Mock Paper 2 Questions Flashcards

Question

Your local GP calls for advice regarding a patient who has forgotten to stop his methotrexate therapy whilst on a course of antibiotics for community-acquired pneumonia (CAP). The patient’s usual dose of methotrexate is 15mg once a week. The patient takes amoxicillin 500 mg TDS for his CAP. What is the most likely outcome of the patient taking both amoxicillin and methotrexate concurrently? A. No interaction exists between amoxicillin and methotrexate will occur B. The patient will be more susceptible to methotrexate toxicity C. The patient will be more susceptible to a flare-up of their rheumatoid arthritis D. The concentration of amoxicillin is reduced, and therefore, the patient will have a sub-therapeutic response to his infection E. The patient is at an increased risk of experiencing side effects from the amoxicillin

Answer 1

B. The patient will be more susceptible to methotrexate toxicity Penicillins (for example, amoxicillin) may reduce the clearance of methotrexate via the kidneys by competitive inhibition. This increases the risk of methotrexate toxicity.

Answer 2

E. 12 hours and 0.8–1 mmol/litre Samples should be taken 12 hours after the dose to achieve a serum-lithium concentration of 0.4–1 mmol/litre (lower end of the range for maintenance therapy and elderly patients). A target serum-lithium concentration of 0.8–1 mmol/litre is recommended for acute episodes of mania, and for patients who have previously relapsed or have sub-syndromal symptoms. It is important to determine the optimum range for each individual patient.The correct answer is: 12 hours and 0.8–1 mmol/litre

Answer 3

D.lisdexamfetamine

Answer 4

C. pain lasting for more than one week Back pain, particularly lower back pain, is very common. It usually improves within a few weeks but can sometimes last longer or keep coming back.

Answer 5

H. treatment failure UTI in men 1st: trimethoprim 200mg BD for 7 days 2nd: nitrofurantoin 100mg MR BD for 7 days (50mg QDS)

Answer 6

G. reduced seizure threshold

Answer 7

H.nifedipine

Answer 8

G.nicorandil TREATMENT OF ANGINA Sublingual glyceryl trinitrate (GTN). 1ST: A beta-blocker or a calcium-channel blocker 2ND: long-acting nitrate (for example isosorbide mononitrate), nicorandil, ivabradine, or ranolazine. 3RD: SWITCH OR ADDING 4TH: Referral to a cardiologist, Starting a third anti-anginal drug should be considered whilst waiting for specialist assessment.

Answer 9

F.diphenhydramine

Answer 10

E. Metformin

Answer 11

C. liver function NB: creatine kinase only measured when patient has persistent, generalised, unexplained muscle pain, tenderness or weakness

Answer 12

C. the live attenuated vaccine is given by nasal spray and inactivated vaccines are administered by IM

Answer 13

D. She should close her lips firmly around the mouthpiece and take a long, steady, deep breath in Anoro Ellipta is a dry powder inhaler (fast and deep)

Answer 14

C. 5ml of 250mg/5ml eevery 4-6 hours, max 4 doses per day NB: 6 years old - 250mg QDS

Answer 15

C. Sell a 30g tube of crotamiton 10% w/v cream to a 23 year old female patient with sunburn NB: only allow GSL sales

Answer 16

E. Sell Master T hydrogen peroxide 1% cream and advise him to apply it two or three times a day for 5 days Local non bollous impetigo 1st line: hydrogen peroxide 1% cream 2nd line: near eyes - Fusidic acid 2% 3rd line: fusidic resistance - mupirocin 2%

Answer 17

B. Add exenatide 2mg once weekly Exenatide is GLP1 agonist - Type 2 diabetes mellitus in combination with other antidiabetic drugs (including insulin) if existing treatment fails to achieve adequate glycaemic control

Answer 18

C. 15 Atovaquone with proguanil 250mg Mefloquine: 2-3 weeks before and 4 weeks after Doxycycline: 1-2 days before and 4 weeks after Atovaquone with proguanil (Malarone): 1-2 days before and 1 week after (shortest duration)

Answer 19

B. Enteral feeding NB: enteral nutrition not for maintenance therapy

Answer 20

C. Doxycycline Doxycycline increase anticoagulant effect of warfarin hence increase INR

Answer 21

E. This is an expected reaction of UV-damaged skin to 5-FU, they can use moisturisers to settle the irritation, and should seek medical advice only if the extent of irritation is making it difficult to adhere to treatment and complete teh course.

