Amar Iqbal

Questions 1–3 concern Child J, aged 12, who presents to hospital with a suspected staphylococcal skin infection. Child J has a documented history of acute porphyria.

1. Prior to prescribing any antibiotics, which of the following factors need not be considered by the prescribing doctor looking after Child J?
   
   
   
   1.  A  allergy status
      
   2.  B  ethnic origin
      
   3.  C  formulation
      
   4.  D  taking skin swabs
      
   5.  E  treatment duration
   
   
2. Which of the following statements is not true regarding acute porphyria?
   
   
   
   1.  A  They are hereditary disorders.
      
   2.  B  They affect haem biosynthesis.
      
   3.  C  Attacks are common before puberty.
      
   4.  D  Attacks can be induced by certain drugs.
      
   5.  E  Haem arginate can be used as a treatment.
   
   
3. On your morning ward round while you are reviewing Child J, the duty consultant asks for your advice on which of the following antibiotics is safe to prescribe for his presenting complaint. What do you advise?
   
   
   
   1.  A  clindamycin
      
   2.  B  erythromycin
      
   3.  C  flucloxacillin
      
   4.  D  griseofulvin
      
   5.  E  rifampicin
   
   

   Questions 4–5 concern the aminoglycoside antibiotic agent, gentamicin, which is widely used in your hospital Trust.

   
   
4. You are in the process of updating the listed indications for intravenous use of this drug in the hospital formulary. Which one of the following is not a recognised indication for intravenous gentamicin?
   
   
   
   1.  A  acute pyelonephritis
      
   2.  B  bacterial endocarditis
      
   3.  C  listerial meningitis
      
   4.  D  neonatal sepsis
      
   5.  E  urinary tract infection
   
   
5. Which of the following is an irreversible side-effect of gentamicin?
   
   
   
   1.  A  antibiotic-related colitis
      
   2.  B  electrolyte disturbances
      
   3.  C  nephrotoxicity
      
   4.  D  ototoxicity
      
   5.  E  stomatitis
   
   

   Questions 6–8 concern a phone call you receive from your local GP surgery for some advice regarding Mr DW, one of your regular patients who is on the following repeat medication:

   
   
   
   
   1. Amlodipine 10mg OM
      
   2. Aspirin 75mg OM
   
   
6. Your local GP would like to prescribe simvastatin for hypercholesterolaemia and wants to know the maximum dose that he can give to Mr DW as his recent blood cholesterol level was at 6 mmol/L.
   
   
   
   1.  A  5 mg
      
   2.  B  10 mg
      
   3.  C  20 mg
      
   4.  D  40 mg
      
   5.  E  80 mg
   
   
7. Which of the following side-effects of simvastatin does Mr DW not need to report immediately to his GP?
   
   
   
   1.  A  cough
      
   2.  B  difficulty breathing
      
   3.  C  headache
      
   4.  D  muscle pain
      
   5.  E  weight loss
   
   
8. Which of the following monitoring is needed before initiating statin therapy in order to ensure that Mr DW’s lipid abnormality is not due to another resolvable cause?
   
   
   
   1.  A  blood glucose levels
      
   2.  B  creatine kinase levels
      
   3.  C  liver function tests
      
   4.  D  platelet counts
      
   5.  E  thyroid function tests
   
   

   Questions 9–12 concern a phone call you receive from a rheumatology registrar regarding advice for Mrs RA in whom she wants to initiate methotrexate for arthritis.

   
   
9. In which of the listed group of patients does methotrexate not need to be used with caution?
   
   
   
   1.  A  In those with acute porphyria.
      
   2.  B  In those with hepatic impairment.
      
   3.  C  In those with a raised neutrophil count.
      
   4.  D  In women who are pregnant.
      
   5.  E  In those with renal impairment.
   
   
10. Which of the following is not suitable advice for you to provide Mrs RA when counseling her on taking her newly prescribed methotrexate?
    
    
    
    1.  A  The drug is needed to treat her arthritis.
       
    2.  B  The drug is taken once weekly in the morning.
       
    3.  C  The drug will be given to her in a single strength.
       
    4.  D  The drug will be prescribed with folic acid.
       
    5.  E  The drug does not require routine monitoring.
    
    
11. Which of the following would you advise Mrs RA as not being a sign of methotrexate-related toxicity?
    
    
    
    1.  A  becoming easily bruised
       
    2.  B  developing mouth ulcers
       
    3.  C  having abdominal pain
       
    4.  D  shortness of breath
       
    5.  E  precipitation of diabetes
    
    
12. Which one of the following drugs can Mrs RA safely purchase over the counter for its analgesic action while she is on methotrexate?
    
