501 21/22

Question 1

Which of the following is not recommended before the initiation of lithium salts
EGFR
FBC
LFT
Patient body weight
Thyroid function test

Answer 1

LFT

Question 2

A 38-year-old man presents to the emergency department with a decreased level of consciousness and symptoms of confusion, ataxia and
weakness of the eye muscles. The patient is assessed as a heavy drinker and, due to the risk of Wernicke’s Encephalopathy, requires
treatment with intravenous Pabrinex, two pairs of ampoules three times a day for five days. When the course is complete, the patient will be
prescribed oral supplements.
Which of the following vitamin or mineral deficiencies can result in Wernicke’s Encephalopathy?
A. calcium
B. folate
C. iron
D. magnesium
E. thiamine

Answer 2

Thiamine

Question 3

which of the following medications can be continued prior to surgery and would
not require any peri-operative advice?
A. estradiol
B. levetiracetam
C. priadel
D. ramipril
E. warfarin

Answer 3

Levetiracetam

Question 4

Post-operatively, Mrs Y is reviewed by the colorectal surgeon and the dietician. Mrs Y is recovering well and is managing to eat and take
oral medication. The stoma site is healthy and is functioning, but the volume of contents needs managing. It is decided to start the patient
on medication to reduce the stoma output.
Which of the following is the least appropriate pharmacological management in reducing Mrs Y’s stoma output?
A. codeine
B. loperamide
C. metoclopramide
D. octreotide
E. omeprazole

Answer 4

❗ C. Metoclopramide — Least appropriate
It’s a prokinetic — stimulates gastric emptying and gut motility.
The opposite of what you want in someone with high stoma output.

Question 5

A 45-year-old woman presents to the surgical admissions unit with an abrupt onset of unilateral abdominal pain. She describes the pain as
severe and radiates to the groin. Investigations are carried out and a kidney stone is found on her scan. Following the consultant ward
round the plan in the notes is the following:
o tamsulosin MR 400 micrograms daily until stone passed
o diclofenac 100 mg PR BD PRN
o paracetamol 1 g QDS
She has no known drug allergies.
Which of the following is the most appropriate reason to challenge the planned medication?
A. diclofenac dose is incorrect
B. NSAIDs
are not effective for kidney stones
C. opioids
should be prescribed for pain relief
D. paracetamol
is not effective for kidney stones
E. tamsulosin
should never be prescribed in a female patient

Answer 5

The diclofenac dose is too high and would need to be adjusted to avoid potential side effects. Therefore, A. Diclofenac dose is incorrect is the most appropriate reason to challenge the medication plan.

Question 6

A 36-year-old man has presented to the surgical admissions unit with severe abdominal pain. After investigating, he is diagnosed with
acute pancreatitis. Prior to this admission he was generally fit and well and has no previous history of pancreatitis. He has no known drug
allergies but has an intolerance to metformin.
His current medication is shown below:
o salbutamol 100 microgram Inh TWO puffs QDS PRN
o lamotrigine 100 mg BD
o dulaglutide 0.75 mg SC Once Weekly (Wednesdays)
o citalopram 20 mg OM
o cetirizine 10 mg OM
o multivitamin (OTC)
The surgical doctor asks if any of his medication could be the possible cause for this admission. You are unable to speak to the patient as
he is off the ward and the GP practice is currently closed.
Which of the following is the most likely cause of this patient’s drug induced acute pancreatitis?
A. cetirizine
B. citalopram
C. dulaglutide
D. lamotrigine
E. salbutamol

Answer 6

Dulaglutide

Question 7

A 91-year-old man has been diagnosed with mild to moderate dementia with lewy bodies and is now starting treatment. He has no known
drug allergies and takes levothyroxine and regular paracetamol.
Which of the following would be the most appropriate to start for this patient?
A. donepezil
B. galantamine
C. memantine
D. olanzapine
E. quetiapine

Answer 7

Donepezil is an acetylcholinesterase inhibitor and is approved for the treatment of mild to moderate Alzheimer’s disease as well as dementia with Lewy bodies (DLB).
Donepezil works by increasing acetylcholine levels in the brain, which helps improve cognitive function, attention, and memory.
While it may worsen hallucinations in some patients, it is generally preferred over other acetylcholinesterase inhibitors (such as galantamine) for DLB because of its more favorable side effect profile.
In DLB, donepezil can help with cognitive symptoms and is a reasonable first-line option for treatment of mild to moderate symptoms.

Question 8

A 28-year-old man has been accessing treatment for depression via his GP. Alongside talking therapy in a shared care decision, they have
decided to try antidepressant medication therapy. The patient has no known drug allergies and takes no other medication.
Which of the following drug options would be most appropriate to start for this patient?
A. amitriptyline
B. citalopram
C. mirtazapine
D. trazodone
E. venlafaxine

Answer 8

Citalopram

Question 9

Two weeks ago, Mr W, age 74-years-old, attended A&E with chest pain. He was diagnosed with acute coronary syndrome and started on
the following secondary prevention medication:
o aspirin
o atorvastatin
o bisoprolol
o ramipril
o ticagrelor
Mr W is now back in A&E presenting with shortness of breath and heart palpitations. He is found to have a potassium level of 6.2.
Which of the following medications that the patient has started will have caused this rise in potassium?
A. aspirin
B. atorvastatin
C. bisoprolol
D. ramipril
E. ticagrelor

Answer 9

Ramipril - hyperkalemia

Question 10

An 82-year-old woman with heart failure is on your ward and the consultant would like to start another treatment for hypertension. She has
no known drug allergies and has a past medical history of heart failure with an ejection fraction of 20%. The consultant would like to start a
calcium channel blocker and has asked for your advice on which one. The patient is taking the following regular medicines:
- furosemide 40 mg OD
- ramipril 2.5 mg OD
- aspirin 75 mg OD
- atorvastatin 20 mg OD
Which of the following calcium channel blockers would be most appropriate for this patient?
A. amlodipine
B. diltiazem
C. felodipine
D. lercanidipine
E. nifedipine

Answer 10

Amlodipine is a dihydropyridine calcium channel blocker that lowers blood pressure through its vasodilatory effect without significantly affecting heart contractility or heart rate. This makes it safer for use in heart failure with reduced ejection fraction (HFrEF).
Amlodipine does not have the negative inotropic effects (i.e., reducing the force of heart muscle contraction) that non-dihydropyridine CCBs have, which could worsen heart failure.
It is widely used in hypertension and angina, and it is generally well-tolerated in patients with heart failure.

