Exam sample paper - Part II (Open book)

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Autumn 2010 (for examination sittings in 2011)

PART II (OPEN BOOK and CALCULATIONS)2

Instructions to candidates:

1. For each question there are five options, A, B, C, D and E. Choose only one of the options as your answer for each question.

2. You should answer the questions as though you were a registered pharmacist, not a preregistration trainee.

3. Unless otherwise stated you should answer all questions as though a pandemic situation has not arisen and is not anticipated.

4. There are 30 open book questions in this paper and 10 calculation questions i.e. the paper is half the size of the actual registration examination open book/calculations paper.

5. You should score one mark for each correct answer: no marks to be deducted for incorrect answers or omissions.

6. The time allowance for this paper is 75 minutes.

7. The reference sources that may be used in this test are the British National Formulary Number 60 (September 2010 edition), the Drug Tariff3 England & Wales (April 2010 Edition) OR Scotland (April 2010 edition) and the Medicines, Ethics and Practice guide Number 34 (July 2010 edition).

8. The use of calculators is not permitted.

1All questions in the sample paper are taken from previous sittings of the RPSGB registration examination. (Amendments have been made where necessary to ensure that the questions are still contemporary.) The sample paper is matched to the actual examination in terms of word count, syllabus coverage, ratio of question types and overall facility (the fraction of candidates getting the questions correct). 2 If you are using this sample paper as part of a "mock" examination, please note that in the "real" examination candidates undertake the closed book paper first. 3 The actual edition of the Drug Tariff (England & Wales OR Scotland) required for the 2011 Registration Examination sittings will be the April 2011 Edition.

All rights reserved. Apart from any fair dealing for the purpose of research or private study, as permitted by the Copyright, Designs and Patents Act 1988, this Autumn sample examination paper may only be reproduced, stored or transmitted, in any form or means, with the prior permission in writing of the General Pharmaceutical Council (GPhC). Applications should be made in writing, to the Preregistration Division, GPhC, 129 Lambeth Road, London SE1 7BT. Copyright © GPhC 2010.

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SECTION I (10 questions)

Directions for questions 1 to 10. Each of the questions or incomplete statements in this section is followed by five suggested answers. Select the best answer in each case. Questions 1 to 3 concern Mr M who is admitted to hospital for the treatment of bleeding oesophageal varices and whose doctor decides to prescribe terlipressin. 1. You are asked to advise how the terlipressin should be administered. Which

of the following should you recommend? A orally B subcutaneous injection C intramuscular injection D intravenous injection E intravenous infusion 2. During treatment Mr M complains of feeling unwell and asks you if this could

be due to the terlipressin. Which one of the following symptoms is most likely to be caused by the terlipressin?

A sweating B fatigue C drowsiness D pruritus E anxiety

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3. Mr M’s doctor asks you what other medicines could be used as an alternative treatment for variceal bleeding if the terlipressin does not work. Which one of the following medicines would it be most appropriate for you to recommend?

A oxytocin B somatropin C lutropin alfa D pegvisomant

E octreotide

4. You are asked to recommend an anti-emetic for a 15-year-old girl who is

feeling nauseous following a minor surgical procedure. Given that she is otherwise well and does not take any other medicines, which one of the following would it be most appropriate for you to recommend?

A cyclizine

B metoclopramide hydrochloride

C nabilone

D chlorpromazine hydrochloride

E cinnarizine

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5. Which one of the following statements best describes the role of trimethoprim in the treatment of infections caused by meticillin-resistant Staphylococcus aureus (MRSA)? A does not have a role in the treatment of infections caused by MRSA

B should be reserved for MRSA resistant to other antibacterials

C may be used for urinary tract infections caused by some strains of

MRSA D is recommended to eradicate nasal carriage of MRSA

E is first line choice for all infections caused by MRSA

6. Which one of the following is not contra-indicated for women who are breast-feeding?

A piroxicam B telithromycin C meprobamate D topiramate E phenindione

7. A previously healthy 7-year-old is taken by his mother to the local Accident

and Emergency department after developing an anaphylactic reaction to a wasp sting. Which one of the following is the initial dose of adrenaline (epinephrine) 1 in 1000 that the child should be given by intramuscular injection?

