GPhC Registration Assessment Why you shouldn’t be scared of the changes!

HONESTLY! Don’t and

What is the point of this session! • There have been two significant changes to the exam

recently • This has caused concern for some pre-regs • We plan to go through some sample questions to get

you in the mindset needed for the exam We want you to: • Tell us which information is important or identify

which resource is needed • Answer the questions • Tell us what you have actually been asked

Questions 1 to 3 concern Mrs C who attends your community pharmacy for cardiovascular disease (CVD) risk assessment. She is 56 years old, weighs 85 kg and is a non-smoker. After examining the patient, you record the following clinical parameters: • pulse: 60 beats per minute (regular); • blood pressure: 161/100 mmHg; • random blood glucose: 5 mmol/L; and • body mass index: 27.5 kg/m2 A recent cholesterol measurement has indicated that her serum total cholesterol to HDL cholesterol ratio is 4. Mrs C does not have any chronic disease states, is not prescribed medication from her doctor and has no known drug allergies. There is no family history of premature cardiovascular disease.

1. Using the Cardiovascular Risk Prediction Charts in the BNF, which one of the following statements estimates Mrs C’s absolute risk of developing cardiovascular disease?

A less than 10 percent over the next 10 years B between 10 and 20 percent over the next 10

years C between 20 and 30 percent over the next 10

years D exactly 30 percent over the next 10 years E greater than than 30 percent over the next 10

years

Questions 1 to 3 concern Mrs C who attends your community pharmacy for cardiovascular disease (CVD) risk assessment. She is 56 years old, weighs 85 kg and is a non-smoker. After examining the patient, you record the following clinical parameters: •pulse: 60 beats per minute (regular); •blood pressure: 161/100 mmHg; •random blood glucose: 5 mmol/L; and •body mass index: 27.5 kg/m2 A recent cholesterol measurement has indicated that her serum total cholesterol to HDL cholesterol ratio is 4. Mrs C does not have any chronic disease states, is not prescribed medication from her doctor and has no known drug allergies. There is no family history of premature cardiovascular disease.

Actual Question

• What is the absolute cardiovascular risk for a non smoking, 56 year old hypertensive woman with low cholesterol?

• or

• What is the 10 year risk for a woman with 2 cardiovascular risk factors?

You refer Mrs C to her GP for ambulatory blood pressure monitoring. The results indicate an average ambulatory blood pressure measurement of 155/95mmHg. The additional investigations performed on Mrs C have been reported as: •ECG and left ventricular function normal; •electrolytes, urea, eGFR and albumin:creatinine ratio within the laboratory reference ranges; and •no evidence of hypertensive retinopathy on fundi examination.

2.The GP asks for your advice regarding the management of Mrs C’s hypertension. Which one of the following is the most appropriate treatment to recommend for Mrs C?

A a beta-blocker B a thiazide-related diuretic C an aldosterone antagonist D an angiotensin-converting enzyme inhibitor E a calcium-channel blocker

From part 1 you know she is 56 years old From part 2 the important information is highlighted The results indicate an average ambulatory blood pressure measurement of 155/95mmHg. The additional investigations performed on Mrs C have been reported as: •ECG and left ventricular function normal; no heart failure •electrolytes, urea, eGFR and albumin:creatinine ratio within the laboratory reference ranges; and •no evidence of hypertensive retinopathy on fundi examination. No renal problems

2.The GP asks for your advice regarding the management of Mrs C’s hypertension. Which one of the following is the most appropriate treatment to recommend for Mrs C?

A a beta-blocker Last resort B a thiazide-related diuretic 2nd choice C an aldosterone antagonist 4th choice D an angiotensin-converting enzyme inhibitor 3rd choice E a calcium-channel blocker

Actual question • What is the first line antihypertensive treatment

for a 56 year old with no heart or renal problems?

• Or

• What is step 1 of the NICE guidelines for hypertension in adults over 55?

3. Mrs C’s GP has advised her that excessive alcohol consumption is associated with increased blood pressure and adverse cardiovascular health. Which one of the following is considered a safe recommended limit of alcohol for Mrs C?

