LDN25 of note

Question 1

Which of the following is least likely to be a risk factor for venous thromboembolism in patients taking COC?
- Age over 40
- Obesity
- Family Hx
- Smoking
- Hypertension

Answer 1

Hypertension

Question 2

When considering “provide person centred care” which of the following would be the LEAST applicable when applying this standard
- involve, support and enable every person when making decisions about their health, care and wellbeing
- Carry out a range of CPD activities relevant to their practice
- Consider the impact of their practice whether or not they provide care directly
- Respect and safeguard the persons dignity
- Make the best use of resources available

Answer 2

CPD

Question 3

Which of the following is a toxic effect of theophylline ?
- Bruising
- Drowsiness
- Convulsions
- Goitre
- Watering eyes

Question 4

Mr R has presented to A+E with central crushing pain which radiates down his arm. He is SOB and feels nauseous. The doctor has ordered an ECG and troponin I levels to be taken immediately and after 12 hrs. Which of the following statements is incorrect?
- ECG will differentiate between STEMI and nSTEMI
- Troponin I is a specific indicator of damage to the heart muscle
- Tropin I levels are taken immediately after chest pain is experienced and then after 12 hours to determine of the levels have decreased
- Patient symptoms are charactetic of a myocardial infarction
- Aspirin 300mg should be administered

Answer 4

The incorrect statement is:

Troponin I levels are taken immediately after chest pain is experienced and then after 12 hours to determine if the levels have decreased
Explanation:
This statement is incorrect because troponin I levels are measured to assess if they have increased, indicating ongoing or recent myocardial damage, not to see if they have decreased.

Question 5

Patient has been prescribed ferrous sulphate tablets with folic acid.
Which of the following counselling points regarding oral iron is false?
- Patient has been prescribed a combination product as the folic acid helps aid the absorption of iron from the stomach
- Can cause constipation
- Can cause diarrhoea
- Can cause discoloured stools
- Avoid consuming large amounts of tea, coffee or milk as these can reduce the absorption of iron

Answer 5

The false counselling point is:

Patient has been prescribed a combination product as the folic acid helps aid the absorption of iron from the stomach
Explanation:

Folic acid does not enhance the absorption of iron. They are often prescribed together in cases of combined iron and folate deficiency, such as in pregnancy or certain types of anaemia, but folic acid does not directly improve iron absorption

Question 6

Which of the following drugs that has been started in the last 3 months could of reduced the hb1ac marker ?
- Aspirin
- Chlortalidone
- Linsinopril
- Prednisolone
- Warfarin

Answer 6

Lisinopril, an ACE inhibitor, may reduce HbA1c levels slightly, particularly in patients with diabetes or metabolic syndrome, by improving insulin sensitivity and enhancing glucose uptake in peripheral tissues. It’s not a primary treatment for diabetes, but studies have shown modest improvements in glycaemic control.

Question 7

Which of the following statements regarding carbocisteine is not correct?
- It is available in both capsule and liquid formualtions
- The initial dose is 2.25g daily in divided doses
- Reduces sputum viscocity
- It has no known drug interactions
- It should be continued even if there is no symptomatic improvement

Answer 7

• It should be continued even if there is no symptomatic improvement

Question 8

Patient was started on fluoxetine 20mg OD to treat major depression 3 weeks ago. She tells you that she has had no response to treatment but confirms she is taking as prescribed

• Advise that 3 weeks is too short of a period to see any benefit and it would be worth continuing for another 1-2 weeks before reviewing
• Increase dose to 40mg OD
• Add in an augmentation agent like lithium
• Add in a second antidepressant such as mirtazepine
• Switch to different antidepressants

Answer 8

Continue for a further 1-2 weeks and rv

Question 9

Regarding vet medicines, pharmacists must keep records of the receipt and supply of POM-V and POM-VPS products. Which of the following is not a valid statement
- All records and documents must be kept for at least 5 years
- The name and address of the prescriber should be recorded if provided with a written prescription
- The batch number of the medicine should be recorded
- Pharmacies that supply pOM-v and POM-VPS must undertake an audit annually
- Any records must be kept electronically

Answer 9

Any records must be kept electronically is not a valid statement

Question 10

A locum Gp at one of the nearby surgries rings you and would like to prescribe a medicine as a private repeat. He is unsure about repeatable prescribing and how to supply lawfully/ Which of the following statements is least appropriate when advising the GP about repeatable prescribing?

