MOCK CLINICAL 5

Single best answers (90 Questions)

⦁ Mrs Rena Ava comes into your pharmacy to ask for your advice about the influenza vaccine. She has received a letter that morning from the GP surgery inviting her to bring her 3-year-old son to a clinic next week to receive the intranasal influenza vaccine. The child does not have any medical conditions, has no known allergies and does not take any regular medication. The child currently has a cold and a slightly runny nose but does not have a temperature and is not systemically unwell. Mrs R has a lot of questions about the vaccine and you advise her appropriately.

Which one of the following is true?

You receive a prescription for zuclopenthixol deconate depot injections for Mrs Abigail Knowles. Your patient medication record system shows that Mrs A.K usually takes zuclopenthixol tablets.

Which one of the following is most likely reason that the zuclopenthixol has been changed from tablets to depot injection?

Which one of the following patients, with symptoms of a chest infection, is at greatest risk of complications as a result of the infection and is in most need of immediate intravenous antibiotics?

Mr Abu Basu is one of your patients in the cardiology ward. Mr A.B has a history of heart failure with sinus rhythm , hypertension, and previous suffered from myocardial infarction 2 years ago. She is on the following medication:

⦁ Ramipril 5mg BD
⦁ Digoxin 125mcg OD
⦁ Bisoprolol 5mg OD
⦁ Aspirin 75mg OD
⦁ Furosemide 40mg BD

One of the junior doctors on your wards has found out from Mr A.B biochemical blood readings and from the senior registrar that Mr A.B has newly diagnosed severe bilateral renal artery stenosis. Which of the following Mr A.B’s medication should be stopped and should be avoided in patients with severe bilateral renal artery stenosis?

Pharmacists are required to apply evidence to their practice. Often results of a clinical trial are analysed statistically. Which of the following p values indicates a result that is statistically significant?

You are a pharmacist working in the anticoagulation clinic. Mr Micheal Shaw is a regular patient of yours on warfarin. His INR was recorded at 6.5 today and he reports no signs of bleeding or bruising. He drank more alcohol than usual two days before his clinic visit. He is on a regular alternating dose of 3mg and 4mg. Which of the following is the most appropriate action to take:

Mr Mendes Ru is one of your regular patients who passed away two weeks ago and her daughter returned six diamorphine 30mg ampoules and a sealed 500ml bottle of Oramorph 10mg/5ml. Which one of the following statement is legally correct?

Your pharmacy is participating in a public health campaign to raise awareness of the benefits of the benefits of influenza vaccination and to encourage all patients who are eligible to have the vaccination via their general practitioner (GP) and to get into the habit of booking an appointment to have the vaccination administered on a yearly basis. You discuss the importance of having an influenza vaccination with Mrs Aya Yumencko (who has not had the vaccine before but is eligible for it under the NHS). By the end of your discussion, she promises you that she will come to a decision by tomorrow and contact you whether she would like to book an appointment with you or her GP to get the vaccine. Which stage of the ‘stages of change model’ is Mrs A.Y at?

Mr Barber Allan comes into your pharmacy regarding his alcohol addiction. Your pharmacy has recently started an alcohol awareness campaign and you decided it is a good idea to promote the campaign by starting with Mr B.A. Mr B.A currently has 2 pints of lager every day in the evening. How many units does this equate to weekly and is Mr B.A within the national guideline for alcohol intake for men?

Practising evidence-based medicine requires practitioners to critically appraise the available evidence. Which of the following correctly lists 3 types of research in order, from the highest level of evidence to the lowest?

Case controlled trial = CCT
Observational study = OS
Randomised controlled trial = RCT

Regarding audit, which one of the following statements is true?

A patient comes into your pharmacy requesting to buy some paracetamol 500mg tablets. The patient is requesting if you could supply them the maximum amount of paracetamol tablets under your discretion. What is the maximum number of paracetamol 500mg tablets that may legally be sold from a registered pharmacy at any one time to a person without a prescription in terms of pack sizes?

Whilst working as a locum pharmacist in a community pharmacy you realise that a dispensing error was made the previous day when penicillamine was dispensed instead for phenoxymethylpenicillin. Which of the following statements regarding dealing with complaints in respect of a dispensing incident is not true?

Regarding continuing professional development (CPD) which one of the following statements is false?

Which one of the following is the average time that it takes for a healthy adult to excrete one unit of alcohol?

A 55-year old male with past medical history of prolongation of QT interval. You are doing your drug history taking for this patient as part of the medicines reconciliation. You are concern that due to the patients past medical history certain medications should not be used or is contraindicated in this patient. Which one of the following drugs is contraindicated in patients with risk factors of prolongation of the QT interval?

In which of the following situations would it be permissible to disclose confidential patient information without a patient’s consent?

Which of the following processes is not an example of clinical governance?

You are dispensing medication on your usual day as a locum pharmacist where one of your pre-registration students asks about the legal requirements on a dispensing label. Which one of the following is not required by law to be on broken down from bulk container for dispensing?

You are newly qualified pharmacist working on the neurology ward and come across a patient who has recently been started on phenytoin. You are aware that phenytoin is narrow-therapeutic index medication and requires patients to have a desired therapeutic range. Which of the following is the desired therapeutic range of phenytoin?

