Mock Paper 2 Questions Flashcards by Christina Chong

A 24-year-old patient is told that they carry a gene mutation associated with breast cancer (BRCA gene). The clinician is advising the patient on the safest contraceptive methods for use. Which method of contraception below does the proven risk usually outweigh the advantages?

A. combined hormonal contraception
B. copper intrauterine device
C. levonorgestrel-releasing intrauterine system
D. progestogen-only implant
E. progestogen-only pill

A. combined hormonal contraception

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A man who complains to the doctor regarding his symptoms of bloating, nausea, and abdominal pain. Recently had a course of flucloxacillin for a skin infection. The man mentions he has not responded to OTC medication.

Considering a retest is required, how long does the man have to wait after having finished his course of flucloxacillin, before taking the test again to prevent getting a false negative result?

A.1 week
B.2 weeks
C. 3 weeks
D. 4 weeks
E.5 weeks

D. 4 weeks

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A 22-year-old man has presented to the doctor after having unusual bowel movements for two weeks and is now starting to become anxious. He has tried but has not responded to increasing fibre in his diet.

What is the recommended first-line treatment for this patient?

A. docusate sodium capsules
B. ispaghula husk sachets
C. loperamide capsules
D. macrogol sachets
E. senna tablets

B. ispaghula husk sachets

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A patient presents with xerostomia and asks what she could use to reduce its severity. She says she recently started taking a new medication, ever since then she has had this problem.

Which of her medications is most likely to have caused the xerostomia?

A.amitriptyline
B.aspirin
C.bisoprolol
D.gliclazide
E.metformin

A. amitriptyline

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Gina (estradiol) 10microgram vaginal tablet is a P medicine indicated for the treatment of vaginal atrophy in postmenopausal women.

Which of the following is contraindicated with the use of Gina and will require referral to the GP?

A. acute liver disease
B. patient has amenorrhea
C. patient who takes warfarin for a non-mechanical heart valve
D. symptoms of vaginal soreness, burning and painful intercourse
E. Women aged above 50

A. acute liver disease

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A 7-year-old boy with type I diabetes mellitus is suffering with a fever and is feeling nauseous. His mother is seeking advice on how tomanage her son’s condition while he is ill.

In relation to ‘sick day’ rules for type I diabetes mellitus, which is the correct piece of advice?

A. avoid unhealthy foods such as sugary drinks or ice cream
B. drink only clear fluids such as water
C. Do not adjust your insulin doses
D. do not continue taking insulin if you are not eating
E. measure your ketones

E. measure your ketones

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A 65-year-old woman takes methotrexate 10mg weekly for rheumatoid arthritis. She has been maintained on this dose for over a year and her condition is stable.

How often does she need to have her full blood count monitored?

A. at least fortnightly
B. at least monthly
C. at least every twelve weeks
D. at least every six months
E. at least every year

C. at least every twelve weeks

NB: full blood count and renal and liver function tests repeated every 1–2 weeks until therapy stabilised, thereafter patients should be monitored every 2–3 months.

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A mother presents in the pharmacy with her anxious 14-year-old daughter who is going into a private hospital for a minor procedure. The mother has been advised to purchase a numbing cream OTC. Emla cream is available to buy.

What does Emla cream contain?
A. lidocaine with adrenaline
B. lidocaine with cetrimide
C. lidocaine with prilocaine
D. lidocaine with phenylephrine
E. lidocaine only

C. lidocaine with prilocaine

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A 67-year-old man is admitted to the hospital with an infective exacerbation of COPD. Pre-admission he was taking salmeterol 100 micrograms (Serevent), one dose twice daily and a salbutamol 100 micrograms inhaler to be used when required for his COPD. The patient has asthmatic features.

Which inhaler is the most suitable to add on to the treatment plan for this patient?

A. Clenil (beclometasone dipropionate)
B. Relvar Ellipta 92/22 (fluticasone furoate, vilanterol trifenatate)
C. Seretide 50 (fluticasone propionate and salmeterol xinafoate)
D. Trimbow (beclometasone dipropionate, formoterol fumarate dihydrate, glycopyrronium bromide)
E. Ultibro Breezhaler (glycopyrronium bromide, indacterol)

A. Clenil (beclometasone dipropionate)

NB: COPD with asthmatic features step is LABA + ICS then LABA + LAMA + ICS

In this case, patient already has LABA so adding only ICS

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A 4-year-old boy is prescribed salbutamol and Clenil (beclometasone CFC-free) metered dose inhalers from the pharmacist independent prescriber at the GP practice. He is also prescribed a spacer device. His father presents the prescription to your community pharmacy. You are counselling the parent and child on how to use both inhalers and the spacer.

