, accompanied by a 10 kg weight loss. His medical history was unremarkable, except for being treated for hypertension with amlodipine 10 mg daily. His blood pressure on admission was 130/80 mmHg. He has no family history of diabetes. His initial blood glucose level was 30 mmol/L and a diagnosis of diabetic ketoacidosis was made.
What would be the most appropriate treatment for this condition?
| Answer or metric | Value |
|---|
| Number and % correct answers |
63% / 26 correct answers from 41 total answers received |
| A- dapagliflozin | 0 times selected / 0% |
| B- glucagon | 2 times selected / 5% |
| C- insulin zinc suspension | 1 times selected / 2% |
| D- liraglutide | 2 times selected / 5% |
| E- soluble insulin | 26 times selected / 63% |
| Unanswered | 10 times selected / 24% |
39. Mrs S visits your pharmacy seeking advice for her 2-year-old son Master S. She explains that his left eye was sticky in the morning and now appears red. Master S has no other medical conditions and is not on any regular medication.
Which of the following would be the most appropriate advice to give Mrs S?
| Answer or metric | Value |
|---|
| Number and % correct answers |
61% / 25 correct answers from 41 total answers received |
| A- inform Mrs S that she must make an appointment for her son to see his GP as soon as possible | 1 times selected / 2% |
| B- inform Mrs S that this is a self-limiting condition and should resolve within 3 days; if not, then to see his GP | 1 times selected / 2% |
| C- recommend chloramphenicol 0.5% w/v eye drops, one drop to be applied to the affected eye every two hours for the first 48 hours and 4 hourly thereafter | 25 times selected / 61% |
| D- recommend chloramphenicol 0.5% w/v eye drops, one drop to be applied to the affected eye every six hours for five days | 0 times selected / 0% |
| E- recommend holding a warn compress over the affected eye for five to 10 minutes and repeat three to four times a day until the eye clears up | 2 times selected / 5% |
| Unanswered | 12 times selected / 29% |
40. Mr T presents a prescription for oxycodone 5 mg/5 mL oral solution.
Which of the following is the maximum recommended duration of supply on a single prescription for this medicine?
| Answer or metric | Value |
|---|
| Number and % correct answers |
39% / 16 correct answers from 41 total answers received |
| A- 14 days | 2 times selected / 5% |
| B- 28 days | 13 times selected / 32% |
| C- 30 days | 16 times selected / 39% |
| D- 3 months | 0 times selected / 0% |
| E- 6 months | 0 times selected / 0% |
| Unanswered | 10 times selected / 24% |
41. Mr U has been taking morphine sulfate oral solution 10 mg/5 mL, 6 mL every six hours for the past 7 days. Now that his pain is controlled on this dose, his doctor would like to switch him to buprenorphine patches.
Which of the following patches would provide an approximate equivalent daily dose of morphine sulfate?
| Answer or metric | Value |
|---|
| Number and % correct answers |
71% / 29 correct answers from 41 total answers received |
| A- BuTrans ‘5’ patch | 1 times selected / 2% |
| B- BuTrans ‘10’ patch | 1 times selected / 2% |
| C- BuTrans ‘20’ patch | 29 times selected / 71% |
| D- Transtec ‘35’ patch | 0 times selected / 0% |
| E- Transtec ’52.5’ patch | 0 times selected / 0% |
| Unanswered | 10 times selected / 24% |
42. You are a pharmacist at a mental health clinic. Mr V’s most recent prescription is for haloperidol depot injection. Mr V’s patient medication record shows that he usually takes haloperidol tablets.
Which of the following is the most likely reason that the haloperidol has been changed from tablets to a depot injection?
| Answer or metric | Value |
|---|
| Number and % correct answers |
59% / 24 correct answers from 41 total answers received |
| A- to improve efficacy | 3 times selected / 7% |
| B- to improve adherence | 24 times selected / 59% |
| C- to provide a more rapid response | 3 times selected / 7% |
| D- to reduce the risk of neuroleptic malignant syndrome | 1 times selected / 2% |
| E- to reduce the risk of extra-pyramidal side-effects | 0 times selected / 0% |
| Unanswered | 10 times selected / 24% |
43. Which term best describes the following ‘the process of withdrawal of an inappropriate medication, supervised by a health care professional with the goal of managing polypharmacy and improving outcomes’?
| Answer or metric | Value |
|---|
| Number and % correct answers |
66% / 27 correct answers from 41 total answers received |
| A- Polypharmacy | 0 times selected / 0% |
| B- Appropriate polypharmacy | 2 times selected / 5% |
| C- Deprescribing | 27 times selected / 66% |
| D- Hyperpolypharmacy | 0 times selected / 0% |
| E- Oligopharmacy | 1 times selected / 2% |
| Unanswered | 11 times selected / 27% |
44. Questions 44 and 45 relate to a new member of staff who is receiving emergency first aid.
The superintendent pharmacist is running a training course for a few new members of staff at the pharmacy. One of the staff members has bought some nuts to snack on during the training. A member of the team starts to become increasingly unwell and you suspect an anaphylactic reaction. The superintendent is qualified to deliver emergency first aid, and reaches for the First Aid kit in the room.
Which of the following is the recommended dosage of adrenaline to be administered by intramuscular injection?
| Answer or metric | Value |
|---|
| Number and % correct answers |
73% / 30 correct answers from 41 total answers received |
| A- 150 micrograms repeated every 5 minutes if necessary | 0 times selected / 0% |
| B- 300 micrograms repeated every 5 minutes if necessary | 1 times selected / 2% |
| C- 300 micrograms repeated every 15 minutes if necessary | 0 times selected / 0% |
| D- 300 micrograms initially and then 500 micrograms repeated every 5 minutes if necessary | 0 times selected / 0% |
| E- 500 micrograms repeated every 5 minutes if necessary | 30 times selected / 73% |
| Unanswered | 10 times selected / 24% |
45. Questions 44 and 45 relate to a new member of staff who is receiving emergency first aid.
The superintendent pharmacist is unsure about whether to call an ambulance and asks for your advice.
Which of the following responses would be most appropriate for you to give?
| Answer or metric | Value |
|---|
| Number and % correct answers |
46% / 19 correct answers from 41 total answers received |
| A- if the staff member does not improve he should administer a second adrenaline injection 30 minutes after the first | 0 times selected / 0% |
| B- he does not need to call an ambulance if the symptoms have improved after the first adrenaline injection | 1 times selected / 2% |
| C- he should call for an ambulance immediately even if the staff member’s symptoms are improving | 19 times selected / 46% |
| D- he should only call for an ambulance if the second adrenaline injection fails to improve symptoms | 9 times selected / 22% |
| E- he should wait 15 minutes and continue to assess the staff member’s condition before calling an ambulance | 2 times selected / 5% |
| Unanswered | 10 times selected / 24% |
46. Miss D, a 20-year-old female, weighing 100kg, is admitted to hospital following a suspected Paracetamol overdose. Miss D’s mother found two empty packets of 16x500mg paracetamol tablets, on the floor in Miss D’s room, and believes she took the entire contents about three hours ago. Miss D’s bloods are taken to determine her paracetamol plasma concentration; however, you are informed by the pathology department that the results will be out within 2 hours, due to a technical difficulty.
Which of the following statements is correct?
| Answer or metric | Value |
|---|
| Number and % correct answers |
17% / 7 correct answers from 41 total answers received |
| A- Miss D does not require any treatment, as the dose ingested was below the toxic level of 150mg/kg and is unlikely to cause serious toxicity.
| 9 times selected / 22% |
| B- Miss D’s ingested dose is above the toxic level of 150mg/kg, and Acetylcysteine must be administered immediately.
| 10 times selected / 24% |
| C- Miss D’s ingested dose is above the toxic level of 150mg/kg, and the plasma-paracetamol concentration needs to be determined before deciding whether Acetylcysteine needs to be administered.
| 7 times selected / 17% |
| D- Miss D should be treated with repeated doses of activated charcoal
| 2 times selected / 5% |
| E- Miss D does not require any treatment, as the dose ingested was less than 75mg/kg, and so is unlikely to cause serious toxicity.
| 2 times selected / 5% |
| Unanswered | 11 times selected / 27% |
47. Miss D’s Plasma paracetamol concentration is found to be 90mg/litre. The registrar on call decides to start an IV acetylcysteine regimen.
What is the total requisite volume of acetylcysteine 200mg/mL in millilitres (mL) to be administered over the three consecutive infusions?
| Answer or metric | Value |
|---|
| Number and % correct answers |
59% / 24 correct answers from 41 total answers received |
| A- 155 mL
| 0 times selected / 0% |
| B- 157 mL
| 0 times selected / 0% |
| C- 159 mL | 24 times selected / 59% |
| D- 162 mL
| 1 times selected / 2% |
| E- 165 mL | 0 times selected / 0% |
| Unanswered | 16 times selected / 39% |
48. Ms. W, a 28-year-old woman presents at the pharmacy seeking your advice. She has just discovered she is 4 weeks pregnant and asks you to suggest a suitable supplement to take while pregnant.
Which of the following supplements should be avoided in pregnancy?
| Answer or metric | Value |
|---|
| Number and % correct answers |
49% / 20 correct answers from 41 total answers received |
| A- Glucosamine
| 7 times selected / 17% |
| B- Vitamin D
| 0 times selected / 0% |
| C- Calcium | 1 times selected / 2% |
| D- Cod Liver oil
| 20 times selected / 49% |
| E- Zinc | 3 times selected / 7% |
| Unanswered | 10 times selected / 24% |
49. Question 49 and 50 relate to Mr U, a 66-year-old man, who has developed diarrhoea after a course of broad-spectrum antibiotics. A stool sample has confirmed an anaerobic Clostridium difficile infection. It is his first episode of C. difficile. His symptoms are mild, with less than three stools per day, and there is no increase in white cell count. Mr U has normal renal and hepatic function.
