Clinical Past papers I didn't get right Flashcards
Mr C has been confirmed to have C. Difficile. You are reviewing his medical history to see if there are any drugs which may need to be stopped, in case they contribute to developing C. Difficile.
Which one of the following drugs below is most likely to contribute to developing C. Difficile?
A. Metronidazole B. Vancomycin C. Fidoxamicin D. Omeprazole
C. Fidoxamicin
What drug would you expect to see prescribed alongside Isoniazid for the treatment of Tuberculosis to prevent peripheral neuropathy?
A. Folic Acid 5mg Daily
B. Folic Acid 400mcg Daily
C. Pyridoxine 10-20mg Daily
D. Pyridoxine 50mg TDS
C. Pyridoxine 10-20mg Daily (vitamin b6)
Mr H has been admitted to hospital with a lower respiratory tract infection. He is awaiting microbiology results on his sputum; an atypical pathogen is not suspected.
Which of the following is the most likely cause of the respiratory tract infection?
A. Clostridium botulinum
B. Legionella pneumophillia
C. Mycoplasma pneumoniae
D. Mycobacterium tuberculosis
E. Streptococcus pneumoniae
E. Streptococcus pneumoniae
Streptococcus pneumoniae is the most common cause of lower respiratory tract infections. Mycoplasma pneumoniae is also a common cause however this is an atypical pathogen.
A regular patient comes into your pharmacy to pick up her prescription for Daktarin (miconazole) cream for a fungal skin infection. The patient asks you how long she should use the cream for.
Which of the following statements regarding Daktarin cream is TRUE?
A. Continue to apply for 5 days after the lesions have cleared
B. Continue to apply for 7 days after the lesions have cleared
C. Continue to apply for 10 days after the lesions have cleared
D. Continue to apply for 14 days after the lesions have cleared
E. Continue to apply for 21 days after the lesions have cleared
C.
BNF monograph: For adults and children, apply twice daily continuing for 10 days after lesions have healed.
Mrs TR has been diagnosed with acute pyelonephritis and is being treated with an intravenous infusion of gentamicin, administered once daily. She received her first dose 21 hours ago. Her next dose is in 3 hours.
Which tests should be performed 18-24 hours after the first dose of gentamicin?
A. C-reactive protein concentration
B. Audiometry
C. Serum creatinine concentration
D. Serum gentamicin concentration
E. Estimated glomerular filtration rate
D. Serum gentamicin concentration
For once daily dosing, gentamicin levels should be checked 20 hours post dose. The level should be below 1mg/L before the next dose can be administered.
Mrs Shelly is 42-year-old who comes into the pharmacy with a prescription for an antibiotic. She tells you that she has been diagnosed with an exacerbation of chronic bronchitis. She has no allergies and is not taking no other medication.
Which of the following is most likely to be on the prescription?
A. Amoxicillin
B. Cefradine
C. Erythromycin
D. Metronidazole
E. Fusidic acid
A.
Amoxicillin/Ampicillin is first line for an exacerbation of chronic bronchitis. Tetracycline is an alternative.
Miss L is a 9-year-old and has been admitted to your ward with infective exacerbation of cystic fibrosis. Her sputum sample has returned from microbiology and the following medication has been prescribed: Ceftazidime, Tobramycin and Flucloxacillin.
Which of the following organisms are the prescribed antibiotics most likely to be covering?
A. Haemophilus and staphylococcus aureus
B. Haemophilus and streptococcus pneumoniae
C. Pseudomonas and streptococcus pneumoniae
D. Staphylococcus aureus and pseudomonas
E. Streptococcus and staphylococcus aureus
D. Staphylococcus aureus and pseudomonas
Tobramycin is active pseudomonas and Flucloxacillin is commonly used for staphylococcal infections.
A customer asks the pharmacist to recommend an antacid for them as they are experiencing mild heartburn following a heavy lunch. Questioning reveals that they are also taking antibiotics and are due to take another dose now.
Which one of the following antibiotics is least likely to have its absorption and/or efficacy impaired if taken after a meal with an antacid?
A. Ciprofloxacin 250mg tablets
B. Co-amoxiclav 250mg/125mg tablets
C. Flucloxacillin 250mg capsules
D. Phenoxymethylpenicillin 250mg tablets
E. Tetracycline 250mg tablets
B. Co-amoxiclav 250mg/125mg tablets
Co-amoxiclav can be taken with antacids without affecting the absorption of the antibiotic.
A patient calls your pharmacy concerned that he is having an allergic reaction to his antibiotic. He explains that he started taking co-amoxiclav this morning and has since started having an itch and rash all over his body. He is also asthmatic and is currently suffering from hay fever.
Which of the following options would be the most appropriate advice to give to the patient?