What is the maximum duration that a spacer device should be used before replacing?
A. weekly
B.monthly
C. 6 monthly
D. yearly
E. 2 yearly

D. yearly

You should replace your spacer at least every year, especially if you use it daily, but some may need to be replaced sooner.

If it’s a new spacer, clean it before you use it for the first time, then once a month afterwards.

Take your spacer apart and gently clean it with warm water and a detergent, such as washing-up liquid.

Only a small number of brands of spacer are dishwasher safe, so check the instructions on the label.

Use warm water instead of boiling water, as boiling water may damage the spacer.

Be careful not to scrub the inside of your spacer as this might affect the way it works.

Leave it to air-dry as this helps to reduce static (an electrical charge that builds up) and prevent the medicine sticking to the inside of the spacer.

When it’s completely dry, put your spacer back together ready for use.

Wipe the mouthpiece or mask clean before you use it again. The correct answer is: yearly

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A woman presents into your pharmacy with her 3-year-old daughter. She wants to speak to the pharmacist regarding a skin rash around her daughter’s mouth. On closer inspection,n you can see fluid-filled blisters around her lips. From the symptoms, you have confirmed this to be bullous impetigo. The daughter has a penicillin allergy.

Which of the following is the most appropriate to recommend?

A. See GP for clarithromycin
B. See GP for flucloxacillin
C. See GP for fusidic acid 2% cream
D. See GP for tetracycline
E. Sell hydrogen peroxide cream

A. See GP for clarithromycin

NB: First line - Flucloxacillin, pt has penicillin allergy do Clarithromycin will be given

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A woman who has severe anaemia as a result of inflammatory bowel disease. She is due to receive iron viaintravenous infusion.

Which statement regarding intravenous iron is INCORRECT?

A. intravenous desferrioxamine can be given to manage iron overdose

B. intravenous iron can cause a serious hypersensitivity reaction

C. intravenous iron should be avoided in the second and third trimester of pregnancy

D. Patients should be monitored for signs of hypersensitivity for at least 30mins after every dose of intravenous iron

E. Patients with asthma are at an increased risk of hypersensitivity reactions associated with intravenous iron therapy

C. intravenous iron should be avoided in the second and third trimester of pregnancy

NB: only avoid in first trimester

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A woman who has severe anaemia as a result of inflammatory bowel disease. She is due to receive iron viaintravenous infusion. On discharge, the GP has advised the woman to continue taking oral iron tablets.

Which of the following statements regarding oral iron treatment is true?

A. common side effect of oral iron is tooth discolouration

B. Iron salts differ marginally in their efficiency of absorption of elemental iron

C. m/r preparations of iron are superior to immediate release preparations

D. oral iron is only available on prescription

E. oral iron and folic acid should be prescribed together to aid absorption of elemental iron

B. Iron salts differ marginally in their efficiency of absorption of elemental iron

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A 54-year-old man presents at the pharmacy and asks for advice about erectile function. He wants to know how often he can use CialisTogether (tadalafil) OTC without having to get it on prescription.

Which of the following is the recommended maximum use of Cialis Together?

A. once a day
B. twice a day
C. thrice a week
D. twice a week
E. once a week

E. once a week

The recommended dose is one 10mg tablet taken at least 30 minutes prior to anticipated sexual activity. It is not recommended for continuous daily use. Men who use this product frequently (i.e.at least twice weekly) should consult their physician to discuss whether a once daily regimen with the lowest doses of tadalafil would be more suitable. Cialis Together may be taken with or without food. The maximum dosing frequency is once per day.

RECOMMENDED dosing is ONCE A WEEK

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A 4-year-old girl is admitted to hospital. She is diagnosed with non-severe hospital-acquired pneumonia that is treatable with antibiotics.She has NKDA and takes no other medication.

Which of the following is the most appropriate antibiotic for her to take for a 5-day course?