Answer 22

C. Activated charcoal Acetylcysteine - Paracetamol Adrenaline - anaphylaxis Activated charcoal - aspirin, theophylline, TCA, SSRI, 2nd gen antipsy, CCB Dicobalt edetate - cyanides Naloxone hydrochloride - opioids

Answer 23

A. Gina can be purchased OTC and she needs to use one vaginal tablet twice a week for 3 months as her initial OTC supply is from the pharmacy Initial dose: One vaginal tablet daily for two weeks. Maintenance dose: One vaginal tablet twice a week. Reinstituting treatment: For patients still experiencing symptom relief after a break from therapy, it is recommended that treatment is restarted at the maintenance dose. For patients experiencing bothersome symptoms again after a break from therapy, it is recommended to restart treatment at the initial daily dose regimen for 2 weeks, followed by the maintenance twice weekly dose. Switching from other local vaginal oestrogen preparations: Patients experiencing symptom relief from vaginal oestrogen preparations that are being used at the recommended dose can be switched to the maintenance dose of Gina provided: * The woman has used her current vaginal oestrogen product for more than 3 months, and; * Her symptoms are adequately controlled, and; * Her health status is unchanged since her last prescription. Treatment may be started on any convenient day.

Answer 24

D. Ciprofloxacin Ibuprofen potentially increases the risk of seizures when given with Ciprofloxacin. Manufacturer advises caution.

Answer 25

<135/85 mmHg

Answer 26

<150/90 mmHg

Answer 27

H. Spironolactone potassium level <4.5 - spironolactone potassium level >4.5 - beta blocker or alpha locker

Answer 28

E. Indapamide 3rd step: ACEi + CCB + thiazide-like diuretic

Answer 29

A. Suggest booking an urgent appointment with their GP Scarlet fever - refer to GP

Answer 30

C. Psoriasis scaly and itchy patches

Answer 31

D. Rosacea Redness bump, filled with pus, exacerbate with alcohol

Answer 32

G. Melasma (hyperpigmentation) Dark patches, discolouration, outdoor under the sun

Answer 33

H. Valacyclovir (500mg BD for 3-5 days - recurrent) Aciclovir 800mg TDS for 2 days or 200mg five times a day for 5 days or 400mg TDS for 3-5 days for recurrent infection

Answer 34

D. 1 in 10000 400mg in 4000ml 1000mg in 10000ml 1g in 10000ml

Answer 35

D. use ibuprofen gel You can take ibuprofen or use it on your skin while breastfeeding. It is one of the painkillers that's usually recommended if you're breastfeeding. Only tiny amounts get into breast milk, and it's unlikely to cause side effects in your baby. Many people have used it while breastfeeding without any problems. Back pain often improves on its own within a few weeks. There are things you can do to help speed up your recovery. Paracetamol on its own is not recommended for back pain but it may be used withanother painkiller

Answer 36

D. order from the wholesaler and place it in the fridge when it arrives

Answer 37

B. codeine linctus Codeine linctus is now a POM and pholcodine has been withdrawn from the UK market

Answer 38

C. 29 June 2024 Schedule 2, 3, and 4 Part 1 CDs are valid for 28 days AFTER the appropriate date

Answer 39

A. accept the tablets and arrange for their disposal without entering receipt in the CD register Returned schedule 2 CDs do NOT get entered into the CD register and do NOT need an authorised witness to witness thedisposal

Answer 40

A. that there is no problem normal blood pressure is considered to be between 90/60mmHg and 120/80mmHg (this applies if it's measured at home or at a pharmacy,GP surgery or clinic) High blood pressure is considered to be 135/85 or higher if your reading was taken at home, or 140/90mmHg or higher if your reading wastaken at a pharmacy, GP surgery or clinic Low blood pressure is considered to be 89/59mmHg or lower

Answer 41

C. 1-2 weeks after starting Check renal function and serum electrolytes 1–2 weeks after starting treatment and 1–2 weeks after each dose increase. Thereafter, check renal function and serum electrolytes annually unless clinical judgement or abnormal blood testing parameters indicate a need for more frequent monitoring. Check blood pressure 4 weeks after each dose titration. For people who are at higher risk of hyperkalaemia or deteriorating renal function (for example, those with peripheral vascular disease, diabetes mellitus, or pre-existing renal impairment or older people), consider checking renal function and serum electrolytes sooner (within 1 week).

