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REGISTRATION ASSESSMENT
Part 2 example questions
Notes
1. For questions 1-20 there are five options, A, B, C, D and E. For questions 21-30 there are eight options, A, B, C, D, E, F, G and H. Choose only one of the options as your answer for each question. 2. The answers are on page 19. 3. In the registration assessment, where you see this icon, you may find the resource pack provided useful. 4. No electronic calculating devices can be used in part 2 of the registration assessment. 5. These questions are examples and do not cover the entire registration assessment framework.
Directions for questions 1 to 20. Each of the questions or incomplete statements in this section is followed by five suggested answers. Select the single best answer in each case.
1. A 68-year-old man has an acute attack of gout. He had an MI three years ago and has mild osteoarthritis but is otherwise well. He is taking the following medication:
- aspirin 75 mg once daily
- atorvastatin 40 mg once daily
- ramipril 10 mg once daily
- co-codamol 30/500 mg two tablets up to four times a day as required
He has no known drug allergies.
What is the most suitable drug treatment for his acute attack of gout?
A allopurinol
B colchicine
C diclofenac sodium
D etoricoxib
E febuxostat
2. A 54-year-old woman started to take pioglitazone 30 mg once daily one month ago. She has also been taking metformin 500 mg three times a day for the past two years. When collecting her repeat prescription, she complains of having dark urine, nausea and fatigue for the last two weeks. She wonders if her new tablet is to blame.
What is the most appropriate advice to give to this patient?
A she is experiencing a side-effect of pioglitazone, and whilst safe to continue taking it, she may wish to see her GP for an alternative
B she should see her GP as the dose of pioglitazone may need to be increased
C she should see her GP as the dose of pioglitazone may need to be reduced
D stop taking pioglitazone straight away and see her GP as soon as possible
E the symptoms described are not known to be caused by pioglitazone
4. A man is taking MST Continus (morphine sulfate m/r) tablets 60 mg every 12 hours. In addition, he is taking morphine sulfate oral solution 10 mg/5 mL, 7.5 mL four times a day. Although his pain is controlled on this regimen, he is now unable to take medicines by mouth. He is converting to fentanyl transdermal patches. The information below is from the BNF.
Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press http://www.medicinescomplete.com [Accessed on 30 September 2019 ]
What dose of fentanyl transdermal patch is approximately equivalent to the daily dose of morphine sulfate taken by this patient?
A fentanyl ‘12’ patch every 72 hours
B fentanyl ‘25’ patch every 72 hours
C fentanyl ‘50’ patch every 72 hours
D fentanyl ‘75’ patch every 72 hours
E fentanyl ‘100’ patch every 72 hours
Questions 5 to 7 relate to a 78-year-old man with COPD and ischaemic heart disease. He is admitted to hospital from home with a lower respiratory tract infection. He began taking antibiotics the day before admission. His blood pressure on admission is 98/58 mmHg. He has no known drug allergies and his current medication is listed below.
Drug name Dose Route Frequency
clarithromycin 500 mg oral 12 - hourly Relvar Ellipta (fluticasone furoate 92 micrograms/vilanterol 22 micrograms/ inhalation)
1 puff inhaled daily
isosorbide mononitrate m/r 60 mg oral daily ramipril 10 mg oral daily aspirin 75 mg oral daily Clexane (enoxaparin sodium) 40 mg sc daily salbutamol 100 micrograms/inhalation 2 puffs inhaled prn
5. Microbiology results are not yet available, but an atypical pathogen is not suspected.
What is the most likely cause of this man’s respiratory tract infection?
A Chlamydia psittaci
B Legionella pneumophilia
C Mycoplasma pneumoniae
D Pneumocystis jirovecii
E Streptococcus pneumoniae
8. Psorin ointment contains the following active ingredients:
- salicylic acid 1.6%
- coal tar 1%
- dithranol 0.11%
Which of the following gives the correct weights of active ingredients required to make 350 g of the ointment?