• RX for sch 2 and 3 CD are not repeatable
• NHS rx are not repeatable
• When a prescriber has endorsed REPEAT X 3, the rx can be dispensed a max 3 times
• When a prescriber writes REPEAT for an oral contraceptive pill the prescription may be dispensed a maximum 6 times
• If the prescription states RPEAT but the number of repeats is not stated then it can only be repeated once (dispensed twice in total) unless it is for an OCP

Answer 10

C

Question 11

A patient has undergone a carbon urea breath test. It has come back positive for the isotope labelled carbon dioxide.
Which of the following is the most appropriate action ?

• Recommend treatment with ABX and PPI
• Refer for pulmonary function tests
• Recommend treatment with SABA and LAMA
• Refer for chest x ray
• Nothing as there is nothing wrong with the patient

Answer 11

ABX and PPI

Question 12

Which of the following statements regarding QVAR and Clenil is NOT correct
- Inhaled corticosteroids can cause oral candidiasis
- Beclometasone inhalers should be prescribed by brand
- QVAR and clenil are interchangeable in well controlled asthma

Answer 12

QVAR and clenil are interchangeable in well controlled asthma

Question 13

Which of the following medicine is most likely to aggravate the symptoms of acid reflux and should therefore be taken after food
- Amox
- Digoxin
- Mefenamic acid
- Lisinopril
- Temazepam

Answer 13

Mefenamic acid is a non-steroidal anti-inflammatory drug (NSAID), and NSAIDs are known to:

Aggravate acid reflux and gastritis
Increase the risk of gastric ulcers and GI bleeding
Cause GI irritation if taken on an empty stomach
➡️ Therefore, mefenamic acid should always be taken after food or with food to reduce GI side effects.

Question 14

Co-amoxiclav needs to be crushed for the patient as he is nil by mouth which of the following is not correct?
- Is available in liquid form and should be used first line
- By crushing the tablets they are giving the medicine in an unlicensed manner
- Crushing the tablets country to the prescribing practitioner would be in breach of the medicine act 1968
- Co-amoxiclav will have the exact same effect whether the tablet is crushed or is administered whole
- Manufacture will not be liable for any ensuing harm that may occur to the patient by crushing the tablet

Answer 14

Co-amoxiclav will have the exact same effect whether the tablet is crushed or is administered whole

Question 15

Which of the following is the most appropriate advice to give with regards to Microgynon 30

Answer 15

• To report any increase in headache frequency to her doctor
• If she is ever prescribed any antibiotics she needs to take additional contraceptive precautions whilst she is on the treatment and for 4 weeks after stopping
• A missed pill is one that is taken more than 12 hours late
• It may have a protective effect against breast cancer
• If she vomits within 4 hours after taking a pill, she needs to take another pill as soon as possible

Question 16

A customer comes into the pharmacy asking for advice regarding mosquito bites. They are travelling to a malarial region and have already organised antimalarial medication they require but want extra advice about how to avoid getting bitten
- Take a vitamin B supplement as this can help repel mosquitoes
- Use a mosquito net impreganted with pyrethroid insecticide over the bed at night
- Wear long sleeves and trousers
- If possible avoid going outside at dusk and at night as this is when mosquitos prefer to feed
- Apply insect repellent such as 50% DEET to exposed skin

Answer 16

Vit B

Question 17

Which of the following medicine is the most widely used intravenous anaesthetic in adults and children due to quicker patient recovery and less hangover effect
- Etomidate
- Ketamine
- Nitrous Oxide
- Propofol
- Thiopental sodium

Answer 17

Propofol

Question 18

Which of the following may be an unintentional barrier to adherence
- Patient’s concern about side effects
- Patient’s concern about addiction to medicine
- Patient’s religious and cultural beliefs
- Patient’s perception of medicine and stigma
- Patient’s learning disability

Question 19

Mrs P has recently been diagnosed with gestational diabetes. She has failed to respond to Two weeks restriction of energy and carbohydrate intake and an increase in physical activity. Her fasting blood glucose is 6.1 mmol/l
Which of the following is most appropriate
- Initiate on metformin
- initiate on insulin
- Initiate on glicazide
- Offer no treatment and refer to dietician
- Offer no treatment and advise to continue healthy diet during pregnancy and emphasis to eat foods with low glycemic index

Answer 19

Metfomin. (below 7)

Question 20

Which of the following is an example of tertiary prevention of disease
- Storke rehab programme
- immunisation agaçant infectious disease
- Mammograms to detect breast cancer
- Smoking bans in public areas
- Legislation around use of seatbelts in automobiles