Answer 42

D. medical history Licensed from 18-65. Migraine can be diagnosed by a doctor or pharmacist. He has an established pattern of migraines. Duration less than 24 hours and less than 4 attacks per month. He has hypertension so OTC supply is contraindicated

Answer 43

E. 12 months Following remission, antidepressant treatment should be continued at the same dose for at least 6 months (about 12 months in the elderly), or for at least 12 months in patients receiving treatment for generalised anxiety disorder (as the likelihood of relapse is high). Patients should be reviewed every 1–2 weeks at the start of antidepressant treatment. Treatment should be continued for at least 4 weeks (6 weeks in the elderly) before considering whether to switch antidepressant due to lack of efficacy. In cases of partial response, continue for a further 2–4 weeks (elderly patients may take longer to respond).

Answer 44

D. 280mL Supply 3 bottles of 100ml and dicard the remainder

Answer 45

A. amiodarone as first-line antiarrhythmic therapy in supraventricular tachyarrhythmias In the elderly, amiodarone is potentially inappropriate (STOPP criteria) as first-line antiarrhythmic therapy in supraventricular tachyarrhythmias (higher risk of side-effects than beta-blockers, digoxin, verapamil or diltiazem)

Answer 46

D. 52mL Key word here is with. 2g with 100mL of water. DV = 500mg/mL = 2000mg/4mL so 100mL + 4mL = 104mL so2000mg/104mL = 1000mg/52mL

Answer 47

C. metformin Symptoms suggest low vitamin B12 levels. Decreased vitamin B12 levels, or vitamin B12 deficiency, is now considered to be a common side effect in patients on metformin treatment, especially in those receiving a higher dose or longer treatment duration and in those with existing risk factors. We are therefore advising checking vitamin B12 serum levels in patients being treated with metformin who have symptoms suggestive of vitamin B12 deficiency. We also advise that periodic monitoring for patients with risk factors for vitamin B12 deficiency should be considered.

Answer 48

B. no register entry required, no safe custody required, 28 days prescription validity Phenobarbital is schedule 3

Answer 49

B. atorvastatin in the morning Alendronic must be taken first thing in the morning and stay 30 minutes upright after taking it

Answer 50

E. scarlet fever Sandpaper skin and strawberry tongue (peeled, leaving the tongue red, swollen, and covered in little bumps)

Answer 51

B. co-amoxiclav 500/125mg three times a day for 5 days Suspected or confirmed uncomplicated acute diverticulitis Oral first line: Co-amoxiclav. Alternative in penicillin allergy or co-amoxiclav unsuitable: cefalexin (caution in penicillin allergy) with metronidazole, or trimethoprim with metronidazole, or ciprofloxacin (only if switching from intravenous route with specialist advice) with metronidazole.

Answer 52

D. salbutamol, oxygen, and oral prednisolone Severe acute asthma Can’t complete sentences in one breath or too breathless to talk or feed; SpO2 < 92%; Peak flow 33–50% best or predicted; Heart rate > 140/minute in children aged 1–5 years; heart rate > 125/minute in children aged over 5 years; Respiratory rate > 40/minute in children aged 1–5 years; respiratory rate > 30/minute in children aged over 5 years.

Answer 53

C.ketoconazole Ketoconazole shampoo is used for seborrhoeic dermatitis and dandruff

Answer 54

B. place on the tongue The manufacturer advises that oral lyophilisates should be placed on the tongue and allowed to dissolve. Patients should be advised not to swallow for 2 minutes and not to consume food or drink for at least 5 minutes after administration

Answer 55

C. provide general advice about the condition and recommend the use of paracetamol for the headache and general aches as necessary It's chicken pox Do NOT recommend ibuprofen in children with chickenpox

Answer 56

A. Child-bearing age

Answer 57

A. aPTT What does the result mean? The result of aPTT testing provides information on the blood's ability to form clots. It helps identify deficiencies or abnormalities in clotting factors, assess the risk of bleeding disorders, and monitor the effectiveness of anticoagulant therapy. Why conduct the analysis? The test may be conducted: To investigate a bleeding or thrombotic episode. To assess the risk of excessive bleeding before a surgical procedure. To monitor anticoagulant therapy involving unfractionated heparin. When to conduct the analysis? The test may be conducted: When a patient is experiencing unexplained bleeding or thrombosis. When a patient is on unfractionated or intravenous (IV) heparin anticoagulant therapy

Answer 58

E. EEG An electroencephalogram (EEG) is a recording of brain activity. During this painless test, small sensors are attached to the scalp to pick up the electrical signals produced by the brain. These signals are recorded by a machine and are looked at by a doctor. The EEG procedure is usually carried out by a clinical neurophysiologist, during a short visit to the hospital. EEG can be used to help diagnose and monitor several conditions affecting the brain. It may help identify the cause of certain symptoms, such as seizures (fits) or memory problems, or find out more about a condition you've already been diagnosed with. The main use of an EEG is to detect and investigate epilepsy, a condition that causes repeated seizures. An EEG will help your doctor identify the type of epilepsy you have, what may be triggering your seizures, and how best to treat you.