In your ward, you have a patient that has been diagnosed with septicaemia and the consultant has prescribed the patient gentamicin at a dose of 3.5m/kg in 3 divided doses to be given as a multiple daily dose regimen and the doses to be divided every 8 hours by IV over 3 minutes. A blood sample was taken 1 hour after the dose was administered and the pre-dose (trough) concentration came back as high. The consultant asks for your advice on what would be the most appropriate action to ensure the pre-dose (trough) concentration remains normal. Which one of the following options would be the most appropriate advice regarding the gentamicin pre-dose (trough concentration)?

Questions 22 to 24 concern Mr Zahir Ahmed who is diagnosed with non-Hodgkin’s lymphoma and whose doctor wants to initiate filgrastim (Accofil) for the reduction of neutropenia with the treatment of chemotherapy for Mr M. Mr M renal and hepatic functions are normal and he has is known to have fructose intolerance. (https://www.medicines.org.uk/emc/medicine/29329)

The doctor wants to administer filgrastim (Accofil) for the indication of maintaining normal neutrophil counts which of the following statements is true?

Mr Z.A asks you for information relating to side-effects. Which of the following statements is true in relations to side-effects of filgrastim (Accofil) IV?

Mr Z.A has fructose intolerance and certain excipients can trigger this intolerance. Which one of the following is true about filgrastim IV?

A patient comes to your pharmacy with an unexpected rash and has been complaining of high fever, general malaise and swollen lymph nodes. The patient has recently started some medication 3 weeks ago. Patient’s medical history includes epilepsy, hypertension and type 2 diabetes. You suspect that this could be due to a medication that is causing the symptoms. Which one of the following medications is most likely to have caused the patients symptoms?

Mr Batista Amero a 77 year old man has been diagnosed with leukaemia and has been prescribed vincristine. The oncology consultant wants to administer vincristine IV at a dose of 1.4 to 1.5 mg/m2 up to a maximum weekly dose of 2 mg. You are aware that vincristine is a vinca alkaloids and has certain side effects when administering vinca alkaloid. Which of the following is the most concerning side-effect that requires monitoring when administering vinca alkaloids?

Mr Alverez Winoa a 45 year old man has been diagnosed with advanced osteoarthritis and the doctor wants to start Mr AW on NSAID’s. However, Mr A.W has a history of medical conditions that may make NSAID’s unsuitable to be prescribed for his condition. Which of the following conditions are NSAID’s contraindicated in?

A 5-year old child has been diagnosed with chronic asthma. The doctor has prescribed standard-dose of inhaled corticosteroid (beclometasone dipropionate) inhaler. Which of the following doses is the most appropriate dose for a 5 year old child diagnosed with chronic asthma?

A one-year old child has been diagnosed with urinary tract infection. The doctor has decided to prescribe the child amoxicillin for the urinary tract infection. The doctor asks you for a recommended dose for the child. Which of the following is the most appropriate dose for a 1 year old child?

Baby C’s mother comes to your pharmacy to ask you about Baby C’s vaccines. Baby C’s mother is aware that Baby C is due a vaccine within 3 months. Baby C is currently 3 months and the mother is asking which vaccine Baby C will receive at 3 months stage. Which of the following vaccines will Baby C be due when Baby C is 3 months of age?

Mr Aman Srivastav a 56 year old man comes to your pharmacy reporting symptoms of sore throat, fever and rash and mouth ulcers. The patient tells you that have been recently started on a short course medication for urinary tract infection from their GP. The patient takes the following repeat medication:
⦁ Carbimazole 10mg BD
⦁ Trimethoprim 100mg BD (newly started) for UTI
⦁ Mirtazapine 45mg OD
⦁ Diclofenac 75mg TDS
⦁ Co-codamol 8/500 capsules 1 QDS

Which of the following medication is most likely the cause of Mr A.S sore throat, fever and rash and mouth ulcer symptoms?

⦁ A 21 year old woman comes to your pharmacy today requesting an emergency contraceptive pill. She had unprotected sex yesterday and she is one the first week of her menstrual cycle and she is asking for your advice what would be the most recommended action to take in order to reduce the chances of pregnancy. The patient is on the following medication:
⦁ Carbamazepine 200mg BD
⦁ Paracetamol 500mg 1 QDS
⦁ Ferrous sulphate 200mg 1 TDS

What would be the most recommended course of action for her to take in order to reduce the risk of pregnancy?

Questions 33 to 35 concern Mr Mohammad Qayyum who is diagnosed with tumour-induced hypercalcaemia and whose doctor wants to initiate Pamidronate (Medac). Mr M renal and hepatic functions are normal and he has is no known drug allergies. (https://www.medicines.org.uk/emc/medicine/15008).

The doctor wants to administer pamidronate to Mr M.Q and asks for your advice on how to administer pamidronate. Which of the following statement is true regarding the administration of pamidronate?

Mr M.Q blood results indicated a calcium level of 2.4 mmol/l and the Dr wants your advice on what the recommended dose for Mr M.Q according to his calcium level for the treatment of tumour induced hypercalcaemia. Which of the following is the appropriate dose to be initiated for Mr M.Q?

Which of the following statements is true about pamidronate?

A 31 year old woman has come to the GUM clinic regarding advice on starting on contraceptives. She is concerned about starting on oral contraceptives as her friends on have been using oral contraceptives have had serious weight gain which is a side effect of oral contraceptives. However, she has heard that one of the oral contraceptives can help lose weight and prevent weight gain that she would like to consider to start on. Which of the following oral contraceptives prevents weight gain?