Which of the following doses of metronidazole would be the most appropriate to use when treating Mr U?
| Answer or metric | Value |
|---|
| Number and % correct answers |
10% / 4 correct answers from 41 total answers received |
| A- 200mg every 6 hours
| 0 times selected / 0% |
| B- 200 mg every 8 hours
| 3 times selected / 7% |
| C- 400 mg every 6 hours | 1 times selected / 2% |
| D- 400 mg every 8 hours
| 23 times selected / 56% |
| E- 400 mg every 12 hours | 4 times selected / 10% |
| Unanswered | 10 times selected / 24% |
50. Question 49 and 50 relate to Mr U, a 66-year-old man, who has developed diarrhoea after a course of broad-spectrum antibiotics. A stool sample has confirmed an anaerobic Clostridium difficile infection. It is his first episode of C. difficile. His symptoms are mild, with less than three stools per day, and there is no increase in white cell count. Mr U has normal renal and hepatic function.
Which of the following antibiotics is least likely to have caused Mr U’s C. difficile infection?
| Answer or metric | Value |
|---|
| Number and % correct answers |
41% / 17 correct answers from 41 total answers received |
| A- co-amoxiclav
| 5 times selected / 12% |
| B- ciprofloxacin
| 5 times selected / 12% |
| C- cefixime | 3 times selected / 7% |
| D- vancomycin
| 17 times selected / 41% |
| E- clindamycin | 1 times selected / 2% |
| Unanswered | 10 times selected / 24% |
51. Mr C has been admitted to A&E following an overdose of digoxin. His serum digoxin concentration on admission is 4.5 micrograms/L.
Given that digoxin has a half-life of 60 hours, and assuming that his renal function is stable and absorption is complete, how long will it take for the digoxin plasma level to reach 1.125 micrograms/L?
| Answer or metric | Value |
|---|
| Number and % correct answers |
73% / 30 correct answers from 41 total answers received |
| A- 30 hours
| 1 times selected / 2% |
| B- 60 hours
| 0 times selected / 0% |
| C- 90 hours | 0 times selected / 0% |
| D- 120 hours
| 30 times selected / 73% |
| E- 150 hours | 0 times selected / 0% |
| Unanswered | 10 times selected / 24% |
52. Mrs V is a 28-year-old female who presents at the pharmacy to collect her husband’s prescription for carbimazole. She informs you that she is 2 weeks pregnant and would like to purchase folic acid tablets.
Which of the following advice is the most appropriate to give Mrs V?
| Answer or metric | Value |
|---|
| Number and % correct answers |
32% / 13 correct answers from 41 total answers received |
| A- Mrs V should take folic acid 400mcg daily for the first 12 weeks of pregnancy
| 13 times selected / 32% |
| B- Mrs V should take folic acid 5mg daily to be continued until for the first 12 weeks of pregnancy
| 2 times selected / 5% |
| C- Mrs V should see her doctor immediately as her baby is at risk of congenital abnormalities
| 14 times selected / 34% |
| D- Advise Mrs V that in addition to folic acid, she should also take iron and vitamin D supplements
| 0 times selected / 0% |
| E- Advise Mrs V that she should have started taking folic acid 12 weeks pre-conception
| 2 times selected / 5% |
| Unanswered | 10 times selected / 24% |
53. Mrs W, a 52-year-old patient weighing 62kg, was initiated on phenytoin, the doctor orders a serum phenytoin concentration.
Which of the following is the target therapeutic range of serum-phenytoin concentration that should be achieved?
| Answer or metric | Value |
|---|
| Number and % correct answers |
56% / 23 correct answers from 41 total answers received |
| A- 0.5-1 mg/L
| 1 times selected / 2% |
| B- 10-20 mg/L
| 23 times selected / 56% |
| C- 4-12 mg/L
| 2 times selected / 5% |
| D- 6-12 mg/L
| 3 times selected / 7% |
| E- 8-15 mg/L
| 2 times selected / 5% |
| Unanswered | 10 times selected / 24% |
54. Miss T presents at your pharmacy after being bitten on her hand by a dog and asks for your advice. Her hand is rather warm and tender, and she is worried that it may be infected. You suggest Miss T visits her GP as she may need antibiotics.
Given that Miss T has no known drug allergies, which of the following antibiotics would be the most appropriate for the GP to prescribe?
| Answer or metric | Value |
|---|
| Number and % correct answers |
44% / 18 correct answers from 41 total answers received |
| A- co-amoxiclav
| 18 times selected / 44% |
| B- Doxycycline
| 3 times selected / 7% |
| C- Clarithromycin
| 0 times selected / 0% |
| D- Amoxicillin
| 1 times selected / 2% |
| E- Flucloxacillin
| 9 times selected / 22% |
| Unanswered | 10 times selected / 24% |
55. Mrs L presents in the pharmacy with a new prescription for Risedronate 35mg once weekly which her doctor has prescribed to reduce her risk of hip fractures.
Which of the following would be the most suitable counselling advice to give Mrs L?
| Answer or metric | Value |
|---|
| Number and % correct answers |
54% / 22 correct answers from 41 total answers received |
| A- Avoid food and drink for at least 2 hours before or after taking risedronate
| 2 times selected / 5% |
| B- Swallow tablets whole with a full glass of water; on rising 30 minutes before the first food or drink of the day
| 22 times selected / 54% |
| C- Swallow tablets whole with a full glass of water; on rising 1 hour before first food or drink of the day
| 2 times selected / 5% |
| D- If taking tablets at bedtime remain standing for at least 30 minutes
| 1 times selected / 2% |
| E- Stand or sit upright for at least 1 hour after taking the tablet
| 4 times selected / 10% |
| Unanswered | 10 times selected / 24% |
56. You are working as a GP practice pharmacist. The Physician’s Associate asks you for advice regarding Mr N, a 64-year-old male with atrial fibrillation, takes daily warfarin for stroke prevention. The Physician’s Associate has measured his INR today as 6.0 and informs you that he is not experiencing any bleeding.
Given that Mr N is not experiencing any bleeding, which of the following is most appropriate advice to give him?
| Answer or metric | Value |
|---|
| Number and % correct answers |
44% / 18 correct answers from 41 total answers received |
| A- Mr N should stop warfarin and be administered phytometadione (Vitamin K1) by slow intravenous injection. He can restart warfarin when his INR <5.0
| 1 times selected / 2% |
| B- Mr N should withhold the next 1 or 2 doses of warfarin and the subsequent maintenance dose should be reduced
| 18 times selected / 44% |
| C- Mr N should stop warfarin and take phytometadione (Vitamin K1) orally using the intravenous preparation. The dose of phytometadione should be repeated if INR is still high after 24 hours and restart warfarin when INR<5.0
| 5 times selected / 12% |
| D- Mr N should stop warfarin and be administered phytometadione by slow intravenous injection. The dose of phytometadione should be repeated if INR still high after 24 hours and restart warfarin when INR<5.0
| 4 times selected / 10% |
| E- Stop taking warfarin and refer to A&E for further assessment
| 3 times selected / 7% |
| Unanswered | 10 times selected / 24% |
57. Miss Z is a 25-year-old female comes into your pharmacy on Monday morning at 9 am, enquiring about the morning after pill. She informs you that she normally takes Desogestrel 75mcg daily, at 11 pm every evening. However, she forgot to take last nights’ dose, and has had unprotected intercourse. Miss Z would like to purchase the morning after pill, as she has heard that it can be very effective in preventing a pregnancy.
What is the most appropriate advice to give Miss Z?
| Answer or metric | Value |
|---|
| Number and % correct answers |
34% / 14 correct answers from 41 total answers received |
| A- Take the missed contraceptive pill immediately and take the next pill at the normal time. Miss Z does not need to take the morning after pill.
| 14 times selected / 34% |
| B- Supply levonorgestrel 1500 mcg to be taken immediately. If Miss Z experiences vomiting in the next 3 hours she should return for another dose.
| 5 times selected / 12% |
| C- Supply Ulipristal acetate 30mg to be taken immediately. If Miss Z experiences vomiting in the next 3 hours she should return for another dose.
| 0 times selected / 0% |
| D- Take the next contraceptive pill at the same time. No further action needs to be taken.
| 0 times selected / 0% |
| E- Take the missed contraceptive pill immediately and take the next pill at the normal time. Use barrier contraception for the next 48 hours.
| 11 times selected / 27% |
| Unanswered | 11 times selected / 27% |
58. You are a hospital pharmacist and have been requested to review the discharge medication for a 63-year-old female patient who was admitted with atrial fibrillation last week. During her stay, the patient was stabilised on amiodarone 200mg tablets and it has been decided that she should continue to take this medication post-discharge to maintain sinus rhythm at a dose of 200mg DAILY.
Which of the following counselling points should be provided to the patient?
| Answer or metric | Value |
|---|
| Number and % correct answers |
66% / 27 correct answers from 41 total answers received |
| A- Amiodarone should be taken 1 hour before meals
| 0 times selected / 0% |
| B- Amiodarone can make the urine a red colour, this is harmless
| 0 times selected / 0% |
| C- Discourage all exercise during the use of amiodarone as it could strain the heart
| 0 times selected / 0% |
| D- Amiodarone can cause unexplained bruising, report this immediately if it develops
| 3 times selected / 7% |
| E- The patient should use a wide-spectrum sunscreen and avoid the prolonged exposure to sunlight and the use of sunbeds | 27 times selected / 66% |
| Unanswered | 11 times selected / 27% |
59. You are the Responsible Pharmacist on duty in a community pharmacy. You are the only pharmacist working on the premises, but you need to be absent for an hour to attend a meeting at the CCG. You have made all the appropriate arrangements to ensure you are contactable.
Which of the following tasks could be undertaken by the pharmacy staff during your absence?
| Answer or metric | Value |
|---|
| Number and % correct answers |
34% / 14 correct answers from 41 total answers received |
| A- Receive a prescription for atorvastatin 20mg tablets and dispense it in the presence of an Accredited Checking Technician (ACT)
| 6 times selected / 15% |
| B- Give out previously checked and prepared prescriptions to the relevant patients
| 6 times selected / 15% |
| C- Make a sale of a pack of 7 esomeprazole 20mg tablets
| 14 times selected / 34% |
| D- Make a sale of a tube of hydrocortisone 1% cream for a 25 year old with eczema on the wrist
| 0 times selected / 0% |
| E- Wholesale of medicines
| 4 times selected / 10% |
| Unanswered | 11 times selected / 27% |
60. Mrs. K, a 65-year-old female, with a body weight of 70kg, and a CrCL of 72 ml/min, presents to the A&E department of the hospital with shortness of breath, chest pain and increased fatigue. She is found to have an irregular pulse, and following an ECG, a diagnosis of non-valvular atrial fibrillation is made. Mrs K has a past medical history of Hypertension and Diabetes, and is on the following regular medication:
- Amlodipine 10mg OD
- Ramipril 5mg OD
- Metformin 500mg TDS
- Gliclazide 80mg OD
Mrs K is needle phobic.