Answer 59

F. SC Yellow Fever is administered by deep SC injection

Answer 60

D. PR Mesalazine is available as an m/r tablet, gastro-resistant tablet, m/r granules, suppository, enema and rectal foam

Answer 61

B.20mg in hypertension, initially 5mg once daily, usual maintenance 10mg once daily; increased if necessary up to 20mg oncedaily.

Answer 62

D. Intervention necessary – reassure patient. reassure patient as this is common with initial dose for ACE

Answer 63

F. Recommend to patient to purchase OTC drug rinse mouth after using inhaled corticosteroids, oral thrush treatment OTC

Answer 64

A. 12 The HPV vaccine helps protect against HPV. It's recommended for children aged 12 to 13 years old and people at higherrisk from HPV

Answer 65

B Heart failure Based on the patient's symptoms of a productive cough with pink-coloured sputum and increased breathlessness, along with her medical history of cardiovascular disease and the medications she is taking, the most likely cause of her signs and symptoms is heart failure. In heart failure, the heart is unable to pump blood effectively, leading to fluid accumulation in the lungs. This can result in symptoms such as cough, pink-tinged sputum (indicating blood-tinged secretions), and breathlessness, especially with exertion.

Answer 66

D Wet combing For a pregnant woman with suspected head lice, wet combing is the most appropriate option to recommend. Wet combing involves using a fine-toothed comb to comb through wet hair, removing lice and nits (eggs) manually. It is a safe and chemical-free method that can be used during pregnancy without any concerns about the use of medications or chemicals. Another suitable option would be the use of dimeticone 4% lotion, which can be used for pregnant or breastfeeding women, young children aged 6 months to 2 years, and people with asthma or eczema.

Answer 67

C Gabapentin Gabapentin is classified as a Schedule 3 controlled drug in the United Kingdom. As such, it cannot be supplied as an emergency medication without a valid prescription. Emergency supplies of Schedule 3 controlled drugs are not permitted under normal circumstances. Mrs H will need to contact her prescriber or find a local pharmacy that can help her obtain her prescription while she is away from home.

Answer 68

C Ethosuximide Ethosuximide is considered the most appropriate first-line treatment for absence seizures. Absence seizures, also known as petit mal seizures, are characterized by brief episodes of loss of consciousness or "blanking out." 1st Line Absence Seizures: Ethosuximide Tonic clonic, Myoclonic, Atonic, or Tonic: Sodium Valproate Focal seizure: Lamotrigine or Levetiracetam

Answer 69

C Lansoprazole Lansoprazole is a proton pump inhibitor (PPI) commonly used to reduce stomach acid production in conditions such as gastroesophageal reflux disease (GORD). However, long-term use or high doses of PPIs like lansoprazole can lead to vitamin and mineral deficiencies, including vitamin B12, calcium, and magnesium. These deficiencies can manifest as symptoms such as loss of appetite, fatigue, muscle cramps, and numbness.

Answer 70

D 10mg twice a day for the first 7 days For the treatment of acute deep vein thrombosis (DVT) and pulmonary embolism (PE), apixaban is commonly initiated with a loading dose schedule. The recommended dosing regimen is 10mg of apixaban taken orally twice a day for the first 7 days. Following the initial 7-day period, the maintenance dose is reduced to 5mg taken orally twice a day.

Answer 71

B 2 Different formulations or presentations of the same drug or preparation, such as a pessary and cream, are considered separate items and therefore incur two prescription charges. In the UK, prescription charges are payable for each item on a prescription, regardless of whether the items are combined in a single pack. Therefore, a prescription for Canesten combi pessary and cream would attract two prescription charges.

Answer 72

B Cyclophosphamide Mesna is a drug used for the prevention and treatment of urothelial toxicity caused by cyclophosphamide, a commonly used cytotoxic drug. Cyclophosphamide can cause damage to the bladder lining, leading to urothelial toxicity and the development of haemorrhagic cystitis. Mesna helps to protect the bladder by binding to and detoxifying the harmful metabolite (acrolein), thus reducing the risk of urothelial toxicity.

Answer 73

D Sodium Hyaluronate Sodium hyaluronate is a naturally occurring substance that is found in the eye. It helps to keep the eye moist and lubricated. Sodium hyaluronate eye drops are available over-the-counter and can be used to treat dry eyes. In this case, Mrs. T has been using carbomer 0.2% eye gel for dry eyes, but she is still experiencing persistent symptoms. Sodium hyaluronate eye drops are a more viscous option than carbomer 0.2% eye gel, and they may be more effective in treating her dry eyes.