Answer 20

Stroke rehab programme

Question 21

Which of the following statements regarding aspirin is INCORRECT
- Not licensed for use in children <16
- May be a contributory factor in the causation of Reye syndrome
- Can be used in the treatment of Kawasaki disease
- Is CI in gastric/intestinal haemorrahagic or other kinds of bleeding such as cerebrovascular haemorrhage
- Promotes prostaglandin synthesis via COX inhibition

Answer 21

• Promotes prostaglandin synthesis via COX inhibition

Question 22

Which of the following statements would be the least appropriate to counsel a patient for vitamin D

• Vit D deficiency can cause bone pain, poor growth and deformities of the skeleton
• Vit D is fat soluble
• Vit D requires conversion by the kidney and liver to the active form. Therefore anyone with kidney or liver impairment need the already active form alfacalcidol
• Dietary sources of vitamin D include oily fish, red meat, liver, eggs
• Taking too much vitamin d supplements over a long period of time can cause low levels of calcium. this can weaken the bones and damage the kidneys and heart

Answer 22

• Taking too much vitamin d supplements over a long period of time can cause low levels of calcium. this can weaken the bones and damage the kidneys and heart

Question 23

Which of the following situations are you least likely to supply EHC using the PGD for levonelle ?

A) she is taking COC and has missed two concurrent days in the first week of the pack and had UPSI during this week

B) she admits to being abused

C) She is taking amitriptyline for neuropathic pain and has had UPSI in the last 24 hours

D) She had UPSI five days ago and also on a second occasion 48 hrs ago and has not taken any EHC

E) She already has had levonelle in this cycle

Answer 23

D

Question 24

Mr B has flown to the Uk from France. Late on saturday afternoon he enters the pharmacies and explains he has left his supply of sodium valproate 500mg MR tablets in France, it is prescribed by his GP in France for epilepsy.

• SV cannot be supplied as an emergency supply
• You do not know him and do not have access to this medical notes and therefore you cannot make an emergency supply
• You do not believe an emergency supply is necessary and it would be more practical for mr B to obtain a rx
• Mr B should attempt to contact his doctor in France
• An emergency supply can be made as France is within the EEA

Answer 24

• An emergency supply can be made as France is within the EEA

Question 25

How long must you keep the CD register booklet from the last entry 12 months 18 months 2 years 3 years 5 years

Answer 25

2 years

Question 26

A patient has been taking warfarin for AF. They have just had their routine INR test and the results show they have an INR of 8.2 and there is no signs of bleeding - Stop warfarin and admit patient to hospital to receive IV vitamin K and dried prothrombin complex - Stop warfarin and admit the patient to hospital to receive IV vitamin K - Stop warfarin and give IV phytomenadione orally - Withhold 1-2 doses of warfarin and reduce the subsequent maintenance dose - Withhold 1-2 doses of warfarin and restart the previously prescribed maintenance dose

Answer 26

Stop wafering and give IV phytomenadione orally

Question 27

Miss S enters the pharmacy. She is 17 years old with no allergies or other medical concerns. She tells you that she would like to consider a regular form of contraception without seeing her doctor and that her friend told her she could purchase something OTC. Which one of the following is the most appropriate in regards to the use of HANA as an OTC use of daily contraception? - Miss S meets the age restrictions for the sale of Hana as an OTC contraceptive - HANA can be started on days 1-5 without the need for extra contraceptive precautions - a max of 1 month can be supplied as a first time supply - the patient will be required to have a 7 day tablet free interval before starting their next pack - Hana can be started on days 2-5 of menstrual bleeding, in which case the extra contraceptive precautions are recommended for the first 7 days

Answer 27

- Hana can be started on days 2-5 of menstrual bleeding, in which case the extra contraceptive precautions are recommended for the first 7 days

Question 28

Which of the following combinations is most likely to warrant permanently changing one of the drugs to an alternative ? - Levothroyxine 100mcg OD and ADCAL d3 1g BD - Clarithromycin 500mg BD and simvastatin 40mg ON - Warfarin 3md OD and ibuprofen 400mg TDS - Amlodipine 10mg OD and simvastatin 80mg - MTX 10mg once a week and ibuprofen 400mg TDS

Answer 28

warfarin and ibuprofen

Question 29

Which of the following statements regarding croup is not correct - it commonly affects young children aged between 6 months and six years - Mild croup symptoms usually resolve within 48 hrs - Between coughs, they may gasp for breath - this may cause a whoop sound - If severe it can be treated with steroids - It is commonly caused by a virus

