NHS MOCK Q/As Flashcards
Sick day rules - duration for them to apply?
> 3 days or earlier if concerns about dehydration or vomiting
Emergency surgery which medication should remain from regular, OD/basal and fast acting insulin?
Basal insulin continues
CKD 4 eGFR 25ml/min, which colecalciferol should be given from colecalciferol, alfacalcidol, ergocalciferol alpha tocopherol?
alfacalcidol as this has been hydroxylated (done by kidneys)
eGFR 32ml/min, ?gout attack treatment
colchicine
precipitation of gout attacks?
A High level of beer consumption
B Overweight
D High intake of sardines and liver
E High blood pressure
How much should insulin dose be adjusted by when required?
10% or 2 units
Medications causing increase BP. One has MHRA alert?
NSAIDs Na and water retention
Mirabegron - MHRA
MRSA prosthetic hip joint treatment?
Vancomycin
Sumatriptan Contraindicated?
codeine in migraine?
C/I - IHD
Codeine not effective plus emetic action
- A 58 year old male presents to your pharmacy with a cough.
Which of the following would warrant referral to GP surgery? Where would others be referred?
A Chesty cough for > 1 week B Unable to swallow saliva / fluids (not due to pain) C Coughing up pink/red frothy mucus D Loss of taste and smell E Fever and yellow mucus
E sign of bacterial infection. GP referral - fever mucus
Refer if cough > 3 weeks,
pink/frothy mucus A&E (pulmonary oedema),
unable to swallow saliva / fluids A&E or potentially 999]
eGFR which alendronic acid should be avoided?
[avoid if <35 ml/min/1.732]
30 Mr Q has started taking fludrocortisone 100 micrograms daily for postural hypotension.
Which of the following side effects should you monitor for?
A Raised blood glucose B Hypokalaemia C Osteoporosis D Hyponatraemia E Dyspepsia
Answer B [mineralocorticoid: hypertension, Na / H2O retention, K / Ca loss.
(PREDNISOLONE) Glucocorticoid: diabetes, OP, muscle wasting]
LITHIUM AND SODIUM?
Lithium and NSAIDs, diuretics, ACE-I?
Signs of tocixity
Hypernatraemia - fall in lithium levels
Hyponatraemia - increase in levels
coarse tremor, n+v+d, blurred vision, drowsiness, muscle weakness, confusion
Amiodarone contraindicated
37 A total of 360 patients participated in a randomised controlled trial designed to compare the effectiveness of drug X in reducing deaths with a placebo. Out of 120 patients in the treatment group, 12 patients died within three years. Out of 240 patients in the control group, 48 patients died within three years.
Which of the following measures for the risk of death within 3 years is correct (to 1 decimal place)?
A The event rate in the control group is 0.3
B The event rate in the treatment group is 0.2
C The relative risk (of treatment compared with control group) is 0.25
D The relative risk reduction is 67% (to the nearest %)
E The number needed to treat to prevent 1 death is 10
Answer E
Event rate in the control group (CER) = 48/240 = 0.2.
Event rate in the experimental group (EER) = 12/120 = 0.1.
Absolute risk reduction (ARR) = CER−EER = 0.2−0.1 = 0.1.
Relative risk reduction (RRR) = ARR/CER = 0.1/0.2 = 50%.
Numbers needed to treat (NNT) = 1/ARR = 10.
rate of compressions CPR
Answer E [Rate of compressions 100-120/minute]
40 Mr P has diabetes insipidus which is normally well controlled with desmopressin nasal spray. He was admitted to the orthopaedic ward for an elective hip replacement and did not receive his desmopressin for a few days post operatively as it was not available on the ward and had not been ordered. Desmopressin is a synthetic form of antidiuretic hormone.
Which of the following would not be expected to occur as a result of omitting desmopressin?
A Dehydration B Hypertension C Hypernatraemia D Acute kidney injury E Death
Answer B [Omission of desmopressin without adequate fluids can results in severe dehydration, hypertnatraemia, hypotension, AKI, circulatory failure, death
Desmopressin – like ADH. If miss dose become very quickly polyuric increased thirst drink lots of fluids]
You are carrying out a medication review on an elderly patient who has been suffering from falls. You are keen to reduce the anticholinergic burden. She has a past medical history of COPD, urinary incontinence and polymyalgia rheumatica.
Which of the following would you prioritise to discuss stopping with the patient on the basis that the diseases listed above are well controlled?
A Prednisolone B Tiotropium C Solifenacin D Amitriptyline E Omeprazole
Answer D [High anticholinergic risk scale (3) and no clear indication. Solifenacin (2), tiotropium (2)]
45 Mrs E, 55 kg, is suffering from status epilepticus which has not responded to intravenous lorazepam. The doctor wants to prescribe a loading dose of phenytoin.
What is the quickest time the loading dose can be administered?
A 2 minutes B 10 minutes C 20 minutes D 22 minutes E 40 minutes
Answer D [BNF – LD 20 mg/kg = 1100 mg, max rate 1 mg/kg/min (max 50 mg / min) 1100/50 = 22 mins]
48 A 66 year old female who is on carbamazepine 400 mg at night, fluoxetine 20 mg daily and thiamine 300mg daily. Started on furosemide 40 mg daily and salbutamol 5 mg nebules four times daily for acute shortness of breath.