    
    
    1.  A  aspirin
       
    2.  B  co-codamol
       
    3.  C  diclofenac
       
    4.  D  ibuprofen
       
    5.  E  mefenamic acid
    
    

    Questions 13–14 concern topical dermatological preparations and their use in Mr CT, a 26-year-old male, who has presented to his GP with symptoms suggestive of scabies.

    
    
13. What is the maximum recommended usual quantity of Lyclear Dermal Cream that can be practically dispensed to a patient who requires two applications, each a week apart, for scabies?
    
    
    
    1.  A  30 g
       
    2.  B  60 g
       
    3.  C  90 g
       
    4.  D  100 g
       
    5.  E  120 g
    
    
14. To which of the following body part does the manufacturer recommend you should not apply Lyclear Dermal Cream when treating scabies?
    
    
    
    1.  A  arms
       
    2.  B  ears
       
    3.  C  feet
       
    4.  D  legs
       
    5.  E  neck
    
    

    Questions 15–17 concern the use of vaccinations.

    
    
15. Child SW, who is two months old, has a history of anaphylaxis from egg-based products. Which of the following vaccines must be given to Child SW in a hospital setting under specialist referral due to evidence of previous anaphylactic reactions?
    
    
    
    1.  A  Fluarix
       
    2.  B  Meningitec
       
    3.  C  Pediacel
       
    4.  D  Pneumovax II
       
    5.  E  Rotarix
    
    
16. Mr GT is due to travel to Africa for a safari trip in three weeks’ time. He approaches you in your community pharmacy for advice regarding the oral typhoid vaccine that has been prescribed for him. He would like to know when he should have his last capsule in order to ensure that he starts his treatment in time to gain adequate protection before he gets to Africa. What should you advise?
    
    
    
    1.  A  On the day of travel
       
    2.  B  1 day before travel
       
    3.  C  3 days before travel
       
    4.  D  5 days before travel
       
    5.  E  7 days before travel
    
    
17. Child FS is due for his first routine MMR vaccine. The outpatient clinic telephones you to confirm its appropriateness. Which of the following is not a contraindication for the use of the MMR vaccine?
    
    
    
    1.  A  known allergy to gelatin
       
    2.  B  known allergy to neomycin
       
    3.  C  regular use of ciclosporin
       
    4.  D  use of human normal immunoglobulin in the last ten weeks
       
    5.  E  use of a live vaccine in the last eight weeks
    
    

    Questions 18–19 concern the use of drugs that can affect the genito-urinary system.

    
    
18. You are covering a gynaecology ward when you are asked by the multidisciplinary team to suggest suitable hormone replacement therapy (HRT) for Mrs AC, a 55-year-old woman with an intact uterus. She has no past medical history of note, does not take any regular medications, and has no known allergies or sensitivities. Which is the most suitable preparation?
    
    
    
    1.  A  Bedol
       
    2.  B  Elleste-Solo
       
    3.  C  FemSeven
       
    4.  D  Premique
       
    5.  E  Premarin
    
    
19. Which of the following is the most effective method of contraception?
    
    
    
    1.  A  condoms
       
    2.  B  copper coil
       
    3.  C  hormonal contraception
       
    4.  D  lubricating jelly
       
    5.  E  spermicides
    
    

    Questions 20–21 concern the use of drugs in Mrs LB, a 31-year-old woman who is 35 weeks pregnant with her second child and presents at your pharmacy.

    
    
20. Mrs LB asks for some pain relief as she has had a painful back since last night. The counter assistant refers her to you as she is pregnant. Assuming she is not allergic or sensitive to anything, which of the following would be the safest analgesic product to sell to her?
    
    
    
    1.  A  aspirin tablets
       
    2.  B  caffeine based tablets
       
    3.  C  codeine based tablets
       
    4.  D  ibuprofen tablets
       
    5.  E  paracetamol tablets
    
    
21. One month later, Mrs LB presents again for some advice. She has recently given birth and is unsure as to whether she should be breastfeeding while on her regular prescribed medications. Which drug on her prescription may not be suitable for her during the first few weeks after birth?
    