Which of the following is most appropriate course of action?
| Answer or metric | Value |
|---|
| Number and % correct answers |
54% / 22 correct answers from 41 total answers received |
| A- Mrs. K has a CHA2DS2-VASc score of 1 and does not need to be commenced on anticoagulation.
| 0 times selected / 0% |
| B- Mrs. K has a CHA2DS2-VASc score of 2 and does not need to be commenced on anticoagulation | 1 times selected / 2% |
| C- Mrs. K has a CHA2DS2-VASc score of 3 and should be commenced on Dabigatran 150mg BD | 5 times selected / 12% |
| D- Mrs. K has a CHA2DS2-VASc score of 4 and should be commenced on Apixaban 5mg BD.
| 22 times selected / 54% |
| E- Mrs. K has a CHA2DS2-VASc score of 4 and should be commenced on Warfarin 5mg initially, with the dose adjusted according to her INR.
| 1 times selected / 2% |
| Unanswered | 12 times selected / 29% |
61. You are a regular locum at a community pharmacy. Lately, you have noticed that the regular pharmacist has been coming into work smelling of alcohol. He has also developed a bad temper and been making an increasing number of dispensing errors. You are aware that you should raise concerns about issues which are likely to cause danger to the health or safety of an individual.
Which of the following acts protect individuals who make disclosures of information the public interest?
| Answer or metric | Value |
|---|
| Number and % correct answers |
17% / 7 correct answers from 41 total answers received |
| A- Whistleblowing Act
| 16 times selected / 39% |
| B- Pharmacy Act
| 1 times selected / 2% |
| C- Duty of Candour Act
| 5 times selected / 12% |
| D- Caldicott Disclosure Act
| 0 times selected / 0% |
| E- Public Interest Disclosure Act
| 7 times selected / 17% |
| Unanswered | 12 times selected / 29% |
62. Mrs A is receiving treatment for tuberculosis. She has been prescribed rifampicin, isoniazid and pyridoxine. She has no known allergies and takes metformin 500 mg twice daily for type 2 diabetes mellitus. Mrs A asks you what the pyridoxine is for.
Which of the following is the most appropriate reason for prescribing pyridoxine for Mrs A?
| Answer or metric | Value |
|---|
| Number and % correct answers |
73% / 30 correct answers from 41 total answers received |
| A- For the management of vitamin B12 deficiency caused by metformin
| 0 times selected / 0% |
| B- To prevent the development of diabetic foot ulcer
| 0 times selected / 0% |
| C- For the prevention of isoniazid-induced peripheral neuropathy
| 30 times selected / 73% |
| D- To reduce the risk of seizures while receiving treatment for tuberculosis
| 0 times selected / 0% |
| E- To prevent the development of skin rashes
| 0 times selected / 0% |
| Unanswered | 11 times selected / 27% |
63. Mrs B is a 52-year-old patient weighing 60kg and requires treatment for deep vein thrombosis. You have been asked to provide advice on an appropriate dose of Edoxaban to administer to Mrs B.
Which of the following is the most appropriate dose to be administered to Mrs B?
| Answer or metric | Value |
|---|
| Number and % correct answers |
34% / 14 correct answers from 41 total answers received |
| A- Edoxaban 30mg once daily
| 14 times selected / 34% |
| B- Edoxaban 30mg twice daily
| 8 times selected / 20% |
| C- Edoxaban 30mg three times daily
| 0 times selected / 0% |
| D- Edoxaban 60mg once daily
| 3 times selected / 7% |
| E- Edoxaban 60mg twice daily
| 5 times selected / 12% |
| Unanswered | 11 times selected / 27% |
64. During a medication review with Mr T, he informs you that due to recent pressures at work, he has increased his alcohol intake.
Which one of the following statements is correct in accordance with the current alcohol guidelines?
| Answer or metric | Value |
|---|
| Number and % correct answers |
59% / 24 correct answers from 41 total answers received |
| A- Sudden reduction in alcohol intake increases your risk of developing cancer
| 0 times selected / 0% |
| B- To keep health risks from alcohol to a low level, it is safest not to drink more than 3 units a day on a regular basis
| 3 times selected / 7% |
| C- If you regularly drink as much as 14 units per week, it is best to spread your drinking evenly over three or more days
| 24 times selected / 59% |
| D- If you have one or two heavy drinking episodes a week, your risk of long-term illness and injury is low
| 0 times selected / 0% |
| E- If you wish to cut down the amount you drink, a good way to help achieve this is to have no more than two drink-free days a week
| 3 times selected / 7% |
| Unanswered | 11 times selected / 27% |
65. Both patients and healthcare professionals are encouraged to report all suspected adverse drug reactions should be 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?
| Answer or metric | Value |
|---|
| Number and % correct answers |
22% / 9 correct answers from 41 total answers received |
| A- Mr J is 42 years old and develops a dry cough whilst taking ramipril
| 0 times selected / 0% |
| B- Miss K is 25 years old who experiences constipation whilst taking ferrous sulphate
| 0 times selected / 0% |
| C- Mrs L who is 62 years old, has noticed a dry mouth since she started taking solifenacin
| 15 times selected / 37% |
| D-Mr M is 32 years old and develops diarrhoea after taking clindamycin
| 9 times selected / 22% |
| E- Mr N is 56 years old and experiences cold hands whilst taking metoprolol
| 5 times selected / 12% |
| Unanswered | 12 times selected / 29% |
66. Mrs. Y, a 49-year-old woman has been diagnosed with a malignant tumor. She is to commence chemotherapy following surgical removal of the tumor. Mrs. Y has read about chemotherapy related side effects and is worried that the nausea and vomiting may interfere with her daily activities.
Which of the following cytotoxic medications is considered to be the least emetogenic treatment?
| Answer or metric | Value |
|---|
| Number and % correct answers |
39% / 16 correct answers from 41 total answers received |
| A- Cisplatin
| 2 times selected / 5% |
| B- Doxorubicin
| 7 times selected / 17% |
| C-Mitoxantrone
| 0 times selected / 0% |
| D-Vincristine
| 16 times selected / 39% |
| E- Cyclophosphamide
| 4 times selected / 10% |
| Unanswered | 12 times selected / 29% |
67. Miss G comes into the pharmacy seeking head lice treatment for her 2 children. She mentions that one is 3 years old and the other is 6 years old. She tells you that she would like a preparation that can be left in overnight as she feels that would be most effective.
Which of the following products is the most appropriate to give to Miss G?
| Answer or metric | Value |
|---|
| Number and % correct answers |
54% / 22 correct answers from 41 total answers received |
| A- Dimeticone 4% lotion
| 22 times selected / 54% |
| B- Dimeticone 4% spray gel
| 2 times selected / 5% |
| C- Mineral oil and dimeticone spray
| 0 times selected / 0% |
| D- Isopropyl myristate and cyclomethicone solution
| 2 times selected / 5% |
| E- Olive oil with a nit comb
| 3 times selected / 7% |
| Unanswered | 12 times selected / 29% |
68. Mrs B presents at the pharmacy with a prescription for flucloxacillin 500 mg capsules. She informs you that the GP prescribed the antibiotics for an infected ear piercing. She confirms she has no known drug allergies and asks you for advice on how she should take the capsules.
Which of the following is the most appropriate counselling advice to give to Mrs B regarding this medication?
| Answer or metric | Value |
|---|
| Number and % correct answers |
66% / 27 correct answers from 41 total answers received |
| A- avoid indigestion remedies two hours before or after you take this medicine
| 2 times selected / 5% |
| B- avoid milk 30 minutes before taking a capsule
| 0 times selected / 0% |
| C- take one capsule every six hours at least 1 hour before food or 2 hours after food
| 27 times selected / 66% |
| D-take one capsule every eight hours with or after food
| 0 times selected / 0% |
| E- take one capsule every twelve hours with a full glass of water
| 0 times selected / 0% |
| Unanswered | 12 times selected / 29% |
69. You are required to deliver a training session on the concept of pharmaceutical care.
Which of the following descriptions best describe pharmaceutical care?
| Answer or metric | Value |
|---|
| Number and % correct answers |
34% / 14 correct answers from 41 total answers received |
| A- ‘the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve the patient’s quality of life’
| 14 times selected / 34% |
| B- ‘a patient-focused approach to getting the best from investment in and use of medicines’
| 3 times selected / 7% |
| C- ‘a systematic process of establishing best practice by measuring against criteria and taking action to improve care’
| 2 times selected / 5% |
| D-‘providing care that supports people to achieve the health outcomes that give them the best opportunity to lead the life that they want’
| 8 times selected / 20% |
| E- ‘a system of processes and behaviours that determines how medicines are used by patients and by the NHS
| 0 times selected / 0% |
| Unanswered | 14 times selected / 34% |
70. Mrs R, a 62-year-old woman presents in A&E with abdominal pain, nausea, vomiting and confusion. Further investigations reveal Mrs R is dehydrated and has raised serum creatinine levels. A diagnosis of acute kidney injury is made.
Which of the following is not considered a risk factor for developing acute kidney injury?
| Answer or metric | Value |
|---|
| Number and % correct answers |
5% / 2 correct answers from 41 total answers received |
| A- Dementia | 16 times selected / 39% |
| B-Age over 60 years
| 2 times selected / 5% |
| C- Liver disease
| 6 times selected / 15% |
| D- Use of aminoglycosides
| 1 times selected / 2% |
| E- Use of iodinated contrast agents within the past week
| 4 times selected / 10% |
| Unanswered | 12 times selected / 29% |
71. Biosimilar medicines have been used in the NHS for many years as treatments for growth hormone replacement, neutropenia and anaemia related to chronic renal failure or cancer.