A 10 micrograms B 50 micrograms C 150 micrograms D 300 micrograms E 500 micrograms

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8. Mrs A, who is 55-years-old, visits your pharmacy to ask you to recommend treatment for her haemorrhoids. Her GP has previously prescribed Anugesic-HC cream for her, which worked well, and Mrs A wonders if she can buy something similar without a prescription. Which one of the following would it be appropriate for you to recommend to Mrs A?

A Anusol Plus HC ointment B Xyloproct ointment C Ultraproct ointment D Uniroid-HC ointment E Scheriproct ointment 9. Regarding the sale of ranitidine as a pharmacy (P) medicine, which one of the

following statements is true?

A it can be sold for use in children over 12 years

B packs must not contain more than 1 weeks’ supply

C it is indicated for epigastric bloating and belching D the maximum daily dose is 300 mg E the maximum single dose is 150 mg

10. Which one of the following patients may need the dose of their medication

to be altered after giving up smoking tobacco? A a man taking propranolol tablets B a woman taking theophylline tablets C a man taking isosorbide mononitrate m/r tablets D a woman taking phenobarbital tablets E a man taking warfarin tablets

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SECTION II (6 questions)

Directions for questions 11 to 16. For each numbered question select from the list above it the one lettered option which is most closely related to it. Within each group of questions each lettered option may be used once, more than once, or not at all. Questions 11 to 13 concern the following options:

A a relatively minor adverse reaction which does not need to be reported to the Medicines and Healthcare products Regulatory Agency (MHRA)

B a relatively minor adverse reaction which should be reported to the

MHRA because the medicine is intensively monitored by the MHRA C a relatively minor adverse reaction caused by an established

medicine, which should be reported to the MHRA D a serious adverse reaction which should be reported to the MHRA E not an adverse reaction therefore it does not need to be reported to

the MHRA

Select, from A to E, which one of the above applies to the following: 11. a man taking Sinthrome tablets for the treatment of DVT who is found to

have an international normalised ratio (INR) of 2.5 12. a 7-year-old child who develops dizziness while taking Tegretol tablets 13. a woman who develops nausea while taking Erdotin capsules

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Questions 14 to 16 concern the following types of infusion and infusion fluids: A intermittent infusion in sodium chloride 0.9% B intermittent infusion in glucose 5% C continuous infusion in sodium chloride 0.9% D continuous infusion in glucose 5% E continuous infusion in compound sodium lactate

Select, from A to E, which one of the above is the most appropriate type of infusion and infusion fluid for the administration of the following medicines when given by intravenous infusion: 14. calcitonin (salmon) 15. zidovudine 16. insulin (soluble)

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SECTION III (8 questions)

Directions for questions 17 to 24. Each of the questions or incomplete statements in this section is followed by three responses. For each question ONE or MORE of the responses is (are) correct. Decide which of the responses is (are) correct. Then choose: A if 1, 2 and 3 are correct B if 1 and 2 only are correct C if 2 and 3 only are correct D if 1 only is correct E if 3 only is correct

Directions Summarised

A 1, 2, 3

B 1, 2 only

C 2, 3 only

D 1

only

E 3

only

17. Which of the following statements relating to phenobarbital tablets is/are

true: 1 phenobarbital tablets are exempt from the safe custody requirements

of the Misuse of Drugs Regulations 2 phenobarbital tablets are exempt from the legal requirement to keep

records in the prescription-only register when supplied on a private prescription

3 prescriptions for phenobarbital tablets are legally valid for 6 months

from the date specified on the prescription

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A 1, 2, 3

B 1, 2 only

C 2, 3 only

D 1

only

E 3

only

Question 18 concerns Miss K who is admitted to hospital after taking an overdose. She is known to have taken 40 co-codamol 30/500 tablets 6 hours ago and also to have drunk half a bottle of vodka. She does not take any regular medication and is generally fit and well. On admission to hospital she is in a coma and has a slow respiratory rate. Her plasma-paracetamol concentration is found to be 150 mg/litre. Which of the following medicines is/are indicated to treat Miss K?