A. amoxicillin 250mg/5mL suspension- 10mL BD

B. clarithromycin 250mg/5mL suspension- 10mL BD

C. co-amoxiclav 125mg/31mg/5mL suspension- 10mL TDS

D. doxycycline 100mg capsules – 1 BD

E. erythromycin 125mg/5mL suspension- 5mL QDS

C. co-amoxiclav 125mg/31mg/5mL suspension- 10mL TDS

HAP: CO-AMOXICLAV 500MG TDS FOR5 DAYS

CAP: AMOXICILLIN 500MG TDS FOR 5 DAYS

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Pneumococcal polysaccharide vaccine is an inactivated, 23-valent vaccine that protects against pneumococcal disease caused by Streptococcus pneumoniae.

At what age and over is this vaccine recommended to be given?

A. 25 years
B. 35 years
C. 50 years
D. 60 years
E. 65 years

E. 65 years

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A man who uses Pred Forte (prednisolone acetate 1%) eye drops to treat local eye inflammation.On handing the medication to him you provide him with some advice regarding the eye drops. The man also uses hypromellose eye drops for dry eye.

What advice would you provide the patient regarding using both his eye drops?

A. discard both eye drops 3 months after opening the bottle

B. Leave 5 minutes in between application of each eye drop

C. Store both eye drops in the fridge after opening the bottle

D. Use hypromellose eye drops each time after using Pred Forte eye drops

E. Use Pred forte eye drops more frequently because of the hypromellose eye drops

B. Leave 5 minutes in between application of each eye drop

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A grandmother presents in the community pharmacy with her 13-year-old grandson, who has had a cough for two days. He does not take any medicines for any reason and has no significant medical history. He has NKDA or red flags. You decide to recommend Simple Linctus Sugar-Free.

From what age is it licensed?

A. 3 months
B. 1 year
C. 2 years
D. 6 years
E. 12 years

E. 12 years

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Pharmacists working in registered premises are authorised to supply veterinary medicines when provided with a valid prescription. These can be for veterinary medicines or for human medicines if necessary.

Which of the below is NOT a legal requirement for a veterinary prescription for a prescription-only medicine?

A. Identification and species of the animal
B. Name and address of animal owner
C. Name, address, telephone number and qualification of prescriber
D. Written words stating ‘prescribed under the veterinary cascade’
E. Written words stating ‘prescribed under the care of the veterinarian’

E. Written words stating ‘prescribed under the care of the veterinarian’

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A 62-year-old woman broke her wrist in May 2024 and was started on bisphosphonate therapy. The patient takes zoledronic acid.

When should this patient’s bisphosphonate treatment be reviewed?

A. May 2025
B. May 2026
C. May 2027
D. May 2028
E. October 2026

C. May 2027

Bisphosphonate treatment should be reviewed after 5 years of treatment with alendronic acid, risedronate sodium or ibandronic acid, and after 3 years of treatment with zoledronic acid.

IN THIS CASE, PATIENT TAKING ZOLEDRONIC ACID

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An 8-year-old boy has been advised to take desmopressin 0.2mg tablets with instructions to take one at night for primary nocturnal enuresis. The patient’s mother comes into the pharmacy to ask for some advice about her son’s medication

Which of the below advice would be INCORRECT to give this patient’s mother?

A. an overdose of desmopressin may lead to reduced sodium levels

B. common side effects include stomach-ache, vomiting and a rash

C. if her son suffers from vomiting or diarrhoea, she should not give him his medication until his fluid balance is back to normal

D. if this desmopressin dose does not work, the doctor can choose to increase the dose to take 2 tablets daily

E. She should limit her son’s fluid intake from 1 hour before taking desmopressin dose and then for 6 hours after

When desmopressin tablets are used for the treatment of enuresis, fluid intake must be limited from 1 hour before taking the tablets at bedtime until the next morning and in any case for a minimum of 8 hours after administration.

NB: Treatment with desmopressin without restricting fluid intake may lead to fluid retention and/or hyponatraemia.

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A 36-year-old man takes levothyroxine for an underactive thyroid. He believes his medication dose needs increasing.

Which of the following symptoms is NOT typical for someone with an underactive thyroid?

A. bradycardia
B. brittle nails
C. constipation
D. heat intolerance
E. weight gain

D. heat intolerance

Common symptoms include:
tiredness
being sensitive to cold
weight gain
constipation
depression
slow movements and thoughts
muscle aches and weakness
muscle cramps
dry and scaly skin
brittle hair and nails
loss of libido (sex drive)
pain, numbness and a tingling sensation in the hand and fingers (carpal tunnel syndrome)
irregular periods or heavy periods

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A dose of medicine is made by diluting one part of the concentrate to four parts of water. How much concentrate will there be in a 20 mL dose?

