Clinical Quiz

Question relate to a 35-year-old woman, Mrs A, who has an eczema flare up on her hands. She currently uses Doublebase gel (isopropyl myristate and liquid paraffin) as a general emollient.

It is decided that Mrs A will purchase Eumovate cream (clobetasone 0.05%) over the counter to treat her eczema flare up on her hands. 

What potency is clobetasone 0.05% cream?

Question relate to a 35-year-old woman, Mrs A, who has an eczema flare up on her hands. She currently uses Doublebase gel (isopropyl myristate and liquid paraffin) as a general emollient.

When counselling Mrs A on how to use the cream she asks how much she should use, so you explain she should use finger tip measurements.

One fingertip should cover what surface?

Question relate to a 35-year-old woman, Mrs A, who has an eczema flare up on her hands. She currently uses Doublebase gel (isopropyl myristate and liquid paraffin) as a general emollient.

How should Mrs A be counselled on the directions of use for the cream?

An 8-month-old child has fever associated with a viral infection. It has been recommended that the parents purchase paracetamol infant suspension (120mg/5ml) to control the fever and help reduce pain associated with the infection.

What is the correct dose for the child?

A 60-year-old man is being discharged from hospital after an ST-segment elevation myocardial infarction. He has no other conditions and no intolerances or allergies.

Which of the following medications would you NOT expect to see in the long term management of his condition?

A 70-year-old house-bound woman has asked her daughter to buy her a vitamin which was recommended by her GP. The daughter has forgotten what the vitamin was called, but tells you it is because her mother does not get out of the house and she fractured her wrist 3 months ago.

What is the most likely vitamin that she was recommended to purchase?

A 30-year-old woman has been diagnosed with Helicobacter pylori infection. She has an allergy to penicillin.  

What is an appropriate H.pylori eradication regimen for this patient?

A 42-year-old woman was diagnosed with hypothyroidism one year ago and has since been taking levothyroxine 50 mcg tablets once daily in the morning. Her most recent blood test results are shown below:

What would be the most suitable recommendation to make for this patients thyroid control?

How should the FLUAD vaccine be stored prior to use?

How long does post-vaccination immunity to strains closely related to the vaccine strains last for?

During clinical trials what frequency has been observed for the side effect of malaise?

How should the FLUAD injection be administered?

A 60-year-old man has been diagnosed with stable angina and has been prescribed GTN 500mcg sublingual tablets for anginal attacks. 

Which of the following is appropriate advice to give to this patient?

Which of the following is a high intensity statin?

A 3-year-old child has been prescribed amoxicillin for a urinary tract infection at a dose of 250 mg three times a day. The only stock available is amoxicillin 125mg/5ml suspension.   

What is the exact amount of the 125mg/5ml suspension that will be required to complete a 5 day course?

A 60-year-old man presents at a pharmacy requesting eye drops to help an irritated eye. On questioning, he reveals that his eye is very painful and his upper eyelid is swollen. This has started 2 days ago, he is on no other medication and has not tried anything. His is not a contact lens wearer. 

Which of the following is the most appropriate action to take?

A 21-year-old woman has been diagnosed with ulcerative colitis. She has been commenced on mesalazine 2 g once daily. 

Which of the following is NOT appropriate advice to give her regarding mesalazine?

Mr B, a 77-year-old male with atrial fibrillation. He takes warfarin (dose dependent on INR results) and bisoprolol 2.5 mg tablets once daily.

What is the most appropriate target INR for Mr B?

Mr B, a 77-year-old male with atrial fibrillation. He takes warfarin (dose dependent on INR results) and bisoprolol 2.5 mg tablets once daily.

Mr B has attended his monthly INR blood tests and the result is slightly higher than expected. 

Which of the following is the most likely action that will be taken?

Mr B, a 77-year-old male with atrial fibrillation. He takes warfarin (dose dependent on INR results) and bisoprolol 2.5 mg tablets once daily.