1 acetylcysteine 2 naloxone 3 activated charcoal

19. Mrs P currently takes carbamazepine and sodium valproate. She asks her GP

for advice, as she is planning to become pregnant and has read that some antiepileptic medicines can increase the risk of spina bifida and other developmental abnormalities. The GP refers her to an appropriate specialist for advice. Which of the following actions is the specialist likely to take to reduce the risk of developmental abnormalities?

1 reduce Mrs P’s treatment to a single medicine 2 prescribe daily folic acid supplements for Mrs P 3 prescribe daily vitamin K1 supplements for Mrs P

20. A woman visits your pharmacy to ask you to recommend a suitable medicine

for her 10-year-old son. He has developed hay fever and his main symptoms are sneezing and a runny nose. Given that the child is otherwise well and does not take any other medicines, which of the following non-prescription aqueous nasal sprays would be suitable for you to recommend?

1 fluticasone propionate

2 beclometasone dipropionate 3 azelastine hydrochloride

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A 1, 2, 3

B 1, 2 only

C 2, 3 Only

D 1

only

E 3

only

21. While working in a community pharmacy on a Saturday afternoon you realise

that there has been a dispensing error. Twenty minutes earlier a patient presented a prescription for metoclopramide tablets, but was given metformin tablets. You try to find the patient’s telephone number, but it turns out to be ex-directory. You will only be connected to an ex-directory, no-connection number if: 1 you are calling from a community pharmacy

2 it is a ‘life and death’ situation

3 you give your GPhC registration number

22. Mr T presents with a prescription for disulfiram tablets which he has not

taken before. He asks you to tell him about what will happen if he drinks alcohol while taking the disulfiram. Which of the following is/are likely to occur?

1 bradycardia 2 throbbing headache 3 nausea

23. Which of the following items, prescribed on an NHS prescription issued by a

Community Practitioner Nurse Prescriber would lead you to contact the prescriber for an alternative?

1 Comfeel Plus Ulcer Dressing 10cm x 10cm 2 OptiFlo G catheter maintenance solution 50 mL 3 Hydrocortisone Cream, BP, 1%

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A 1, 2, 3

B 1, 2 only

C 2, 3 only

D 1

only

E 3

only

24. Regarding supplementary prescribing, which of the following must be

included in a clinical management plan?

1 the illnesses or conditions which may be treated by the supplementary prescriber

2 relevant warnings about known sensitivities or difficulties of the

patient with particular medicinal products

3 the potential adverse effects and contra-indications of the medicines to be prescribed

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SECTION IV (6 questions)

Directions for questions 25 to 30. The following questions consist of a first statement in the left-hand column followed by a second statement in the right-hand column. Decide whether the first statement is true or false. Decide whether the second statement is true or false. Then choose:

A if both statements are true and the second statement is a correct explanation of the first statement

B if both statements are true but the second statement is NOT a correct

explanation of the first statement C if the first statement is true but the second statement is false D if the first statement is false but the second statement is true E if both statements are false

First

Statement

Second

Statement


A B C D E

True True True False False

True True False True False

2nd statement is a correct explanation of the first 2nd statement is NOT a correct explanation of the first

Question 25 concerns the following scenario: A dentist telephones to ask you to provide an emergency supply of co-amoxiclav tablets for Miss D who requires a course of antibiotics. The dentist is unable to provide a prescription immediately as he is dealing with an emergency but offers to provide a prescription the following day. FIRST STATEMENT You cannot lawfully provide the emergency supply for Miss D

SECOND STATEMENT Co-amoxiclav tablets are not included in the Dental Practitioners’ Formulary