A. 1mL
B. 2mL
C. 3mL
D. 4mL
E. 5mL

D. 4mL

A 78-year-old woman comes into your pharmacy complaining of heartburn. She brings a copy of her hospital discharge letter with her. This contains the following information: Reason for admission: Hip surgery on fractured neck of femur.

Newly started medications: Adcal D3 chewable tablets, alendronic acid tablets, codeine tablets, paracetamol tablets and macrogol sachets.

Which is the most appropriate course of action to take given her symptoms and history?

A. explain that the symptoms could be as a result of her new medication and sell her some Pyrocalm Control (omeprazole)

B. explain that the symptoms could be as a result of her new medication and sell her some Gaviscon liquid

C. explain that the symptoms could be as a result of her new medication and refer her to her GP

D. explain that the symptoms will settle in a few weeks and offer her diet and lifestyle advice to help reduce her symptoms

E. send her back to the hospital pharmacy to discuss her discharge medications

C. explain that the symptoms could be as a result of her new medication and refer her to her GP

NB: Patients (or their carers) should be advised to stop taking alendronic acid and to seek medical attention if they develop symptoms of oesophageal irritation such as dysphagia, new or worsening heartburn, pain on swallowing or retrosternal pain.

Also cause: Osteonecrosis of the jaw and external auditory canal and atypical femor fractures

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

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.

A 45-year-old man takes Priadel tablets (lithium carbonate modified release) 400mg ON for mania and simvastatin 20mg ON for primary prevention of cardiovascular disease. When should samples be taken after a dose and what target serum-lithium concentration is recommended for acute episodes ofmania? A. 2 hours and 0.4–1 mmol/litre B. 6 hours and 0.4–1 mmol/litre C. 6 hours and 0.8–1 mmol/litre D. 12 hours and 0.4–1 mmol/litre E. 12 hours and 0.8–1 mmol/litre

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

A 6-year-old boy has ADHD. He has no other medical conditions or NKDA.What would be the first-line treatment for this patient? A.atomoxetine B.bupropion C.dexamfetamine D.lisdexamfetamine E.modafinil

D.lisdexamfetamine

The trainee pharmacist is revising the pain ladder. He asks you when you would refer a patient for further investigation. Which of these back pain symptoms would NOT require referral to a GP? A. loss of bladder control B. numbness or tingling in the buttocks C. pain lasting for more than one week D. pain that is not relieved on resting E. pain that is worse at night or affects sleep

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.

For each scenario select the most likely adverse event from the list of side effects below: A 65-year-old man is prescribed flucloxacillin 1g QDS to treat his A. increased risk of QT interval prolongation B. increased risk of myopathy C. increased risk of tendonitis D. increased bleeding risk E. overdose F. risk of Clostridium difficile infection G. reduced seizure threshold H. treatment failure

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

For each scenario select the most likely adverse event from the list of side effects below: A 25-year-old woman with depression and epilepsy takes IV levofloxacin 500mg OD to treat hospital-acquired pneumonia.She also takes sertraline 100mg OM and lamotrigine 100mg BD. A. increased risk of QT interval prolongation B. increased risk of myopathy C. increased risk of tendonitis D. increased bleeding risk E. overdose F. risk of Clostridium difficile infection G. reduced seizure threshold H. treatment failure

G. reduced seizure threshold

For each scenario below select the most appropriate medication from the list: A woman with Raynaud’s syndrome is on first-line therapy to treat her condition. A.bendroflumethiazide B.diltiazem C.doxazosin D.labetalol E.lisinopril F.losartan G.nicorandil H.nifedipine

H.nifedipine

For each scenario below select the most appropriate medication from the list: A patient has failed to respond to a combination of a beta blocker and calcium channel blocker to treat their angina and thus has been commenced on the next suitable option. A.bendroflumethiazide B.diltiazem C.doxazosin D.labetalol E.lisinopril F.losartan G.nicorandil H.nifedipine

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.

