GU Flashcards
Which of the following is a common symptom of a lower urinary tract infection (UTI)?
A) Dysuria
B) Fatigue
C) Headache
D) Nasal congestion
E) Temperature
A
RATIONALE: DYSURIA IS A COMMON SYMPTOM OF A LOWER
URINARY TRACT INFECTION. FATIGUE, HEADACHES, AND A
TEMPERATURE MAY BE INDICATIVE OF AN UPPER URINARY
TRACT INFECTION.
Which medication is commonly used to treat erectile dysfunction?
A) Acetaminophen
B) Ibuprofen
C) Sildenafil
D) Simvastatin
E) Warfarin
C
hich medication is commonly used to treat benign prostatic hyperplasia (BPH)?
A) Aspirin
B) Finasteride
C) Metformin
D) Omeprazole
E) Prednisolone
B
RATIONALE: FINASTERIDE IS A SPECIFIC COMPETITIVE
INHIBITOR OF 5 ALPHA-REDUCTASE, AN INTRACELLULAR
ENZYME THAT CONVERTS TESTOSTERONE TO
DIHYDROTESTOSTERONE (DHT). THIS MECHANISM OF ACTION
IS USEFUL IN MANAGING BENIGN PROSTATE HYPERPLASIA
You are a ward pharmacist and are counselling a patient on her newly started oxybutynin. She has been started on this for urinary urgency. She would like to know what the “classic” side effects of oxybutynin are, so she knows what to look out for and how they can be mitigated. Which of the following is not a common side effect of oxybutynin?
A) Blurred vision
B) Constipation
C) Diarrhoea
D) Dry mouth
E) Urinary retention
C
RATIONALE: OXYBUTYNIN HAS ANTICHOLINERGIC SIDE
EFFECTS I.E. BLURRED VISION, CONSTIPATION, DRY MOUTH
AND URINARY RETENTION. DIARRHOEA IS NOT AN
ANTICHOLINERGIC SIDE EFFECT.
You are a paediatric ward pharmacist on a ward round with the paediatric team. A 10 year old has been admitted with his parents due to nocturnal enuresis. The parents have looked at non-pharmacological interventions such as restricting daily fluid intake and encouraging bladder voiding. The paediatric consultant would like to start a new medication, but wants to know which medication would be the most appropriate. The first line choice for nocturnal enuresis in a child of the age of 10 would be:
A) Amitriptyline
B) Desmopressin
C) Imipramine
D)Mirabegron
E) Oxybutynin
B
RATIONALE: DEMOPRESSIN IS CONSIDERED FIRST LINE IN THE
MANAGEMENT OF NOCTURNAL ENURESIS AFTER NON-
PHARMACOLOGICAL INTERVENTIONS SUCH AS LOOKING AT
DIET AND FLUID INTAKE AND TOILETING PATTERNS.
A young lady appears in your community pharmacy buying some sachets for cystitis. Out of curiosity, she asks about symptoms that would warrant seeing a doctor, rather than self-care and management with cystitis sachets. Which of the following symptoms would not indicate a referral to a doctor?
A) Anuria
B) Dysuria
C) Haematuria
D) Lower flank pain
E) Nausea and vomiting
B
RATIONALE: ANURIA MAY SUGGEST URINARY RETENTION WHICH
MAY BE INDICATIVE OF AN OBSTRUCTION. HAEMATURIA MAY
INDICATE AN UPPER URINARY TRACT INFECTION OR SOMETHING
MORE SINISTER. LOWER FLANK PAIN AND NAUSEA AND VOMITING
ARE ALSO INDICATIVE OF POSSIBLE UPPER URINARY TRACT
INFECTIONS. DYSURIA IS COMMON OF CYSTITIS, AND WOULD NOT
ROUTINELY WARRANT A REFERRAL.
Complicated urinary tract infections are defined as those which fall into any other category than a simple urinary tract infection. In which patient are the symptoms indicative of a simple urinary tract infection?