    
    
    1.  A  bendroflumethiazide
       
    2.  B  enalapril
       
    3.  C  insulin aspart
       
    4.  D  labetalol
       
    5.  E  paracetamol
    
    

    Questions 22–25 concern the supply of medication from your community pharmacy for various patients who present with NHS prescriptions.

    
    
22. The local GP has prescribed sildenafil on an FP10 form for Mr KM, a diabetic patient who has erectile dysfunction. What endorsement is required on the prescription to authorise the dispensing of this drug?
    
    
    
    1.  A  ACBS
       
    2.  B  BB
       
    3.  C  PC
       
    4.  D  PNC
       
    5.  E  SLS
    
    
23. Which of the following preparations is considered by the Joint Formulary Committee to be less suitable for prescribing?
    
    
    
    1.  A  co-amoxiclav
       
    2.  B  co-codamol
       
    3.  C  co-cyprindiol
       
    4.  D  co-dydramol
       
    5.  E  co-phenotrope
    
    
24. Mr BW, a 52-year-old contractor who normally pays for his prescription, presents with an FP10 for the following items:
    
    
    
    1. Warfarin 1 mg tablets
       
    2. Warfarin 3 mg tablets
       
    3. Warfarin 5 mg tablets
    
    

    How many NHS prescription charges should you levy?

    
    
    
    
    1.  A  0
       
    2.  B  1
       
    3.  C  2
       
    4.  D  3
       
    5.  E  4
    
    
25. Miss SY, a 23-year-old dentist who normally pays for her prescription presents with an FP10 for the following items:
    
    
    
    1. Cilest tablets
       
    2. Mefenamic acid tablets
       
    3. Tranexamic acid tablets
    
    

    How many NHS prescription charges should you levy?

    
    
    
    
    1.  A  0
       
    2.  B  1
       
    3.  C  2
       
    4.  D  3
       
    5.  E  4
    
    
26. You receive an urgent call from the hospital paediatric registrar regarding a child for whom he has just reviewed some medical results. The results show that the child has glucose-6-phosphate dehydrogenase deficiency. The registrar needs to prescribe an antibiotic for a urinary-tract infection. Which of the following drugs carries a definite risk of haemolysis?
    
    
    
    1.  A  amoxicillin
       
    2.  B  cefalexin
       
    3.  C  co-amoxiclav
       
    4.  D  nitrofurantoin
       
    5.  E  trimethoprim
    
    
27. Mrs SM comes to your pharmacy for some advice. She has been told in a recent allergy test that she is allergic to sorbic acid, and that this has an ‘E’ number. Which one of the following is the correct E number for sorbic acid?
    
    
    
    1.  A  E102
       
    2.  B  E104
       
    3.  C  E200
       
    4.  D  E211
       
    5.  E  E320
    
    
28. A patient on your ward who is being treated for schizophrenia is unresponsive to chlorpromazine (100 mg TDS) and is due to be switched to clozapine. The medical team asks for your advice as to an equivalent total daily dose of clozapine. Which one of the following is the total daily dose of clozapine equivalent to that of chlorpromazine?
    
    
    
    1.  A  50 mg
       
    2.  B  100 mg
       
    3.  C  150 mg
       
    4.  D  200 mg
       
    5.  E  250 mg
    
    
29. Which one of the following conditions is not a caution for administering atenolol tablets to a patient?
    
    
    
    1.  A  COPD
       
    2.  B  diabetes
       
    3.  C  myasthenia gravis
       
    4.  D  pregnancy
       
    5.  E  psoriasis
    
    
30. The preregistration pharmacist at your local hospital comes across a patient newly started on amiodarone. As the ward pharmacist, he asks you to explain any monitoring required with this drug. Which of the following monitoring parameter is not required prior to initiating amiodarone?
    
    
    
    1.  A  chest radiograph
       
    2.  B  echocardiogram
       
    3.  C  liver function tests
       
    4.  D  serum potassium level
       
    5.  E  thyroid function tests
    
    
31. Mr KF presents to hospital with an inflammatory condition. His drug history shows that he currently takes prednisolone tablets (10 mg daily). The doctor on the ward would like to change the drug to hydrocortisone, which has a greater anti-inflammatory action. What dose of hydrocortisone tablets should the doctor prescribe?
    
    
    
    1.  A  5 mg
       
    2.  B  10 mg
       
    3.  C  20 mg
       
    4.  D  40 mg
       
    5.  E  60 mg
    
    
32. Mrs SC visits her GP as she has a persistent dry cough that is keeping her awake at night. Her GP decides to change her regular medication ramipril as he attributes the cough to this drug. Which one of the following would be the most suitable alternative?
    