Question 11

A patient in a care home has been diagnosed with atrial fibrillation. The pharmacist has been asked for advice regarding the choice of
anticoagulant. The patient has no known drug allergies and takes memantine 10 mg OD for dementia. The patient has a very poor appetite
and struggles to eat regularly.
Which anticoagulant would be least appropriate for this patient, given his poor appetite?
A. apixaban
B. edoxaban
C. rivaroxaban
D. tinzaparin
E. warfarin

Answer 11

Rivaroxaban (take with food at doses 15mg and 20mg)

Question 12

A 50-year-old woman attended the lipid clinic today and was started on simvastatin 40 mg tablets. The pharmacist checking the
prescription notices an interaction with one of the medications she is already taking, causing an increased risk of rhabdomyolysis.
Which of the following medications is most likely to cause the increased risk of rhabdomyolysis?
A. amlodipine
B. bisoprolol
C. felodipine
D. losartan
E. lisinopril

Answer 12

Amlodipine

Question 13

A patient with type 1 diabetes has recently had a chest infection, which was treated in the community. This morning they have been
admitted to the acute admissions ward due to dehydration and a rise in blood glucose. After a blood gas, the patient’s ketones were found
to be 4, suggesting they are in diabetic ketoacidosis (DKA).
Which of the following treatments would be most appropriate for the medical team to start?
A. rapid acting insulin such as Humalog (insulin
lispro) given intravenously
B. rapid acting insulin such as Novorapid (insulin aspart)
given intravenously
C. rapid acting insulin such as Novorapid (insulin
aspart) given subcutaneously
D. soluble
insulin such as Actrapid (insulin soluble human) given intravenously
E. soluble insulin such as Actrapid (insulin soluble human) given subcutaneously

Answer 13

In diabetic ketoacidosis (DKA), the patient’s body is in a state of severe insulin deficiency, leading to hyperglycemia and ketone production. The main goals of treatment are to correct dehydration, reduce blood glucose levels, and reverse ketosis. The preferred method to manage DKA includes:
Intravenous insulin:
The treatment of choice in DKA is IV insulin to lower blood glucose and stop ketone production.
Soluble insulin (like Actrapid, insulin soluble human) is used because it has a rapid onset when administered intravenously. It allows for better control over glucose levels in a critical setting like DKA.
Insulin should be administered as a continuous IV infusion, usually starting with a loading dose followed by a maintenance infusion

Question 14

A 68-year-old man has presented at the GP practice with increased thirst. An HbA1C level has been taken and has come back at 65,
diagnosing type 2 diabetes. The patient is otherwise well, has no known drug allergies and takes no other medication.
Which of the following antidiabetic medication would be most appropriate for the GP to start?
A. dapagliflozin 10 mg OD
B. gliclazide 80 mg BD
C. metformin
500 mg OD, increasing to TDS after 2 weeks
D. metformin 500 mg TDS
E. sitagliptin 100 mg OD

Answer 14

C

Question 15

A 74-year-old woman with type 1 diabetes has been waiting for several hours in an urgent treatment centre to be seen for a swollen leg.
The patient starts to complain of feeling light-headed and sweaty, and suddenly collapses. The nurses treat the patient for hypoglycaemia.
Which of the following glucose containing products would be the most appropriate to give this patient?
A. 2-3 teaspoonfuls of sugar in water
B. 20 mL oral glucose liquid
C. 100 mL of pure fruit juice
D. two glucose tablets
E. two tubes
of glucose 40% gel

Answer 15

In this case, the patient is experiencing hypoglycaemia, and the management involves giving a fast-acting glucose product. Glucose gel (40%) is highly concentrated and is specifically formulated to treat hypoglycaemia in conscious patients.
Glucose 40% gel has several advantages in this situation:
It can be easily administered without the need for chewing, which is particularly helpful for patients who might have difficulty swallowing or have limited time.
The gel form allows for quick absorption through the buccal mucosa, rapidly raising blood glucose levels.
Two tubes typically contain enough glucose to treat mild to moderate hypoglycaemia, as each tube contains around 15-20 grams of glucose

Question 16

A 74-year-old man attends the GP practice feeling lethargic, with low mood and impaired concentration. The GP suspects hypothyroidism.
Which of the following T4 (free thyroxine) and TSH (thyroid stimulating hormone) results would support a diagnosis of
hypothyroidism?
A. TSH high, T4 high
B. TSH high,
T4 low
C. TSH low, T4 high
D. TSH low, T4 low
E. TSH normal, T4 high

Answer 16

High TSH, Low T4

Question 17

A 29-year-old woman has been diagnosed with epilepsy and started on sodium valproate. You have been asked to provide advice
regarding contraception and pregnancy prevention.
Which of the following options would be the most appropriate choice of contraception for this patient?
A. barrier method
B. combined oral contraceptive pill
C. intra-uterine
device
D. natural family planning method
E. progesterone-only pill

Answer 17

IUD

Question 18

Mr N has been struggling with chronic back pain despite various analgesic combinations. Mr N has now been admitted to hospital. He
explains that he has taking tramadol 50 mg capsules, two four times a day, and morphine sulphate 10 mg/5 mL oral solution, at a dose of 5
mL four times a day.
A decision is made with Mr N to streamline his treatment and try modified release morphine tablets, with morphine 10 mg/5 mL liquid for
breakthrough pain as required.
Given that tramadol 100 mg is equivalent to morphine PO 10 mg, which of the following dosing schedules would be most
appropriate for Mr N?
A. morphine MR 20 mg BD and morphine 10 mg/5 mL oral solution 5 mg PRN
B. morphine MR 40 mg BD and morphine 10 mg/5 mL oral solution
5 mg PRN
C. morphine MR 40 mg BD and morphine
10 mg/5 mL oral solution 10 mg PRN
D. morphine MR 60 mg BD and morphine 10 mg/5 mL oral solution
10 mg PRN
E. morphine MR 80 mg BD and morphine 10 mg/5 mL oral solution
10 mg PRN

Answer 18

morphine MR 40 mg BD and morphine 10 mg/5 mL oral solution 10 mg PRN

Question 19

A family require chlorphenamine liquid to treat an allergic reaction in the two children. The older child is 9-years-old and requires
chlorphenamine at a dose of 2 mg every 6 hours, continued throughout the night. The younger child is 3-years-old and required a dose of
1 mg every 4 hours, also continued throughout the night. The 150 mL bottles available to buy over-the-counter contain 2 mg/5 mL.
How many bottles will the family require for 5 days treatment for both children?
A. 1 bottle
B. 2 bottles
C. 3 bottles
D. 4 bottles
E. 5 bottles

Answer 19

2 bottles

Question 20

A 3-year-old baby requires treatment for a lower respiratory chest infection. The GP has asked for your advice regarding which antibiotic to
prescribe.
Which of the following antibiotic would be least appropriate for this patient?
A. amoxicillin
B. clarithromycin
C. co-amoxiclav
D. doxycycline
E. erythromycin

Answer 20

Doxy

Question 22

A patient has been admitted to your ward with confusion and
agitation. The patient is taking the following medications:
-
aspirin 75 mg OD
-
atorvastatin 80 mg ON
-
bisoprolol 2.5 mg OD
-
sertraline 50 mg OD
-
paracetamol 1000 mg QDS
-
tramadol 50 mg QDSPRN
The patient had only recently had her dose of tramadol increased
and so a diagnosis of serotonin syndrome is made.
Which of the
following medications, along with tramadol, is most likely to have caused
serotonin syndrome?
A. aspirin
B. atorvastatin
C. bisoprolol
D. paracetamol
E. sertraline

Answer 22

Sertraline

Question 23

A GP calls you for advice regarding a 48-year-old man with a 2 week history of a symmetrical rash bilaterally of their axillae. The GP informs
you the patient has previously been diagnosed with flexural psoriasis by dermatology and they can see the patient has previously been
prescribed five different topical treatments for their skin, although it is unclear which were previously prescribed for flexural psoriasis.
Using the information above, which of the following topical treatment options would be least appropriate for the initial
management of flexural psoriasis?
A. clobetasol propionate 0.05%
cream BD
B. clobetasone
0.05% with oxytetracycline 3% and nystatin 100,000 units/gram cream BD
C. coal tar 5%
lotion TDS
D. hydrocortisone
1% with miconazole 2% cream BD
E. tacalcitol 4
microgram/g ointment OD