Mr Tapas Buyako a 42 year old man comes to your pharmacy requesting for a blood pressure check. You notice that Mr T.B blood pressure is high compared to his normal range. His blood pressure was recorded at 150/95mmHg. Mr T.B has recently been prescribed some steroid medication. You suspect that one of his medications could be causing his blood pressure to rise. Which one of the following steroid medication may cause a rise in blood pressure as a side effect?

A patient has been diagnosed with G6PD-deficiency. You are aware that some drugs used in G6PD-deficiency can increase risk of haemolysis in patients with G6PD-deficiency. Which of the following drugs is most risk of haemolysis in G6PD-deficiency?

A patient comes to your pharmacy asking you about some information of cytotoxic drugs. The patient has been recently been prescribed some cytotoxic drugs from his consultant during his hospital stay. The patient wants to know what side effects are caused by cytotoxic drugs. Which of the following options is not a side-effect of cytotoxic drugs?

In your community pharmacy, you notice one of your dispensers is preparing a compliance aid box for a patient and you notice that your dispenser is handling a medication that should not be handled by using hands. Which of the following medication should not be handled by women of child-bearing age?

You are working at your regular shift at a community pharmacy and you notice a 7 year old child has ingested a substance that has caused a fatal anaphylactic reaction. The patient is having difficulty breathing and their lips have swollen. You decide to administer an adrenaline injection to the patient. Which of the following dose is most appropriate for 7-year-old child?

Mr Paul Archer has attended your pharmacy regarding his 5-year-old son with a “sticky eye”. Upon examining the eye of the child, you decided that the child is suffering from bacterial conjunctivitis and offer to treat with it with chloramphenicol eye drops or eye ointment over the counter. Mr P.A is concerned about how he will administer the either preparation to his on as he mentions that he is very fidgety and cannot stay still for long enough. Which one of the following options below would be the inappropriate advice to give to Mr P.A?

You are a locum community pharmacist and has been asked to make an assessment on patient to use multiple compliance aid (MCA). However, you are aware that there are stability concerns that could affect whether it is safe and effective to dispense medicines in this way. Which one of the following medicines is suitable for dispensing into an MCA?

You are working as a locum pharmacist in the community setting with a pre-registration pharmacist who has asked you about reporting adverse drug reactions. The pre-registration pharmacist has asked you that as per MHRA guidance to healthcare professionals will no longer need to report which suspected adverse drug reactions to the Yellow card scheme?

Questions 45 to 47 concerns Mrs Barbara Rains who has received a prescription for Fentalis Reservoir 25mcg/hr transdermal patch, dosage instructions includes: ONE patch to be applied every 72 hours and she has been supplied 4 patches in total. She is concerned about this new medication and wanted some advice and counselling regarding the patch. You notice on her PMR that she is also taking morphine 10mg/5ml solution, 2.5mls every 4 hours when required for breakthrough pain. The summary of product characteristics (SPC) for Fentalis Reservoir can be accessed here: https://www.medicines.org.uk/emc/product/6548/smpc#gref

Which of the following statements regarding Fentalis Reservoir 25mcg/hour transdermal patch is true?

Which of the following is medicines is least likely to interacts with Fentalis Reservoir 25mcg/hour transdermal patch?

Mrs BR would like to know some counselling points for starting herself on this new pain patch (Fentalis). Which of the following counselling points would be inappropriate to give to Mrs BR in regard to the treatment with Fentalis 25mcg/hour transdermal patch?

Mr Yui Fi has been recently diagnosed with Parkinson’s disease. He has been prescribed procyclidine due to suffering from extrapyramidal side effects that are associated with his Parkinson’s therapy using L-dopa. You are concern that the initiation of this medicine could lead to more harmful side effects to the patient. Which of the following is the least likely side-effect of procyclidine?

A mother of 7-year old female child has attended your pharmacy regarding her child. The mother is concerned about a spot that has appeared since few weeks ago and has not subsided away. She is really concern about the spots and would like to ask you to have a look at the spots. The child is generally fit and well and has not complained about the spots. Below is a picture of the spots:

What is the most likely cause of the 5-year-old child spots?

A 55-year-old male has attended your diabetes clinic and has been made aware that his HbA1c level is above 6.5% which indicates that he has diabetes. The general practitioner has decided you to prescribe the most appropriate diabetic medication for this patient as part of your independent prescribing training. You have been made aware that this patient has a history of gastrointestinal related problems. Which of the following anti-diabetic medications will require slow upward titration of its dosing regiment to avoid gastro-intestinal related side effects?

A GP has asked you some information regarding the potency of topical corticosteroids. The GP has asked you a recommendation of a potent topical corticosteroid cream that needs to be prescribed to as patient with uncontrolled flare-ups of their eczema condition. Which of the following contains a potent topical corticosteroid?

A 3-year-old child presents to your pharmacy with an unusual rash accompanied by fever, cold-like symptoms, conjunctivitis, cough. The child also seems to get very irritated easily upon seeing the child. The rash has small, greyish, irregular lesions surrounded by the erythematous base, occurring on the inside of the cheeks. The mother of the child who brought the child to your pharmacy mentioned the child experiences these symptoms 3 to 5 days accompanied by a maculopapular rash that appeared behind the ears at first then spreading down to the body and becoming confluent and fading by the third day. Below is a picture of the rash shown present at the pharmacy:

Which of the following conditions would explain the likely cause of the rash and accompanied symptoms of the child?