A) A 35-year-old man with symptoms of a lower urinary tract infection
B) A 25-year-old pregnant woman with symptoms of dysuria with no flank pain or temperature
C) A 27-year-old woman with symptoms of dysuria
D) A 65-year-old gentleman who has symptoms indicative of a urinary tract infection. He is receiving treatment for B-cell lymphoma
E) A 70-year-old woman who has a long-term catheter who has symptoms of anuria
C
RATIONALE: ALL OTHER OPTIONS, APART FROM OPTION C,
WOULD BE DEFINITIVE OF A COMPLICATED URINARY TRACT
INFECTION. DUE TO ANATOMY DIFFERENCES, A URINARY
TRACT INFECTION IN MEN WOULD BE CLASSED AS
COMPLICATED WHICH RULES OUT OPTIONS A AND D. OPTION
B IS COMPLICATED DUE TO PREGNANCY. OPTION E IS
COMPLICATED DUE TO A LONG TERM CATHETER, WHICH MAY
INDICATE AN OBSTRUCTION.
Ms OP has recently been started on hormone replacement therapy (HRT). You are a community pharmacist counselling her on her newly started medication. Ms OP asks what types of side effects would warrant stopping her HRT, as she is very anxious about stopping what she describes will really help her with her symptoms of menopause. She has tried other things such as long distance walking to help maintain her general wellbeing but that hasn’t helped. Which of the following side effects is not a clinically urgent reason to warrant stopping her HRT?
A) Abdominal pain
B) Breast tenderness
C) Calf pain
D) Chest Pain
E) Persistent headaches
A
RATIONALE: BREAST TENDERNESS, CALF PAIN, CHEST PAIN
AND PERSISTENT HEADACHES ARE ALL CONSIDERED RED
FLAGS WHEN LOOKING AT OESTROGEN CONTAINING
MEDICINAL PRODUCTS. ABDOMINAL PAIN IS NOT CONSIDERED
A RED FLAG SYMPTOM.
You are a community pharmacist checking prescriptions. It is 6pm, and you close in half an hour. One of the pharmacy assistants approaches you and explains that a young woman, no older than 27 has entered the pharmacy wanting to speak to the pharmacist. Upon talking to the woman, she explains that she had unprotected sexual intercourse roughly two days ago. In interviewing the patient, she also discloses that she takes levetiracetam for epilepsy. The patient is roughly 95kg, and she is 154cm tall. What is the most appropriate option for supply?
A) Explain that she should present to a sexual health clinic or contraception clinic to get the copper coil. The UPSI only happened two days ago, so she should be fine to present to one tomorrow morning
B) Supply the patient 1500mg of Levonelle OneStep
C) Supply the patient with 3000mg of Levonelle OneStep
D) Supply the patient with 30mg of ellaOne
E) Supply the patient with 60mg of ellaOne
D
RATIONALE: THIS SITUATION IS ARGUABLY TIME CRITICAL;
IT IS NOT HELPED EITHER THAT THE PATIENT IS VAGUE
AND SAYS ROUGHLY TWO DAYS AGO. LEVONELLE IS NOT AN
OPTION DUE TO THE PATIENT’S BMI; YOU COULD OFFER
DOUBLE THE DOSE, HOWEVER THIS IS UNLICENSED. OPTION
A IS VIABLE, HOWEVER YOU CANNOT GUARANTEE WHETHER
THE PATIENT WILL BE ABLE TO ACCESS A CLINIC AT THIS
TIME OF THE DAY; DELAYING ADMINISTRATION OF
EMERGENCY CONTRACEPTION IS NOT APPROPRIATE. OPTION
D WOULD BE THE MOST APPROPRIATE.
Which medication is commonly used to treat urinary tract infections (UTIs) in pregnant women?
A) Amoxicillin
B) Ceftriaxone
C) Nitrofurantoin
D) Trimethoprim-Sulfamethoxazole
E) Vancomycin
A
Which contraceptive method is a suitable recommendation for women who have a history of migraines with aura?
A) Abstinence
B) Combined oral contraceptives
C) Diaphragm
D) Progesterone-only pills
E) Vaginal rings
D
RATIONALE: PROGESTERONE ONLY CONTAINING SUPPLEMENTS
WOULD BE THE MOST APPROPRIATE CHOICE. MIGRAINES WITH
AURA WOULD INDICATE OESTROGEN CONTAINING PRODUCTS
ARE CONTRAINDICATED.
Miss B is a 25-year-old female who often forgets to take her contraceptive pill. She would rather not use barrier methods of contraception. She also has severe anaemia and Wilson’s disease. Which would be the most appropriate choice of long-acting contraceptive?