Answer 23

A

Question 24

You are asked to review a 64-year-old woman following an incidental finding of borderline prolonged QTc interval (453 milliseconds) on an
otherwise normal ECG. She has no personal or family history of long QT. She has a medical history of overactive bladder, pruritic eczema,
hypertension and anxiety. Her blood pressure on examination is 136/88 mmHg. She is not currently taking any acute medication and her
repeat prescription is as follows:
o Felodipine 10 mg once daily
o Solifenacin 5 mg once daily
o Mirabegron 50 mg once daily
o Hydroxyzine 25 mg at night
o Citalopram 20 mg once daily
o Cetraben cream apply at least twice daily
Which of the following interventions would you be least likely to consider during the review?
A. reduce
citalopram or switch to an alternative SSRI
B. reduce felodipine or switch
to an alternative antihypertensive
C. stop
solifenacin
D. stop
mirabegron
E. stop
hydroxyzine or switch to an alternative antihistamine

Answer 24

The least likely intervention would be B. Reduce felodipine or switch to an alternative antihypertensive, as felodipine is not associated with significant QT prolongation and does not pose a particular risk in this case. The other options involve medications with more established associations with QT prolongation or other potential risks in this context.

Question 25

The parent of an 8-week-old infant arrives into the community pharmacy for advice on purchasing paracetamol 120 mg/5mL oral suspension for post immunisation pyrexia. The infant’s first set of routine vaccinations are now due and the parent has been told to have some paracetamol ready to protect against a high fever after vaccination. Which disease that the infant is going to be vaccinated against is the most likely cause of post immunisation pyrexia at this point of the routine immunisation schedule? A. diphtheria B. hepatitis B C. meningitis B D. poliomyelitis E. tetanus

Answer 25

C

Question 26

The mother of a 7-year-old child arrives into the community pharmacy for advice on purchasing treatment for threadworms. She states that her child is constantly scratching their anal area and the mother is concerned about the risk of spreading any infection as she thinks she has seen some worms when she checked her son’s bottom area but is unsure. When asked who else lives at home she states that she lives with her husband (father), her 7-year-old son, her 18-month-old daughter, and she is expecting her third child in 10 weeks time. What is the minimum number of mebendazole 100 mg tablets you would advise the mother to purchase for treating the household at this point in time? A. 1 B. 2 C. 3 D. 6 E. 8

Answer 26

2

Question 27

You are asked by the parent of a child aged 11-years-old weighing 37 kg who is suffering from seasonal allergic rhinitis about over the counter treatment options. The child is experiencing nasal itching, rhinorrhoea, congestion and the continual sneezing and watery eyes symptoms are starting to affect their school work and summer end of year exams and so the child is quite anxious to start treatment as soon as possible. Which of the following treatment options would be the least appropriate over the counter choice for this patient? A. beclometasone dipropionate 50 microgram spray – 2 sprays in each nostril twice a day B. cetirizine dihydrochloride 10 mg tablets – 5 mg (half a tablet) twice a day C. chlorphenamine maleate 4 mg tablets – 2 mg (half a tablet) 4-6 hourly D. loratadine 10 mg tablets – 1 tablet once daily E. sodium cromoglicate 2% eye drops solution – 1-2 drops into each eye four times daily

Answer 27

A

Question 28

Mrs T, a 42-year-old woman, has presented to your community pharmacy with a dental prescription for metronidazole 400 mg tablets, one TDS for five days to treat an infection. Which of the following is the most appropriate counselling point to tell the patient? A. a common side-effect is feeling sleepy after taking so caution if driving or operating machinery B. you should limit the amount of alcohol you drink during this course, but one or two glasses of wine would be safe to drink C. do not drink any alcohol while you’re taking or for at least 48 hours after your last dose D. if you have difficulty swallowing tablets you can crush it and mix with apple sauce or yoghurt, making sure you eat the entire amount E. take on an empty stomach, an hour before or two hours after food

Answer 28

Alcohol

Question 29

A 56-year-old woman attends a warfarin INR monitoring clinic. She takes warfarin for atrial fibrillation 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 3 mg daily. She has been stable on this dose for the past 6 months. The patients’ INR today was 5.2. On questioning, she reports that she has not missed any doses, has had no changes to her diet, and does not drink any alcohol. She has however recently started some new medications. Which of the following medications is most likely to have caused the increased INR? A. bisoprolol B. carbamazepine C. doxycycline D. lithium E. theophylline

Answer 29

Doxycycline is an antibiotic that can increase the anticoagulant effect of warfarin. Antibiotics like doxycycline can alter the gut flora, which in turn affects the metabolism of vitamin K and the production of clotting factors, potentially leading to an increased INR. This is a well-known interaction, and doxycycline can also interfere with the gut absorption of vitamin K

Question 30

A pharmacist is providing information on ‘sick day rules’ for patients taking medicines with known risks in dehydration. Patients taking particular medicines who become unwell with vomiting, diarrhoea, fevers, sweats or shaking are advised to stop these medicines and restart them once they have been eating and drinking normally again for 24 to 48 hours. Which of the following medicines would be least appropriate to stop if a patient is suffering from a dehydrating illness? A. chlorthalidone B. enalapril C. indomethacin D. metformin E. ranolazine

Answer 30

Ranolazine is used to treat chronic angina and works by improving blood flow to the heart. It does not have significant effects on fluid balance, renal function, or electrolyte levels. Therefore, ranolazine is not typically associated with worsening dehydration or creating a risk in patients who are ill with vomiting, diarrhoea, or fever. In contrast, medications such as chlorthalidone, indomethacin, and metformin can exacerbate dehydration or kidney function issues in sick patients, making them more risky during dehydration. Enalapril can also be a concern in dehydration but is generally less problematic than some of the other options listed.

Question 31

A patient has been initiated on methotrexate for psoriasis. To counteract the potential for developing anaemia as a side effect of therapy, the patient is also prescribed a vitamin supplement. Which of the following vitamins should be prescribed alongside methotrexate to avoid developing an anaemia? A. ascorbic acid B. colecalciferol C. folic acid D. pantothenic acid E. pyridoxine

Answer 31

Folic acid

Question 32

A 34-year-old woman has been complaining of a persistent urge to urinate, and a burning sensation on passing water. She is passing small volumes of cloudy urine. A diagnosis of uncomplicated lower urinary tract infection is made and empiric treatment prescribed. Which of the following is the most common cause of urinary tract infections? A. Campylobacter jejuni B. Escherichia coli C. Group A Streptococcus D. Helicobacter pylori E. Neisseria gonorrhoeae

Answer 32

E.coli

Question 33

Nitrates are commonly used in the treatment of stable angina to relieve symptoms by increasing coronary blood flow and reducing myocardial oxygen demand. Which of the following is the least likely adverse effect of nitrate therapy? A. flushing B. headaches C. malignant hyperthermia D. palpitations E. syncope

Answer 33

Malignant hyperthermia

Question 34

A patient has had two elevated HbA1c readings and therefore a diagnosis of type 2 diabetes has been made. They will be initiated on first- line monotherapy treatment with metformin. Which of the following counselling points would be least appropriate to give the patient regarding metformin? A. metformin is safe to use during pregnancy B. metformin may cause diarrhoea when started, but this is usually a short-term side effect C. metformin should be taken with a meal D. patients should promptly report breathlessness, muscle cramps, abdominal pain, hypothermia or weakness, as they may develop lactic acidosis due to metformin E. self-monitoring of blood glucose levels is recommended while taking metformin