Mr B asks what is likely to happen when he needs to go to hospital for an elective surgery that has been planned for 6 months. 

What is the most appropriate action to take in regards to warfarin and elective surgery?

Mr B, a 77-year-old male with atrial fibrillation. He takes warfarin (dose dependent on INR results) and bisoprolol 2.5 mg tablets once daily.

1 year later Mr B has decided to stop warfarin and change to rivaroxaban as he could not fit in the regular INR checks with his busy lifestyle.   

What is the most appropriate dose for rivaroxaban for Mr B?

Which of the following is NOT a common side effect of rivaroxaban?

Which of the following tasks CAN be performed if a pharmacist is absent from a community pharmacy for one hour during a lunch break and no other pharmacist is present? 

Miss C, a 23-year-old woman who has been prescribed Qlaira for contraception.    Miss C is confused by the amount of information the prescriber gave her so you take her through important points she wants clarifying in the information leaflet.  

Which of the following factors will increase Miss C’s risk of a blood clot in a vein?

Miss C, a 23-year-old woman who has been prescribed Qlaira for contraception. Miss C is switching to Qlaira after taking desogestrel 75 mg tablets.  

What is the most appropriate advice to give her on how to switch?

Miss C, a 23-year-old woman who has been prescribed Qlaira for contraception.

What is the most appropriate advice to give Miss C regarding missed pill incidents?

Miss C, a 23-year-old woman who has been prescribed Qlaira for contraception.

Which of the following side effects of Qlaira occurs between 1 and 10 in every 1000 users?

A 7-year-old child has a severe allergy to peanuts which can result in anaphylaxis.

What would be the correct volume of adrenaline 1 in 1000 (1mg/mL) for a healthcare professional to administer to the child in a case of anaphylaxis?

A 16-year-old male suffers from seasonal rhinitis and is concerned that his watering eyes and blocked nose will affect his performance in upcoming exams. He would like an antihistamine that he only needs to remember to take in the morning and will not cause drowsiness.  

What is the most appropriate antihistamine to recommend?

You are clinically screening a prescription for the following medication:

• amlodipine 10 mg tablets, once daily
• amoxicillin 500 mg capsules, one three times daily
• metformin 1 g modified release tablets, once daily
• simvastatin 40 mg tablets, once at night

What is the most appropriate reason for contacting the prescriber?

A 25-year-old female has been diagnosed with asthma. She has been prescribed a salbutamol 100 mcg/dose inhaler.

What is the most appropriate way to explain how to use the inhaler?

A 50-year-old woman presents at the pharmacy looking for something to “help her go to the toilet”. She says she is finding it difficult to pass stools as they are too hard. She has not tried anything and is on no other medication.  

What is the most appropriate medication to recommend?

A 45-year-old man is initiated on perindopril 2 mg tablets once daily for the treatment of hypertension. He was told that he would have to go to his GP surgery regularly to monitor his blood pressure and other parameters.  

What is the most appropriate thing to monitor regularly whilst on perindopril?

A 5-year-old child has a dry cough mainly at night for the past few days. His parents are looking to purchase a cough syrup to help ease his symptoms.  

What is the most appropriate ingredient to supply?

How long does a private prescription record book need to be kept for if it contains records of veterinary prescriptions?

A woman is concerned about possible side effects she may experience from a salbutamol 100 mcg/dose inhaler and would like to know what she is most likely to experience. 

Which of the following is a side effect of salbutamol?

A 40-year-old African man with no known allergies has been diagnosed with hypertension. His blood pressure is 170/95mmHg. 

Which of the following is the most appropriate medication to initiate?

A man taking spironolactone wants to purchase an over the counter supplement to “give him a boost”.  He would like to a purchase a multivitamin and mineral product.

Which of the following ingredients should NOT be recommended?

A woman has been prescribed loperamide 2 mg capsules for the treatment of acute diarrhoea. When picking up her prescription she asks you how many she can take in one day. 