A) Copper IUD
B) Cerazette (desogestrel)
C) Depo-Provera (medroxyprogesterone acetate)
D) Microgynon (Ethinylestradiol with levonorgestrel)
E) Zoely (estradiol with nomegesterol acetate)
C
RATIONALE: GIVEN THAT THE PATIENT FORGETS TO TAKE
HER CONTRACEPTIVE PILL, A USER DEPENDENT OPTION OF
CONTRACEPTIVE IS NOT IDEAL. HER HISTORY OF ANAEMIA
AND WILSON’S DISEASE ALSO MAKES THE COPPER IUD
CONTRAINDICATED - DEPO-PROVERA WOULD BE BEST.
Which antiviral medication and dose is commonly used for the treatment of genital herpes simplex virus (HSV) infection?
A) Aciclovir 800mg to be taken orally five times a day
B) Aciclovir 400mg to be taken orally three times a day
C) Ganciclovir 800mg to be taken orally five times a day
D) Ganciclovir 5mg/kg to be given intravenously twice a day
E) Valganciclovir 450mg to be taken orally twice a day
B- see BNF
What is the maximum recommended dose of sildenafil for erectile dysfunction according to the BNF?
A) 25mg once a day
B) 50mg once a day
C) 75mg once a day
D) 100mg once a day
E) 150mg once a day
D
What is the mechanism of action of finasteride in the treatment of BPH according to the BNF?
A) Agonism of the M3 receptors which cause relaxation of the detrusor muscle to relieve urinary retention
B) Antagonism of the M3 receptors which cause constriction of the detrusor muscle to relieve urinary urgency
C) Beta-adrenergic stimulation within the bladder to relieve urinary retention
D) Inhibition of the enzyme 5-alpha reductase
E) Inhibition of Gonadotrophin
D
RATIONALE: FINASTERIDE IS A SPECIFIC COMPETITIVE
INHIBITOR OF 5 ALPHA-REDUCTASE, AN INTRACELLULAR
ENZYME THAT CONVERTS TESTOSTERONE TO
DIHYDROTESTOSTERONE (DHT).
What is the recommended duration of treatment for uncomplicated cystitis in adult females as per the BNF?
A) 1 day
B) 3 days
C) 5 days
D) 7 days
E) 10 days
B
RATIONALE: THE RECOMMENDED DURATION OF TREATMENT
FOR UNCOMPLICATED CYSTITIS IS 3 DAYS.
A young woman who has epilepsy and multiple allergies presents to a sexual health clinic. You are the pharmacist working there and are reviewing the guidelines for antibacterial treatment. What would be the recommended treatment regimen for uncomplicated urethral gonorrhoea this specific patient? The patient is allergic to aminoglycosides and macrolides and has an intolerance to beta-lactams. She normally takes levetiracetam for her epilepsy
A)Azithromycin 1 g orally as a single dose
B) Ceftriaxone 250 mg intramuscularly as a single dose
C) Ciprofloxacin 500mg orally as a single dose
D) Doxycycline 100 mg orally twice daily for 7 days
E) Gentamicin 240 mg intramuscularly as a single dose
B
RATIONALE: CIPROFLOXACIN IS NOT AN OPTION AS THIS
LOWERS THE SEIZURE THRESHOLD. AZITHROMYCIN IS A
MACROLIDE AND SO CANNOT BE USED. GENTAMICIN IS AN
AMINOGLYCOSIDE AND THEREFORE CANNOT BE USED. SHE
HAS AN INTOLERANCE TO BETA-LACTAMS, HOWEVER THIS IS
NOT AN ALLERGY, AND SO CAN BE USED IN LINE WITH NICE
GUIDELINES.
What is the recommended duration of treatment with leuprorelin for endometriosis according to the BNF?
A) 1 month
B) 3 months
C) 6 months
D) 12 months
E) Indefinitely
C
RATIONALE: SEE BNF.
“11.25 MG EVERY 3 MONTHS FOR
MAXIMUM DURATION OF 6 MONTHS (NOT TO BE REPEATED),
TO BE STARTED DURING FIRST 5 DAYS OF MENSTRUAL
CYCLE.
”
What is the initial empirical treatment for acute prostatitis in men aged under 35 years according to the BNF?
A) Amoxicillin
B) Co-amoxiclav
C) Ciprofloxacin
D) Doxycycline
E) Trimethoprim
C
RATIONALE: ORAL FIRST LINE: CIPROFLOXACIN, OR
OFLOXACIN. ALTERNATIVE FIRST LINE (IF UNABLE TO TAKE
FLUOROQUINOLONES): TRIMETHOPRIM.