Answer 34

E

Question 35

A 74-year-old man has an estimated 10-year cardiovascular disease risk of 34%. To reduce this risk, he will be initiated on rosuvastatin. Using the information in the resource provided, which of the following is the most appropriate starting dose of rosuvastatin for this patient? A. 2.5 mg B. 5 mg C. 10 mg D. 20 mg E. 40 mg

Answer 35

5MG

Question 36

A patient with gastro-oesophageal reflux disease (GORD) is complaining of increased symptoms. Which of the following medicines is least likely to provoke GORD symptoms? A. alendronic acid B. amlodipine C. indapamide D. naproxen E. prednisolone

Answer 36

Indapamide???? is a thiazide-like diuretic used for managing hypertension and edema. While diuretics can sometimes have indirect effects like dehydration, indapamide is not known to exacerbate GORD symptoms directly. Unlike some other medications, it does not relax the lower esophageal sphincter or increase gastric acid secretion. Amlodipine (option B), while not directly causing GORD, can sometimes lead to peripheral edema, which may exacerbate other symptoms, but it does not typically cause reflux or worsen GORD directly

Question 37

In the treatment of depression, a more sedating antidepressant drugs may be preferred for anxious and agitated patients, and those with difficulty sleeping. Which of the following antidepressant drugs is most likely to have sedative effects? A. citalopram B. fluoxetine C. mirtazapine D. paroxetine E. sertraline

Answer 37

Mirtazapine

Question 38

Miss N has been taking lithium for several years to help control her bipolar disorder. Which of the following monitoring requirements is not necessary for patient’s on lithium treatment? A. body mass index B. eGFR C. liver function tests D. thyroid function tests E. urea and electrolytes

Answer 38

LFT

Question 39

Mr E, a 78-year-old man, presents to A&E 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 tablets of his verapamil hydrochloride 120 mg. 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

Answer 39

Activated charcoal

Question 41

Miss B is a 47-year-old woman living with atrial fibrillation. She calls your pharmacy sounding worried, and explains that she has accidentally taken too many of her digoxin 125 microgram tablets. She wants to know what symptoms she should look out for as she knows that digoxin can be toxic in overdose. Which of the following are the most likely symptoms of digoxin toxicity? A. bleeding and slurred speech B. decreased appetite and headache C. drowsiness and rash D. jaundice and fever E. yellow vision and nausea

Answer 41

Yellow vision + Nausea

Question 42

Miss C, aged 32-years, has been newly diagnosed with epilepsy. Her consultant has initiated her on 100 mg of immediate-release carbamazepine, with plans to titrate her to a maintenance dose. Which of the following statements regarding carbamazepine therapy for epilepsy is correct? A. carbamazepine is a potent enzyme inhibitor B. carbamazepine is not associated with antiepileptic hypersensitivity syndrome C. carbamazepine should be used with caution in patients with acute porphyrias D. it is unnecessary to ensure that patients are maintained on a specific manufacturer’s product as therapeutic equivalence can be assumed E. plasma concentration for optimum response should be 4–12 mg/litre (20–50 micromol/litre), measured after 1–2 week

Answer 42

E

Question 43

Miss E is a has recently been initiated on ferrous sulphate 200 mg once daily following a diagnosis of iron deficiency anaemia. She presents to the pharmacy complaining of constipation, nausea and gastrointestinal discomfort. Which of the following advice is most appropriate for Miss E? A. increase fibre intake and drink more water B. stop taking the medication and contact the prescriber C. take some Maalox suspension (aluminium hydroxide 175 mg and magnesium hydroxide 200 mg) D. take the medicine on an empty stomach E. take the medication with or after food

Answer 43

Take with or after food

Question 44

A patient has been taking sertraline 150 mg daily for five months to treat a third episode of depression. They tell you they have felt much better in the last few weeks, and would now like to stop taking the sertraline. According to NICE guidelines, which of the following would be the most appropriate recommendation for this patient? A. continue sertraline for one more month until 6 months of treatment have been completed, and then stop B. continue taking sertraline for 1-2 years from recovering from this episode of depression C. it is safe to stop taking sertraline now D. reduce the sertraline dose by 25 mg each week until stopped E. sertraline should be continued lifelong to prevent future recurrence of depression

Answer 44

B

Question 45

The concerned parent of an 8-year-old child would like advice on treating their child’s diarrhoea and vomiting symptoms, which have lasted about 24 hours. You ask further questions about any red flag symptoms such as bloody diarrhoea and rectal bleeding, assess the child’s dehydration risk, and enquire about any recent travel. You decide treatment with an over the counter product is the best course of action in addition to advice about staying off school, hygiene measures and safety netting advice as this child does not need a medical referral at this point in time. Which of the following is the most appropriate product to recommend in this instance? A. codeine linctus BP B. Dioralyte blackcurrant sachets C. kaolin and morphine mixture BP D. loperamide 2 mg capsules E. Pepto-Bismol (bismuth subsalicylate)

Answer 45

B

Question 46

Mr V brings his 4-month-old baby into the pharmacy for advice about the baby’s crying. The baby has been chewing and biting more often and has been drooling excessively. The baby has not been sleeping very well for the past few days. The father thinks this may be due to teething as his other children had similar symptoms when they were teething. Which of the following would be the most appropriate advice to give Mr V? A. Mr V should take the baby to the GP for an urgent appointment B. supply Bonjela Gel for prn application to the baby’s gums C. supply Bonjela soothing teething gel D. supply clove oil to apply to the painful areas of the mouth E. supply paracetamol 120 mg/5 mL oral suspension

Answer 46

E

Question 47

High levels of lipids (cholesterol, triglycerides, and lipoproteins) in the blood are known as ‘dyslipidaemia’, which is a major risk factor for atherosclerotic cardiovascular disease. Which of the following is a primary cause of dyslipidaemia? A. excessive alcohol consumption B. hypothyroidism C. inherited genetic mutation to the LDLR (low-density lipoprotein receptor ) gene D. liver disease E. uncontrolled diabetes mellitus

Answer 47

C

Question 48

A concerned mother visits the pharmacy with her 3-year-old daughter. The mother explains that her daughter has itchy blisters all over her abdomen accompanied by a high temperature. The pharmacist diagnoses chicken pox. Which of the following statements is the least appropriate advice for the mother? A. drink plenty of fluid to avoid dehydration B. give 5 mL of ibuprofen suspension 100 mg/5 mL up to 3 times in 24 hours C. give 7.5 mL of paracetamol 120mg/5 mL suspension when required for fever D. the child should stay away from nursery until all the spots have formed a scab E. use calamine lotion and cooling gels to ease itching

Answer 48

B

Question 49

Mrs O comes into the pharmacy asking for advice about her daughter, who is 7-years-old. She explains that there has been an outbreak of headlice at the school and she is concerned about her daughter also getting infested. Which of the following is the least appropriate advice to offer Mrs O? A. an itchy scalp suggests an active head lice infestation and treatment should be offered to all household members B. children who are being treated for head lice can still attend school C. detection combing is the best way to confirm the presence of lice D. if there is an infestation, all affected household members should be treated on the same day E. there is no need to wash clothes at high temperature or fumigate bedding that has been in contact with lice

Answer 49

A. an itchy scalp suggests an active head lice infestation and treatment should be offered to all household members Here's why: While an itchy scalp can be a symptom, it does not confirm an active head lice infestation. Many people with lice don’t itch at all, and itching can also be due to other causes (e.g. dry skin, dandruff). Treatment should only be given to those with confirmed infestation, not all household members automatically. The correct approach is to use detection combing to confirm the presence of live lice before treating.

