Exam Questions

Question 1

She is complaining of nausea and loose stools since starting on methotrexate.
Which of the following is the most appropriate strategy to prevent the side effects that the patient is
experiencing?
Select one:
A. Folic acid 5 mg daily
B. Folic acid 5 mg once a week, taken on a different day to methotrexate
C. Folinic acid 15 mg every 6 hours for 24 hours
D. Rinse mouth with lignocaine mouthwash
E. Stop methotrexate immediately

Answer 1

B

Folic acid is indicated for the prevention of side effects from methotrexate however it needs to be taken on a
different day to the methotrexate, otherwise it will reduce the effectiveness of the methotrexate. The use of folinic
acid is reserved for use as a part of treatment protocols for methotrexate infusions.
The correct answer is: Folic acid 5 mg once a week, taken on a different day to methotrexate

Question 2

A 26-year-old female has been diagnosed with microcytic anaemia.
Which one of the following nutritional deficiencies is most likely to be contributing to this diagnosis?
Select one:
A. Folate deficiency
B. Iron deficiency
C. Vitamin B6 deficiency
D. Vitamin B12 deficiency
E. Vitamin D deficiency

Answer 2

B

Microcytic Anaemia (low MCV) most commonly due to iron deficiency.

Question 3

A 23-year-old woman presents to her GP complaining of heavy and irregular menstrual bleeding. She has a past
medical history of antiphospholipid syndrome, for which she is treated with warfarin. After conducting
investigations, the GP did not find any abnormal uterine pathology.
Use the information provided about antiphospholipid syndrome in the resource pack.
Which one of the following treatment options would be most appropriate?
Select one:
A. Levonorgestrel-releasing intrauterine system
B. Mefenamic acid
C. Naproxen
D. Oral combined hormonal contraception
E. Tranexamic acid

Answer 3

Levonorgestrel-releasing intrauterine system.
This will also provide contraception which may be important for this patient as she is on warfarin.

NSAIDs would be contra-indicated as they increase the risk of bleeding when given with warfarin. Tranexamic
acid and the combined oral contraceptive pill are also contra-indicated in antiphospholipid syndrome due to the
additive increase in thrombosis risk.

Question 4

A regular patient comes into the pharmacy and asks for some medicine to treat a wart on their hand.
Which ONE of the following statements about warts is CORRECT?
Select one:
A. Cryotherapy with liquid nitrogen can be carried out to freeze a wart
B. Refer to the GP if the wart is on the hand
C. Topical salicylic acid (15–50%) should be applied once or twice daily for up to 20 weeks
D. Warts are caused by the herpes simplex virus type 2 (HSV-2)
E. Without any treatment, warts may spontaneously resolve but may take 7-10 days

Answer 4

A

The other options are incorrect - Topical salicylic acid (15–50%) should be applied once or twice daily for up to
12 weeks

Warts are caused by infection in the outer layer of the skin (epidermis) with a virus called the ‘human papilloma
virus’. refer to GP for facial warts. Without any treatment, warts may spontaneously resolve but may take many
months or even years

Question 5

You are renewing your registration with the General Pharmaceutical Council (GPhC) and are preparing to submit
your revalidation records.
Which of the following are you NOT required to submit?
Select one:
A. 360 feedback
B. Peer discussion
C. Planned CPD
D. Reflective account
E. Unplanned CPD

Answer 5

A

Question 6

A 45-year-old woman with oestrogen-receptor positive with breast cancer. She is prescribed tamoxifen 20 mg
daily after a total mastectomy. She has a history of depression for which she is taking paroxetine 20 mg every
morning.
Which of the following is the most appropriate counselling point for this patient?
Select one:
A. Redness, pain or swelling in the leg can be managed with painkillers and by elevating the leg
B. She should see her GP to review her paroxetine as it may increase the chance of her experiencing side
effects from the tamoxifen
C. Take the tamoxifen at night to reduce symptoms of hot flushes
D. Tamoxifen also reduces the risk of endometrial cancer
E. Tamoxifen should be taken daily to reduce the risk of the breast cancer returning

Answer 6

Tamoxifen should be taken daily to reduce the risk of the breast cancer returning, with ongoing review of the
benefits versus risks of continuing.
Tamoxifen may increase the risk of endometrial cancer. Paroxetine reduces the effectiveness of tamoxifen
through inhibiting its conversion to its active form. Timing of tamoxifen will not reduce the hot flush which is a
common side effect. Tamoxifen increases the risk of venous thromboembolism and a swollen leg could suggest
a deep vein thrombosis which requires urgent medical attention in a hospital.
Tamoxifen may increase the risk of endometrial cancer. Paroxetine reduces the effectiveness of tamoxifen
through inhibiting its conversion to its active form. Timing of tamoxifen will not reduce the hot flush which is a
common side effect. Tamoxifen increases the risk of venous thromboembolism and a swollen leg could suggest
a deep vein thrombosis which requires urgent medical attention in a hospital.
The correct answer is: Tamoxifen should be taken daily to reduce the risk of the breast cancer returning