Questions 53 to 55 concerns Mrs Jacob Michaels who a 55-year old plumber is who is collecting their monthly prescription of Byetta from the hospital outpatient pharmacy. He has brought in a new prescription to the outpatient pharmacy and you have noticed his does has been increased to 10mcg twice daily. You are also aware he is on bisoprolol 5mg once daily, atorvastatin 40mg at night and metformin 500mg three times a day. He has a BMI of 34 kg/m2 . The summary of product characteristics (SPC) for Byetta 10 micrograms solution for injection can be accessed here: https://www.medicines.org.uk/emc/product/8617/usermanual#gref

Which of the following is a side-effect of Byetta which occurs in <1/10000 patients?

Which one of the following vitamins should be taken in its hydroxylated form by patients with severe renal impairment?

Which of the following statements is true regarding use of Byetta?

Mrs Gabriella Braun has asked for your advice regarding a developed a sore mouth over the past 24 hours. On examination the inside of her cheeks and tongue you notice it looks red and raw. You suspect the newly started inhaler (Symbicort) initiated by the GP may have caused the sore mouth this. Which of the following would be the most appropriate initial treatment for Mrs G.B?

A 77-year-old man who has recently been started on bisoprolol 5mg once daily tablet for hypertension. He has attended his 3-month follow-up review of his blood pressure with you as part of your clinical medication review. He mentions that since being started on bisoprolol he has been suffering from nightmares and coldness of extremities of his hands which could be a side-effect of the bisoprolol. He wanted to know if there is any possibility of alternative medication for his hypertension as these side-effects have been causing him some concern. Which one of the following beta-blockers is least likely to give the side-effects that the gentlemen has been suffering from?

A 45-year-old man has attended the emergency department at the hospital with shortness of breath and tachycardia. He has recently been on business travel from America and landed in the country yesterday. After examination and laboratory testing the junior doctor confirms that the man has a pulmonary embolism and will need to commence on anticoagulant as soon as possible but is unsure which anticoagulant should be used. Which of the following anti-coagulant regimen should be used in the initial management of a suspected pulmonary embolism?

Miss Jennifer Morrison is one of your regular patients and this afternoon she comes into your pharmacy to buy some A-Z multivitamin tablets. Earlier that morning her GP diagnosed her with a number of vitamin deficiencies. She mentioned that the blood results show deficiencies in vitamins A, D, E, and K. However, she was unsure that if she needs to purchase any over the counter multivitamins or get them prescribed by her doctor as she is unwilling to pay for them. You are aware that one of her medicines on her PMR may be causing vitamin deficiencies. Which of the following of her regular medicines may be causing this vitamin deficiency?

Mrs Elizabeth Ackerman comes into your community pharmacy to collect her regular prescription. While handing out her medicines you notice that she is wearing new tinted spectacles. Upon further questioning, you acknowledge that when she is driving, she gets dazzled by car headlights and decided to get her spectacles tinted. Your check her PMR and come to an assumption that this could be caused by one of her regular medications that she has been started recently. Which of her regular medicines may have contributed to this?

A 21-year-old female is wanting to start on contraceptive treatment. She has asked her GP to recommend the most appropriate contraceptive treatment however the GP is aware from her medical records that she is an epileptic patient who is one carbamazepine. The GP has asked you that which would be the most appropriate contraceptive due to possible interaction with her epileptic medication that could cause her contraceptive method to fail.

An 18-year-old male has come to your pharmacy complaining of migraine symptoms and would like to purchase Imigran (sumatriptan) over the counter (OTC). She has made you aware that she has had them before, and it has been over 6 months since she last used them. You decide to sell her Imigran, but she mentioned she would like to be counselled again on this medication. Which of the following statements regarding Imigran is incorrect?

A patient who has recently been started on atorvastatin 40mg daily for the treatment of familial hypercholesterolemia. You are aware that statins require certain blood parameters to be monitored when patients have been newly started on statins. Which of the following blood parameters should be monitored in addition to serum cholesterol?

You are currently delivering a teaching session on the ward at your hospital where one of the pre-registration pharmacists is shadowing you in the ICU ward and comes across a patient who is receiving total parenteral nutrition (TPN). The pre-registration pharmacist asks you to explain what is meant by TPN. Which of the following statements best describes TPN?

A 21-year-old female who is 21 weeks pregnant is suffering from symptoms of possible urinary tract infection. She has been displaying symptoms of burning sensation when urinating and her urine appearance is dark and cloudy of nature. She has been made aware that she has a urinary tract infection that has been diagnosed by the GP after a urine dipstick that showed a presence of nitriles which indicates a urinary tract infection. The GP has asked for you advice to recommend the most suitable antibacterial to treat her symptoms of a urinary tract infection. The GP has also mentioned that she is allergic to penicillin. Which of the following bacterial agents would be the most suitable to treat for a urinary tract infection?

⦁ A mother of 10-year-old child has come to pharmacy to purchase some painkillers for a headache for her 10-year-old child. You decide to recommend her Calpol six-plus oral suspension to treat for the child’s headache. The mother has asked you about the sugar content in certain medicines that are in liquid form and would like to ask what ingredients in medicines should she lookout for that contents sugar. Which of the following excipients are known to be a sugar in medicines?

A newly qualified nurse on the ward is preparing an intravenous injection to a neonate for the prophylaxis treatment of infections for a newborn. However, she is aware from knowledge that certain excipients can be fatal to neonates when being administered intravenously. She has asked for your advice regarding which excipient should be avoided in pre-term neonates. Which of the following excipients should be avoided in pre-term neonates when administering intravenously?