Which of the following is the maximum daily dose of loperamide?

Thalidomide is used as a first-line treatment for untreated multiple myeloma in patients 65-years-old and over. 

Which of the following statements regarding thalidomide treatment is FALSE?

A GP practice has decided to request all patients who have been continually taking a PPI for over one year to attend a blood test to check for a deficiency that may be caused by continual PPI use. 

Which of the following is the most likely level that they will be monitoring?

A 33-year-old woman has been prescribed parenteral iron dextran due to continual blood loss. She has been told that there will be cardiopulmonary resuscitation facilities available as she is at an increased risk of a serious hypersensitivity reaction.   

Which of the following factors does NOT put her at an increased risk of a hypersensitivity reaction?

You are conducting a medicines review with a 62-year-old man on the following medication:

• cetirizine 10 mg tablets, one daily
• Doublebase gel, applied topically when required
• metformin 500 mg tablets, 2 tablets twice a day
• ramipril 5 mg tablets, once daily
• salbutamol 100mcg/dose inhaler, 1-2 puffs up to four times daily when required

He would like to know what his target clinical blood pressure his. He has no kidney, eye or cerebrovascular disease.

Which of the following is the most appropriate clinic blood pressure for this patient?

A care home that you service has taken on a new patient and wants your advice on times to administer their medication.  One of the medications is isosorbide mononitrate 10 mg twice a day.

Which of the following is the most appropriate administration times for this medication?

A 21-year-old man was diagnosed with iron-deficiency anaemia one year ago due to a poor diet. He was prescribed ferrous sulphate 200 mg tablets one three times daily and given a repeat prescription. He improved his diet and after 4 months of treatment his iron stores were replenished and his haemoglobin levels were within range. Today, 8 months later he has presented with another prescription for ferrous sulphate 200mg tablets, one three times a day.

Which of the following is the most appropriate reason for contacting the doctor?

A 49-year-old female who takes atorvastatin 20 mg tablets once daily is suffering from a respiratory tract infection. She has been prescribed clarithromycin 250 mg tablets twice a day.

Which of the following is the most appropriate action to take?

An 80-year-old woman has been taking morphine sulphate 10 mg modified release capsules for 7 days. She has become constipated so her GP has prescribed senna tablets 7.5 mg at night. The woman would like to know how quickly these tablets will work. 

What is the onset of action of senna tablets?

A 45-year-old woman was commenced on tamoxifen 20 mg tablets once daily for the treatment of breast cancer. She has presented in the pharmacy today asking for a pain killer to help with pain her left calf.   

Which of the following is the most appropriate action to take?

80-year-old man who has started gemcitabine for the treatment of metastatic non-small cell lung cancer.

What is the recommended initial dose of gemcitabine?

80-year-old man who has started gemcitabine for the treatment of metastatic non-small cell lung cancer.

What action should be taken if the patient’s absolute granulocyte count is 600×10⁶/L?

A 45-year-old woman currently takes methotrexate 2.5 mg tablets, 4 tablets once weekly, and paracetamol 500 mg tablets, 2 tablets up to four times daily when required. She presents with a prescription for trimethoprim 200 mg tablets, one twice a day for 3 days,  to treat a urinary tract infection.

Which of the following is the most appropriate action to take?

A 62-year-old woman has been prescribed alendronic acid tablets at a dose of 70mg once weekly.   She has never taken this before so would like to know how to most effectively take the tablet.

Which of the following is the most appropriate advice to give on how to take alendronic acid tablets?

Mr D, a 72-year-old man with suspected Parkinson’s Disease.

Mr D has been referred to a specialist who has confirmed the diagnosis of Parkinson’s Disease. He is initiated on pramipexole at a titrating dose.

Which of the following is the LEAST appropriate advice to give regarding pramipexole?

Mr D, a 72-year-old man with suspected Parkinson’s Disease.