Question 7

A 30-year-old woman comes into the pharmacy and mentions she would like to buy something to help ease her
period pain. You suspect her to have primary dysmenorrhoea. You recommend she takes 250 mg naproxen
tablets.
Which ONE of the following is the CORRECT information to provide the patient?
Select one:
A. Do not exceed three tablets daily
B. Do not store above 30 degrees temperature
C. Do not take if you are allergic to Penicillin’s
D. It is safe to take if you have a stomach ulcer
E. Take an additional anti-inflammatory if the pain worsens

Answer 7

The maximum dosage for Naproxen OTC, is one 250 mg tablet 3 times per day

Question 8

A 54-year-old man presents with acute back pain. He has a family history of cardiovascular disease, has a BMI
of 30 kg/m2, and is a smoker.
Which one of the following would be most appropriate for this patient?
Select one:
A. Celecoxib
B. Diclofenac
C. Etoricoxib
D. Meloxicam
E. Naproxen

Answer 8

E

Naproxen (1 g daily) is associated with a lower thrombotic risk, and low doses of ibuprofen (1.2 g daily or less)
have not been associated with an increased risk of myocardial infarction. COX-2 inhibitors), diclofenac and high
dose ibuprofen are associated with increased CVD risk

Question 9

Several Prescription Only Medicines (POMs) are now available to purchase by patients as Pharmacy (P)
medicines.
Which ONE of these POM-P switches are NOT associated with the corresponding common side effect?
Select one:
A. Orlistat and urgent bowel movements
B. Sildenafil and cold hands and feet
C. Sumatriptan and tingling sensations in the skin
D. Tamsulosin and dizziness
E. Tranexamic acid and diarrhoea

Answer 9

B

Sildenafil is commonly associated with flushes/hot flushes

Question 10

Your counter assistant is going through her minor ailments handbook as she would like to improve her
healthcare knowledge about common conditions and infections.
She asks you for which ONE of the following conditions a partner sharing the same house should also
receive treatment, regardless of whether or not they have any symptoms?
Select one:
A. Athlete’s foot
B. Impetigo
C. Ringworm
D. Threadworm
E. Thrush

Answer 10

D

Threadworm, everyone in the household must be treated. Thrush is only required to be treated if the partner has
symptoms

Question 11

A patient suffering with dyspepsia calls you to discuss some symptoms he has been experiencing.
Which of the following symptoms requires urgent referral?
Select one:
A. Aphthous ulcer
B. Dysphagia
C. Nausea
D. People over 50 years with unexplained and persistent recent onset dyspepsia
E. Progressive unintentional weight gain

Answer 11

Dysphagia requires urgent referral. Urgent endoscopic investigation is required for patients with dysphagia,
significant acute gastrointestinal bleeding, or in those aged 55 years and over with unexplained weight loss and
symptoms of upper abdominal pain, reflux or dyspepsia.

Question 12

An 85-year-old man is receiving palliative care for lung cancer has been prescribed morphine sulfate MR
capsules (Zomorph ®) 200 mg twice a day to manage his cancer pain. Over the last few days, he has
complained of constipation, which he was not suffering from previously.
Which of the following is the most appropriate treatment for this patient’s constipation?
Select one:
A. Co-dantrhamer
B. Glycerol
C. Ispaghula husk
D. Methylnaltrexone
E. Naloxegol

Answer 12

A

Opioids reduce peristalsis, increase the anal sphincter tone, and promote absorption of water from the large
intestine; this leads to hard stools and constipation. Ispaghula husk, a bulk-forming laxative, can cause
obstruction and increase the risk of faecal impaction in opioid-induced constipation especially if fluid intake is
inadequate. Constipation from opioid use is best treated with a stimulant laxative, or a stool-softening laxative, or
both if necessary. Adequate fluid intake should be maintained. (Source MHRA)
Methylnaltrexone and naloxegol are reserved for where first line therapies have failed.

Question 13

A 2-year-old girl present with a fever of 38°C. Upon inspection she does NOT have a rash, has not had any
other symptoms, and has tested negative for COVID-19.
What is the MOST appropriate dose of paracetamol 120 mg/5 mL to recommend for this patient?
Select one:
A. 5 mL BD PRN
B. 7.5 mL BD PRN
C. 5 mL QDS PRN
D. 7.5 mL QDS PRN
E. 10 mL QDS PRN

Answer 13

D

Question 14

You sell a patient glyceryl trinitrate 400 micrograms spray over the counter for the treatment of acute angina
pectoris.
Which of the following is the CORRECT advice regarding use of glyceryl trinitrate 400 micrograms
spray?
Select one:
A. Administer 1-2 sprays again after two minutes if the first dose did not work
B. Administer 2-3 sprays again after two minutes if the first dose did not work
C. Spray directly on to the chest area in an emergency situation
D. Spray directly under the tongue and close mouth immediately after use
E. Spray directly under the tongue and leave mouth open to allow for easy breathing

Answer 14

D

Question 15

A 25-year-old male is admitted to hospital feeling unwell with extensive cellulitis caused by methicillin-
resistant Staphylococcus areus and is subsequently started on intravenous vancomycin 1.5 g every 12 hours.

