GPhC Registration Assessment

Why you shouldnt be scared of the changes!

HONESTLY!
Dont
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 Cs 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 Cs
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 Cs
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 2
nd
choice
C an aldosterone antagonist 4
th
choice
D an angiotensin-converting enzyme inhibitor 3
rd
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 Cs 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
Crohns disease. He also has eczema.
9. Mr Ls 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
Crohns 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 Crohns disease. He also has
eczema.
9. Mr Ls 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
Crohns 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 Crohns
disease?

Or

Which of the following is allowed to be prescribed on
the NHS for Crohns disease?
10. Two months later Mr L tells you that his Crohns disease
has worsened, and he presents a prescription for
Budenofalk (budesonide) capsules, 3 mg three times daily
for three months. You should contact Mr Ls GP because:

A Budenofalk capsules are not indicated for Crohns 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!