You are conducting a health-check for a 55-year-old male as part of your healthy living campaign as part of being a healthy living pharmacy. You have conducted the health check and made the gentlemen aware that he is known to have certain risk factors for coronary heart disease. He has asked you about the risk factors that makes him at risk of developing coronary heart disease. Which of the following is known to be a risk factor of developing coronary heart disease?

Mrs Kazmina Ajan is a 50-year old black South African lady who has been resident in the UK for nearly 10 years has just been diagnosed with hypertension. The GP has also assessed her for the risk of heart failure and deems to be at high risk. She has no known allergies and is only currently on allopurinol for the prophylaxis of gout. As part of your independent prescribing competency and training, the GP has asked you to prescribe the most suitable anti-hypertensive medication for Mrs KA. Which of the following would be the most appropriate first-line antihypertensive treatment for Mrs KA?

Mrs Pamela Forbes has come to your pharmacy complaining of unusual bowel problems. She has been suffering from constipation for the past few weeks and is would like to ask you if any of her regular medicines could be causing her issues. Which of the following medicines would be least likely to be causing constipation?

Questions 71 – 73 concerns a patient on the infectious disease unit who has been newly prescribed intravenous ciprofloxacin 400mg BD which will be required to continuous on discharge by the hospital’s outpatient parental antibiotic therapy service. The summary of product characteristics (SPC) for ciprofloxacin 2mg/ml solution for injection can be accessed here: https://www.medicines.org.uk/emc/product/9225

The nurse on the ward has asked you that she wants to reduce the burden on the patient when administering the ciprofloxacin via intravenously. She has asked you what is the least amount of infusion time required to infuse the required dose for the patient?

The nursing team would like to ensure the IV cannula is locked with Hepsal (Heparinised saline 50units/mL) to ensure potency is maintained. Which of the following would be least appropriate to advise the nursing staff in locking the IV cannula?

The nurse has realised that the infusion was set at higher rate then it should have, and she thinks the patient has been overdosed with ciprofloxacin and is concerned that patient have been harmed or displaying overdose symptoms. which of the following statements would be most appropriate to advise the nurse regarding overdose of ciprofloxacin?

Mr Yankee Martin who has been admitted to the acute assessment unit with a suspected G.I bleed. You been made aware that Mr Y.M is not from the UK and is resident in Iceland and has only come to visit the UK to see his granddaughter. You conduct a drug history and notice he has brought in two medicines that he regular takes that are from Iceland with brand news of Xtandi and Reyka. Which of the following resources would be most useful to use to find out the generic product ingredients that Mr Y.M has presented with?

Questions 75-78 relates to a 55-year-old man who has had some recent biochemistry, full blood count and liver function test which are shown below. His previous results were normal prior to surgery that was taken place 3 days ago. Below is the biochemistry, full blood count and liver function test 3 days after the surgery.

Biochemistry results are show below:

He has recently had an elective knee replacement surgery few days ago and has a history of hypertension, hypercholesterolemia, and type 2 diabetes. His medication history includes the following:

• Amlodipine 5mg tablets once daily
• Tinzaparin 4500units once daily for 28 days (Post-surgery)
• Spironolactone 25mg once daily
• Ramipril 10mg once daily
• Atorvastatin 20mg once daily
• Paracetamol 500mg four times a day (Post-surgery)
• Codeine 15mg four times a day when required (Post-surgery)
• Ibuprofen three times a day (Post-surgery)
• Lactulose 10mls twice a day (Post-surgery)

Which of the following medications could be the likely cause of the patient’s low platelet levels?

Which of the following medications could be the likely cause of the patient’s low haemoglobin level?

Which of the following medication could be the likely cause of the patient’s poor renal function?

Which of the following medications should be stopped temporary in the light of the patient’s poor hepatic function?

A mother of 4-year-old child has come to your pharmacy asking for advice on the use of fluoride supplement for her child. She is has made you aware that the local water supply in her area is 500 micrograms per litre. She asks for your advice of the recommended daily dose of fluoride ion would be most appropriate for her child?

The spinal surgeon on the surgical assessment unit has approached you regarding medication interactions regarding a patient who has acute porphyria. The patient has is currently recovering from the surgery but has noticed the patient is experience some symptoms of a possible urinary tract infection that could be due to their urinary catheter/ The surgeon would like to start them on some antibiotics to help clear the infection but is concern some of the antibacterial may not be suitable due to their condition of acute porphyria. Which of the following antibiotics would be least suitable in patient with acute porphyria?

A 55-year-old patient comes to your pharmacy complaining of shortness of breath, cough, and fever. Patient has made you aware that the GP has prescribed them some antibiotics due to a bacterial chest infection and they are coming towards the end of their antibiotic course and there is no signs of improvement in her condition. She has long-standing history of ventricular fibrillation, hypertension, hyperlipidaemia and recently been diagnosed with rheumatoid arthritis a week ago. You are concern that one of her regular medications could be the cause of her symptoms. which of the following drugs would be the most likely cause of the patient’s symptoms?

You are working as a pre-registration pharmacist at a hospital manufacturing unit. You are aware that there are certain sterilisation methods used in the manufacturing of medicines. Which of the following is not classed as a method of terminal sterilisation?