Answer 74

C Supply 5 days treatment Given that zolpidem is a Schedule 4 controlled drug, the appropriate course of action is to supply no more than 5 days' treatment in an emergency supply situation. Although amlodipine is not a controlled drug and could be supplied for up to 30 days, the supply should be limited to 5 days to ensure consistency and patient safety.

Answer 75

B. 12 months It is recommended to switch a child from formula milk to full-fat cow’s milk at 12 months of age. Before this age, a child's digestive system is not fully developed to handle the nutrients in cow’s milk adequately.

Answer 76

D Oral Vitamin K Oral Vitamin K is administered to neonates shortly after birth to prevent Vitamin K deficiency bleeding, which can be a significant risk in preterm infants. This is a standard preventive measure in the first few hours of life.

Answer 77

A Amitriptyline Amitriptyline, a tricyclic antidepressant, does not commonly cause diarrhoea. In fact, it often causes constipation. Amoxicillin, ferrous sulphate, magnesium trisilicate, and metformin are all known to potentially cause diarrhoea.

Answer 78

E Paracetamol caplets Paracetamol is the safest option for pain relief in this patient. Given his current medications (ramipril and amlodipine), NSAIDs like ibuprofen and naproxen are not recommended due to the potential risk of renal impairment and adverse cardiovascular effects. Co-codamol, which contains codeine, may cause additional side effects and is not necessary for this level of pain. Soluble paracetamol tablets contain a high amount of sodium, which is not advisable for a patient on antihypertensive. Thus, paracetamol caplets are the most appropriate choice.

Answer 79

E 61-year-old female Amorolfine 5% nail lacquer can be sold OTC to treat mild cases of fungal infections affecting the nail in those 18 years and over, and provided there are no complicating factors such as diabetes or immunosuppression, and the patient is not pregnant or breastfeeding. A 61-year-old female with no additional contraindications meets the criteria for OTC treatment with amorolfine.

Answer 80

D Sale from a vending machine in an open area accessible 24 hours a day Selling General Sale List (GSL) medicines from a vending machine in an open area accessible 24 hours a day would be the least appropriate legally. This method lacks proper control and supervision to ensure the medicines are sold in a safe and appropriate manner, which is a requirement under the Human Medicines Regulations 2012. However, vending machine sales are acceptable as long as the machine is located within an area that can be closed off to the public and controlled.

Answer 81

D 65 years The herpes zoster vaccine is routinely offered to people turning 65 years old, those aged 70 to 79, and those aged 50 and over with a severely weakened immune system, according to the updated NHS vaccination scheme.

Answer 82

E She should stop taking her medicine and should seek urgent medical advice from her GP If Mrs T experiences symptoms suggestive of bone marrow suppression (Neutropenia and agranulocytosis), such as a sore throat, she should stop taking carbimazole immediately and seek urgent medical advice from her GP to prevent any serious complications.

Answer 83

A Hypoglycaemia Hypoglycaemia is not a symptom of phenytoin overdose. Symptoms of phenytoin overdose typically include nystagmus (uncontrolled eye movements), ataxia (loss of coordination), confusion, and diplopia (double vision).

Answer 84

C Labetalol In the context of a hypertensive emergency, such as the situation described with a blood pressure of 200/140 mmHg, signs of papilloedema, and retinal hemorrhage, immediate blood pressure reduction is necessary. Labetalol is a combined alpha and beta-blocker that can be administered intravenously and is effective for rapid blood pressure control in hypertensive emergencies. It is recommended for its quick onset of action and the ability to be titrated to achieve the desired blood pressure reduction. According to NICE guidelines and other clinical resources, Labetalol is a preferred agent in hypertensive emergencies due to its efficacy and safety profile in rapidly reducing blood pressure.

Answer 85

E Levomepromazine Levomepromazine is a broad-spectrum antiemetic often used in palliative care when other antiemetics are ineffective. It can be particularly useful in managing complex or refractory nausea and vomiting in palliative care patients.

Answer 86

E Erectile dysfunction Bendroflumethiazide, a thiazide diuretic, can cause erectile dysfunction as a side effect. This is a recognised common adverse effect associated with the use of thiazide diuretics.