Which of these statements regarding biosimilar medicines is the most appropriate?
| Answer or metric | Value |
|---|
| Number and % correct answers |
49% / 20 correct answers from 41 total answers received |
| A- The active substance of a biosimilar medicine is identical to the original biological medicine
| 3 times selected / 7% |
| B-Biosimilar medicines are structurally equivalent but not therapeutically equivalent to the originator biological medicines
| 5 times selected / 12% |
| C- A biosimilar medicine is the same as a generic medicine as both contain the molecular structure identical to the originator medicine
| 0 times selected / 0% |
| D- A biosimilar medicine is highly similar and clinically equivalent to an existing biological medicine
| 20 times selected / 49% |
| E- A biosimilar medicine may be authorised by the European Medicines Agency (EMA) up to a year before the patent for the biological medicine expires
| 1 times selected / 2% |
| Unanswered | 12 times selected / 29% |
72. Mrs X asks for your advice about how best she can manage her osteoarthritic pain.
Which of the following is the most appropriate advice to give Mrs X regarding management of osteoarthritis?
| Answer or metric | Value |
|---|
| Number and % correct answers |
49% / 20 correct answers from 41 total answers received |
| A- Mrs X should use a rubefacient cream in addition to oral paracetamol
| 4 times selected / 10% |
| B-Acupuncture may help provide her with pain relief
| 0 times selected / 0% |
| C- Mrs X should not use an NSAID but should use co-codamol instead
| 1 times selected / 2% |
| D- Mrs X may benefit from trying a topical NSAID in combination with exercise
| 20 times selected / 49% |
| E- Mrs X should refrain from exercising and should try taking ibuprofen tablets
| 4 times selected / 10% |
| Unanswered | 12 times selected / 29% |
73. Question 73 and 74 relate to Mrs A, a 37-year-old woman who regularly collects a prescription for Marvelon from your pharmacy.
Mrs A presents in the pharmacy with a prescription for warfarin tablets. She informs you that the doctor has prescribed them for the treatment of venous thromboembolism which he told her was due to the Marvelon tablets that she has been taking for 10 years. She confirms that she has stopped taking the Marvelon and is using alternative methods of contraception as per the doctor’s advice. She appears quite anxious about taking warfarin and asks you whether she would need to take it long term.
According to the recommendations of the British Society for Haematology, Guidelines on Oral Anticoagulation with Warfarin, how long would Mrs A need to continue taking the warfarin tablets for?
| Answer or metric | Value |
|---|
| Number and % correct answers |
34% / 14 correct answers from 41 total answers received |
| A- 4 weeks
| 0 times selected / 0% |
| B- 6 weeks | 2 times selected / 5% |
| C- 3 months
| 14 times selected / 34% |
| D- 6 months | 12 times selected / 29% |
| E- Long term
| 1 times selected / 2% |
| Unanswered | 12 times selected / 29% |
74. Two weeks later, Mrs A returns to the pharmacy and tells you that she is experiencing a burning sensation in the mouth. Her mouth and throat appear red and there are white patches in the mouth. After examining her, you suspect she has oral thrush.
Which of the following would be the most suitable action to take?
| Answer or metric | Value |
|---|
| Number and % correct answers |
54% / 22 correct answers from 41 total answers received |
| A- Sell Mrs A the 15g tube of miconazole oral gel and advise her to apply 2.5ml four times a day for 7 days
| 3 times selected / 7% |
| B- Refer Mrs A to her GP
| 22 times selected / 54% |
| C- Sell Mrs A the 15g tube of miconazole oral gel and advise her to apply 2.5ml four times a day and continue the treatment for at least 7 days after the symptoms have cleared
| 2 times selected / 5% |
| D- Sell Mrs A Nystatin oral suspension and advise her to apply 1ml to the lesions four times a day for 7 days
| 2 times selected / 5% |
| E- Sell Mrs A lidocaine gel for pain relief
| 0 times selected / 0% |
| Unanswered | 12 times selected / 29% |
75. Mr B, a 28-year-old man, was stopped this morning on his way to work by police for speeding and careless driving. Mr B informs the police he takes regular medication prescribed by his doctor that sometimes make him drowsy. The police use a roadside drug-screening device to test his saliva and Mr B tests positive for the presence of a drug.
Which of the following drugs can be detected using a roadside screening device?
| Answer or metric | Value |
|---|
| Number and % correct answers |
15% / 6 correct answers from 41 total answers received |
| A- Codeine | 7 times selected / 17% |
| B- Flunitrazepam | 6 times selected / 15% |
| C- Alprazolam | 6 times selected / 15% |
| D- Fluvoxamine | 1 times selected / 2% |
| E- Tramadol
| 8 times selected / 20% |
| Unanswered | 13 times selected / 32% |
76. Mr D, is a 42-year-old man that experiences neuropathic pain. His doctor has advised that he would benefit from switching from pregabalin 75mg capsules to gabapentin 300mg capsules.
Which of the following is the most suitable advice that Mr D should be given regarding the change in his medication?
| Answer or metric | Value |
|---|
| Number and % correct answers |
10% / 4 correct answers from 41 total answers received |
| A- Pregabalin should normally be tapered down, but not when switching to gabapentin
| 6 times selected / 15% |
| B- Pregabalin should not be abruptly withdrawn but should be tapered down over at least 2 weeks
| 12 times selected / 29% |
| C- Pregabalin should not be abruptly withdrawn but should be tapered down over at least a week
| 4 times selected / 10% |
| D- Mr D should stop taking pregabalin and start the gabapentin immediately
| 3 times selected / 7% |
| E- Pregabalin has a long half life, so Mr D should wait at least 48 hours after stopping the pregabalin before starting gabapentin
| 3 times selected / 7% |
| Unanswered | 13 times selected / 32% |
77. Mrs E, a 54-year-old female patient, presents at the pharmacy and explains that she is experiencing chest pain. Upon questioning, she informs you that the pain occurred suddenly and she does not remember doing anything strenuous. She has no history of heart conditions and does sometimes have mild heartburn especially after she eats a heavy meal for which she takes 10ml Gaviscon, which helps. She tells you that the pain is in the mid chest and is not radiating anywhere else.
Mrs E’s PMR:
- Paracetamol 500mg caplets, one-two caplets when required up to four times a day
- Elleste Duet 1mg tablets (estradiol/norethisterone), use as directed
- Levothyroxine 100mcg tablets daily
Which of the following is the best course of action?
| Answer or metric | Value |
|---|
| Number and % correct answers |
7% / 3 correct answers from 41 total answers received |
| A- Sell omeprazole 10mg capsules to Mrs E and advise her to take 2 capsules daily until symptoms subside
| 8 times selected / 20% |
| B- Advise Mrs E that she should see her GP as her levothyroxine dose may require adjusting
| 5 times selected / 12% |
| C- Provide Mrs E with aspirin 300mg dispersible tablets and GTN spray; call 999
| 12 times selected / 29% |
| D- Provide Mrs E with aspirin 75mg dispersible tablets and GTN spray; call 999
| 0 times selected / 0% |
| E- Advise Mrs E to stop taking Elleste Duet 1mg tablets
| 3 times selected / 7% |
| Unanswered | 13 times selected / 32% |
78. Questions 78, 79 and 80 relate to Mr K, a 53-year-old male patient, who was admitted to hospital after experiencing sudden numbness in his left arm and difficulty speaking. Having excluded the possibility of intracranial haemorrhage, Mr K was given appropriate medication at the specialist acute stroke unit by IV infusion within 3 hours of onset of symptoms.
Which of the following is also a symptom of stroke?
| Answer or metric | Value |
|---|
| Number and % correct answers |
56% / 23 correct answers from 41 total answers received |
| A- Loss of vision
| 23 times selected / 56% |
| B- Stomach cramps
| 0 times selected / 0% |
| C- Yellow vision
| 1 times selected / 2% |
| D- Restlessness | 3 times selected / 7% |
| E- Vomiting | 2 times selected / 5% |
| Unanswered | 12 times selected / 29% |
79. Questions 78, 79 and 80 relate to Mr K, a 53-year-old male patient, who was admitted to hospital after experiencing sudden numbness in his left arm and difficulty speaking. Having excluded the possibility of intracranial haemorrhage, Mr K was given appropriate medication at the specialist acute stroke unit by IV infusion within 3 hours of onset of symptoms.
Which of the following thrombolytic drugs would be the most appropriate for treating acute ischaemic stroke in Mr K?
| Answer or metric | Value |
|---|
| Number and % correct answers |
71% / 29 correct answers from 41 total answers received |
| A- Streptokinase
| 0 times selected / 0% |
| B- Reteplase | 0 times selected / 0% |
| C- Alteplase | 29 times selected / 71% |
| D- Tenecteplase | 0 times selected / 0% |
| E- Urokinase | 0 times selected / 0% |
| Unanswered | 12 times selected / 29% |
80. Following the ischaemic stroke, Mr L has been informed he must receive long-term treatment to reduce the possibility of any further cardiovascular events. Mr L does not have atrial fibrillation and has a slight intolerance to clopidogrel.
Which of the following statements is most appropriate regarding long-term management for Mr L?
| Answer or metric | Value |
|---|
| Number and % correct answers |
46% / 19 correct answers from 41 total answers received |
| A- Mr L should receive rivaroxaban alone. He should also be advised to make lifestyle changes such as having a healthy diet, exercising regularly and reducing his salt intake
| 6 times selected / 15% |
| B- Mr L should receive warfarin alone. He should also be advised to make lifestyle changes such as having a healthy diet, exercising regularly and reducing his salt intake
| 1 times selected / 2% |
| C- Mr L should receive modified-release dipyridamole in combination with aspirin and should be initiated on a beta blocker. He should also be advised to make lifestyle changes such as having a healthy diet and reducing his salt intake
| 3 times selected / 7% |
| D- Mr L should receive modified-release dipyridamole in combination with aspirin. He should start taking a statin, 48 hours after the onset of stroke symptoms and should be advised to make lifestyle changes such as having a healthy diet and exercising regularly
| 19 times selected / 46% |
| E- Mr L should be advised to make lifestyle changes such as having a healthy diet, exercising regularly and reducing his salt intake
| 0 times selected / 0% |
| Unanswered | 12 times selected / 29% |
81. Mrs N has recently been started on rivaroxaban. On coming to collect her prescription, she asks you for more information about her new medication.