What is the primary mechanism of action of levonorgestrel emergency contraception?
A) Blocking sperm transport
B) Induction of menstruation
C) Inhibition of ovulation
D) Prevention of implantation
E) Thickening cervical mucus
C
RATIONALE: LEVONORGESTREL BINDS TO PROGESTERONE
AND ANDROGEN RECEPTORS AND SLOWS THE RELEASE OF
GONADOTROPIN-RELEASING HORMONE (GNRH) FROM THE
HYPOTHALAMUS. THIS PROCESS RESULTS IN THE
SUPPRESSION OF THE NORMAL PHYSIOLOGICAL LUTEINISING
HORMONE (LH) SURGE THAT PRECEDES OVULATION.
What is the recommended initial dose of tolterodine for the treatment of overactive bladder according to the BNF?
A) 1mg daily
B) 2mg daily
c) 4mg daily
D) 5mg daily
E) 10mg daily
C
C
RATIONALE: SEE BNF. THE INTIAL DOSE IS 2MG TWICE DAILY, TO BE
REDUCED TO 1MG TWICE DAILY IF NOT TOLERATED.
Vulvovaginal candidiasis is defined as symptomatic inflammation of the vagina and/or vulva by a superficial fungal infection. In a pregnant woman with acute vulvovaginal candidiasis, which is the most appropriate choice of treatment?
A) Amoxicillin 500mg to be taken orally three times a day for 3 days
B) Clotrimazole 200mg to be inserted vaginally for 3 nights
C) Clotrimazole 100mg to be inserted vaginally for 6 nights
D) Fluconazole 150mg to be taken orally in one dose
E) Itraconazole 200mg to be taken orally twice a day for 1 day
C
RATIONALE: EVIDENCE SUGGESTS THE NEED FOR A LONGER
DURATION OF TREATMENT IN PREGNANCY. THEREFORE, C
WOULD BE THE MOST APPROPRIATE OPTION. ORAL AZOLES
ARE CONTRAINDICATED IN PREGNANCY, AND AMOXICILLIN IS
AN ANTIBIOTIC, RATHER THAN AN ANTIFUNGAL, SO WOULD
BE AN INAPPROPRIATE PRESCRIBING CHOICE.
What is the recommended first line treatment for urethritis caused by chlamydia according to the BNF?
A) Azithromycin
B) Ciprofloxacin
C) Doxycycline
D) Metronidazole
E) Trimethoprim
C
RATIONALE: FIRST LINE: DOXYCYCLINE - ALTERNATIVE IF
TETRACYCLINE ALLERGY OR UNSUITABLE: AZITHROMYCIN.
Below is a list of medication that Ms B takes. Which of the medications from the following list area most likely to cause urinary retention?
A) Dosulepin
B) Mefenamic Acid
C) Microgynon
D) Paracetamol
E) Simvastatin
A
RATIONALE: DOSULEPIN IS A TRICYCLIC ANTIDEPRESSANT,
AND IS THEREFORE THE MOST LIKELY TO CAUSE URINARY
RETENTION.
Miss C has an extensive medical history. She has asthma, COPD, a history of recurrent pulmonary embolism and migraines. She also has endometriosis so is susceptible to heavy menstrual bleeds. She would like to start contraception; which choice of contraceptive would be the most appropriate first line choice, given her medical history
A) Copper IUD
B) Cerazette (desogestrel)
C) Depo-Provera (medroxyprogesterone acetate)
D) Microgynon (Ethinylestradiol with levonorgestrel)
E) Zoely (estradiol with nomegesterol acetate)
B
RATIONALE: OPTIONS D AND E BOTH CONTAIN OESTROGEN,
WHICH IS CONTRAINDICATED GIVEN THE PATIENT’S HISTORY
OF MIGRAINES AND RECURRENT VTE HISTORY. A COPPER IUD
IS AN OPTION, BUT HER PREDISPOSITION TO BLEEDING MAY
MAKE THE COPPER COIL INTOLERABLE. THERE IS NOTHING IN
THE QUESTION TO INDICATE THERE IS A COMPLIANCE ISSUE,
THEREFORE CERAZETTE WOULD BE AN APPROPRIATE FIRST
CHOICE OPTION.