Question 50

You are delivering an alcohol awareness health talk to a local community centre based on the current NHS guidance to help reduce alcohol related health risks. Which of the following patients would most benefit from reducing their alcohol consumption? A. Mr L, a 76 year old man, who drinks a total of 8 units at the weekends B. Mr K, a 48 year old man, who drinks a total of 13 units over 4 days C. Mrs T, a 39 year old woman who works Monday to Friday and drinks 3 units every evening after work D. Ms B, a 26 year old woman, who drinks 4 units a night, 3 days a week E. Ms G, a 36 year old woman, who drinks 9 units on a Saturday night

Answer 50

C

Question 51

Ms G comes into your pharmacy asking for advice about multivitamins and supplements. She started a vegan diet three months ago but has recently been feeling very fatigued, lethargic and faint. She is concerned that her new diet is not providing her body with all the vitamins and minerals it needs and would like you to recommend an over the counter supplement. Which of the following supplement would be most appropriate to recommend to Ms G? A. calcium B. omega-3 C. vitamin B12 D. vitamin C E. vitamin D

Answer 51

B12

Question 52

A pharmacist is reviewing the standard operating procedure for preparing a multi-compartment compliance aid (MCCA) which states that cytotoxic medicines must not be dispensed into the device or tray. Which of the following would be least suitable for inclusion into an MCCA? A. bisoprolol 10 mg tablets B. clopidogrel 75 mg tablets C. doxazosin 4 mg tablets D. finasteride 5 mg tablets E. tamsulosin 400 mcg capsules

Answer 52

Finasteride

Question 53

A pharmacist receives a private prescription for Mr K. After checking the prescription, the pharmacist informs the patient that they are unable to dispense the medication as it is written on an incorrect form and therefore not legally valid. Which of the following medicines was Mr K most likely prescribed? A. amitriptyline B. codeine C. diazepam D. gabapentin E. pseudoephedrine

Answer 53

Gabapentin is a Schedule 3 Controlled Drug (CD) in the UK. As of April 2019, gabapentin (and pregabalin) were reclassified due to concerns about misuse and dependence. For Schedule 2 and 3 CDs: Private prescriptions must be written on a special controlled drug prescription form — FP10PCD (in England), or its equivalent in other UK nations. These forms are traceable and have a prescriber identification number (PIN).

Question 54

A patient is thinking about quitting smoking and asks the pharmacist for advice. In addition to discussing nicotine replacement therapy (NRT), the pharmacist also raises an issue with the patient regarding the olanzapine tablets which they have been taking for the last 12 months. When the patient stops smoking, which of the following may be necessary in relation to their olanzapine? A. give a low dose of NRT alongside the olanzapine to avoid side-effects from the olanzapine B. increase the dose of olanzapine C. maintain the dose of olanzapine D. olanzapine cannot be taken alongside NRT and therefore should be stopped before starting NRT E. reduce the dose of olanzapine

Answer 54

Reduce the dose Smoking induces the enzyme CYP1A2, which increases the metabolism of certain drugs — including olanzapine. This means that smokers may require higher doses of olanzapine to maintain therapeutic levels. When a patient quits smoking, the enzyme induction diminishes, and as a result: Olanzapine levels can rise, potentially leading to toxicity or increased side effects (e.g. sedation, hypotension, extrapyramidal symptoms). Therefore, a dose reduction of olanzapine may be necessary after smoking cessation, with close monitoring for adverse effects and therapeutic response.

Question 55

A pharmacist is checking a prescription for a dog who has been prescribed gabapentin 100 mg capsules. Which of the following is not required for this veterinary prescription? A. a statement highlighting that the medicine is prescribed under the veterinary cascade B. a declaration that ‘the item has been prescribed for an animal or herd under the care of the veterinarian’ C. date, within 28 days D. number of repeats E. the Royal College of Veterinary Surgeons registration number

Answer 55

Number of repeats

Question 56

A man visits a pharmacy with his 3-year-old son. He explains that he has son has spots which have appeared around his nose and mouth, which started a few days ago. Some of the spots have started to have a golden brown crust. The child is otherwise well and has no medical conditions and takes no regular medication. The photograph of the child's face is provided below: Using the information provided, which of the following would be most appropriate for the child? A. apply aciclovir 5 % cream five times daily for 5 days B. keep the area moisturised with E45 cream C. hydrogen peroxide 1% cream applied three times daily for 5 days D. no treatment is needed, the child can return to school E. refer to a prescriber as fusidic acid 2% cream is need

Answer 56

Hydrogen peroxide 1% cream applied TDS for 5/7

Question 57

You are having a clear out in the pharmacy and disposing of old pharmacy record books. How long does the Pharmacy Record need to be kept for before it can be destroyed? A. 1 year B. 2 years C. 3 years D. 5 years E. 10 years

Answer 57

5 years

Question 58

A patient with asthma has had an exacerbation recently. You have been asked to review the patient’s inhaler technique for both devices: - Trimbow (beclometasone, formoterol, glycopyrronium) 87/5/9 pressurised inhaler, two inhalations twice a day - Easyhaler Salbutamol 100 mcg dry powder inhaler, one or two inhalations four times a day, when required Which of the following describes the most appropriate inhaler technique for each device? A. inhale slowly and deeply with both devices B. inhale slowly and deeply with Trimbow and strongly and deeply with Easyhaler salbutamol C. inhale strongly and deeply with both devices D. inhale strongly and deeply with Trimbow and slowly and deeply with Easyhaler salbutamol E. inhale strongly and slowly with Trimbow and slowly and deeply with Easyhaler Salbutamol

Answer 58

B

Question 59

A 21-year-old woman brings a hospital prescription into the pharmacy from her dermatologist for isotretinoin. The prescription states that it is prescribed under the conditions of the Pregnancy Prevention Programme (PPP). Which of the following statements regarding oral retinoid prescriptions is incorrect? A. a prescription for isotretinoin under the PPP should be considered expired seven days after the date on the prescription B. a prescription for isotretinoin under the PPP is valid for 28 days C. a pregnancy test must be done as one of the requirements under the PPP D. if the patient is not under the PPP a supply of more than 30 days can be made E. under the PPP a maximum of 30 days of treatment can be supplied

Answer 59

B - ONLY 7 DAYS

Question 60

A 30-year-old man comes to the pharmacy wanting a decongestant tablet. He describes symptoms consistent with a common cold and nasal congestion. He takes fluoxetine 20 mg tablets OM and cetirizine 10 mg tablets OD. He has no contraindications and therefore you are happy to sell him a product to help relieve his symptoms. However, he wants to stock up in case his wife catches it. Which of the following combinations of OTC products is the pharmacist legally allowed to sell in a single transaction? A. one 100 mL bottle of Benylin MUCUS Cough plus Decongestant syrup (containing 30 mg pseudoephedrine per 5 mL) alongside a 210 mL bottle of Day Nurse liquid (containing 60 mg pseudoephedrine per 30 mL of liquid) B. one pack of 12 Sudafed decongestant tablets (each tablet containing 60 mg pseudoephedrine) with an ephedrine containing nasal spray C. one pack of five Lemsip Max Flu Lemon sachets (each containing 60 mg pseudoephedrine) plus a pack of 10 Sudafed Sinus Pressure & Pain (containing 30 mg pseudoephedrine per tablet) D. two packs of 16 Benylin Day and Night tablets (containing 12 ‘day’ tablets each with 60 mg pseudoephedrine inside) alongside 32 paracetamol 500 mg tablets E. two 100 mL bottles of Sudafed Decongestant Liquid (containing 30 mg pseudoephedrine per 5 mL)