Mrs Gabbie Mandey comes to your pharmacy with a prescription for isoniazid and pyridoxine as part of her treatment for tuberculosis that has recently been diagnosed with. She was counselled from her clinician regarding the isoniazid, but she was unaware that she was also prescribed pyridoxine and wanted to know why she has been prescribed pyridoxine along with isoniazid for her tuberculosis?

Questions 84 and 85 concern a Mr John Jenkins who is 11-year old child who has been recently diagnosed with asthma. After an acute admission in hospital 2 weeks ago with wheeze and shortness of breath. The following medications were prescribed on discharge and has been continued as regular repeat medications. The following prescribed medications are shown below:
– Salbutamol 100micrograms inhaler DPI (Dose: 1 to 2 puffs when required)
– Serevent Evohaler 25 micrograms inhaler DPI (Dose: 2 puffs twice daily)
– Qvar Easi-Beathe 100micrograms inhaler (Dose: 1 puff twice a day)

From the information given regarding Mr John Jenkin’s medication history. Which step is John currently on accorinding to the British Thoracic Society (BTS) guidelines?

Mr John Jenkins has come to your clinic for an asthma review. Mr J.J has mentioned to you that he is currently well controlled, and his peak flow readings are within the expected range for his age and he has not been using his salbutamol inhaler for the last 3 months. From the information provide what would be the most appropriate course of action to take with regards to Mr J.J’s treatment regimen for his asthma according to the BTS guidelines?

Question 86 to 88 concerns a Mr Abbas Rasul 56-year-old male with a past medical history of mania, major depression, epilepsy, hypertension and type 2 diabetes. Mr Abbass Rasul is one of your regular patients at the mental health hospital. His medication history includes the following:
– Sertraline 100mg once daily
– Sodium Valproate 400mg three times a day
– Lithium carbonate (Priadel) 400mg in the morning and 600mg at night
– Amlodipine 5mg once daily
– Atorvastatin 20mg once daily
– Metformin 500mg three times a day
– Fresubin 2kcal (1 x 200ml twice a day)

Mr A.B has been admitted to the psychiatry assessment unit due to recent episode of self-harm and mania and has been sectioned under the mental health authorities. The consultant psychiatrist has assessed Mr A.B and has noticed Mr A.B is quite malnourished and complains of loss of appetite. The consultant psychiatrist would like to change his anti-depressant as he feels his lack of appetite could be due to his medication. Which of the following anti-depressants would be most suitable to switch from sertraline?

The consultant psychiatrist has also commenced with a full psychiatric review of Mr A.B’s episodes of mania and self-harm and has come to conclusion that Mr A.B’s behaviour is due to possible signs of schizophrenia. As the mental pharmacist on the ward the consultant psychiatrist has asked for your recommendation of an appropriate antipsychotic medication to treat Mr A.B’s symptoms of schizophrenia. Which of the following anti-psychotic medication would be most suitable for Mr A.B for the use of his symptoms f schizophrenia?

The consultant psychiatrist has asked you regarding the monitoring requirements that need to be conducted prior to commencing any new antipsychotic and has asked your advice re-guarding this matter. Which of the following parameters should be conducted prior to com-mencing anti-psychotic medicines to Mr A.B?

Mrs Tanya Rai has come to your medication review clinic regarding her depression. She has been taking fluoxetine capsules 20mg daily for 6 months. She not been responding to the treatment and has not be able to tolerate the side effects from the fluoxetine. The GP has reviewed her prior to your review and would like you to start her on phenelzine tablets. However, when switching between antidepressants requires tapering down the doses be-fore switching which is commenced over certain period of time. How soon after stopping fluoxetine can Mrs T.R start taking phenelzine?

A patient who is terminally ill and suffering from nausea as result of raised intracranial pressure requires to be commenced on anti-emetics. The patient has no known allergies to any medicines and has no contraindications. The GP has asked your advised on the most ap-propriate anti-emetic for this patient. Which one of the following anti-emetics is the most appropriate to recommended for this patient as a first-line treatment?

EMQ’s (30 Questions)

For the patients described, select the most likely possible consequence of the drug interaction. Each option may be used once, more than once or not at all.

A 45-year old man attends his yearly medication review at your GP practice. He mentions that his personal life has been affected since his myocardial infarction 2 years ago and has been feeling low in confidence and self-esteem due to his personal issues with his wife. His medication history includes the following medications:

– Isosorbide mononitrate m/r 60mg OD

– Atenolol 50mg OD

– Atorvastatin 40mg OD

– Ramipril 2.5mg OD

As a pharmacist independent prescriber, you decided to prescribe the man tadalafil for his erectile dysfunction, but you are concern that there might be a likely interaction consequence of prescribing tadalafil with his current medication regimen.

A 56-year old man presents to the GP walk-in clinic at your practice with a swollen painful toe that is tender to touch, red and inflamed showing possible symptoms of an acute gout attack. His medication history includes the following medication:

– Aspirin 75mg OD

– Bisoprolol 7.5mg OD

– Simvastatin 20mg ON

As a pharmacist prescriber, you decide to prescribe colchicine 500micrograms BD for acute gout, but you are concern that there might be a likely interaction consequence of prescribing colchicine with his current medication regimen.