    
    
    1.  A  amlodipine
       
    2.  B  atenolol
       
    3.  C  chlortalidone
       
    4.  D  doxazosin
       
    5.  E  irbesartan
    
    
33. Your local GP phones you for advice. He wants to prescribe a ‘mildly potent’ topical corticosteroid.
    

    Which one do you advise?

    
    
    
    
    1.  A  Betnovate RD cream
       
    2.  B  Diprosone cream
       
    3.  C  Eumovate cream
       
    4.  D  Nerisone Forte cream
       
    5.  E  Synalar 1 in 10 cream
    
    
34. You are asked to supply Betnovate cream for Mr GS, a patient on your ward, who is suffering from an eczema flare-up. Mr GS will need to apply the cream twice daily for two weeks to his legs and trunk.
    

    How many 100g tubes of this product should you supply to cover the two-week period?

    
    
    
    
    1.  A  1
       
    2.  B  2
       
    3.  C  3
       
    4.  D  4
       
    5.  E  5
    
    
35. Mrs JT has recently been prescribed hormone replacement therapy (HRT). You counsel her on her new medication and mention possible side-effects that may occur and situations when she should stop her HRT immediately. Which of the following is not a reason for Mrs JT to stop her HRT treatment?
    
    
    
    1.  A  breast tenderness
       
    2.  B  calf pain
       
    3.  C  abdominal pain
       
    4.  D  chest pain
       
    5.  E  prolonged headache
    
    
36. The nutrition team prescribe Kabiven (1026 mL) for a patient who requires parenteral feeding. Approximately how many millimoles of magnesium ions per litre does this bag contain?
    
    
    
    1.  A  2.5
       
    2.  B  2.8
       
    3.  C  4.0
       
    4.  D  4.5
       
    5.  E  5.0
    
    
37. A cardiac house officer asks for you to counsel Mr KB, a patient he has newly initiated on amiodarone for Wolff-Parkinson-White syndrome. Which of the following is unsuitable advice for you to provide Mr KB?
    
    
    
    1.  A  Mr KB needs to take amiodarone three times a day for the first week.
       
    2.  B  Mr KB needs to protect his skin using sunscreen as amiodarone is phototoxic.
       
    3.  C  Mr KB will need thyroid function monitoring as amiodarone can affect this.
       
    4.  D  Mr KB can continue taking amiodarone if he suffers shortness of breath.
       
    5.  E  Mr KB must inform a doctor if he gets dazzled by headlights when driving at night.
    
    
38. The pain sister asks for your advice regarding Mrs DW who has been receiving morphine sulfate 120 mg twice daily. She would like to change her to diamorphine subcutaneous infusion every 24 hours. What should the initial daily dose of diamorphine via a subcutaneous infusion be?
    
    
    
    1.  A  20 mg
       
    2.  B  40 mg
       
    3.  C  60 mg
       
    4.  D  80 mg
       
    5.  E  120 mg
    
    
39. Mrs SG comes to your pharmacy complaining that she has been constipated for three days due to her recently starting dried ferrous sulfate 200mg tablets (at a dose of 200mg TDS). She insists that she would like an alternative iron salt. Which of the following preparations at the said dose and frequency will provide a similar amount of ferrous iron as her current tablets?
    
    
    
    1. 
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       

       A	Fersaday tablets	1 tablet BD
       B	Fersamal syrup	10mL BD
       C	Galfer capsules	1 capsule BD
       D	Ironorm drops	0.6mL OD
       E	Sytron elixir	10mL BD

    
    
40. You are on call and one of the ward sisters pages you to find out which diluent to use with Ambisome and what the recommended method of infusion is. Which of the following tabulated options is correct?
    
    
    
    1. 
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       

       	Diluent	Method of infusion
       A	Compound Sodium Lactate Solution	Intermittent
       B	Glucose 5%	Continuous
       C	Glucose 5%	Intermittent
       D	Sodium Chloride 0.9%	Continuous
       E	Sodium Chloride 0.9%	Intermittent

    
    
41. Mrs AG is taking clomipramine for depression. She is due to be swapped to phenelzine. How long should Mrs AG’s doctor wait before asking her to start her phenelzine?
    