Answer 60

C

Question 61

A 52-year-old regular patient in the pharmacy asks for advice. He tells you that over the last few months, he has noticed a change in his bowel habits. Upon further questioning, he tells you that for the last week or so he has also noticed some blood in his stools, which he thinks is due to straining. He appears to have lost weight since you last saw him, as his clothes seem baggy. He has no past medical history and does not take any medication. Which of the following is the most appropriate action to take? A. explain to him that as we get older our bowel habits do change and not to worry B. give lifestyle advice only to help with his constipation as a first-line treatment and tell him to come back in a week if he has no improvement C. refer Mr P to his GP immediately as he is displaying several red-flag symptoms D. sell him an osmotic laxative to soften the stool and make it easier for him to pass to reduce his need for straining E. sell him a bulk-forming laxative such as ispaghula as this is the first-line for the treatment of constipation

Answer 61

Refer

Question 62

A man has come to the pharmacy for a consultation with the pharmacist to determine whether he is suitable for purchasing Viagra Connect (sildenafil 50 mg tablets) over-the-counter for erectile dysfunction (ED). For which of the following patients would it be least appropriate to supply Viagra Connect? A. an 18-year-old man suffering from ED with no other medical conditions B. a 31-year-old man who suffers from depression and takes 50 mg sertraline OD C. a 55-year-old man who is currently prescribed 100 mg sildenafil for ED but has run out and is unable to get a prescription from the GP until next week D. a 60-year-old man who takes 40 mg simvastatin ON E. a 76-year-old man with COPD which is under control using a Fostair 100/6 inhaler and a salbutamol inhaler when required

Answer 62

C

Question 63

A patient with stable COPD is prescribed modified-release theophylline, as she is unable to use inhaled treatment. One week later you see the patient for a review as she has been experiencing several side effects and you are concerned they may be a sign of toxicity. Which of the following would be least suggestive of theophylline toxicity? A. agitation B. bradycardia C. convulsions D. dilated pupils E. vomiting

Answer 63

Bradycardia

Question 64

A 27-year-old woman is due to start treatment with sodium valproate. Valproate medicines must not be used in women or girls of childbearing potential unless a Pregnancy Prevention Programme (PPP) is in place. Which of the following statements regarding the PPP is correct? A. a Patient Card must be provided at the first valproate dispensing, and again at 6-monthly intervals, ensuring that patients understand its content B. as part of the annual specialist review, the specialist will consider whether valproate is the most suitable treatment for the patient. The specialist should discuss the Annual Risk Acknowledgement Form at initiation and during each annual review and ensure that the patient has understood its content C. patients should be warned of the risk of weight loss at the initiation of therapy and appropriate strategies should be adopted to minimise it D. treatment with valproate can be initiated in women of childbearing potential without a negative pregnancy test result, provided treatment duration does not continue beyond 7 days before being confirmed by a healthcare provider E. valproate is contraindicated for use in women of childbearing potential unless 8 out of 10 conditions of the Pregnancy Prevention Programme are fulfilled

Answer 64

B

Question 65

A woman comes into the pharmacy to buy something for her nausea, vomiting and stomach-ache. She tells you that her appetite has reduced over the past few weeks and she has been feeling more tired than usual. You notice that the whites of her eyes are slightly yellow. Upon further questioning, she tells you that she is currently taking folic acid and methotrexate for the management of Crohn’s disease. The woman has not tried anything yet to relieve her symptoms. Which of the following would be the most appropriate advice for you to give? A. advise her to try Gaviscon Advance for 48 hours and see her GP if symptoms persist B. advise her to purchase omeprazole over the counter C. recommend a pregnancy test as a first priority D. recommend whitening eye drops and a tonic to help boost her appetite E. refer the woman to her GP urgently

Answer 65

Refer to Gp urgently - showing signs of MTX toxicity

Question 66

A patient has been prescribed gentamicin at a dose of 5 mg/kg. Their ideal body weight is 60 kg and the vials of gentamicin available in A&E are 80 mg/2mL. How many vials of gentamicin 80 mg/2 mL will be required to make up this patient’s dose? A. 2 vials B. 3 vials C. 4 vials D. 5 vials E. 6 vials

Answer 66

4 vials

Question 67

When delivering health promotion activities and giving advice to patients in the pharmacy, it can be useful to consider the stages of behaviour change. By doing so, pharmacy staff are able to hold more appropriate conversations with patients, which are ultimately more likely to lead to a positive change in behaviour. Which of the following is not one of the stages of behaviour change? A. action B. maintenance C. pre-contemplation D. preparation E. reflection

Answer 67

Reflection

Question 68

A patient attends A&E with their carer. The carer explains that the patient has new onset confusion, slurred speech and nystagmus. The carer is concerned the patient may be having a stroke. The patient has epilepsy and hypertension, and takes phenytoin, amlodipine and ramipril. The patient has no know drug allergies and no other symptoms. A phenytoin level is taken to check for toxicity. Based on the information above, which of the following scenarios is most likely for this patient? A. the phenytoin level is likely to be <10 mg/litre. The patient’s symptoms suggest a subtherapeutic phenytoin level B. the phenytoin level is likely to come back within range. The patient’s symptoms are not due to toxic levels of phenytoin C. the phenytoin level is >10 mg/litre. The patient’s symptoms are a sign of toxicity D. the phenytoin level is >20 mg/litre. The patient’s symptoms are a sign of toxicity E. there is no need to check phenytoin levels as these symptoms suggest a stroke and are not symptoms of toxicity

Answer 68

D

Question 69

A 14-year-old girl has been prescribed an adrenaline auto-injector pen, for a severe peanut allergy. She is on your ward and requires counselling regarding the use of the pen. Which of the following counselling points is least appropriate to give the patient? A. it is advised to check the expiry date of the adrenaline auto-injectors and obtain replacements before they expire B. the auto-injector should be used prior to being exposed to the allergy C. two adrenaline auto-injectors should be carried at all times D. use a second adrenaline auto-injector if symptoms haven’t improved after 5 minutes E. use the adrenaline auto-injector immediately if you have any signs of anaphylaxis

Answer 69

B

Question 70

A patient has been seeing his GP for ongoing gastric discomfort. The GP sent him to a specialist, who recommended he try a course of treatment with a proton pump inhibitor (PPI) to see if this helps his symptoms. Which of the following statements regarding the use of lansoprazole is incorrect? A. measurement of serum-magnesium concentrations should be considered before and during prolonged treatment with a PPI, especially when used with other drugs that cause hypomagnesaemia B. the use of lansoprazole can increase the risk of fractures, particularly when used at high doses for over a year in the elderly C. the use of lansoprazole may mask the symptoms of gastric cancer in adults D. the use of lansoprazole may increase absorption of vitamin B6 with long-term treatment E. with lansoprazole orodispersible tablets, the tablets should be placed on the tongue, allowed to disperse and swallowed, or may be swallowed whole with a glass of water

Answer 70

D

Question 71

A patient, who was started on morphine 4 days ago, is being reviewed on the ward. The pharmacist notices they appear drowsy, unresponsive, and their respiratory rate has slowed. The pharmacist believes they are suffering from opioid toxicity and informs the medical team immediately. Which of the following antidotes should be used to reverse the effects of the morphine? A. acetylcysteine B. activated charcoal C. flumazenil D. glucagon E. naloxone

Answer 71

Naloxone

Question 72

A 9-year-old child has been prescribed miconazole cream for a fungal skin infection. The pharmacist is handing out the cream to the child’s parents with appropriate counselling. Which of the following is the most appropriate advice for the pharmacist to give? A. apply daily until lesions have healed B. apply daily continuing for 10 days after lesions have healed C. apply twice daily until lesions have healed D. apply twice daily continuing for 10 days after lesions have healed E. apply twice daily continuing for 14 days after lesions have healed

Answer 72

D??