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First

Statement

Second

Statement


A B C D E




Question 26 concerns the following scenario: Mrs E, who is 45-years-old, has endocarditis and has been prescribed gentamicin 60 mg tds in combination with benzylpenicillin. After 3 days of treatment a one-hour (‘peak’) gentamicin serum level is taken and found to be 4 mg/litre and the pre-dose (‘trough’) gentamicin level is 0.5 mg/litre. Mrs E is otherwise well and not allergic to any medicines. FIRST STATEMENT Mrs E is receiving the correct dose of gentamicin

SECOND STATEMENT When treating endocarditis the one-hour (‘peak’) serum concentration for gentamicin should be 3-5 mg/litre and the pre-dose (‘trough’) concentration should be less than 1 mg/litre

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First

Statement

Second

Statement


A B C D E




Question 27 concerns the following scenario: Miss K is 25 years old and suffers from recurrent migraine attacks. She visits her GP to ask if he can prescribe a ‘stronger painkiller’ for her migraines and is given the following prescription: FIRST STATEMENT You should contact Miss K’s GP to recommend that the dose of rizatriptan is halved

SECOND STATEMENT The plasma concentration of rizatriptan is increased by propranolol

Rizatriptan tablets 10 mg Take one tablet as soon as possible after onset, repeat after 2 hours if

migraine recurs Maximum 20 mg in 24 hours

Supply 1 x 6 tablets

Propranolol tablets 40 mg Take one tablet bd Supply 56 tablets

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First

Statement

Second

Statement


A B C D E




Question 28 concerns the information on the following standard NHS prescription which has been issued by a GP. You receive the prescription on 5.10.10:

Pharmacy Stamp

Please don’t stamp age box

Age 66 D.o.B

24/10/1943

Title, Forename, Surname & Address MR NEIL PLATT 1 THE GROVE ANYWHERE TOWNSHIRE AN1 2CD 1234567890 Number of days’ treatment

N.B. Ensure dose is stated

Endorsements

Codalax suspension 10 mL on

1 x 500 mL

Signature of Prescriber

K Kennedy Date

5/10/10

For Dispenser No. of Presns. on form

NHS

Dr K KENNEDY 123456 TOWNSVILLE PRACTICE 7 HIGH STREET TOWNSVILLE AN1 1AB TEL: 0120 123 4567 Newtown PCT 51A PATIENTS – please read the notes overleaf

FIRST STATEMENT You will not be reimbursed for this prescription if dispensed

SECOND STATEMENT NHS prescriptions for Codalax suspension must be endorsed ‘SLS’

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First

Statement

Second

Statement


A B C D E




29. FIRST STATEMENT A person preparing an intravenous infusion of Onkotrone should wear protective clothing and eye protection

SECOND STATEMENT Onkotrone is a cytotoxic agent

30. FIRST STATEMENT A registered pharmacy can legally only supply medicinal products to a GP practice if it has a wholesale dealer’s licence

SECOND STATEMENT The Medicines Act 1968 requires all persons who engage in wholesale dealing to possess a wholesale dealer’s licence

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DESIGNATED CALCULATION QUESTIONS START HERE

Some of these questions will require use of the BNF, others will not. Directions for questions 31(Calc) to 37(Calc). Each of the questions or incomplete statements in this section is followed by five suggested answers. Select the best answer in each case. 31(Calc). If 400 mg of potassium permanganate is dissolved in 2.5 litres of

water what is the percentage strength of the resulting solution? (assume there is no significant volume of displacement)

A 0.008% B 0.016% C 0.032% D 0.064% E 0.08%

You may use this space for your rough working.

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32(Calc). You are asked to advise on the dose of aminophylline for a one-year-old child who weighs 22 pounds. The doctor wants to dilute 500 mg aminophylline in 500 mL of glucose 5% and asks you to calculate the infusion rate. Given that the paediatric dosage of aminophylline is 1 mg/kg/hour, which one of the following is the correct infusion rate?