For each description below select the most appropriate medication from the list: A nurse is looking for something to help her sleep due to her night shifts sleeping patterns. A.azelastine B.betahistine C.cetirizine D.chlorphenamine E.cyclizine F.diphenhydramine G.fexofenadine H.loratadine

F.diphenhydramine

Ms. A, a 72 years old women is admitted to hospital with a suspected hip fracture after experiencing a fall at home. Which of the following medication is least likely to have contributed to Ms A's fall? A. Amitriptyline B. Bendroflumethiazide C. Gliclazide D. Losartan E. Metformin

E. Metformin

Mr B, a 51-year-old man who attends the clinic for a health check. During the health check, you calculate the QRISJ for Mr B and find it greater than 10%. Mr B agrees to starting atorvastatin for primary prevention of cardiovascular disease. Three months later, Mrs B returns for a review. In addition to serum cholesterol, which of the following parameters should be measured 3 months after starting a statin? A. creatine kinase B. HbA1c C. liver function D. renal function E. thyroid function

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

Th pharmacy you work in offers the flu vaccine service to patients. You are aware that there are two main types of flu vaccine available: inactivated and live attenuated. Which of the following statements regarding flu vaccines is correct? A. all the children under 17 years of age are eligible to receive the nasal spray flu vaccine B. Inactivated vaccines are administered by nasal spray while the live attenuated vaccine is given by IM C. the live attenuated vaccine is given by nasal spray and inactivated vaccines are administered by IM D. the inactivated vaccines are administered by subcutaneous injection while the live attenuated vaccines are administered by IM and nasal spray E. patients with weakened immune system should receive the nasal spray flu vaccine rather the IM

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

Ms. H, a 66-year-old with COPD presents at the pharmacy with a prescription for Anoro-Ellipta 55/22mcg (umeclidium/vilanterol) inhaler and informs you that this is a new inhaler that the GP has just prescribed for her. She asks for your advice on how to use the Anoro-Ellipta inhaler. Which of the following is the best advice to give Ms H regarding using the Anoro-Ellipta inhaler? A. Ms H should take a deep breath in before using the inhaler B. Ms H will be benefit from using a spacer with this inhaler as it will help with the technique and reduce side effects C. She should close her lips firmly around the mouthpiece and breath in slowly and steadily D. She should close her lips firmly around the mouthpiece and take a long, steady, deep breath in E. The inhaler should be shaken before each dose

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)

6 year old girl that has burnt her right hand on the iron. The burn has affected approximately 20% of the hand and the area is red, swollen and blistering Miss I is in pain and her parents would like to administer paracetamol for pain relief. Which of the following is the most appropriate dose of paracetamol for Miss I? A. 4.6ml of 250mg/5ml every 4-6 hours, max 4 doses per day B. 5ml of 120mg/5ml every 4-6 hours, max 4 doses per day C. 5ml of 250mg/5ml eevery 4-6 hours, max 4 doses per day D. 7.2ml of 250mg/5ml every 4-6 hours, max 4 doses per day E. 10ml of 250mg/5ml every 4-6 hours, max 4 doses per day

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

Which of the following activities can the pharmacy staff conduct in the absence of RP? A. Sell a 15g tube of hydrocortisone 1% w/w cream to a 19-year-old female patient with eczema on her hand B. Sell a 100ml bottle of Benadryl Allergy Children's 1mg/ml oral solution (cetrizine hydrochloride 1mg/ml) to be used by a 5-year-old child with hay fever C. Sell a 30g tube of crotamiton 10% w/v cream to a 23 year old female patient with sunburn D. Sell a pack of 32 paracetamol 500mg soluble tablets to a 35 year old female patient with migraine E. Sell a pack of 24 ibuprofen 200mg tablets to 27 year old male patient with back pain

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

Master T, an 8 years old boy presents at the pharmacy with his father. Master T's father explains that two days ago, his son developed red sores around his nose and mouth which since burst leaving behind thick golden crusts. Master T explains that although the sores were a little itchy, he is not in any pain and is otherwise well but does not like having the crusts on his face and would like to advise on treatment to remove them. You measure Master T's temperature in the pharmacy to be 37.1. Master T confirms he is not on any regukar medication and has NKDA. Which of the following is the most suitable advice to give Master T? A. Advise Master T that he has viral infection that is self-limiting and should resolve without treatment within 7 days B. Advise Master T to see GP as he needs treatment with a 7-day course of oral fluclox C. Advise Master T to see the GP as he needs treatment with fusidic acid 2% cream for 5 days D. Advise Master T to see the GP as he needs treatment with mupirocin 2% cream for 5 days E. Sell Master T hydrogen peroxide 1% cream and advise him to apply it two or three times a day for 5 days