Answer 29

➡️ "Between coughs, they may gasp for breath – this may cause a whoop sound" ✅ Why this is not correct: This description refers to whooping cough (pertussis), not croup. In croup, the classic symptoms are: A barking cough (like a seal) Stridor (a high-pitched noise on inspiration) Hoarse voice Symptoms often worsen at night

Question 30

Which of the following is the most appropriate with regards to the use of viagra connect as an OTC treatment for ED A) You should provide advice of booking an appointment to see his doctor within 3 months of using this product B) You cannot sell to patients taking amlodipine 5mg OD C) if is is suitable, only one box can be sold on the first time supply D) if you decide to not make a supply then you should refer them to the GP to address any underlying concerns of the symptoms expereicned E) if after taking on the firs occasion there is no change then you should see the GP

Answer 30

D

Question 31

Which of the following is false with regards to the diagnosis of iron deficiency aneamia ? A) in children 12-14, anaemia is defined as haemoglobin levels below 120g/L B) for pregnant women with low haemoglobin and low mean cell volume, consider checking ferritin levels but be aware that results may be less reliable in pregnancy C) Blood loss from the GI tract is the most common cause of iron deficiency anaemia in adult men D) In a patient who is not pregnant, a serum ferritin concentration is less than 30 microgram/L usually confirms iron deficiency E) A low haemoglobin level by itself is a specific and reliable marker for iron deficiency anaemia

Answer 31

E ➡️ E) A low haemoglobin level by itself is a specific and reliable marker for iron deficiency anaemia ✅ Explanation: Haemoglobin alone is not specific for iron deficiency anaemia (IDA). It can be low in various types of anaemia (e.g. B12 deficiency, chronic disease). Ferritin, MCV, and transferrin saturation help determine iron deficiency more specifically.

Question 32

Is often raised in patients who have a liver blockage (blocked bile ducts) Potassium Sodium Magnesium Creatinine ALT ALP Albumin Phosphate

Answer 32

ALP is often raised in conditions involving bile duct obstruction (cholestasis), such as: Gallstones blocking the bile duct Biliary atresia Primary biliary cholangitis Pancreatic cancer compressing the bile duct This is because ALP is found in high concentrations in the cells lining the bile ducts, and blockage leads to increased release into the bloodstream.

Question 33

Deficiency of this is often seen in severe asthmatics Potassium Sodium Magnesium Creatinine ALT ALP Albumin Phosphate

Answer 33

Magnesium Magnesium deficiency is associated with severe asthma, especially if the patient is: On long-term beta-2 agonists (e.g. salbutamol), which can lower magnesium levels. Experiencing poor dietary intake or malabsorption. Low magnesium can lead to bronchial hyperreactivity, making asthma symptoms worse. In acute severe asthma, intravenous magnesium sulfate may even be used as a bronchodilator.

Question 34

Binds to acidic drugs Potassium Sodium Magnesium Creatinine ALT ALP Albumin Phosphate

Answer 34

Albumin

Question 35

Found in foods such as dark chocolate and avocado Potassium Sodium Magnesium Creatinine ALT ALP Albumin Phosphate

Answer 35

Magnesium

Question 36

Is the by product of muscle breakdown Potassium Sodium Magnesium Creatinine ALT ALP Albumin Phosphate

Answer 36

Creatine

Question 37

Is licensed for the treatment of Ménière's disease Lithium Clozapine Haloperidol Prochlorperazine Flupentixol Risperidone Nortritpyline Pregabalin

Answer 37

Prochlorperazine

Question 38

Is licensed for treatment for a patient who has not responded to pharmacological interventions to manage the behavioural and psychological symptoms of Alzheimer dementia? Lithium Clozapine Haloperidol Prochlorperazine Flupentixol Risperidone Nortritpyline Pregabalin

Answer 38

Risperidone

Question 39

Is a licensed treatment for a patient suffering from neuropathic pain? Lithium Clozapine Haloperidol Prochlorperazine Flupentixol Risperidone Nortritpyline Pregabalin

Answer 39

Pregabalin

Question 40

A patient taking this drug would need to maintain a constant diet especially their salt intake Lithium Clozapine Haloperidol Prochlorperazine Flupentixol Risperidone Nortritpyline Pregabalin

Answer 40

Lithium

Question 41

A patient who is receiving treatment with high dose cyclophosphamide and is experiencing haemorrhagic cystitis Gabapentin Mesna Granulocyte-colony stimulating factor Acyclovir Allopurinol Benzydamina hydrochloride Loperamide Urate oxidase