    
    
    1.  A  1 week
       
    2.  B  2 weeks
       
    3.  C  3 weeks
       
    4.  D  4 weeks
       
    5.  E  5 weeks
    
    
42. A patient on your ward has just been started on numerous medications. You check for cautions and interactions on his prescription chart. Which of the following combinations from his prescription chart does not have a potential caution or interaction when used concomitantly?
    
    
    
    1.  A  alendronic acid and Adcal D3
       
    2.  B  amphotericin and prednisolone
       
    3.  C  ciprofloxacin and ferrous sulfate
       
    4.  D  ondansetron and voriconazole
       
    5.  E  prednisolone and Zineryt
    
    
43. Mr AS has returned some buprenorphine 2.5 mcg patches to your pharmacy as he no longer uses them. Assuming you have a witness, which of the following options is the most appropriate manner in which to destroy the patches?
    
    
    
    1.  A  Cut the patches in to small parts and throw in a special waste bin.
       
    2.  B  Place the patches into a small amount of soapy water.
       
    3.  C  Place the patches into a denaturing kit.
       
    4.  D  Throw the patches into the ‘sharps’ bin.
       
    5.  E  Remove the backing paper and fold patches upon themselves.
    
    
44. Mr FZ is a 45-year-old with an average blood pressure of 180/95 mmHg and a serum total cholesterol to HDL cholesterol ratio of 8. He has no past medical history and does not smoke. What is the percentage cardiovascular risk prediction for Mr FZ over the next 10 years?
    
    
    
    1.  A  <15%
       
    2.  B  >15%
       
    3.  C  10–20%
       
    4.  D  >20%
       
    5.  E  >30%
    
    
45. A prescription is brought to your pharmacy for Zomig. You wish to check the approved name for this drug so that you can check the dose and potential interactions with any of the customer’s current medication. What is the approved name of the medicine on the prescription?
    
    
    
    1.  A  almotriptan
       
    2.  B  naratriptan
       
    3.  C  pizotifen
       
    4.  D  sumatriptan
       
    5.  E  zolmitriptan
    
    
46. A doctor wishes to prescribe some Copegus capsules for Mr FP who is 32 years old and weighs 66 kg. Mr FP has a history of HIV, and has just been diagnosed with chronic hepatitis C. The doctor asks you to suggest a dose for Mr FP who has ‘normal’ renal function. What dose regimen is most suitable?
    
    
    
    1.  A  400 mg twice daily
       
    2.  B  400 mg in the morning and 600 mg in the evening
       
    3.  C  600 mg twice daily
       
    4.  D  600 mg in the morning and 400 mg in the evening
       
    5.  E  200 mg in the morning and 400 mg in the evening
    
    
47. Assuming no cautions or contraindications apply, which of the following products is not available for counter-prescribing for the listed indication and patient?
    
    
    
    1.  A  Hydrocortisone 1% cream for eczema in a 12-year-old child.
       
    2.  B  Clobetasone butyrate 0.05% cream for seborrhoeic dermatitis in a 12-year-old child.
       
    3.  C  Diclofenac 2.32% gel for musculoskeletal pain in an 18-year-old football player.
       
    4.  D  Ibuprofen 5% gel for rheumatic pain in a 45-year-old-builder.
       
    5.  E  Miconazole 2% cream in a 33-year-old man with a fungal nail infection.
    
    
48. Child SC who is 6 years old and weighs 15 kg requires intramuscular adrenaline (epinephrine) due to an anaphylactic reaction he has had to some cashew nuts. Which of the following dose of intramuscular adrenaline (epinephrine) would be most suitable for him?
    
    
    
    1.  A  50 mcg
       
    2.  B  100 mcg
       
    3.  C  150 mcg
       
    4.  D  300 mcg
       
    5.  E  500 mcg
    
    
49. Mr SG comes to your pharmacy asking you to recommend something for his sore throat and fever. You check his patient medication record (PMR) and decide to immediately refer him to the nearest hospital emergency department. Which of the following drugs from his PMR gave you cause for concern?
    
    
    
    1.  A  aspirin
       
    2.  B  carbimazole
       
    3.  C  enalapril
       
    4.  D  hydrocortisone ointment
       
    5.  E  pravastatin
    
    
50. Which of the following chemotherapy drugs may be administered intrathecally?
    
    
    
    1.  A  cytarabine
       
    2.  B  doxorubicin
       
    3.  C  vincristine
       
    4.  D  vindesine
       
    5.  E  vinorelbine