Answer 87

B Clopidogrel Clopidogrel is an antiplatelet agent, not an anticoagulant. It is not suitable for the treatment of deep vein thrombosis, which requires anticoagulant therapy to prevent clot extension and embolisation. Anticoagulants like apixaban, dabigatran, dalteparin, enoxaparin, heparin (unfractionated), rivaroxaban, and tinzaparin are used to treat DVT.

Answer 88

F Recommend the doctor to stop the drug immediately Severe bruising and haematuria are signs of significant bleeding, likely due to over- anticoagulation with warfarin. Immediate cessation of warfarin is necessary to prevent further bleeding complications, and the patient may require reversal of anticoagulation and further medical evaluation.

Answer 89

H Tolbutamide Tolbutamide is a suitable sulphonylurea for patients with chronic kidney disease as it has a shorter duration of action and a lower risk of prolonged hypoglycaemia.

Answer 90

A Glibenclamide

Answer 91

C Furosemide Furosemide is a loop diuretic commonly used to relieve fluid retention and reduce oedema in patients with chronic heart failure. It is effective in managing symptoms of breathlessness and oedema associated with heart failure.

Answer 92

F Carvedilol Carvedilol is a beta blocker that is commonly prescribed for heart failure. The initial dose of 3.125 mg twice daily is typical for starting treatment with carvedilol, which helps improve heart function and reduce symptoms in patients with heart failure.

Answer 93

G Hydralazine + nitrates Hydralazine in combination with nitrates is a suitable alternative treatment for heart failure in patients who cannot tolerate ACE inhibitors or angiotensin receptor blockers due to side effects such as a persistent dry cough or known intolerance. This combination can help manage heart failure symptoms and control blood pressure.

Answer 94

A Advise the patient to increase fluid intake and take paracetamol for symptom relief According to CKS guidance, uncomplicated lower urinary tract symptoms in women can initially be managed with self-care and simple analgesia such as paracetamol or ibuprofen, unless contraindicated. Encouraging adequate hydration (around 1.5 litres/day) is also advised. The use of cranberry products or urine alkalinising agents such as potassium citrate or sodium bicarbonate is not recommended due to lack of consistent evidence. Referral may be necessary if symptoms persist or worsen after 48 hours.

Answer 95

B Add furosemide 40mg daily while continuing spironolactone In ascites due to cirrhosis, spironolactone is typically started first due to its aldosterone-antagonising effect, but if insufficient, furosemide is added to promote fluid loss and maintain electrolyte balance. A spironolactone to furosemide ratio of 100:40 is commonly used to balance potassium levels and minimise adverse effects. Monotherapy with furosemide is avoided due to the risk of hypokalaemia and worsening renal function. Increasing spironolactone further without furosemide is unlikely to achieve sufficient diuresis at this stage.

Answer 96

C Provide a delayed prescription with safety-netting advice This patient has symptoms of a self-limiting viral upper respiratory tract infection. According to NICE and PHE antimicrobial prescribing guidelines, immediate antibiotics are not usually indicated unless red flags are present (e.g. very unwell, immunocompromised, or signs of bacterial infection). A delayed prescription is appropriate when symptoms are not severe but the patient is concerned, as it allows for antibiotics to be started if symptoms worsen or do not improve within 3-5 days, while promoting antibiotic stewardship. Safety-netting advice is essential.

Answer 97

E Signs of high blood sugar such as excessive thirst and urination Olanzapine is associated with a high risk of metabolic side effects, including hyperglycaemia, weight gain, and diabetes mellitus. Patients should be counselled to monitor for signs such as increased thirst, frequent urination, fatigue, or unexplained weight loss, and to seek prompt medical advice if these occur. While other side effects such as sedation or restlessness (e.g. akathisia) may occur, metabolic complications are often silent until severe, making early counselling critical.

Answer 98

C Coarse tremor Coarse tremor is a classic neurological sign of lithium toxicity, typically accompanied by symptoms such as confusion, ataxia, slurred speech, and sometimes seizures or coma at higher levels. The risk of lithium toxicity increases significantly when interacting medicines such as thiazide diuretics (e.g. bendroflumethiazide) or ACE inhibitors are introduced, as they reduce renal clearance of lithium.

Answer 99

C Lactulose oral solution In pregnancy, bulk-forming laxatives are considered first-line, but if ineffective, osmotic laxatives such as lactulose are considered safe and effective. Stimulant laxatives like senna or bisacodyl are generally reserved for short-term use and may cause uterine contractions in high doses. Docusate can be considered, but lactulose has a longer track record of safe use in pregnancy.