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%

Following a recent blood test and urine sample, Mr U a 67 year old patient with type 2 diabetes mellitus is found to have an HbA1c of 69mmol/mol and an eGFR of 32ml/min/1.73m2. He is currently taking metformin 500mg BD and linagliptin 5mg OD to manage T2DM. A decision is made to intensify diabetes management. Mr U has BMI of 35.3kg/m2 Which of the following is the most appropriate action to take? A. add canagliflozin 100mg daily B. Add exenatide 2mg once weekly C. Add gliclazide 80mg in the morning D. Add insulin glargine 100units/ml E. Increase the metformin to 1000mg BD

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

Mrs Bean is travelling to Ghana for 1 week in a month's time, she asks you what tablets she should take to protect her from catching malaria as she knows she will need tablets for this. She is currently taking citalopram 40mg, she says she wants the shortest course of the treatment for the malaria cover. You check the guidance and note there is a high risk of malaria in Ghana. Antimalarials recommended: atovaquone with proguanil or doxycycline or melfloquine Which of the following is the most appropriate prophylaxis regimen for her? A. 7 Melfloquine 250mg B. 15 Doxycycline 100mg C. 15 Atovaquone with proguanil 250mg D. 36 Atovaquone with proguanil 250mg E. 36 Doxycycline 100mg

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)

Bade is a 13 years old has been admitted to the children's ward with a new diagnosis of Crohn's disease. Which of the following would the most appropriate treatment on admission? A. Azathioprine B. Enteral feeding C. IM methylprednisolone D. oral prednisolone E. Sulphasalazine

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

A 56-year-old women attends a warfarin INR monitoring clinic. She takes warfarin for AF and has a target range of 2.0-3.0. On her last appointment 4 weeks ago, she had an INR of 2.3 and was told to continue taking her normal dose of 3mg daily. She has been stable on this dose for the past 6 months. The patient's INR today was 5.2. On questioning, she reports that she has not missed any doses, has had no chnages to diet, and does not drink any alcohol. She has however recently started some new medications. Which of the following medications is the most likely to have caused the increased INR? A. Bisoprolol B. Carbamazepine C. Doxycycline D. Lithium E. Theophylline

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

A 74-year-old presents two weeks after having starting topical treatment with 5-fluorouracil 5% (5-FU) cream. The cream was prescribed to be used twice daily for 4 weeks for actinic keratosis on the forehead. The patient expresses concerns due to a reaction to the cream. They inform you it started a few days ago and has gradually got more irritable since. What initial advice would be most appropriate to offer? A. They have likely had an allergic reaction to 5-FU or an excipient and should discontinue the cream whilst they seek medical advice. B. They are likely had an allergic reaction to the active ingredient or an excipient but should try to continue with treatment, using moisturisers to settle the irritation, whilst they seek medical advice. C. This is a sever form of an expected reaction of UV-damaged skin to 5-FU, they should try to continue with treatment and seek medical advice D. This is a severe form of an expected reaction of UV damaged skin to 5-FU, they should try to continue with treatment but reduce application frequency to once daily and 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 the course 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.

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.

Mr E, a 78-year-old man, presents to A7E with symptoms of vomiting, dizziness, agitation and confusion. He is accompanied by his daughter who explains that, 30 minutes ago, Mr E accidentally took four of his verapamil hydrochloride 120mg. Which of the following would be the most appropriate drug to manage the patient's symptoms and associated poisoning? A. Acetylcysteine B. Adrenaline C. Activated charcoal D. Dicobalt edetate E. Naloxone hydrochloride

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

Ayesha is a 55-year-old women who has been on Vagifem (estradiol hemihydrate) vaginal tablets for 12 months and found it works well to control her symptoms for vaginal atrophy. She has requested a supply of Gina OTC as she has seen this in the pharmacy and finds it easier to come in than see her GP Which of the following is the most appropriate advice regarding the supply of Gina to Ayesha? 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 B. Gina can be purchased OTC for use as one tablet daily for the first 2 weeks and then one tablet twice a week thereafter, and she should return for her next supply after 7 weeks C. Gina should not be supplied to women over 54 years of age due to increase risk of breast cancer D. Gina will help with all symptoms of menopause and cen be purchased as long as she switches immediately from Vagifem with no breaks E. she must go back to see the GP for approval before she can purchase Gina to replace Vagifem

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.