Which of the following statements regarding the novel oral anticoagulants (DOACs) is the most appropriate?
| Answer or metric | Value |
|---|
| Number and % correct answers |
66% / 27 correct answers from 41 total answers received |
| A- Dabigatran and rivaroxaban are direct inhibitors of Factor Xa
| 0 times selected / 0% |
| B- Rivaroxaban is the most appropriate DOAC for patients with dyspepsia
| 0 times selected / 0% |
| C- Patients on NOACs should be advised to avoid excessive consumption of vitamin K
| 0 times selected / 0% |
| D-The antidote for rivaroxaban is idarucizumab
| 2 times selected / 5% |
| E- Monitoring of INR levels is not required
| 27 times selected / 66% |
| Unanswered | 12 times selected / 29% |
82. Mr Q’s drug chart includes instructions for the administration of heparin for prophylaxis of deep vein thrombosis, as shown below:
Name: Mr Q
Age: 56 years old
Administer heparin sodium 5000 units SC (2 hours pre-operatively),
followed by 5000 units SC every 4 hours
Which of the following statements is most relevant with respect to the administration of heparin for Mr Q?
| Answer or metric | Value |
|---|
| Number and % correct answers |
39% / 16 correct answers from 41 total answers received |
| A-Heparin should only be administered by continuous intravenous infusion
| 4 times selected / 10% |
| B- Heparin should be administered every 8-12 hours following the initial pre-operative dose
| 16 times selected / 39% |
| C- Mr Q should receive 10,000 units pre-operatively followed by 5000 units every 12 hours for 5 days
| 1 times selected / 2% |
| D- Mr Q should receive 10,000 units of heparin every 12 hours
| 4 times selected / 10% |
| E- Mr Q should receive 20,000 units of heparin every 4-hours post operatively
| 0 times selected / 0% |
| Unanswered | 16 times selected / 39% |
83. Which of the following is considered a common side effect of heparin?
| Answer or metric | Value |
|---|
| Number and % correct answers |
39% / 16 correct answers from 41 total answers received |
| A- Urticaria | 2 times selected / 5% |
| B- Cyanosis | 0 times selected / 0% |
| C- Skin necrosis
| 1 times selected / 2% |
| D- Haematoma
| 9 times selected / 22% |
| E- Erythematous nodules
| 16 times selected / 39% |
| Unanswered | 13 times selected / 32% |
84. Mr T, a 35-year-old male patient, presents at the pharmacy with a prescription for vildagliptin. He informs you that this is a new medication that his GP has added to his treatment for type 2 diabetes.
Which of the following would be appropriate advice to give Mr T when dispensing his prescription for vildagliptin?
| Answer or metric | Value |
|---|
| Number and % correct answers |
49% / 20 correct answers from 41 total answers received |
| A- Mr T should avoid exposure to sunlight whilst taking vildagliptin
| 2 times selected / 5% |
| B- Mr T should seek immediate medical attention if he experiences nausea, vomiting, abdominal pain, fatigue or dark urine
| 20 times selected / 49% |
| C- Mr T should take vildagliptin on an empty stomach, at least one hour before food
| 0 times selected / 0% |
| D- Mr T should monitor his blood pressure whilst taking vildagliptin
| 1 times selected / 2% |
| E- Mr T should temporarily stop taking vildagliptin if he has vomiting, diarrhoea or fever
| 4 times selected / 10% |
| Unanswered | 14 times selected / 34% |
85. Questions 85 and 86 relate to Ms W, a 33-year-old woman who has asthma.
Ms W attends the surgery for an asthma review with you, the GP Practice Pharmacist. During the review she informs you she has a “blue” inhaler which she uses when required and another “egg shaped” inhaler which she uses every day as a preventer.
Which of the following is most likely to be Ms W’s “preventer” inhaler?
| Answer or metric | Value |
|---|
| Number and % correct answers |
51% / 21 correct answers from 41 total answers received |
| A- Fostair NEXThaler (beclomethasone and formoterol)
| 0 times selected / 0% |
| B- Symbicort Turbohaler (budesonide and formoterol)
| 4 times selected / 10% |
| C- Seretide Evohaler (Fluticasone and salmeterol)
| 2 times selected / 5% |
| D- Relvar Ellipta (fluticasone and vilanterol)
| 21 times selected / 51% |
| E- Flixotide Evohaler (Fluticasone)
| 2 times selected / 5% |
| Unanswered | 12 times selected / 29% |
86. Ms W informs you that her symptoms are not always relieved after using the “blue” inhaler. She has brought her Ventolin Accuhaler with her, and you proceed to check her technique when using it.
Which of the following is the most appropriate advice to give Ms W regarding using the Ventolin Accuhaler?
| Answer or metric | Value |
|---|
| Number and % correct answers |
32% / 13 correct answers from 41 total answers received |
| A- Ensure you breathe in slowly and deeply
| 7 times selected / 17% |
| B-Always use the inhaler with an AeroChamber spacer device to avoid coordination problems
| 0 times selected / 0% |
| C- Ensure you breathe in forcefully and deeply
| 13 times selected / 32% |
| D- Ensure you breathe in forcefully and slowly
| 2 times selected / 5% |
| E- After using the inhaler, hold your breath for five seconds or for as long as comfortable
| 7 times selected / 17% |
| Unanswered | 12 times selected / 29% |
87. Mr A, a 54-year-old, comes into the pharmacy to speak to a pharmacist in private. He informs you that he has heard from a friend that you can purchase Viagra over the counter. He informs you that recently he has recently started to experience erectile dysfunction which is proving to be an issue in his relationship with his girlfriend. You obtain his consent to access his Summary Care Record and can see he is on the following medication:
- Tamsulosin 400mcg capsules
- Metformin 500mg tablets
- Paracetamol 500mg tablets
What is the most appropriate advice to give Mr A?
| Answer or metric | Value |
|---|
| Number and % correct answers |
54% / 22 correct answers from 41 total answers received |
| A- Give Mr A non-pharmacological advice to try first. Inform Mr A that if he still requires the Viagra, he can return and purchase it
| 2 times selected / 5% |
| B- Sell Viagra to Mr A and keep a note of this on his records
| 1 times selected / 2% |
| C- Sell Viagra to Mr A but ask him to come back to see you before his next purchase
| 0 times selected / 0% |
| D- Sell Viagra to Mr A but ask him to see his GP for future purchase’s
| 1 times selected / 2% |
| E- Refer Mr A to his GP
| 22 times selected / 54% |
| Unanswered | 15 times selected / 37% |
88. Ms C comes to the pharmacy seeking your advice regarding her 4-month-old daughter who has been unwell with a blocked nose and cold-like symptoms. She informs you that her daughter is having difficulty breast-feeding due to her blocked nose and has had no wet nappies for the past day.
What is the most appropriate recommendation for Ms C’s child?
| Answer or metric | Value |
|---|
| Number and % correct answers |
44% / 18 correct answers from 41 total answers received |
| A- Recommend Ms C gives her child paracetamol oral suspension to help with the cold-like symptoms
| 0 times selected / 0% |
| B-Recommend saline nasal drops to help with her blocked nose and advise Ms C bottle feeds her daughter until her symptoms resolve
| 5 times selected / 12% |
| C- Recommend a combination of paracetamol oral suspension, saline nasal drops and a baby rub
| 6 times selected / 15% |
| D- Reassure Ms C that the blocked nose is restricting her daughter’s feeding and the situation will improve once that resolves
| 0 times selected / 0% |
| E- Advise Ms C to seek immediate medical attention
| 18 times selected / 44% |
| Unanswered | 12 times selected / 29% |
89. Mrs E, a 62-year-old woman presents at the pharmacy requesting information. She has been taking hormone replacement therapy for the last 5 years as she found the menopause symptoms rather debilitating, particularly the hot flushes. She tells you that she is aware of the risks involved with HRT use and is considering stopping it.
Which of the HRT risks increase within 1 year of initiating treatment and is reduced within 5 years of stopping?
| Answer or metric | Value |
|---|
| Number and % correct answers |
24% / 10 correct answers from 41 total answers received |
| A- Breast cancer
| 10 times selected / 24% |
| B- Endometrial cancer
| 5 times selected / 12% |
| C- Ovarian cancer
| 6 times selected / 15% |
| D- Coronary heart disease
| 4 times selected / 10% |
| E- Stroke | 3 times selected / 7% |
| Unanswered | 13 times selected / 32% |
90. Mrs H, a 32-year-old lady comes in asking for advice regarding the yellow fever vaccine as she is considering travelling to Africa with her family later this year. She has an 8-year-old son and a 5-month-old daughter.
What is the most appropriate advice to give Mrs H?
| Answer or metric | Value |
|---|
| Number and % correct answers |
15% / 6 correct answers from 41 total answers received |
| A- Children under 6 months should not be vaccinated due to the risk of vaccine associated encephalitis
| 18 times selected / 44% |
| B- Immunisation with the yellow fever vaccine must take place at least 10 days before travelling
| 6 times selected / 15% |
| C- The yellow fever vaccine can be given immunosuppressed and HIV-infected individuals
| 0 times selected / 0% |
| D- Two doses of the yellow fever vaccine are required and provide life-long immunity
| 2 times selected / 5% |
| E- The yellow fever vaccine is a recombinant vaccine
| 1 times selected / 2% |
| Unanswered | 14 times selected / 34% |
91. For the patients described, select the most likely drug from the list below. Each option may be used once, more than once or not at all.
Mrs Y, a 52-year-old woman who has a chronic health condition, is admitted to hospital with severe intractable vomiting and a rapid pulse. Her blood results indicate low potassium levels. She informs the medical team that she has recently been on a diet as she is trying to lose weight and has stopped smoking to improve her health.
| Answer or metric | Value |
|---|
| Number and % correct answers |
54% / 22 correct answers from 41 total answers received |
| A- Phenobarbitone | 0 times selected / 0% |
| B- Lithium | 1 times selected / 2% |
| C-Digoxin
| 4 times selected / 10% |
| D- Phenytoin | 0 times selected / 0% |
| E- Gentamicin | 0 times selected / 0% |
| F-Carbamazepine | 0 times selected / 0% |
| G- Theophylline | 22 times selected / 54% |
| H- Valproic acid
| 0 times selected / 0% |
| Unanswered | 14 times selected / 34% |
92. For the patients described, select the most likely drug from the list below. Each option may be used once, more than once or not at all.