Answer 100

E 150/90 mmHg According to NICE NG136 guidelines, the clinic blood pressure target for adults aged 80 years and over is below 150/90 mmHg. A lower target (e.g. 140/90 mmHg) applies to younger adults under the age of 80. This patient’s blood pressure of 142/88 mmHg meets the target, but his symptoms of postural hypotension may indicate overtreatment or the need to review timing of administration and standing BP. Therefore, 150/90 mmHg remains the most appropriate clinical target for his age group.

Answer 101

E Isophane insulin NICE guidance recommends that insulin therapy should be initiated immediately in women diagnosed with gestational diabetes who have a fasting plasma glucose level above 7.0 mmol/L at the time of diagnosis. Insulin can be started with or without metformin, but it remains the primary treatment of choice in this context due to the increased risk of complications with higher fasting glucose levels. Metformin may be used if fasting plasma glucose is below 7.0 mmol/L and dietary measures fail. Gliclazide, pioglitazone, and exenatide are not recommended during pregnancy due to safety concerns.

Answer 102

C 3 sprays The standard guidance for GTN spray in angina is to use one or two sprays under the tongue at the onset of chest pain. If the pain does not resolve after 5 minutes, a second dose can be used. If the pain persists 5 minutes after the second dose, a third and final spray may be used. If there is no improvement after three sprays within 15 minutes, the patient should call 999 for an ambulance immediately.

Answer 103

e. red Informing patients of harmless side effects reduces the rate of treatment failures. Urine may be pink or red for up to 48 hours after treatment. This is usually because of the colour of doxorubicin. It is not harmful.

Answer 104

e. reduce Spironolactone to 25 mg ONCE daily and recheck potassium and BP in one week A - distractor because calcium channel blockers are appropriate for HTN in this age group but will not impact potassium in any way. B– Inappropriate given patient’s BP. C – Tomatoes are high in potassium. D - Disproportionate for the level of hyperkalaemia and he has good BP control.E – Proportionate approach

Answer 105

c. elevated bilirubin A is incorrect as alopecia is a dose-dependent side effect and often reversible, thus this would not require a dose reduction. B is more of a potential side effect (under the umbrella term of gastrointestinal disturbances); thus, this is also incorrect. D is a distractor; the product specification suggests a dose reduction for those also receiving cyclosporin. E is incorrect as not specified in the product specification; bronchospasms are noted as a side effect.

Answer 106

a.assign the same pharmacy colleague to deliver all the sessions of an intervention for a given patient To promote continuity of care, when possible, the same staff member should deliver all the sessions of an intervention if more than one session is needed. Interventions should never be carried out based on commercial targets or personal experience; rather, they should be based on national or local guidelines and according to an individual's needs. All staff involved in the campaign should be trained on the topic and skills needed for its successful delivery. Although training as a mental health aider would be advantageous to the pharmacy team and public, it is not necessary or ‘best practice’ to train as a mental health aider before carrying out interventions for the campaign. A tailored approach should be used when providing community pharmacy health and wellbeing interventions to maximise their impact and effect. Signposting is an integral part of any successful public health campaign,n and pharmacies should consider establishing a formal referral process with other services such as local GP surgeries

Answer 107

e.supply mebendazole to the whole family, followed by a repeat dose after 14 days Mebendazole is drug of choice to people over the aged of two. It is recommended that all family membersshould be treated, and a repeated dose should be given

Answer 108

d.pubic lice A is incorrect as chlamydia is often symptom-free, but when symptoms are present, they include pain and swollen testicles in males B is incorrect because genital herpes usually presents as blisters and tingling pain C is incorrect as there is no discharge from the penis E is incorrect as early signs include sores on the penis and general unwellnessIt is likely that the patient has a pubic lice infestatio

Answer 109

c.sell a pack of 12 hyoscine hydrobromide 300 microgram tablets The patient’s medical conditions do not interfere with or relate to travel sickness and thus can be supported without referral. Domperidone is ineffective in managing travel sickness and thus is not a suitable option. Encouraging fluid consumption is unlikely to prevent travel sickness. Hyoscine butylbromide is licensed to treat abdominal cramps/spasms and IBS-like symptoms. Hyoscine HYDRObromide is used for travel sickness and is available to purchase without a prescription.

Answer 110

d.omeprazole 10 mg / 5 mL oral suspension – 10 mL once daily Individuals with Sjogren’s syndrome have reduced secretions so find it difficult to swallow tablets andcapsules. Therefore, only A and D are viable options. Option D is correct as it is closest to her current dose.