A 56 g salicylic acid; 35 g coal tar; 3.85 g dithranol
B 56 g salicylic acid; 3.5 g coal tar; 38.5 g dithranol
C 5.6 g salicylic acid; 3.5 g coal tar; 0.385 g dithranol
D 5.6 g salicylic acid; 3.5 g coal tar; 3.85 g dithranol
E 0.56 g salicylic acid; 0.35 g coal tar; 0.385 g dithranol
9. A 59-year-old man presents his prescription for oxycodone hydrochloride 40 mg m/r tablets.
What is the maximum recommended duration of supply on a single prescription for this medicine?
A 7 days
B 28 days
C 30 days
D 3 months
E 6 months
Question 10 relates to a 69-year-old man whose most recent biochemistry results are shown below. He previously had normal biochemistry results.
Test Result Units Reference Range Serum sodium 139 mmol/L 137 – 145 Serum potassium 5.1 mmol/L 3.5 – 5. Serum urea 6.2 mmol/L 2.5 – 7. Serum creatinine 132 micromol/L 46 – 92 Estimated GFR 41 mL/min/1.73 m^2 >
He had an elective hip replacement two weeks ago and has a history of hypertension which is treated with amlodipine 5 mg daily and lisinopril 10 mg daily. There have been complications after surgery due to an infection.
10. Which of the following drugs started in hospital is the most likely cause of his abnormal biochemistry results?
A co-codamol
B Clexane (enoxaparin sodium)
C flucloxacillin
D fusidic acid
E naproxen
11. You receive a prescription for haloperidol depot injections for one of your patients. Your PMR system shows that the patient usually takes haloperidol tablets.
What is the most likely reason in this patient that the haloperidol has been changed from tablets to a depot injection?
A to improve adherence
B to improve efficacy
C to provide a more rapid response
D to reduce the risk of extrapyramidal side-effects
E to reduce the risk of neuroleptic malignant syndrome
14. A patient has received four doses of gentamicin 80 mg by intravenous infusion over 60 minutes every 12 hours for Gram-positive bacterial endocarditis (target range for gentamicin: peak 3–5 mg/L, trough <1 mg/L). The peak gentamicin level is reported as 2.5 mg/L one hour after intravenous administration, and the trough concentration is 0.8 mg/L just before the next dose.
Which of the following is an appropriate method of dose rationalisation?
A decrease the dose and decrease the dosage interval
B increase the dose and increase the dosage interval
C increase the dose and maintain the same dosage interval
D maintain the same dose and decrease the dosage interval
E maintain the same dose and increase the dosage interval
15. You want to obtain guidance on the record keeping requirements for the management and monitoring of vaccine stocks in a pharmacy.
Which of the following is the most appropriate reference source to consult for this information?
A British National Formulary
B British Pharmacopoeia
C Immunisation against infectious disease (known as the Green Book)
D Martindale: The Complete Drug Reference
E Rules and Guidance for Pharmaceutical Manufacturers and Distributors (known as the Orange Guide)
16. A 76 - year-old man is taking the following medicines: - atorvastatin 40 mg once daily - dipyridamole m/r 200 mg twice daily - esomeprazole 40 mg once daily - metformin m/r 500 mg twice daily - ramipril 2.5 mg once daily
He has type 2 diabetes and had a transient ischaemic attack two years ago. He has just been diagnosed with AF and is to commence rivaroxaban 20 mg once daily.
Which of his existing medicines should be stopped due to the commencement of rivaroxaban?
A atorvastatin
B dipyridamole
C esomeprazole
D metformin
E ramipril
17. A 45-year-old black man of African family origin has been diagnosed with hypertension. His BP is 160/100 mmHg. He is starting antihypertensive therapy. He does not have any other medical conditions and has no known allergies.
What is the most appropriate first-line anti-hypertensive for this man?
A amlodipine
B bisoprolol
C candesartan cilexetil
D indapamide
E ramipril
Questions 19 and 20 relate to a 36-year-old woman who has been experiencing very heavy, painful periods since the birth of her first child. Her GP has prescribed tranexamic acid 500 mg tablets. She presents in the pharmacy with her new prescription.