He weighs 78 kg, his height is 185 cm, and his eGFR is >90 m/min/1.73m2
.

Which of the following is the most appropriate advice in relation to managing vancomycin?
Select one:
A. A vancomycin peak plasma concentration level should be measured after the first dose
B. A vancomycin trough plasma concentration level should be measured before the second dose
C. A vancomycin trough plasma concentration level should be taken before the 4th dose
D. After taking a vancomycin trough plasma concentration level, the next dose should always be withheld
until the results are back
E. The dose should be administered over 30 minutes

Answer 15

C

Question 16

A patient should seek urgent medical attention if they develop blurred or yellow vision whilst taking this medicine?

Lithium
Carbamazepine
Digoxin
Apixaban
Methotrexate

Answer 16

Digoxin

Question 17

The doctors decide to start the patient on a broad spectrum antimicrobial drug which has activity
particularly against atypical bacteria. (Penicillin allergy)

Which ONE of the following antimicrobials would be the MOST appropriate treatment for him?
A Amoxicillin
B Ciprofloxacin
C Clarithromycin
D Co-amoxiclav
E Metronidazole

Answer 17

C- Clarithromycin has affect against atypical bacteria.

Metronidazole- has broad spec activity but no against atypical bacteria

Question 18

Mr T has come to see the doctor regarding a red, non-itchy, painless rash which is increasing in size that looks like a bullseye. He reports feeling fatigued with aching joints and headache. The doctor suspects lyme disease. Which antibiotic is fist line?

A- Doxycycline 100mg BD for 21 days
B- Azithromycin 500mg OD for 7 days
C- Amoxicillin 500mg TDS for 7 days
D- Flucloxacillin 500mg QDS for 14 days

Answer 18

A

In patients presenting with erythema migrans rash with or without non-focal symptoms, oral doxycycline is recommended as first-line. If doxycycline cannot be given, oral amoxicillin should be used as an alternative. Oral azithromycin should be given if both are unsuitable.

In patients presenting with focal symptoms of cranial nerve or peripheral nervous system involvement, oral doxycycline is recommended as first-line. If doxycycline cannot be given, oral amoxicillin should be used.

In patients presenting with symptoms of central nervous system involvement, intravenous ceftriaxone is recommended as first-line. Oral doxycycline should be used as an alternative.

Question 19

A 36-year-old woman asks for OTC vaginal thrush treatment for her second outbreak in eight months. She is particularly complaining about vulval itchiness and soreness.
What is the most appropriate course of action in this instance?

A Recommend that the woman visits her local sexual health clinic

B Refer to GP

C Sell the sodium citrate granules that can be used to help with her vulval discomfort

D Sell the woman clotrimazole 1% cream to alleviate external symptoms of thrush

E Sell the woman hydrocortisone 1% cream to help reduce the vulval itchiness

Answer 19

The correct answer was Sell the woman clotrimazole 1% cream to alleviate external symptoms of vaginal thrush

If the patient has more than 2 episodes of thrush in 6 months she should be referred to her GP. As this is not the case - she can be treated with clotrimazole 1% cream.

Question 20

Rheumatoid arthritis presents with a myriad of symptoms, of which a very common presentation is pain and inflammation.

Which of the following is licensed for pain and inflammation in rheumatoid arthritis?

A Domperidone
B Esketamine
C Febuxostat
D Nabumetone
E Naloxone

Answer 20

The correct answer was Nabumetone

The only medication on this list licensed for pain and inflammation in rheumatoid arthritis is nabumetone.

Question 21

For which drug is it important to ensure adequate hydration at all times in patients receiving higher-strength preps of this drug.

A Olsalazine 
B Felopidine
C Alendronic acid
D Pancreatin 
E Amiodarone

Answer 21

D

BNF

It is important to ensure adequate hydration at all times in patients receiving higher-strength pancreatin preparations

Pancreatin is inactivated by gastric acid therefore manufacturer advises pancreatin preparations are best taken with food (or immediately before or after food).

Since pancreatin is inactivated by heat, excessive heat should be avoided if preparations are mixed with liquids or food; manufacturer advises the resulting mixtures should not be kept for more than one hour and any left-over food or liquid containing pancreatin should be discarded.

Enteric-coated preparations deliver a higher enzyme concentration in the duodenum (provided the capsule contents are swallowed whole without chewing).

Manufacturer advises gastro-resistant granules should be mixed with slightly acidic soft food or liquid such as apple juice, and then swallowed immediately without chewing. Capsules containing enteric-coated granules can be opened and the granules administered in the same way. For infants, Creon® Micro granules can be mixed with a small amount of milk on a spoon and administered immediately—granules should not be added to the baby’s bottle.