Answer 41

Mesna

Question 42

A patient who is receiving treatment for leukaemia whose lab results are indicating they have tumour lysis syndrome Gabapentin Mesna Granulocyte-colony stimulating factor Acyclovir Allopurinol Benzydamina hydrochloride Loperamide Urate oxidase

Answer 42

Allopunriol

Question 43

A patient who is about to start their second cycle of chemotherapy which has been delayed as they suffered from neutropenic sepsis following their first cycle Gabapentin Mesna Granulocyte-colony stimulating factor Acyclovir Allopurinol Benzydamina hydrochloride Loperamide Urate oxidase

Answer 43

✅ Granulocyte-colony stimulating factor (G-CSF) Why? The patient previously developed neutropenic sepsis — a serious complication caused by low neutrophil counts after chemotherapy. To prevent this happening again, G-CSF is often used prophylactically in future cycles. It stimulates the bone marrow to produce more neutrophils, reducing the risk of infection.

Question 44

A patient who is taking flurouracil has developed small sores in the mouth and swollen gums Gabapentin Mesna Granulocyte-colony stimulating factor Acyclovir Allopurinol Benzydamina hydrochloride Loperamide Urate oxidase

Answer 44

Benzydamine hydrochloride

Question 45

A patient is taking capecitabine who is suffering from a dose limiting toxicity that can lead to severe dehydration If left unmanaged Gabapentin Mesna Granulocyte-colony stimulating factor Acyclovir Allopurinol Benzydamina hydrochloride Loperamide Urate oxidase

Answer 45

Loperamide Capecitabine is a chemotherapy drug known to commonly cause diarrhoea, which can become severe and dose-limiting. If unmanaged, this diarrhoea can lead to serious dehydration, electrolyte imbalance, and hospitalisation. Loperamide is an antidiarrhoeal agent used to manage this toxicity.

Question 46

in combination with methotrexate, would be the step up treatment after initial first line treatment in the management of rheumatoid arthritis and prevent disease progression Budesonide Sulfasalazine Prednisolone Omeprazole Loperamide Glucosamine Allopurinol Naproxen

Answer 46

Sulfasalazine

Question 47

A patient presents with a case if diarrhoea, following a bout of constipation. They often feel bloated but this is ussually relieved by defection. They appear to be some mucus in the stools but no blood or warning symptoms Budesonide Sulfasalazine Prednisolone Omeprazole Loperamide Glucosamine Allopurinol Naproxen

Answer 47

Loperamide

Question 48

Mrs R has been suffering from nasal congestion and sinus pain and after investigation it has been found she has several small nasal polyps Budesonide Sulfasalazine Prednisolone Omeprazole Loperamide Glucosamine Allopurinol Naproxen

Answer 48

Budesonide

Question 49

Mrs C is suffering from an acute episode of moderate proctitis. his doctor would like to start him on first line mono therapy as an oral agent Budesonide Sulfasalazine Prednisolone Omeprazole Loperamide Glucosamine Allopurinol Naproxen

Answer 49

Sulfasalazine

Question 50

Used in the treatment of both hypothyroidism and hyperthyroidism Levothroxine Risedronate Carbimazole Topical iodine Liothyronine sodium Amiodarone Lithium Metoprolol

Answer 50

Levothroxine

Question 51

Should be prescribed for a post menopausal who has been untreated for hyperthyroidism for a long time and their latest dexa scan result was -2.5 Levothroxine Risedronate Carbimazole Topical iodine Liothyronine sodium Amiodarone Lithium Metoprolol

Answer 51

Risedronate

Question 52

Has MHRA/CSM advise regarding an increased risk of congenital malformations suggesting women of childbearing potential should use effective contraception during treatment Levothroxine Risedronate Carbimazole Topical iodine Liothyronine sodium Amiodarone Lithium Metoprolol

Answer 52

Carbimazole

Question 53

Can be prescribed for a patient requiring adjunct treatment for the management of side effects associated with hyperthyroidism Levothroxine Risedronate Carbimazole Topical iodine Liothyronine sodium Amiodarone Lithium Metoprolol

Answer 53

Metoprolol

Question 54

May be used as an alternative to levothyroxine in the treatment of hypothyroidism Levothroxine Risedronate Carbimazole Topical iodine Liothyronine sodium Amiodarone Lithium Metoprolol

Answer 54

Liothryoine sodium