You receive a phone call from the daughter of Mr Z, a 67-year-old man, who is a regular customer at your pharmacy. She appears quite anxious on the phone and asks for your advice. She tells you that upon visiting her father this morning, he did not recognise her at first and told her everything was blurry. He was quite confused and lethargic and appeared to be rather thin and frail. He told her he had a stomachache with diarrhoea and vomiting.
| Answer or metric | Value |
|---|
| Number and % correct answers |
37% / 15 correct answers from 41 total answers received |
| A- Phenobarbitone | 1 times selected / 2% |
| B- Lithium | 4 times selected / 10% |
| C-Digoxin
| 15 times selected / 37% |
| D- Phenytoin | 2 times selected / 5% |
| E- Gentamicin | 1 times selected / 2% |
| F-Carbamazepine | 3 times selected / 7% |
| G- Theophylline | 1 times selected / 2% |
| H- Valproic acid
| 0 times selected / 0% |
| Unanswered | 14 times selected / 34% |
93. For the patients described, select the most likely drug from the list below. Each option may be used once, more than once or not at all.
Miss A, a regular customer of yours, presents at the pharmacy looking quite confused and unsteady She tells you that she has been unwell with vomiting and diarrhoea and feels very weak and “shaky”. You notice a slight tremor in her hands.
| Answer or metric | Value |
|---|
| Number and % correct answers |
32% / 13 correct answers from 41 total answers received |
| A- Phenobarbitone | 1 times selected / 2% |
| B- Lithium | 13 times selected / 32% |
| C-Digoxin
| 2 times selected / 5% |
| D- Phenytoin | 5 times selected / 12% |
| E- Gentamicin | 0 times selected / 0% |
| F-Carbamazepine | 5 times selected / 12% |
| G- Theophylline | 1 times selected / 2% |
| H- Valproic acid
| 0 times selected / 0% |
| Unanswered | 14 times selected / 34% |
94. For the patients described, select the most likely drug from the list below. Each option may be used once, more than once or not at all.
Mr B, who is 8 years old, is admitted into hospital with nystagmus, confusion and slurred speech. His records show he recently started treatment to help manage a newly diagnosed condition.
| Answer or metric | Value |
|---|
| Number and % correct answers |
37% / 15 correct answers from 41 total answers received |
| A- Phenobarbitone | 2 times selected / 5% |
| B- Lithium | 2 times selected / 5% |
| C-Digoxin
| 1 times selected / 2% |
| D- Phenytoin | 15 times selected / 37% |
| E- Gentamicin | 0 times selected / 0% |
| F-Carbamazepine | 4 times selected / 10% |
| G- Theophylline | 0 times selected / 0% |
| H- Valproic acid
| 2 times selected / 5% |
| Unanswered | 15 times selected / 37% |
95. For the patients described, select the most suitable cardiovascular drug from the list below. Each option may be used once, more than once, or not at all.
A 38-year-old Caucasian female, who has chronic hypertension and has just discovered she is pregnant. She has no other medical conditions and no known allergies.
| Answer or metric | Value |
|---|
| Number and % correct answers |
63% / 26 correct answers from 41 total answers received |
| A- amlodipine | 0 times selected / 0% |
| B- bisoprolol | 0 times selected / 0% |
| C- digoxin | 0 times selected / 0% |
| D- furosemide | 0 times selected / 0% |
| E-indapamide | 0 times selected / 0% |
| F-ramipril | 0 times selected / 0% |
| G-verapamil | 0 times selected / 0% |
| H- Labetalol | 26 times selected / 63% |
| Unanswered | 15 times selected / 37% |
96. For the patients described, select the most suitable cardiovascular drug from the list below. Each option may be used once, more than once, or not at all.
A 62-year-old white female who has suffered from hypertension for the past 10 years. Her most recent blood pressure was measured as 145/100 mmHg. She is currently taking ramipril 10 mg once daily and amlodipine 10 mg once daily to control the condition. She also suffers from type 2 diabetes which is controlled by a strict diet. She has no known allergies.
| Answer or metric | Value |
|---|
| Number and % correct answers |
54% / 22 correct answers from 41 total answers received |
| A- amlodipine | 0 times selected / 0% |
| B- bisoprolol | 2 times selected / 5% |
| C- digoxin | 0 times selected / 0% |
| D- furosemide | 1 times selected / 2% |
| E- indapamide | 22 times selected / 54% |
| F- ramipril | 0 times selected / 0% |
| G- verapamil | 0 times selected / 0% |
| H- Labetalol | 0 times selected / 0% |
| Unanswered | 16 times selected / 39% |
97. For the patients described, select the most suitable cardiovascular drug from the list below. Each option may be used once, more than once, or not at all.
Mr G visits his GP after experiencing several episodes of chest pain during physical activity. He informs the GP that the pain starts in the front of chest and radiates to his arms and neck and is relieved when he rests. A diagnosis of stable angina is made, and Mr G is commenced on medication to take regularly to reduce the symptoms.
| Answer or metric | Value |
|---|
| Number and % correct answers |
44% / 18 correct answers from 41 total answers received |
| A- amlodipine | 2 times selected / 5% |
| B- bisoprolol | 18 times selected / 44% |
| C- digoxin | 0 times selected / 0% |
| D- furosemide | 0 times selected / 0% |
| E- indapamide | 0 times selected / 0% |
| F- ramipril | 0 times selected / 0% |
| G- verapamil | 4 times selected / 10% |
| H- Labetalol | 0 times selected / 0% |
| Unanswered | 17 times selected / 41% |
98. For the patients described, select the most likely vitamin deficiency from the list below. Each option may be used once, more than once, or not at all.
Mr X is a type 2 diabetic who has been taking metformin for the past 5 years. He has recently been experiencing a lack of energy, and complains of a sore tongue and regular mouth ulcers.
| Answer or metric | Value |
|---|
| Number and % correct answers |
37% / 15 correct answers from 41 total answers received |
| A- Vitamin A | 1 times selected / 2% |
| B- Vitamin B1 | 0 times selected / 0% |
| C- Vitamin B6 | 3 times selected / 7% |
| D- Vitamin B12 | 15 times selected / 37% |
| E- Vitamin C | 4 times selected / 10% |
| F- Vitamin D | 1 times selected / 2% |
| G- Vitamin E | 1 times selected / 2% |
| H- Vitamin K | 0 times selected / 0% |
| Unanswered | 16 times selected / 39% |
99. For the patients described, select the most likely vitamin deficiency from the list below. Each option may be used once, more than once, or not at all.
Mr Y is a chronic alcoholic and is showing signs of ataxia, confusion and ophthalmoplegia.
| Answer or metric | Value |
|---|
| Number and % correct answers |
34% / 14 correct answers from 41 total answers received |
| A- Vitamin A | 1 times selected / 2% |
| B- Vitamin B1 | 14 times selected / 34% |
| C- Vitamin B6 | 3 times selected / 7% |
| D- Vitamin B12 | 4 times selected / 10% |
| E- Vitamin C | 0 times selected / 0% |
| F- Vitamin D | 1 times selected / 2% |
| G- Vitamin E | 1 times selected / 2% |
| H- Vitamin K | 1 times selected / 2% |
| Unanswered | 16 times selected / 39% |
100. For the patients described, select from the list below, the single most likely cause of the patient’s symptoms. Each option may be used once, more than once or not at all.
A 66-year-old woman is examined in A&E following a two-day history of confusion, diarrhoea, vomiting and lethargy. The junior doctor has ordered blood tests. The patient was commenced on lithium carbonate at an initial dose of 400 mg daily for the management of bipolar disorder two weeks ago.
| Answer or metric | Value |
|---|
| Number and % correct answers |
41% / 17 correct answers from 41 total answers received |
| A- hypernatraemia | 5 times selected / 12% |
| B- hyponatraemia | 17 times selected / 41% |
| C- hypermagnesaemia | 1 times selected / 2% |
| D- hypomagnesaemia | 0 times selected / 0% |
| E- hypercalcaemia | 0 times selected / 0% |
| F- hypocalcaemia | 0 times selected / 0% |
| G- hyperkalaemia | 2 times selected / 5% |
| H- hypokalaemia | 0 times selected / 0% |
| Unanswered | 16 times selected / 39% |
101. For the patients described, select from the list below, the single most likely cause of the patient’s symptoms. Each option may be used once, more than once or not at all.
A 68-year-old man with a history of heart failure has been admitted to hospital with suspected deterioration in his condition. Following treatment with spironolactone, his symptoms improve but he now develops fatigue, nausea and vomiting.
His current medication is shown below:
| Answer or metric | Value |
|---|
| Number and % correct answers |
51% / 21 correct answers from 41 total answers received |
| A- hypernatraemia | 0 times selected / 0% |
| B- hyponatraemia | 1 times selected / 2% |
| C- hypermagnesaemia | 0 times selected / 0% |
| D- hypomagnesaemia | 0 times selected / 0% |
| E- hypercalcaemia | 0 times selected / 0% |
| F- hypocalcaemia | 0 times selected / 0% |
| G- hyperkalaemia | 21 times selected / 51% |
| H- hypokalaemia | 3 times selected / 7% |
| Unanswered | 16 times selected / 39% |
102. For the patients described, select from the list below, the single most likely cause of the patient’s symptoms. Each option may be used once, more than once or not at all.
Mr U has recently undergone a kidney transplant and is taking ciclosporin 100mg capsules. Mr U develops ventricular arrhythmias and tetany. Recent blood tests indicate his calcium levels are 2.50 mmol/L, magnesium levels are 0.4 mmol/L and potassium levels are 4.4 mmol/L.
| Answer or metric | Value |
|---|
| Number and % correct answers |
41% / 17 correct answers from 41 total answers received |
| A- hypernatraemia | 0 times selected / 0% |
| B- hyponatraemia | 0 times selected / 0% |
| C- hypermagnesaemia | 0 times selected / 0% |
| D- hypomagnesaemia | 17 times selected / 41% |
| E- hypercalcaemia | 1 times selected / 2% |
| F- hypocalcaemia | 5 times selected / 12% |
| G- hyperkalaemia | 1 times selected / 2% |
| H- hypokalaemia | 0 times selected / 0% |
| Unanswered | 17 times selected / 41% |
103. For the patients described, select the single most likely possible consequence the drug interaction from the list below. Each option may be used once, more than once or not at all.