For the patients described, select the most likely possible consequence of the drug interaction. Each option may be used once, more than once or not at all

A 75-year-old man has arrived in hospital for a fall with a swollen, red left leg with a presenting complaint and shortness of breath. The junior doctor on the ward probable diagnosis with the presenting symptoms suggest a suspected deep vein thrombosis (DVT). The junior doctor on the ward has confirmed diagnosis with his seniors and decides to prescribe the man Fragmin (Dalteparin) 5000 units for Thromboprophylaxis during his hospi-tal stay. On questioning the man his medication history includes the following medications:

– Ramipril 5mg OD

– Simvastatin 80mg ON

– Bisoprolol 5mg OM

The junior doctor is concern that there might be a likely interaction consequence of prescribing colchicine with his current medication regimen.

For the patient described, select the most likely possible consequence of the drug interaction. Each option may be used once, more than once or not at all.

A 35-year year old man presented with symptoms of hallucinations, delusional thoughts and bouts of mood swings and has history of epilepsy. He has just been sectioned in one of the mental health assessment unit and has been seen by the psychiatrist consultant on the ward. The consultant has examined the patient and diagnosed the man with schizophrenia from his presenting symptoms. The man’s medication history includes the following medica-tions:

– Carbamazepine 200mg BD

– Lamotrigine 200mg OD

– Amlodipine 5mg OD

The consultant has decided to prescribe clozapine to help manage the man’s condition however the consultant is concerned there may be possible interaction with his medications and is unsure whether it would be suitable to prescribe clozapine with his current medications.

For the patient described, select the most likely possible consequence of the drug interaction. Each option may be used once, more than once or not at all.

A 45-year old man on the orthopaedic ward with a fractured ulna has been given the go ahead for rehabilitation at his home and is ready to be discharged to his home. However, during his ward stay, he showed signs of a possible urinary tract infection displaying symptoms of burning sensation during urinating, and foul-smelling urine. The urine sample was investigated using a urinalysis dipstick and showed positive in leukocytes and nitrite confirming the diagnosis of urinary tract infection. The junior doctor on call decided to obtain cultures and results showed sensitivity to ciprofloxacin hence ciprofloxacin was prescribed. On discharge the medications prescribed include the following:

– Ciprofloxacin 500mg BD for 7 days

– Ibuprofen 400mg TDS PRN

– Codeine 30mg QDS

– Lactulose

– Sodium valproate 200mg BD

You are the on-call pharmacist on the ward dealing with the discharge medications and con-cerned that there might be a likely interaction consequence of prescribing ciprofloxacin with his current medication regimen.

For the patients described, select the most likely possible consequence of the drug interaction. Each option may be used once, more than once or not at all.

For the following scenarios described, select the most likely possible diagnostic testing tool/blood parameters best suited to each scenario. Each option may be used once, more than once or not at all.

A 5-year old child with a presenting complaint of productive cough, high grade fever of 38.8°C and with pale discolouration of skin. What blood parameter would indicate there is tissue damage or inflammation in the body from an infection.

A 65-year old man attends to emergency department with shortness of breath, ankle swelling, and with a blood pressure reading of 158/90 mmHg with a history of hypertension. What test would be used as a rule out test to confirm diagnosis of heart failure for this patient?

For the following scenario described, select the most likely possible diagnostic testing tool/blood parameters best suited to each scenario. Each option may be used once, more than once or not at all.

A 77-year old woman who needs to be initiated with anticoagulant to risk the reduce of future events of thrombosis associated with atrial fibrillation. What scoring system is used to assess the risk of major bleed in patients with atrial fibrillation?

A 55-year old women who has a history of atrial fibrillation has been initiated on warfarin for recurrent deep vein thrombosis (DVT) and would like to know the chances of her suffering from a stroke in the future after being prescribed warfarin. What scoring systems is used to calculate the stroke risk for patients in atrial fibrillation?

A 30-year old men has been admitted to ward with neutropenic sepsis. During infections inflammatory markers such C-reactive protein are raised along with other blood parameters and cell counts are raised. What type of cells are increased during an infection?

For questions 101-105 For the patients described, select the pathogen most likely to be the cause of the infection for each disease state. Each option may be used once, more than once or not at all.

Mr C has suffered from recurring infection of the right outer ear and has received prolonged antibiotic treatment. He has presented to the GP with fungal overgrowth in his right ear and was subsequently diagnosed with otomycosis. This pathogen is the most likely cause of the infection.

Miss M presents with profuse, frothy, greenish-yellow and malodorous discharge accompanied by vulvar itching and dysuria. This pathogen is the most likely cause of the infection.

Mr B is a breeder of birds and has travelled the world to buy wild parrots. Two weeks after returning from his travels he has developed severe pneumonia accompanied by splenomeg-aly. Blood analysis shows leukopenia, thrombocytopenia and moderately elevated liver en-zymes. This pathogen is the most likely cause of the infection.

Mr P is an 82-year-old man who has just returned from a cruise to Mexico. He particularly enjoyed the hot tub and pool facilities on the ship. One week after his return he developed an uncommon form of severe community-acquired pneumonia accompanied by chest pain and mental confusion. This pathogen is the most likely cause of the infection.

Mrs R is a 61-year-old woman who has developed hospital-acquired pneumonia. She is be-ing treated with piperacillin with tazobactam by intravenous infusion 4.5g every 8 hours. This pathogen is the most likely cause of the infection.

For questions 106-110 For the patients described, select the most suitable regimen for the following patients presenting with features of poisoning and medical emergencies. Each option may be used once, more than once or not at all.

A 17-year-old female presenting with symptoms of nausea and vomiting that has occurred for the past 4 hours. On examination you notice the patient has yellowing of the whites of the skins and parts of her skin, and she is also displaying some discomfort around right up-per quadrant of her abdomen.