Mr D has been told that he will need to see the specialist regularly for reviews.

After diagnosis of Parkinson’s Disease, how often should the diagnosis be reviewed?

Mr D, a 72-year-old man with suspected Parkinson’s Disease.2 years later, Mr D’s Parkinson’s Disease has advanced and he know takes co-beneldopa 50mg/200mg capsules one three times a day.

Which of the following is NOT a common side effect of co-beneldopa?

Mr D, a 72-year-old man with suspected Parkinson’s Disease. Mr D’s Parkinson’s Disease has progressed further and he is experiencing unpredictable ‘off’ periods. Apomorphine hydrochloride is initiated at a specialist clinic. Mr D is taught how to self-administer this medication.

Which of the following is the most appropriate way to administer apomorphine hydrochloride?

A 45-year-old woman has been diagnosed with tuberculosis. She has been told she will undergo 2 phases of treatment, an initial phase and a continuation phase.

Which of the following medications are most appropriate to use in the continuation phase of treatment?

Rifampicin can cause a change in coloration of urine. Which of the following is the most likely coloration that will be experienced?

A 29-year-old woman takes fludrocortisone tablets at a dose of 50mcg tablets daily, and levothyroxine 25mcg tablets at a dose of 3 tablets daily. She has realised that for the past week she has confused the directions of her medications and has accidentally been taking 3 fludrocortisone tablets daily.

Which of the following is the MOST likely effect she will experience?

A 30-year-old woman has been prescribed disulfiram for the treatment of alcohol dependence. She would like to know what she will experience if she drinks alcohol whilst taking disulfiram.

Which of the following effects will she NOT experience?

A 55-year-old man has been taking varenicline to aid smoking cessation. He tells you that he has been feeling increasingly anxious and has a depressed mood.

Which of the following is the most appropriate action to take?

A 50-year-old man has been prescribed oxybutynin hydrochloride tablets to treat urinary incontinence.

How often should the need for continuing therapy be reviewed?

25-year old woman is going on holiday next month and has calculated that she is due to menstruate whilst on holiday. She sees her GP who has prescribed her norethisterone 5 mg tablets.

The prescription has the directions “use as directed”. The woman has forgotten how the doctor told her to take the tablets.

Which of the following is the most appropriate dosage regimen for this patient?

25-year old woman is going on holiday next month and has calculated that she is due to menstruate whilst on holiday. She sees her GP who has prescribed her norethisterone 5 mg tablets.

Which of the following is the most appropriate time for her to start taking norethisterone?

25-year old woman is going on holiday next month and has calculated that she is due to menstruate whilst on holiday. She sees her GP who has prescribed her norethisterone 5 mg tablets.

When is menstruation likely to start after stopping norethisterone?

A 42-year-old man is currently taking ciprofloxacin 500 mg twice a day for a respiratory tract infection. He would like to purchase some ibuprofen tablets to treat a headache.

Which of the following is the most appropriate reason for recommending an alternative to ibuprofen?

A patient is on a prolonged course of clindamycin, and treatment has exceeded 10 days.

Which of the following should be monitored?

A 45-year-old man uses Fentanyl patches for the treatment of chronic pain. He currently is suffering from a systemic infection resulting in a headache and fever.

What is the most appropriate reason for increased monitoring of the patient for side effects?

A 25-year-old woman is going to go on an 8 hour journey and she would like to purchase something to help prevent motion sickness. She is going on the journey in 3 hours and would prefer something that will not make her too drowsy.

What is the most appropriate medication to recommend?

You are training your pharmacy staff on the safe supply of Viagra Connect (sildenafil 50 mg tablets) over the counter.

In which of the following circumstances would it be most appropriate to supply Viagra Connect without a prescription? Assume no PGDs are in place.

Mrs D is prescribed vancomycin 1g every 12 hours by intravenous infusion.

What is the most likely reason why vancomycin was not prescribed orally?

Mrs D, a 50-year-old woman with endocarditis.