A not more than 1 to 2 units per day and a maximum of 7 units per week

B not more than 2 to 3 units per day and a maximum of 14 units per week

C not more than 2 to 3 units per day and a maximum of 21 units per week

D not more than 3 to 4 units per day and a maximum of 21 units per week

E not more than 3 to 4 units per day and a maximum of 28 units per week

Actual question

• What is the recommended alcohol consumption limit for women?

4. Which one of the following is a suitable treatment for a neonate of postmenstrual age 37 weeks with meningitis caused by group B streptococcus? The neonate has no known medicine allergies.

A flucloxacillin B ceftriaxone C cefotaxime D co-trimoxazole E vancomycin Which book do you go to? Which answer is a deliberate trap?

5. A 3-year-old boy has had fever and difficulty breathing for the last 3 days. The fever has not responded to paracetamol. He has reduced breathing sounds, and bilateral expiratory wheezing. There is no pallor or signs of dehydration. He is eating at the usual times, but he is not finishing his meals.

He is up to date with the childhood immunisation schedule and there is no other medical history of note. A diagnosis of community-acquired pneumonia is made.

Which of the following is the most appropriate initial treatment option?

A antibiotics to commence if symptoms persist for a further 72

hours B amoxicillin + clarithromycin both by mouth C co-amoxiclav by intravenous injection D amoxicillin by mouth E amoxicillin + flucloxacillin both by mouth

5. A 3-year-old boy has had fever and difficulty breathing for the last 3 days. The fever has not responded to paracetamol. He has reduced breathing sounds, and bilateral expiratory wheezing. There is no pallor or signs of dehydration. He is eating at the usual times, but he is not finishing his meals.

He is up to date with the childhood immunisation schedule and there is no other medical history of note. A diagnosis of community-acquired pneumonia is made.

Which of the following is the most appropriate initial treatment option?

A antibiotics to commence if symptoms persist for a further

72 hours B amoxicillin + clarithromycin both by mouth C co-amoxiclav by intravenous injection D amoxicillin by mouth E amoxicillin + flucloxacillin both by mouth

Actual question

• What is the recommended treatment for low severity community acquired pneumonia in children?

6. A 3-year-old boy, who suffers from asthma, has intermittent wheezing despite using Clenil Modulite aerosol inhalation 200 micrograms twice daily via a spacer device. His parents are administering salbutamol aerosol inhaler to him at least once a day. The child weighs 15 kg and is otherwise well. In accordance with the recommendations of the British Thoracic Society, what is the most appropriate next step in treatment?

A increase the dose of Clenil Modulite aerosol inhalation to 300 micrograms twice daily

B add montelukast 4 mg once daily in the evening C add nedocromil aerosol inhalation 4 mg 4 times daily D add Slo-Phyllin 60 mg twice daily E add prednisolone 15 mg daily for 3 days

6. A 3-year-old boy, who suffers from asthma, has intermittent wheezing despite using Clenil Modulite aerosol inhalation 200 micrograms twice daily via a spacer device. His parents are administering salbutamol aerosol inhaler to him at least once a day. The child weighs 15 kg and is otherwise well. In accordance with the recommendations of the British Thoracic Society, what is the most appropriate next step in treatment?

A increase the dose of Clenil Modulite aerosol inhalation to 300 micrograms twice daily

B add montelukast 4 mg once daily in the evening C add nedocromil aerosol inhalation 4 mg 4 times daily D add Slo-Phyllin 60 mg twice daily E add prednisolone 15 mg daily for 3 days

Actual question

• What drug is added at step 3 of the BTS guidelines for children under 5?

7. You are asked by a local GP to recommend treatment for Mrs Z who has oropharyngeal candidiasis that has not responded to nystatin suspension. Given that she is otherwise well, not allergic to any medicines and is breast-feeding her 5-month-old baby, which one of the following would it be most appropriate for you to recommend to the GP?

A itraconazole oral liquid B terbinafine tablets C fluconazole capsules D posaconazole suspension E ketoconazole tablets

7. You are asked by a local GP to recommend treatment for Mrs Z who has oropharyngeal candidiasis that has not responded to nystatin suspension. Given that she is otherwise well, not allergic to any medicines and is breast-feeding her 5-month-old baby, which one of the following would it be most appropriate for you to recommend to the GP?