Question 73

A 54-year-old woman is on the medical admissions ward with an exacerbation of asthma. She has been prescribed 40 mg prednisolone and salbutamol nebulised. The woman tells you this is her 5th admission in 3 months, and every time she has received a course of prednisolone. Which of the following is the most appropriate advice for the management of her current course of steroids? A. a 5-day course of prednisolone 40 mg then stop B. a 5-day course of prednisolone 40 mg then wean gradually C. a 7-day course of prednisolone 40 mg then stop D. a 10-day course of prednisolone 40 mg then wean gradually E. the patient should not receive any further steroids

Answer 73

5 day course of pred then gradually wean

Question 74

A man who has previously suffered two seizures has been newly diagnosed with tonic-clonic seizures. The specialist wants to prescribe an antiepileptic for the patient. You are the responsible pharmacist working in the pharmacy when a prescription for the antiepileptic is brought into the pharmacy. You would like to query the prescription with the prescriber as the brand is not specified. Which of the following is the most likely drug prescribed? A. carbamazepine B. lamotrigine C. levetiracetam D. oxcarbazepine E. sodium valproate

Answer 74

Carbamazepine (CP3)

Question 75

Clinical audit is vital for patient care and safety, as well as for the development and improvement of professional practice. Which of the following statements regarding clinical audit is incorrect? A. part of the process of clinical audit is to compare your service to existing standards or criteria B. patient consent will not be required if you are collecting data which you already provide as part of your care to the patient, and which does not identify the patient C. the aim of a clinical audit is to determine whether a current service or procedure reaches a specified standard, to use that information to inform improvements in care, and then evaluate those changes by re-auditing D. the re-audit phase of the audit cycle involve collecting a second set of data and analysing the results to determine whether the changes made in the initial audit have been effective E. you must receive ethical approval before conducting a clinical audit

Answer 75

E

Question 76

Miss D comes into your pharmacy and asks for the morning after pill. She had unprotected sex 24 hours ago. Her menstrual cycle is regular, and she is expecting her period in the next 3 days. She is currently taking carbamazepine for management of her epilepsy. A. Call the parents B. Call the police C. No supply, chances of pregnancy low D. Refer to get an IUD fitted E. Refer to GP F. Supply EllaOne (ulipristal acetate) G. Supply Levonelle One Step (levonorgestrel) H. Supply two tablets of Levonelle One Step (levonorgestrel)

Answer 76

Refer for IUD

Question 77

Miss L, a 21 year old female, comes into your pharmacy on Tuesday morning and asks for the morning after pill. She had unprotected sex on Friday night around 11pm. She is currently taking citalopram 10mg tablet. She would like to take something immediately as emergency contraception. A. Call the parents B. Call the police C. No supply, chances of pregnancy low D. Refer to get an IUD fitted E. Refer to GP F. Supply EllaOne (ulipristal acetate) G. Supply Levonelle One Step (levonorgestrel) H. Supply two tablets of Levonelle One Step (levonorgestrel)

Answer 77

Supply ellaone

Question 78

A 30-year-old woman with very poor diet complains of bleeding gums. A. vitamin A B. vitamin B1 C. vitamin B6 D. vitamin B12 E. vitamin C F. vitamin D G. vitamin E H. vitamin K

Answer 78

Key facts about vitamin C (ascorbic acid): Function: Important for collagen synthesis, wound healing, and maintaining healthy gums and blood vessels. Deficiency symptoms: Bleeding gums Easy bruising Fatigue Poor wound healing Joint pain Corkscrew hairs

Question 79

A 35-year-old patient recently diagnosed with coeliac disease complains of prolonged bleeding after a small cut. The prothrombin time is increased. A. vitamin A B. vitamin B1 C. vitamin B6 D. vitamin B12 E. vitamin C F. vitamin D G. vitamin E H. vitamin K

Answer 79

Vitamin K

Question 80

A 25-year-old African man presents with symmetrical dermatitis on sun-exposed skin, diarrhoea and depression. He has recently been on anti-tuberculosis treatment. A. vitamin A B. vitamin B1 C. vitamin B6 D. vitamin B12 E. vitamin C F. vitamin D G. vitamin E H. vitamin K

Answer 80

The correct answer is: C. vitamin B6 (pyridoxine) ✅ Here’s why: 🔍 Classic triad of symptoms: Dermatitis (especially symmetrical and on sun-exposed areas) Diarrhoea Depression (or other neurological symptoms) These are hallmark features of pellagra, which is actually due to niacin (vitamin B3) deficiency, but it can also occur secondarily due to vitamin B6 deficiency, especially in the context of isoniazid therapy (a key anti-TB drug). Why this fits: Isoniazid (used for tuberculosis) inhibits the action of vitamin B6, leading to symptoms mimicking niacin deficiency. Vitamin B6 is needed for the synthesis of niacin from tryptophan. So a B6 deficiency can cause pellagra-like symptoms: Dermatitis (symmetric, sun-exposed) Diarrhoea Depression/Dementia

Question 81

A 23-year-old newly diagnosed with type 1 diabetes to be started on a basal bolus insulin regimen. A. Abasaglar (insulin glargine) twice daily B. Continuous subcutaneous insulin pump C. Humulin I (isophane) four times a day D. Humalog Mix25 (insulin lispro) three times a day with meals and Lantus at night E. Insulatard (insulin human) once a day in the morning F. NovoMix 30 (insulin aspart) twice daily G. NovoRapid (insulin aspart) three times daily with meals and Lantus at night H. Victoza (liraglutide) once daily

Answer 81

G

Question 82

A 72-year-old patient who is required to start an intermediate acting insulin regimen which can be administered by her carers. A. Abasaglar (insulin glargine) twice daily B. Continuous subcutaneous insulin pump C. Humulin I (isophane) four times a day D. Humalog Mix25 (insulin lispro) three times a day with meals and Lantus at night E. Insulatard (insulin human) once a day in the morning F. NovoMix 30 (insulin aspart) twice daily G. NovoRapid (insulin aspart) three times daily with meals and Lantus at night H. Victoza (liraglutide) once daily

Answer 82

E

Question 83

A 45-year-old patient with type 2 diabetes who wants to change from his current basal-bolus insulin regimen to a biphasic insulin regimen to reduce his number of daily injections. A. Abasaglar (insulin glargine) twice daily B. Continuous subcutaneous insulin pump C. Humulin I (isophane) four times a day D. Humalog Mix25 (insulin lispro) three times a day with meals and Lantus at night E. Insulatard (insulin human) once a day in the morning F. NovoMix 30 (insulin aspart) twice daily G. NovoRapid (insulin aspart) three times daily with meals and Lantus at night H. Victoza (liraglutide) once daily