Answer 111

c. take the delayed dose as soon as possible and take the next dose at the usual time A is incorrect as nausea can be a side effect of desogestrel tablets; since the patient has been on the contraceptive pill for three months, it’s unlikely for her to be pregnant. The scenario also doesn’t tell us that she has missed pills in the past. B is incorrect as, by missing the pill by eleven hours, protection against pregnancy is not lost. D and E are incorrect and not suitable for the scenario described.

Answer 112

c. the use of the new drug in juvenile idiopathic arthritis may be supported as there is a significant difference between the placebo group and treatment group The p-value of 0.006 is statistically significant, so it can be concluded that the results of this trial may support the use of the new drug in juvenile idiopathic arthritis. As this trial has a randomised double-blind design, the chance of selection bias is eliminated. Although the sample population may not be large enough to be reflective of the total population, the results of the trial are still significant, and a conclusion can still be made. A, is not correct: NNT = 1/(0.01*(39-20) = 5.2 (quoted as 6 as NNT is rounded up to a whole person)

Answer 113

e. metformin is only effective in the presence of insulin Metformin exerts its effect mainly by decreasing gluconeogenesis and by increasing peripheral utilisation ofglucose; since it acts only in the presence of endogenous insulin it is effective only if there are some residualfunctioning pancreatic islet cells

Answer 114

e.hypoglycaemia Both metformin and empagliflozin are antidiabetics that can increase the risk of hypoglycaemia.

Answer 115

b.mirabegron Mirabegron acts on beta-3-adrenocetors. Therefore, it has a minimal anticholinergic burden unlike the other options which are all antimuscarinics and have a high anticholinergic burden.

Answer 116

b.azithromycin Amoxicillin and co-amoxiclav are not appropriate due to allergy. Doxycycline – deposits in bones/teeth so not ideal for children. Ciprofloxacin should be used with caution in children, so azithromycin is most appropriate

Answer 117

a.can be sold for mild cases of distal lateral subungual onychomycosis Curanail 5% w/v medicated nail lacquer SPC. The product only covers the treatment of up to two toenailsare affected and should be used between 6-9 months for optimum effect. It is only licensed for 18 years andover and cannot be used in diabetic or patients with peripheral arterial disease. It is licensed for treatmentwhere fungal infection has originated from the distal or lateral areas of the toenail.

Answer 118

c.a 72-year-old patient prescribed atorvastatin, citalopram and clopidogrel People are at high risk of GI adverse effects with antiplatelet treatment if concomitant medicines that areknown to increase the risk of GI bleeds are also given. An example of these medicines is SSRIs such ascitalopram. Whilst NSAIDs do come with a high risk of GI bleeding or ulceration, when used topically they donot carry this risk

Answer 119

d.apply the patch to the side of the chest for 12-14 hours and then remove. The patch may also be applied to the upper arm, abdomen, or shoulder. The GTN patch remains on the skin for only 12-14 hours and then removed. It is not replaced every 12-14hours. The patient needs a nitrate free period to prevent tolerance occurring

Answer 120

c.most ear infections clear up on their own within 48 hours A – Do not give cetirizine B – This is not a licensed use of chlorpheniramine C – most infection clear up on their own within 72 hours D – there is no need to refer to the GP immediately – maybe after 72 hours or, if not, treatable via PharmacyFirst E – this will not treat an ear infection or relieve the symptoms

Answer 121

b.refer to an urgent medical centre The patient scenario suggests that the pain is related to a bone. Bone pain is commonly known to be dull and deep-seated. Bone pain can arise from osteosarcoma (‘cancer of the bone’) or be due to osteomyelitis, therefore, referral to a medical doctor is essential and should be done urgently. Thus, options A, C, D and E are incorrect. Note that the use of topical ibuprofen gel with oral ibuprofen tablets is contraindicated. Thus, this option could be immediately ruled out.

Answer 122

b.fluvastatin 80 mg tablets od Fluvastatin 80 mg is a medium intensity drug. The others are high intensity similar to atorvastatin 80 mg

Answer 123

a.10 mcg Babies from birth to 1 year of age who are being breastfed should be given a daily supplement of 8.5-10 mcgof vitamin D.

Answer 124

d.glycerol suppository Glycerol suppository is the only non-oral option

Answer 125

h.naloxegol Opioids are commonly known to cause constipation, naloxegol is licensed to treat opioid inducedconstipation

Answer 126

f.sexual dysfunction Sexual dysfunction is a common side effect of tamsulosin hydrochloride.

Answer 127

d.advise the patient that you are unable to dispense prescriptions from this country and refer them toa UK registered prescriber Prescriptions from prescribers in the USA do not fall into the approved countries list and therefore theprescription cannot be dispensed.

Mock Paper 2 Questions Flashcards

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