A. Advise the patient to stop taking their medication and see their doctor as soon as
B. Advise the patient that they are experiencing a side effect of the medication and it is safe to continue taking the medication
C. Advise the patient to see their doctor as soon as possible as the dose of their medication may need to be decreased
D. Advise the patient to see their doctor as soon as possible as the dose of their medication may need to be increased
A. Advise the patient to stop taking their medication and see their doctor as soon as
The symptoms the patients are experiencing is that if a positive penicillin allergy. The patient also has a history of atopic allergy, which puts him at higher risk of anaphylaxis. The patient should stop taking and seek medical attention immediately.
A 9-year-old presents at the pharmacy
What is the most appropriate treatment for a 9-year-old with a widespread impetigo infection?
A. Clindamycin
B. Flucloxacillin
C. Fusidic acid
D. Ciprofloxacin
E. Amoxicillin
B
Oral Flucloxacillin is the most appropriate for widespread impetigo. If streptococci suspected in severe infection, add Phenoxymethylpenicillin. If penicillin-allergic, oral clarithromycin/azithromycin/erythromycin. Suggested duration of treatment 7 days.
A doctor calls the pharmacy regarding a patient with bacterial vaginosis.
What is the most appropriate treatment for a patient with bacterial vaginosis?
B
For bacterial vaginosis, oral metronidazole 5-7 days (or high-dose metronidazole 2g as a single dose). Alternatively, topical metronidazole for 5 days or topical clindamycin for 7 days.
Mrs K presents to your pharmacy and tells you that she has a sudden pain behind her ankle and is unable to weight bear on that leg, her daughter who is a physiotherapist told her she may have ruptured her tendon. She tells you that she was recently prescribed Ciprofloxacin. Which other factor would predispose Katherine to tendon rupture if she was taking Ciprofloxacin?
A. T aking NSAIDs
B. Those aged 40 years and over
C. Those with a history of osteoarthritis
D. Those with a history of tendon disorders related to quinolone use
E. Those patients taking drugs causing hyperuricaemia
D
Those with a history of tendon disorders related to quinolone use would predispose to tendon rupture.
A mother contacts the community pharmacy by telephone to seek further advice regarding an antibiotic prescription that had been supplied for her 3-year-old daughter. Her daughter has been diagnosed with a severe skin infection and is required to commence Flucloxacillin 125mg/5mL oral suspension, at a dose of 5mL QDS for 10 days.
Which of the following statements regarding Flucloxacillin is incorrect?
A. Cholestatic jaundice may occur very rarely, up to 6 months after treatment with
B. Flucloxacillin can cause gastro-intestinal disturbances, which are common side effects
C. Flucloxacillin should be used with caution in patients with hepatic impairment
D. Flucloxacillin should be taken on an empty stomach, which means one hour before food
or two hours after
E. The doses should be spaced evenly throughout the day. Keep taking Flucloxacillin until
the course is finished, unless you are told to stop.
A. Cholestatic jaundice may occur very rarely, up to 6 months after treatment with
This is an important blue box for Flucloxacillin. Cholestatic jaundice and hepatitis may occur very rarely, up to 2 months after treatment has stopped. Flucloxacillin should not be used in patients with a history of hepatic dysfunction associated with Flucloxacillin and should be used with caution with hepatic impairment.
- Mrs P, a 64-year-old lady with diabetes mellitus, did not have the influenza vaccination this year. She has now been prescribed oseltamivir as she is caring for her husband who has been diagnosed with influenza.
Which of the following statements regarding oseltamivir is INCORRECT?
A. Oseltamivir can reduce the risk of complications from influenza in the elderly and in patients with chronic disease
B. It is not appropriate for this patient to take oseltamivir as she is not displaying any
C. Oseltamivir should be given within 48 hours of exposure of influenza
D. Oseltamivir can be used during pregnancy provided the potential benefits outweigh the
risks, such as during a pandemic
E. Oseltamivir is not a substitute for vaccination, which remains the most effective way of
preventing illness from influenza
B
BNF 74 p623/624 ‘At-risk’ patients are those over 65 or have one or more chronic conditions, including diabetes. See NICE technology appraisal on p624. It is appropriate for this patient to receive oseltamivir as she is classed as ‘at risk’ because she has diabetes.
a 39-year-old patient who has started taking medication prescribed by her doctor last month for tuberculosis. Today she tells you that she has felt nauseous almost every day for the last week. She also has a high temperature and mentions she feels very weak and tired. Which of the following medication is LEAST likely to be causing Mrs T’s symptoms?
A. Ethambutol
B. Isoniazid
C. Pyrazinamide D. Rifabutin
E. Rifampicin
A
The patient reports nausea, fever and loss of energy which are signs of liver disorder (along with persistent vomiting, jaundice, weight loss and abdominal pain).
* * Rifampicin, Rifabutin, Isoniazid and Pyrazinamide are all associated with liver toxicity.
* * Ethambutol is not linked to liver toxicity.