Answer 83

F

Question 84

A common condition where the skin develops small lumps which are pearly-white or slightly pink. Each lump looks like a small swelling on the skin and is round, firm and about 2-5 mm across. It is most common in children and mostly happens in children aged 1-4 years. A. cellulitis B. herpes zoster C. impetigo D. measles E. miliaria F. molluscum contagiosum G. psoriasis H. varicella zoster

Answer 84

F

Question 85

This type of rash is common in infancy, but may occur at any age. It arises from obstruction of the sweat glands and is most commonly found in hot, humid conditions. A. cellulitis B. herpes zoster C. impetigo D. measles E. miliaria F. molluscum contagiosum G. psoriasis H. varicella zoster

Answer 85

E

Question 86

An infection of the dermis and subcutaneous tissues, commonly in the lower leg. Affected skin feels warm, may look swollen and looks red and inflamed. The infected area may spread and is usually tender. Sometimes blisters occur on the skin. A. cellulitis B. herpes zoster C. impetigo D. measles E. miliaria F. molluscum contagiosum G. psoriasis H. varicella zoster

Answer 86

Cellulitis

Question 87

A fever, conjunctivitis and a runny nose usually occur first, followed by small white spots which usually develop inside the mouth a day or so later. Treatment aims to ease symptoms until the body's immune system clears the infection. A. cellulitis B. herpes zoster C. impetigo D. measles E. miliaria F. molluscum contagiosum G. psoriasis H. varicella zoster

Answer 87

Measles

Question 88

A 32-year-old man complains of rapid-onset pain around his left eye every night for the last ten days, associated with watery eye, lid swelling and flushing. He suffers from these bouts every three months. A. acute glaucoma B. cluster headache C. epilepsy D. meningitis E. migraine F. sinusitis G. subarachnoid haemorrhage H. tension headache

Answer 88

cluster

Question 89

A 42-year-old man complains of a severe headache of sudden onset 3 hours ago, likened to being kicked in the back of the head. He has vomited twice and is now feeling stiff in his neck. A. acute glaucoma B. cluster headache C. epilepsy D. meningitis E. migraine F. sinusitis G. subarachnoid haemorrhage H. tension headache

Answer 89

G

Question 90

A 45-year-old solicitor complains of a headache that feels light a tight band around her head. A. acute glaucoma B. cluster headache C. epilepsy D. meningitis E. migraine F. sinusitis G. subarachnoid haemorrhage H. tension headache

Answer 90

Tension

Question 91

Mr H is 78-years-old and has been taking citalopram 20 mg tablets once daily. For the past few days Mr H has been feeling very drowsy and confused. He is at the hospital to check his blood electrolyte levels. A. hyperglycaemia B. hypoglycaemia C. hyponatraemia D. hypernatraemia E. hypercalcaemia F. hypocalcaemia G. hypokalaemia H. hyperkalaemia

Answer 91

Hyponatraemia

Question 92

Mrs L is 35-years-old and suffering from severe asthma. She brings in her repeat prescription for theophylline and salbutamol. She tells you she has used her salbutamol inhaler more frequently than normal, as her asthma has become worse. She also tells you she has been feeling more tired recently, and is feeling fatigued, along with constipation. A. hyperglycaemia B. hypoglycaemia C. hyponatraemia D. hypernatraemia E. hypercalcaemia F. hypocalcaemia G. hypokalaemia H. hyperkalaemia

Answer 92

Hypokalaemia

Question 93

Miss M is 42-years-old and takes ramipril 10 mg OD. She visits the pharmacy with a new prescription for spironolactone 25 mg once daily. You ask to speak to her GP regarding the interaction between these medicines. A. hyperglycaemia B. hypoglycaemia C. hyponatraemia D. hypernatraemia E. hypercalcaemia F. hypocalcaemia G. hypokalaemia H. hyperkalaemia

Answer 93

Hyperkalemia

Question 94

A 3-year-old boy presents in the pharmacy with his mother. He has a distinctive barking cough and wheeze when he breathes in. You suspect that it’s a viral infection and you refer him to the GP. A few hours later, his mother brings him back with a prescription explaining that he has been diagnosed with croup. Which of the above medicines is most likely on the prescription? A. buserelin B. canagliflozin C. ibandronic acid D. liraglutide E. norethisterone F. prednisolone G. propylthiouracil H. tibolone

Answer 94

Prednisolone

Question 95

Mrs L presents in the pharmacy with yellow skin. You explain this is likely the result of high bilirubin levels in her blood due to one of her medicines. A. buserelin B. canagliflozin C. ibandronic acid D. liraglutide E. norethisterone F. prednisolone G. propylthiouracil H. tibolone

Answer 95

Propylthiouracil

Question 96

A 26-year-old woman has been prescribed a 12-week course of trimethoprim for acne. You advise her of a warning sign which she should look out for and seek immediate medical attention if it occurs. A. binge eating B. confusion C. hyperglycaemia D. mouth ulcers E. oily stools F. pain in both knees G. reduced dental mobility H. sweating

Answer 96

Mouth ulcers - blood disorders

Question 97

Which warning sign indicates that a patient on ropinirole should be withdrawn or have their dose reduced until the symptoms resolve? A. binge eating B. confusion C. hyperglycaemia D. mouth ulcers E. oily stools F. pain in both knees G. reduced dental mobility H. sweating

Answer 97

Binge eating

Question 98

A 72-year-old women is receiving treatment of postmenopausal osteoporosis with zoledronic acid. You remind her to look out for a specific adverse drug reaction which should be reported to her GP. A. binge eating B. confusion C. hyperglycaemia D. mouth ulcers E. oily stools F. pain in both knees G. reduced dental mobility H. sweating

Answer 98

Reduced dental mobility

Question 99

Mr Y enters your pharmacy requesting tamsulosin 400 mcg for an enlarged prostate. You assess his symptoms, age and conduct a medical history. He is eligible to receive an initial supply of 14 tablets. You also advise him to visit his GP to confirm the diagnosis within 6 weeks of treatment. A. 6 years B. 10 years C. 12 years D. 14 years E. 16 years F. 18 years G. 35 years H. 45 years

Answer 99

45

Question 100

Miss B presents to your pharmacy with a test result letter. You notice from the letter that she has been tested positive for genital Chlamydia trachomatis. She does not want to see her GP, as he is a family friend. Her friend has told her she is able to buy azithromycin 500 mg tablets over the counter to treat her Chlamydia. You make the supply. A. 6 years B. 10 years C. 12 years D. 14 years E. 16 years F. 18 years G. 35 years H. 45 years

Answer 100

16 years

Question 101

Mr Q enters your pharmacy, requesting a medicine called orlistat 60mg capsules (Alli) used to treat obesity. You check his BMI, which is 30 kg/m2. You also ask him his age. You decide to make a supply to the patient. A. 6 years B. 10 years C. 12 years D. 14 years E. 16 years F. 18 years G. 35 years H. 45 years

Answer 101

18

Question 102

Mr U presents his daughter to your pharmacy. She has developed a mild rash on her neck after wearing a new necklace. You decide to make a supply of hydrocortisone 1% cream. A. 6 years B. 10 years C. 12 years D. 14 years E. 16 years F. 18 years G. 35 years H. 45 years

Answer 102

10 years