Miss F is a 19-year-old woman who was admitted to A&E following a seizure. She is also suffering from a bad chest infection. The junior doctor on the ward prescribes ciprofloxacin 500 mg every 12 hours for 7 day to treat the infection. The neurologist prescribes lamotrigine 25 mg once daily, increasing to 50 mg once daily after 14 days for juvenile myoclonic epilepsy.
| Answer or metric | Value |
|---|
| Number and % correct answers |
44% / 18 correct answers from 41 total answers received |
| A- increased risk of acute kidney injury | 0 times selected / 0% |
| B- increased risk of bleeding | 0 times selected / 0% |
| C- hypertensive crisis | 0 times selected / 0% |
| D- increased risk of convulsions | 18 times selected / 44% |
| E- marked hypotensive effect | 1 times selected / 2% |
| F- thrombosis | 0 times selected / 0% |
| G- drug overdose | 0 times selected / 0% |
| H- prolongation of QT interval | 5 times selected / 12% |
| Unanswered | 17 times selected / 41% |
104. For the patients described, select the single most likely possible consequence the drug interaction from the list below. Each option may be used once, more than once or not at all.
A 75-year-old woman has been admitted to hospital following a fall. She has a history of congestive heart failure. She appears confused and her son informs you that she has not been drinking much over the past few days. Her blood pressure is measured as 95/60 mmHg. The junior doctor on the ward prescribes ibuprofen 400 mg three times daily for the pain.
The patient is on the following medication:
| Answer or metric | Value |
|---|
| Number and % correct answers |
41% / 17 correct answers from 41 total answers received |
| A- increased risk of acute kidney injury | 17 times selected / 41% |
| B- increased risk of bleeding | 2 times selected / 5% |
| C- hypertensive crisis | 1 times selected / 2% |
| D- increased risk of convulsions | 0 times selected / 0% |
| E- marked hypotensive effect | 3 times selected / 7% |
| F- thrombosis | 1 times selected / 2% |
| G- drug overdose | 0 times selected / 0% |
| H- prolongation of QT interval | 0 times selected / 0% |
| Unanswered | 17 times selected / 41% |
105. For the patients described, select the single most likely possible consequence the drug interaction from the list below. Each option may be used once, more than once or not at all.
A 55-year-old patient comes in with a prescription for metronidazole 400mg tablets. He currently takes warfarin 5 mg daily for atrial fibrillation.
| Answer or metric | Value |
|---|
| Number and % correct answers |
51% / 21 correct answers from 41 total answers received |
| A- increased risk of acute kidney injury | 1 times selected / 2% |
| B- increased risk of bleeding | 21 times selected / 51% |
| C- hypertensive crisis | 0 times selected / 0% |
| D- increased risk of convulsions | 0 times selected / 0% |
| E- marked hypotensive effect | 0 times selected / 0% |
| F- thrombosis | 1 times selected / 2% |
| G- drug overdose | 1 times selected / 2% |
| H- prolongation of QT interval | 0 times selected / 0% |
| Unanswered | 17 times selected / 41% |
106. For each of the patients described, select from the list below, the most appropriate antibiotic treatment. Each option may be used once, more than once or not at all.
A 54 year old man with no long-term medical conditions visits his GP complaining of fever. He has also developed a rash on the face and cheeks that is red, swollen, painful and warm to the touch. He has just completed a 7 day course of Metronidazole 400mg that was prescribed by his dentist for an abscess. He is allergic to penicillin.
| Answer or metric | Value |
|---|
| Number and % correct answers |
29% / 12 correct answers from 41 total answers received |
| A- Amoxicillin | 1 times selected / 2% |
| B- Co-Amoxiclav | 0 times selected / 0% |
| C- Flucloxacillin | 1 times selected / 2% |
| D- Clarithromycin | 12 times selected / 29% |
| E- Metronidazole | 0 times selected / 0% |
| F- Tetracycline | 2 times selected / 5% |
| G- Erythromycin | 8 times selected / 20% |
| H- Ciprofloxacin | 0 times selected / 0% |
| Unanswered | 17 times selected / 41% |
107. For each of the patients described, select from the list below, the most appropriate antibiotic treatment. Each option may be used once, more than once or not at all.
A 4 year old boy has recently developed small fluid filled blisters on the upper abdomen and neck. His parents have noticed that the blisters have spread to other parts of the body including the arms and legs and the child is complaining of pain and itching. Upon examination, you notice that the child has a slight fever and swollen glands and that some of the blisters on his abdomen appear to have burst leaving behind a yellow crust. The child has no penicillin allergies.
| Answer or metric | Value |
|---|
| Number and % correct answers |
34% / 14 correct answers from 41 total answers received |
| A- Amoxicillin | 8 times selected / 20% |
| B- Co-Amoxiclav | 1 times selected / 2% |
| C- Flucloxacillin | 14 times selected / 34% |
| D- Clarithromycin | 0 times selected / 0% |
| E- Metronidazole | 0 times selected / 0% |
| F- Tetracycline | 0 times selected / 0% |
| G- Erythromycin | 1 times selected / 2% |
| H- Ciprofloxacin | 0 times selected / 0% |
| Unanswered | 17 times selected / 41% |
108. For each of the patients described, select from the list below, the most appropriate antibiotic treatment. Each option may be used once, more than once or not at all.
A 31-year-old mother who has given birth one month ago visits her GP complaining of an extremely burning pain in her right breast when breastfeeding. Her breast appears to be swollen and red and the lady is suffering with a fever. She explains that the symptoms developed yesterday and she has tried applying a warm flannel to the area and expressing the extra milk after feeds but has found that the symptoms have not improved. The doctor requests a small sample of her breast milk for a culture and decides to initiate treatment with an antibiotic in the meantime. The mother has no known allergies.
| Answer or metric | Value |
|---|
| Number and % correct answers |
10% / 4 correct answers from 41 total answers received |
| A- Amoxicillin | 9 times selected / 22% |
| B- Co-Amoxiclav | 2 times selected / 5% |
| C- Flucloxacillin | 4 times selected / 10% |
| D- Clarithromycin | 1 times selected / 2% |
| E- Metronidazole | 0 times selected / 0% |
| F- Tetracycline | 1 times selected / 2% |
| G- Erythromycin | 7 times selected / 17% |
| H- Ciprofloxacin | 0 times selected / 0% |
| Unanswered | 17 times selected / 41% |
109. For the patients described, select the most suitable dosage of paracetamol from the list below. Each option may be used once, more than once, or not at all.
A mother brings in her 3-year-old child who is suffering from Chickenpox. You recommend Piriton but she also informs you that he has a high temperature.
| Answer or metric | Value |
|---|
| Number and % correct answers |
41% / 17 correct answers from 41 total answers received |
| A- 60 mg as a single dose repeated once after 4-6 hours if needed | 0 times selected / 0% |
| B- 60 mg every 4-6 hours (max. 4 doses in 24 hours) | 0 times selected / 0% |
| C- 120 mg every 4-6 hours (max. 4 doses in 24 hours) | 5 times selected / 12% |
| D- 180 mg every 4-6 hours (max. 4 doses in 24 hours) | 17 times selected / 41% |
| E- 240 mg every 4-6 hours (max. 4 doses in 24 hours) | 2 times selected / 5% |
| F- 240 - 250 mg every 4-6 hours (max. 4 doses in 24 hours) | 0 times selected / 0% |
| G- 360 - 375 mg every 4-6 hours (max. 4 doses in 24 hours) | 0 times selected / 0% |
| H- 480 - 500 mg every 4-6 hours (max. 4 doses in 24 hours) | 0 times selected / 0% |
| Unanswered | 17 times selected / 41% |
110. For the patients described, select the most suitable dosage of paracetamol from the list below. Each option may be used once, more than once, or not at all.
A 11-year-old boy has injured his elbow whilst playing rugby. The arm appears red and swollen and he is experiencing mild pain. A cold compress was used immediately after the injury.
| Answer or metric | Value |
|---|
| Number and % correct answers |
41% / 17 correct answers from 41 total answers received |
| A- 60 mg as a single dose repeated once after 4-6 hours if needed | 0 times selected / 0% |
| B- 60 mg every 4-6 hours (max. 4 doses in 24 hours) | 0 times selected / 0% |
| C- 120 mg every 4-6 hours (max. 4 doses in 24 hours) | 0 times selected / 0% |
| D- 180 mg every 4-6 hours (max. 4 doses in 24 hours) | 0 times selected / 0% |
| E- 240 mg every 4-6 hours (max. 4 doses in 24 hours) | 3 times selected / 7% |
| F- 240 - 250 mg every 4-6 hours (max. 4 doses in 24 hours) | 0 times selected / 0% |
| G- 360 - 375 mg every 4-6 hours (max. 4 doses in 24 hours) | 3 times selected / 7% |
| H- 480 - 500 mg every 4-6 hours (max. 4 doses in 24 hours) | 17 times selected / 41% |
| Unanswered | 18 times selected / 44% |
111. For the patients described, select the most suitable dosage of paracetamol from the list below. Each option may be used once, more than once, or not at all.
A worried mother comes into the pharmacy with her 2-month-old child who has just been immunised that morning and has developed a high temperature.
| Answer or metric | Value |
|---|
| Number and % correct answers |
44% / 18 correct answers from 41 total answers received |
| A- 60 mg as a single dose repeated once after 4-6 hours if needed | 18 times selected / 44% |
| B- 60 mg every 4-6 hours (max. 4 doses in 24 hours) | 3 times selected / 7% |
| C- 120 mg every 4-6 hours (max. 4 doses in 24 hours) | 3 times selected / 7% |
| D- 180 mg every 4-6 hours (max. 4 doses in 24 hours) | 0 times selected / 0% |
| E- 240 mg every 4-6 hours (max. 4 doses in 24 hours) | 0 times selected / 0% |
| F- 240 - 250 mg every 4-6 hours (max. 4 doses in 24 hours) | 0 times selected / 0% |
| G- 360 - 375 mg every 4-6 hours (max. 4 doses in 24 hours) | 0 times selected / 0% |
| H- 480 - 500 mg every 4-6 hours (max. 4 doses in 24 hours) | 0 times selected / 0% |
| Unanswered | 17 times selected / 41% |
112. For the patients described, select the most likely childhood condition. Each option may be used once, more than once, or not at all.