What should the pre-dose ‘trough’ concentration be of vancomycin for Mrs D?

Mrs D, a 50-year-old woman with endocarditis.

Which of the following should be monitored during Mrs D’s treatment?

A 27-year-old female takes fluoxetine 20 mg capsules once daily for depression. She suffers from migraines and so far today has taken one sumatriptan 50 mg tablet, 4 paracetamol 500 mg tablets, and 4 tramadol 50 mg capsules. She has started to feel anxious, nauseous and has tremor.  

What is the most appropriate action to take?

A 19-year-old man is being treated with clozapine for schizophrenia. He has been experiencing hypersalivation and is finding it is affecting his quality of life. 

What is the most appropriate medication to treat the hypersalivation?

For which of the following antiepileptic drugs is it most appropriate to maintain the patient on a  specific manufacturer’s brand?

A 50-year-old woman with COPD has been prescribed prednisolone 5 mg tablets, 8 tablets daily for 5 days, for a COPD exacerbation.  She has not taken prednisolone tablets before.

What is the most appropriate advice to give regarding her prednisolone prescription?

A 30-year-old woman currently takes fluconazole 150 mg once weekly for recurrent vulvovaginal candidiasis. A month into treatment she discovers that she is pregnant so asks your advice on what she should do.

What is the most appropriate advice to give?

A 30-year-old man asks for your advice on antimalarials as he is travelling around Africa for one year. He remembers being told in the past that there is an antimalarial he cannot take due to a history of psychiatric disorders.

What is the most likely medication that this patient was told not to take?

Miss E, an 11-year-old girl recently diagnosed with type 1 diabetes.

80. Miss E has been taught how to effectively inject herself with insulin. Her mother cannot remember all the information that they were told and would like you to explain the key advice again.

What is the most appropriate advice to give?

Miss E, an 11-year-old girl recently diagnosed with type 1 diabetes. Miss E has been initiated on a basal-bolus insulin regimen.

Which of the following medications can be used as part of a basal-bolus regimen?

Miss E, an 11-year-old girl recently diagnosed with type 1 diabetes. Miss E’s mother would like to know what will happen in the future if/when Miss E would like to have a child of her own.

Which of the following is the most appropriate advice to give?

Miss E, an 11-year-old girl recently diagnosed with type 1 diabetes. Miss E wants to know what the symptoms are of hypoglycaemia.

Which of the following is NOT sign of hypoglycaemia?

A 50-year-old woman takes solifenacin 5 mg once daily for urinary incontinence. She isn’t sure that the dose is high enough and knows that a 10 mg tablet is available. Her GP has told her that she cannot increase the strength of solifenacin due to another medication that she takes.

Which of the following is the most likely medication that her GP is referring to?

Miss F, a 32-year-old woman, who takes theophylline.

Which of the following factors will decrease theophylline concentration?

Miss F, a 32-year-old woman, who takes theophylline.

Miss E has been prescribed theophylline for the treatment of asthma. She had her plasma-theophylline concentration measured 5 days after starting the treatment. She would like to know if she will need any future monitoring.

When is the most appropriate time to monitor plasma-theophylline levels?

Miss F, a 32-year-old woman, who takes theophylline.

Miss E is taking modified release 250 mg Slo-phyllin capsules. She is struggling to swallow the capsule and wants to know if there is another way of taking it.

What is the most appropriate advice to give Miss E?

Miss F, a 32-year-old woman, who takes theophylline.

Miss E has been told to be vigilant for signs of overdose.

Which of the following is NOT a sign of theophylline overdose?

A 40-year-old man has been prescribed amiodarone and has reduced his dose down to 200 mg daily for the treatment of arrythmia. He has developed corneal microdeposits and is concerned that his vision is going to deteriorate if he continues treatment.

Which of the following is the most appropriate advice to give this patient?

What does a black triangle symbol indicate when included in a patient information leaflet?