The SmPC for tranexamic acid 500 mg tablets would be provided in the resource pack in the assessment. It can be accessed here https://www.medicines.org.uk/emc/product/2359/smpc
19. The instructions on the prescription are to take 'as directed' and the patient cannot remember the maximum dosage her GP advised.
What is the maximum recommended dosage of tranexamic acid that should be taken during one menstrual cycle?
A 3 g
B 4 g
C 12 g
D 16 g
E 21 g
20. She returns to the pharmacy 6 weeks later and explains that she is experiencing disturbances in her vision particularly with colours.
What is the most appropriate advice to give to the patient?
A she is experiencing a side effect of tranexamic acid, but it is safe to continue
B she is experiencing a side effect of tranexamic acid, but this should resolve with continued treatment
C she should reduce her dose of tranexamic acid to minimise the problem
D she should stop taking tranexamic acid and see her GP for further advice
E the symptoms described are not known to be caused by tranexamic acid
Directions for questions 21 to 30. For each question in this section select one answer from the list of eight options above it. Each option may be used once, more than once, or not at all. Theme: Drug interactions
A bleeding risk increased B bradycardia C diarrhoea D hypertensive crisis E myopathy F QT interval prolongation G reduced eGFR H thrombosis
For the patients described, select the most likely possible consequence of the drug interaction from the list above. Each option may be used once, more than once, or not at all.
21. A 49-year-old woman has bipolar disorder and has taken lithium carbonate 800 mg daily for five years. She has been newly prescribed ramipril 2.5 mg daily for hypertension. 22. An 83-year-old woman takes the following medication: - isosorbide mononitrate 50 mg m/r daily - aspirin 75 mg daily - amlodipine 10 mg daily
She has been newly prescribed simvastatin 40 mg at night.
23. A 64-year-old man takes escitalopram 20 mg daily for generalised anxiety disorder. He had a transient ischaemic attack 12 years ago and has recently been diagnosed with non-valvular atrial fibrillation. He has been newly prescribed dabigatran etexilate 150 mg twice daily.
24. A 37-year-old man takes methadone 1 mg/mL oral solution 90 mg daily for opioid addiction. He has been diagnosed with depression by his GP who has prescribed citalopram 20 mg daily. The man has no other relevant medical history and has no known allergies.
27. A 70-year-old man weighs 60 kg and has benign prostatic hypertrophy, congestive cardiac failure and hypertension. He is admitted to hospital with moderate-severity community-acquired pneumonia and is expected to have ongoing reduced mobility relative to his normal state. He takes the following medication:
- bisoprolol 3.75 mg once daily
- bumetanide 1 mg once daily
- doxycycline 100 mg twice daily for 7 days
- finasteride 5 mg once daily
- perindopril 4 mg once daily
He has a CrCl of 25 mL/min and is to be prescribed Clexane for venous thromboembolism (VTE) prophylaxis.
The SmPC for Clexane Forte Syringes would be provided in the resource pack in the assessment. It can be accessed here https://www.medicines.org.uk/emc/medicine/
Theme: Electrolyte abnormalities
A hypercalcaemia B hyperkalaemia C hypermagnesaemia D hypernatraemia E hypocalcaemia F hypokalaemia G hypomagnesaemia H hyponatraemia
For the patients described, select from the list above, the most likely drug-induced cause of the patient’s symptoms. Each option may be used once, more than once, or not at all.
28. A 66-year-old woman is reviewed in A&E following a two-day history of increasing drowsiness, nausea and confusion. She was diagnosed with moderate depression three weeks previously and has been taking fluoxetine 40 mg once daily.
29. A 78-year-old man has been admitted to hospital with worsening heart failure. His symptoms of heart failure have improved following treatment with IV furosemide, but he is now complaining of fatigue, dizziness and muscle spasms.
His current medication is shown below:
Drug name Dose Route Frequency furosemide 40 mg iv bd bendroflumethiazide 2.5 mg oral daily isosorbide mononitrate m/r 60 mg^ oral^ daily bisoprolol 5 mg oral daily aspirin 75 mg oral daily Clexane (enoxaparin sodium) 40 mg^ sc^ daily digoxin 125 micrograms oral daily