A itraconazole oral liquid B terbinafine tablets C fluconazole capsules D posaconazole suspension E ketoconazole tablets

Actual question

• Which of the following is the most appropriate treatment for oral candidiasis in patients where topical treatment has failed?

• Or

• Which of the following is the most appropriate treatment for oral candidiasis?

8. The following customers ask to buy a non-prescription

medicine. Given there are no other contraindications, it would be appropriate for you to make the sale to which of them?

1 a 17-year-old woman who wants to give up smoking asking to buy Nicorette chewing gum

2 a man asking to buy Phenergan elixir (promethazine hydrochloride) for his 18-month-old son who is having trouble sleeping

3 a woman asking to buy Spasmonal capsules (alverine) for

her 10-year-old daughter who is suffering from stomach cramps

• Mr L, who often visits your pharmacy. He is 27 years old, and regularly takes Asacol MR (mesalazine) tablets for Crohn’s disease. He also has eczema.

9. Mr L’s GP asks for your advice. He wants to prescribe a nutritional supplement for Mr L which is approved by the Advisory Committee on Borderline Substances (ACBS) for prescribing on an NHS prescription form for patients with Crohn’s disease. Which one of the following is suitable?

A Renamil powder B MSUD Aid lll powder C Renapro powder D TYR express20 powder E Alicalm powder

• Questions 1 and 2 concern Mr L, who often visits your pharmacy. He is 27 years old, and regularly takes Asacol MR (mesalazine) tablets for Crohn’s disease. He also has eczema.

9. Mr L’s GP asks for your advice. He wants to prescribe a nutritional supplement for Mr L which is approved by the Advisory Committee on Borderline Substances (ACBS) for prescribing on an NHS prescription form for patients. with Crohn’s disease Which one of the following is suitable?

A Renamil powder B MSUD Aid lll powder C Renapro powder D TYR express20 powder E Alicalm powder

Actual question

• Which of the following has ACBS approval for NHS prescribing for patients suffering from Crohn’s disease?

• Or

• Which of the following is allowed to be prescribed on the NHS for Crohn’s disease?

10. Two months later Mr L tells you that his Crohn’s disease has worsened, and he presents a prescription for Budenofalk (budesonide) capsules, 3 mg three times daily for three months. You should contact Mr L’s GP because:

A Budenofalk capsules are not indicated for Crohn’s disease B there is an interaction between Budenofalk capsules and

Asacol tablets C the dose of Budenofalk capsules is too high D a course of Budenofalk capsules should not exceed 8

weeks E Budenofalk capsules are contra-indicated in patients with

eczema

Actual question

• You have received a prescription for budenofalk, which of the following issues would lead you to contact the GP?

11. You receive a phone call from Dr G, a local GP, who is on a house call. The patient, an adult who is allergic to penicillin, has otitis externa with spreading cellulitis. Dr G asks for advice on choice of antibiotic. Which one of the following is the most appropriate recommendation?

A flucloxacillin B rifampicin C trimethoprim D oxytetracycline E clarithromycin

11. You receive a phone call from Dr G, a local GP, who is on a house call. The patient, an adult who is allergic to penicillin, has otitis externa with spreading cellulitis. Dr G asks for advice on choice of antibiotic. Which one of the following is the most appropriate recommendation?

A flucloxacillin B rifampicin C trimethoprim D oxytetracycline E clarithromycin

Actual question

• Which of the following is the most appropriate treatment for otitis externa in penicillin allergic patients?

12. A 5-month-old baby is hospitalised with chickenpox. The baby weighs 7 kg, has a body surface area (BSA) of 0.36 m2 and is not immunocompromised.

The baby is prescribed a 5-day course of intravenous aciclovir. How many milligrams of aciclovir will be administered per day assuming the baby has no renal insufficiency?

A 90 mg B 180 mg C 270 mg D 360 mg E 450 mg

12. A 5-month-old baby is hospitalised with chickenpox. The baby weighs 7 kg, has a body surface area (BSA) of 0.36 m2 and is not immunocompromised.

The baby is prescribed a 5-day course of intravenous aciclovir. How many milligrams of aciclovir will be administered per day assuming the baby has no renal insufficiency?

A 90 mg B 180 mg C 270 mg D 360 mg E 450 mg

And relax!