A 7-year-old child presenting with symptoms of nausea, vomiting, and abdominal pain. The mother of the child has brought the child to your pharmacy and is concerned with the child’s symptoms. The mother mentioned the child had swallowed some tablets they saw in her kitchen but is unsure what the child has ingested and few hours later she noticed the child had persistent diarrhoea that is dark in nature and bloody vomit.

A 55-year-old male has come to your pharmacy complaining of blurred vision, tinnitus, and fine tremors of the hands and also notice his eyes seems to be sunken. One questioning the gentlemen has mentioned that he has been suffering from diarrhoea since yesterday, how-ever you notice the gentlemen feels agitated when continue to probe the patient with questions about their symptoms and appears confusion at times when you rely the information back to the patient. His medication history includes the following:

– Lithium 400mg ON

– Bendroflumethiazide

– Amlodipine 10mg OD

– Atorvastatin 20mg ON

– Ibuprofen 400mg TDS (As OTC purchased 2 days ago for back pain)

A 33-year-old IV drug user who is your regular patient at your pharmacy that collects their daily supervised methadone. You notice the patient not being their usual self and notice they are showing signs of hallucinations. Further examining the patient, you notice their pu-pils are dilated and upon questioning the patient you notice they seem to be getting agitated when you are questioning him. You also notice that the patient seems to be fidgeting and showing random and unusual reflexes of their hands.

A 18 year-old female presenting with a complaint of nausea, vomiting and severe drowsiness that has seem to impair her cognitive function. On examination you notice fine tremor of hands and feels very light headed and ask the patient to sit on a chair in the consultation room however you notice a packet of tablets have fallen off her jacket which seems to be an empty strip of fluoxetine 20mg capsules.

For questions 111-115 for the patients described, select the most suitable regimen for the following patients in relation to diabetic management, side effects of drug initiation, and contraindications. Each option may be used once, more than once or not at all.

A 45-year-old male who has been diagnosed with type 2 diabetes a month ago that is struggling to lose weight despite adhering to dietary measures and increased physical activity. His current BMI is 35kg/m2. His medication history includes the following:

– Metformin 500mg TDS

– Ramipril 2.5mg caps OD

– Atorvastatin 20mg OD

A 55-year-old male who has been a type 2 diabetic for nearly over 5 years has attended to your medication review clinic. He has been suffering from recurrent diabetic skin ulcers and diabetic neuropathy. You are concern that one of his current diabetic medication should be discontinued due to his pre-existing complications as mentioned.

A 45-year-old male who is having renal biopsy and CT scan using contrast media to examine for diabetic nephropathy after being referred by their GP with presenting complaint of upper flank pain, pain when urinating and urinalysis indicated abnormality in urine. Prior to having the renal biopsy, the patient was told to stop taking one of their medication prior to the CT scan

A 25-year-old male who has recently been diagnosed with type 2 diabetes and was initiated with anti-diabetic regimen. After 1 month of therapy of the anti-diabetic medication, the gentlemen has attended to your medication review clinic today complaining of abdominal pain near upper right quadrant, high grade fever of 38 degrees, diarrhoea and vomiting. You suspect that the symptoms could be due to adverse effect of one of his anti-diabetic medication.

A 65-year-old male who has recently been diagnosed with bladder cancer and has long standing history of diabetes, hypercholesterolemia, and hypertension. He attends your regu-lar annual diabetic review at your clinic. You have been made aware of his recent diagnosis of bladder cancer and you are aware that one of his diabetic medications will be required to stop due to his new condition.

For questions 116-120 for the patients described, select the most likely cytotoxic/chemotherapy agent from the above option list. Each option may be used once, more than once or not at all.

You are working on the oncology ward as junior pharmacist and have been informed by the nurse that one of the patients is showing signs of bone marrow suppression and is con-cerned that one of the chemotherapy regimen may be the cause of it.

Mr John Blekin has been recently diagnosed with advanced stage of colorectal cancer and has been initiated with chemotherapy treatment. Several days of undertaking his chemo-therapy regimen John has been complained of sore and dry mouth and lack of salivation. One of the chemotherapy nurses is concerned that john is suffering from oral mucositis that could be due to one of his chemotherapy regimens.

One of the senior ward sisters has approached you on the chemotherapy day unit and wanted to ask for your advice regarding administration of a chemotherapy agent to one of their patients. The chemotherapy prescription has been prescribed intrathecally. Before pro-ceeding with the administration, the nurse wants your advice on how to set this up as an in-fusion. You are aware that this chemotherapy agent is lethal if given intrathecally and ask the nurse to contact the prescriber to change the route of administration.

Mrs Uzma Qureshi has been on chemotherapy treatment for the past 2 days. You notice on the medical notes that she has been complaining of pain when urinating and showing pres-ence of blood in the urine which has been diagnosed by the clinician as haemorrhagic cystitis which is side effect of the chemotherapy treatment. Looking at her medication history she has not been prescribed a drug to treat the side-effect of the chemotherapy treatment and suggest a drug to the senior clinician on the ward.

Mr Adam Banks is 59-year-old male who has been undergoing chemotherapy treatment for his advanced stage of colon cancer. Initially after having his first infusion of chemotherapy treatment Mr Banks suddenly develops a rash with blistering and red lesions accompanied by high grade fever of 38 degrees and feeling unwell. You are concerned that this could be caused by his chemotherapy agent.