A 67-year-old man comes to the community pharmacy seeking pain relief for muscle injury. He mentions a friend recommended ibuprofen. The patient has a medical history of epilepsy, hypercholesterolemia, hypertension and gout, and is taking sodium valporate, atorvastatin, allopurinol and amlodipine regularly. He is also on a 2-week course of ciprofloxacin for acute cholecystitis. You advise him that ibuprofen is not suitable due to a potential drug interaction. Which of his medications is most likely causing this interaction with ibuprofen? A. Allopurinol B. Amlodipine C. Atorvastatin D. Ciprofloxacin E. Sodium Valporate

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

Ms B, a 42-year-old female attended the GP surgery for an NHS health check. During the consultation, she was advise that her clinical BP was raised, and she was referred for ABPM. Ms B asked for advise about what BP she should aim for when measuring at home. Ms B has no long term health conditions and takes no regular medication.

<135/85 mmHg

Mr C, an 82-year-old patient with a history of hypertension for which he takes amlodipine, visits the GP surgery for a hypertension review. During the review, Mr C's blood pressure is measured, and he asks what his BP should be, Mr C has no other long term conditions and takes no other regular medication.

<150/90 mmHg

Mrs W, a 64-year-old woman who suffers from resistant hypertension and is compliant with medication. She is currently taking ramipril 10mg OD, amlodipine 10mg OD, indapamine 2.5mg OD. Her blood potassium level is 4.2 mmol/L A. Amlodipine B. Bendroflumethiazine C. Bisoprolol D. Diltiazem E. Indapamide F. Losartan G. Ramipril H. Spironolactone

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

Mr B, a 50 year-old male with uncontrolled high BP. He suffers from diabetes and is currently taking metformin 500mg TDS, lisinopril 20mg OD and amlodipine 10mg OD. A. Amlodipine B. Bendroflumethiazine C. Bisoprolol D. Diltiazem E. Indapamide F. Losartan G. Ramipril H. Spironolactone

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

A concerned parents presents to the pharmacy with their 4-year-old child as they are concerned about a red blanching rash that has recently developed on the child's chest and tummy. They explain that initially, a couple of days ago, they had a high temperature (39 degrees cantigrade) and a sore throat. A white coating has started to develop on the child's tongue this morning which the parent describes as ' looking like strawberry'. The rash has now spread to the rest of the body and has a rough texture. They are not on any medication, have NKDA and have not tried anything A. Suggest booking an urgent appointment with their GP B. Suggest calamine lotion and Piriton syrup C. Suggest clotrimazole 1% cream D. Suggest clotrimazole 2% cream E. Suggest going to A&E F. Suggest hydrocortisone 1% cream G. Suggest paracetamol oral suspension H. Suggest using an emollient

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

A 22-year-old women presents with red, scaly patches on elbows and knees. The lesions are well-demarcated and covered with silvery scales. She reports that the patches are sometimes itchy but more often they are just unsightly. She mentions that her mother has a similar skin condition. A. Acne vulgaris B. Atopic dermatitis C. Psoriasis D. Rosacea E. Tinea versicolor F. Eczema G. Melasma H. Contact dermatitis

C. Psoriasis scaly and itchy patches

A 35-year-old man comes to the clinic with redness on his cheeks and nose. He mentions that his skin often feels hot, and he gets red bumps that look like pimples but are not filled with with pus. The symptoms worsen when he drinks alcohol. A. Acne vulgaris B. Atopic dermatitis C. Psoriasis D. Rosacea E. Tinea versicolor F. Eczema G. Melasma H. Contact dermatitis

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

A 40-year-old women complains of dark, irregular patches on her face, particularly on her cheeks, forehead and upper lip. She notes that the discolouration started gradually over the past few months, and she is often outdoors. She is currently on oral contraceptive pills and spends a lot of time in the sun due to her outdoor job. A. Acne vulgaris B. Atopic dermatitis C. Psoriasis D. Rosacea E. Tinea versicolor F. Eczema G. Melasma H. Contact dermatitis

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

A 22-year-old man reports painful blisters on his penis that have appeared over the last few days. He also has flu-like symptoms, including fever and body aches. He recalls a similar episode occurring about six months ago. He is diagnosed with genital herpes. He prefers a treatment requires the least frequent administration A. Aciclovir B. Azithromycin C. Benzathine penicillin G D. Ceftriaxone E. Doxycycline F. Metronidazole G. Phenoxymethylpenicillin H. Valacyclovir

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