1

Registration Assessment 2013 Practice questions: February

This set contains 10 practice questions.

Questions 1-5 are examples of Open Book questions. The references that may be used are British National Formulary 64th edition (September 2012) and BNF for Children 2012-2013.

Questions 6-10 are examples of Closed Book questions.

A sample paper that is half the size of the actual Registration Assessment and is matched to the actual assessment in terms of difficulty, syllabus coverage and question types can be accessed at http://www.pharmacyregulation.org/education/pharmacist-pre-registration-training/trainees/registration-assessment/assessment

Copyright © General Pharmaceutical Council 2013. The content of this document is the property of the General Pharmaceutical Council and may not be reproduced.

2

Directions for questions 1 to 5. 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 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 30 percent over the next 10 years

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.

3

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

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

4

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

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

Directions for questions 6 to 8. 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

6. You are asked to prepare an AmBisome (amphotericin B) solution for infusion for a

65-year-old woman who weighs 50 kg. She has been prescribed AmBisome at a daily dose of 2.5 mg/kg body weight to be administered as an intermittent infusion in glucose 10% over 30 minutes at a concentration of 2 mg/mL . Each 50 mg vial of AmBisome should be reconstituted with 12 mL water for injections, to produce a preparation containing 4 mg/mL amphotericin B. Which of the following statements is/are correct?

1 each reconstituted vial of AmBisome results in a preparation containing 0.4% w/v amphotericin B

2 the volume of glucose 10% solution for infusion required to produce a final concentration of 2 mg/mL amphotericin B is 31.25 mL

3 the infusion rate should be set at 125 mL/hour

6

Directions Summarised

A 1, 2, 3

B 1, 2 only

C 2, 3 only

D 1

only

E 3

only

7.

Which of the following prescribed items for different adult patients would require you to contact the prescriber?

1

Methotrexate tablets 10 mg x 56

Take 10 mg once a day

2 Fluticasone propionate 50 micrograms/metered dose inhalation x 1op

Two puffs twice a day

Budesonide turbohaler 100 micrograms/metered dose inhalation x 1op Two puffs twice a day

3 Diclofenac e/c 50 mg tablets x 84

Take three tablets twice a day

7

Directions Summarised

A 1, 2, 3

B 1, 2 only

C 2, 3 only

D 1

only

E 3

only

8. Your pharmacy has received a delivery of 10 x oxycodone hydrochloride injection

10 mg/mL. Which of the following must be recorded in the controlled drug register?

1 name and address from whom received

2 date supply received

3 the quantity received

8

Directions for questions 9 and 10. 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

Directions Summarised

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

9

First Statement

Second Statement

Directions Summarised

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 9 and 10 concern the following scenario:

Mrs K, aged 56, has presented to an Accident and Emergency Department with a swollen, red, right leg. She has no relevant past medical history, is not on any regular medicines and has no known medicine allergies. A diagnosis of deep-vein thrombosis is made. She is prescribed enoxaparin 80 mg once daily by subcutaneous injection and a warfarin loading dose of 10 mg daily for 3 days. 9. FIRST STATEMENT SECOND STATEMENT It is appropriate initially for Mrs K to be prescribed both enoxaparin and warfarin

Enoxaparin will act rapidly but warfarin takes 3-4 days to exert its full anticoagulant effect

10. FIRST STATEMENT SECOND STATEMENT A base-line INR should be measured before commencement of warfarin therapy

It would be appropriate to aim for an INR of 2.5 for Mrs K