Master T, a 5-year-old boy, has been feeling generally unwell. He had a body temperature of 38oC headache and muscle aches. This was followed by pain and swelling on one side of the face, in front of the ear, and under the chin. He also experienced a loss of appetite and discomfort when chewing.
| Answer or metric | Value |
|---|
| Number and % correct answers |
44% / 18 correct answers from 41 total answers received |
| A- Croup | 0 times selected / 0% |
| B- Roseola | 0 times selected / 0% |
| C- Whooping cough | 0 times selected / 0% |
| D- Mumps | 18 times selected / 44% |
| E- Slapped cheek disease (fifth disease) | 4 times selected / 10% |
| F- Hand, foot and mouth disease | 2 times selected / 5% |
| G- Measles | 0 times selected / 0% |
| H- chickenpox | 0 times selected / 0% |
| Unanswered | 17 times selected / 41% |
113. For the patients described, select the most likely childhood condition. Each option may be used once, more than once, or not at all.
Mrs. F presents at the pharmacy with her 4-year-old daughter. She explains that her daughter has been experiencing symptoms of a cold and a cough for the last 2 weeks. The cough was becoming progressively worse, and she recently started to have coughing fits. She also informs you that her daughter became short of breath on occasions and had episodes of choking and vomiting. Her daughter appeared to be weak and exhausted.
| Answer or metric | Value |
|---|
| Number and % correct answers |
44% / 18 correct answers from 41 total answers received |
| A- Croup | 7 times selected / 17% |
| B- Roseola | 0 times selected / 0% |
| C- Whooping cough | 18 times selected / 44% |
| D- Mumps | 0 times selected / 0% |
| E- Slapped cheek disease (fifth disease) | 0 times selected / 0% |
| F- Hand, foot and mouth disease | 0 times selected / 0% |
| G- Measles | 0 times selected / 0% |
| H- chickenpox | 0 times selected / 0% |
| Unanswered | 16 times selected / 39% |
114. For the patients described, select the most likely childhood condition. Each option may be used once, more than once, or not at all.
Mrs. G presents at your pharmacy with her 5-year-old son. She explains that a couple of days ago, her son had a sore throat and a fever and was refusing to eat. Today, she noticed a mouth ulcer on his tongue and a rash on his hands, feet, thighs and bottom. On examination, you notice that he has raised spots that appear darker than surrounding skin and that some had formed blisters which appeared lighter than the surrounding skin.
| Answer or metric | Value |
|---|
| Number and % correct answers |
49% / 20 correct answers from 41 total answers received |
| A- Croup | 0 times selected / 0% |
| B- Roseola | 2 times selected / 5% |
| C- Whooping cough | 0 times selected / 0% |
| D- Mumps | 0 times selected / 0% |
| E- Slapped cheek disease (fifth disease) | 0 times selected / 0% |
| F- Hand, foot and mouth disease | 20 times selected / 49% |
| G- Measles | 2 times selected / 5% |
| H- chickenpox | 1 times selected / 2% |
| Unanswered | 16 times selected / 39% |
115. For the patients described, identify the first line treatment for each skin condition. Each option may be used once, more than once, or not at all.
Mr H, a 28-year-old gentleman presents with itchy, burning and sometimes painful lesions. Upon examination, the lesions appear on the extensor surfaces of the body and over the scalp as well.
| Answer or metric | Value |
|---|
| Number and % correct answers |
15% / 6 correct answers from 41 total answers received |
| A- Oral antifungal | 8 times selected / 20% |
| B- Topical antifungal | 4 times selected / 10% |
| C- Oral antibiotics | 0 times selected / 0% |
| D- Oral retinoids | 1 times selected / 2% |
| E- Topical corticosteroids | 5 times selected / 12% |
| F- Topical therapies: benzoyl peroxide, antibiotics and retinoids | 0 times selected / 0% |
| G- Phototherapy | 1 times selected / 2% |
| H- Topical therapies: Vitamin D and coal tar preparations | 6 times selected / 15% |
| Unanswered | 16 times selected / 39% |
116. For the patients described, identify the first line treatment for each skin condition. Each option may be used once, more than once, or not at all.
Mr G, a 22 year old gentleman who presents with inflamed lesions on the face. Upon examination, you notice papules, nodules and cysts on both cheeks.
| Answer or metric | Value |
|---|
| Number and % correct answers |
46% / 19 correct answers from 41 total answers received |
| A- Oral antifungal | 0 times selected / 0% |
| B- Topical antifungal | 0 times selected / 0% |
| C- Oral antibiotics | 5 times selected / 12% |
| D- Oral retinoids | 1 times selected / 2% |
| E- Topical corticosteroids | 0 times selected / 0% |
| F- Topical therapies: benzoyl peroxide, antibiotics and retinoids | 19 times selected / 46% |
| G- Phototherapy | 0 times selected / 0% |
| H- Topical therapies: Vitamin D and coal tar preparations | 0 times selected / 0% |
| Unanswered | 16 times selected / 39% |
117. For the patients described, identify the first line treatment for each skin condition. Each option may be used once, more than once, or not at all.
Miss S, a 35-year-old woman who presents with scaling and dryness in the palmar creases of her right hand.
| Answer or metric | Value |
|---|
| Number and % correct answers |
2% / 1 correct answers from 41 total answers received |
| A- Oral antifungal | 0 times selected / 0% |
| B- Topical antifungal | 1 times selected / 2% |
| C- Oral antibiotics | 0 times selected / 0% |
| D- Oral retinoids | 2 times selected / 5% |
| E- Topical corticosteroids | 14 times selected / 34% |
| F- Topical therapies: benzoyl peroxide, antibiotics and retinoids | 0 times selected / 0% |
| G- Phototherapy | 1 times selected / 2% |
| H- Topical therapies: Vitamin D and coal tar preparations | 7 times selected / 17% |
| Unanswered | 16 times selected / 39% |
118. For the patients described, select the most appropriate anti-diabetic. Each option may be used once, more than once, or not at all.
Ms A was diagnosed with type 2 diabetes mellitus 2 years ago and was being managed with metformin 1000mg twice a day. Following a recent blood test 3 months ago, it was agreed to intensify treatment and a second oral agent was added. Ms A has noticed that despite making no changes to her lifestyle, her clothes have become tighter, and she has gained 1kg in weight.
| Answer or metric | Value |
|---|
| Number and % correct answers |
27% / 11 correct answers from 41 total answers received |
| A- Metformin | 0 times selected / 0% |
| B- Empagliflozin | 5 times selected / 12% |
| C- Sitagliptin | 7 times selected / 17% |
| D- Isophane insulin | 0 times selected / 0% |
| E- Dulaglutide | 1 times selected / 2% |
| F- Liraglutide | 0 times selected / 0% |
| G- Gliclazide | 11 times selected / 27% |
| H- Insulin glargine | 0 times selected / 0% |
| Unanswered | 17 times selected / 41% |
119. For the patients described, select the most appropriate anti-diabetic. Each option may be used once, more than once, or not at all.
Mr B, a 52-year-old man was diagnosed with type 2 diabetes mellitus 6 years ago and is currently being managed with metformin 1000mg twice a day and linagliptin 5mg once a day. A recent blood test yielded an HbA1c of 62mmol/mol and a decision was made to add on a third glucose lowering agent. Mr B has no other co-morbidities and has a BMI of 30.3kg/m2. He also has a phobia of needles.
| Answer or metric | Value |
|---|
| Number and % correct answers |
41% / 17 correct answers from 41 total answers received |
| A- Metformin | 0 times selected / 0% |
| B- Empagliflozin | 17 times selected / 41% |
| C- Sitagliptin | 2 times selected / 5% |
| D- Isophane insulin | 0 times selected / 0% |
| E- Dulaglutide | 1 times selected / 2% |
| F- Liraglutide | 0 times selected / 0% |
| G- Gliclazide | 4 times selected / 10% |
| H- Insulin glargine | 0 times selected / 0% |
| Unanswered | 17 times selected / 41% |
120. For the patients described, select the most appropriate anti-diabetic. Each option may be used once, more than once, or not at all.
Following a diabetes review, it has been agreed to start Mr C on injectable therapy. Mr C is 67 years old and has a BMI of 25.1kg/m2. He is currently taking metformin 1g MR twice a day, glimepiride 4mg daily and canagliflozin 100mg daily and has an HbA1c of 74mmol/mol. Mr C will need help injecting himself and a carer can visit once a day for that purpose.
| Answer or metric | Value |
|---|
| Number and % correct answers |
44% / 18 correct answers from 41 total answers received |
| A- Metformin | 0 times selected / 0% |
| B- Empagliflozin | 0 times selected / 0% |
| C- Sitagliptin | 0 times selected / 0% |
| D- Isophane insulin | 1 times selected / 2% |
| E- Dulaglutide | 4 times selected / 10% |
| F- Liraglutide | 1 times selected / 2% |
| G- Gliclazide | 0 times selected / 0% |
| H- Insulin glargine | 18 times selected / 44% |
| Unanswered | 17 times selected / 41% |
S= salt factor, F= Bioavailability, τ= dosing interval
Assuming the patient takes the digoxin regularly at the prescribed dose, calculate the expected steady state concentration of digoxin. Give your answer to two decimal places.
{{{0.97}}}mcg/L
What is the total quantity of capsules that Mr D would require for two cycles of treatment?
{{{12}}}capsules
Age in years
Weight in kilograms; use IBW for obese patients
Serum creatinine in micromol/litre
Constant = 1.23 for men; 1.04 for women
What is the patient’s creatinine clearance in mL/min that can be used to calculate an appropriate dose of gentamicin? Give your answer to two decimal places.
{{{48.15}}}mL/min
Levofloxacin 5 mg/mL eye drops are available in a 5 mL bottle.
Assume 1 mL contains 15 drops.
What quantity of levofloxacin expressed in micrograms will the patient have administered to his affected eye by the end of his treatment course?
{{{12000}}} mcg