[1 kg = 2.2 lbs]

A 5.5 mL/hour

B 10 mL/hour

C 22 mL/hour

D 30 mL/hour

E 33 mL/hour


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33(Calc). What weight of light magnesium carbonate is contained in 350 mL of

Aromatic Magnesium Carbonate Mixture, BP? A 1.05 g B 1.75 g C 9 g D 10.5 g E 17.5 g


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34(Calc). A woman presents the following prescription for her daughter who is 4 years old:

carbamazepine liquid 100 mg/5mL – 150 mg bd sodium valproate oral solution 200 mg/5mL – 250 mg bd

Which one of the following is the correct volume of each syrup needed to provide a 4-week supply?

A 210 mL carbamazepine liquid; 175 mL sodium valproate oral

solution

B 210 mL carbamazepine liquid; 350 mL sodium valproate oral solution

C 420 mL carbamazepine liquid; 350 mL sodium valproate oral

solution

D 420 mL carbamazepine liquid; 420 mL sodium valproate oral solution

E 560 mL carbamazepine liquid; 420 mL sodium valproate oral

solution You may use this space for your rough working.

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35(Calc). Mr C is prescribed 8 mmol of magnesium ions to be given by intravenous injection for the emergency treatment of serious arrhythmias. Which one of the following is the minimum volume that the magnesium sulphate 50% injection should be diluted to prior to administration?

[magnesium sulphate 1 g is equivalent to approximately 4 mmol Mg2+;

suggested concentration for administration up to 200 mg/mL]

A 2.5 mL

B 4 mL

C 6 mL

D 10 mL

E 40 mL


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36(Calc). Mr B, who weighs 60 kg, attends a pre-admission clinic at your hospital 1-month prior to having orthopaedic surgery. He is found to have moderate anaemia and his doctor prescribes a course of subcutaneous epoetin alfa. Given that the epoetin alfa is given at a dose of 300 units/kg daily for 15 days, which one of the following is the total weight of epoetin alfa that Mr B will be given?

A 4,500 units

B 27,000 units C 45,000 units D 270,000 units E 450,000 units


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37(Calc). A 72-year-old non-obese patient weighing 70 kg requires a loading dose of drug X. Which one of the following is the most suitable intravenous loading dose of drug X for this patient?

(Volume of distribution = 5 L/kg; therapeutic range 1-2 nanograms per mL)

A 62.5 micrograms B 125 micrograms C 250 micrograms D 500 micrograms E 750 micrograms


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Directions for questions 38(Calc) and 39(Calc). For each numbered question select the one lettered option above it which is most closely related to it. Within the group of questions each lettered option may be used once, more than once, or not at all. Questions 38(Calc) and 39(Calc) concern the following quantities:

A 0.02 mg B 0.2 mg C 2.0 mg D 20 mg E 200 mg

Select, from A to E, which one of the above: 38(Calc). is the weight of phytomenadione in 10 mL of Vitlipid N Emulsion,

infant 39(Calc). is the weight of sodium fluoride contained in 40 mL of En-De-Kay Daily

fluoride mouthrinse (sodium fluoride mouthwash 0.05%) You may use this space for your rough working.

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Directions for question 40(Calc). The question in this section is followed by three responses. ONE or MORE of the responses is (are) correct. Decide which of the responses is (are) correct. Then choose: A if 1, 2 and 3 are correct B if 1 and 2 only are correct C if 2 and 3 only are correct D if 1 only is correct E if 3 only is correct


A 1, 2, 3

B 1, 2 only

C 2, 3 only

D 1

only

E 3

only

40(Calc). Which of the following is/are correct?

1 60 mL of Codeine Linctus BP is required to prepare 300 mL of Codeine Linctus Paediatric BP

2 50 mL of Simple Linctus BP is required to prepare 200 mL of

Simple Linctus Paediatric BP

3 100 mL of Strong Pholcodine Linctus BP is required to prepare 500 mL of Pholcodine Linctus BP

END OF QUESTIONS Now go back and check your work


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Exam sample paper - Part II (Open book)