Which electrolyte may be affected?
Sodium
hyponatraemia
carbamazepine, fluoxetine, furosemide
50 A 56 year old male has been taking carbamazepine 400 mg twice daily for trigeminal neuralgia. He also takes paracetamol and cod liver oil. He presents to A&E with confusion, nausea, reduced concentration and headache
hyponatraemia
51 An 88 year old lady trimethoprim 100 mg at night long term for prophylaxis of urinary tract infection. She presents to her GP with weakness, nausea and palpitations.
hyperkalaemia
Trimethoprim function like amiloride in the distal portion of the renal tubule. TMP inhibits the uptake of sodium by the epithelial cell sodium channels in the distal tubule. This prevents the reabsorption of sodium from the urine but also alters the electrical balance of the tubular cell. As a result, the epithelial cell reduces the amount of potassium transported from the cell into the tubular lumen and thus into the urine. The result is a reduction in the amount of potassium excreted in the urine and an accumulation of serum potassium
52 A 67 year old woman, BMI 48 kg/m2, requiring 3 months of treatment dose dalteparin for a recent deep vein thrombosis. which parameter should be monitored?
G anti-Factor Xa
54 A 75 year old male with suspected iron deficiency anaemia
which parameter should be monitored?
ferritin
55 An 84 year old female with a lower urinary tract infection. eGFR 25 ml/min/1.73m2
Trimethoprim
eGFR <15ml/min 50-100% of dose
Nitro C/I <45ml/min
mild cellulitis with allergy to penicillin
clarithromycin
Stable angina treatment non-asthmatic and asthmatic?
B-Blocker
ifC/I - rate limiting CCB eg diltiazem
During the chat the patient asks how they should clean their Volumatic® device
with warm water containing mild detergent, then air dry twice a week
you are working in a community pharmacy providing an Influenza Vaccination Service. There is currently a shortage of the adrenaline auto-injectors and you do not have enough stock to provide these for your urgent prescriptions from patients.
Which one of the following is the most appropriate action to take?
order adrenaline 1 in 1000 dilute solution for injection ampoules for the Flu Vaccination Service and ensure competency to administer this
Novorapid® disposable pen in a pocket in her ski-jacket to the slopes today so that she could inject when she had her lunch on the mountain. She has taken it out for use and the insulin looks cloudy.
Which of the following is the most appropriate advice for this patient?
discard the pen safely and use a new pen
You are handing out a prescription for bicalutamide 150 mg tablets for a 59-year-old man diagnosed with prostate cancer. This is the first time the patient has received this prescription.
Which one of the following is the most appropriate counselling advice for this patient?
avoid excessive exposure to UV light and sunlight
The doctor asks if ibuprofen 10% gel is suitable for this patient
Which one of the following is the most appropriate response?
the gel is suitable for the patient if they do not have hypersensitivity to the ingredients
12-year-old girl presents to your pharmacy with her mother. She has a red, sore eye with a gritty sensation and has yellow, purulent discharge in the corner. She is going on a school trip tomorrow and is keen to have something to speed up her recovery. There is an open bottle of chloramphenicol 0.5% eye drops in the fridge at home and her mother wonders if she could use the bottle.
: recommend supply of chloramphenicol 1% eye ointment
You are counselling a carer on the use of midazolam 10 mg oromucosal solution which he is collecting from your pharmacy. He hasn’t administered it before and asks you how many syringes may be administered per seizure.
Which one of the following is the most appropriate response?
only one dose should be administered by a carer
letter for methadone cover 2nd consecutive day?
explain to the woman that you need a new letter from the patient confirming that you may give the friend the dose for the second, consecutive day before issuing the medicine
You dispense a prescription for chloramphenicol 0.5% eye drops to an elderly gentleman who is experiencing bacterial conjunctivitis in his left eye. When you ask if he uses any other medicines, he tells you he uses timolol 0.25% eye drops twice a day in each eye. He asks if it is acceptable to use both eye drops concurrently.
: allow a minimum of 5-15 minutes between applying the chloramphenicol and timolol drops
counselling dithranol/dithrocream?
the cream can stain the skin, hair and fabrics
. She presents with a purpuric skin rash on her back
Which of the following is the most likely cause of this patient’s rash?
side effect of phenytoin
A 75-year-old man with osteoporosis takes calcium supplements twice a day after breakfast (8am) and his evening meal (7pm). He has been prescribed a course of ciprofloxacin to treat sinusitis after a course of doxycycline failed.
Which of the following times are the most appropriate for the patient to take the ciprofloxacin?
10am and 9pm
non-drowsy sickness tablet otc?
cinnarizine
A 39-year-old man is discharged from your surgical ward following splenectomy and requires prophylaxis against pneumococcal infection; he has no known drug allergies.
Select the single most suitable medicine from the list.
phenoxymethylpenicillin
You are a hospital pharmacist and asked to deal with cannabis for personal use removed from a 22-year-old man on admission.
Select the single most appropriate action from the list.
call the police but maintain confidentiality
