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.
1
All 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.
1
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.
2.
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
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
2
3.
4.
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
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
3
5.
6.
7.
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
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
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
4
8.
9.
10.
Mrs A, who is 55-years-old, visits your pharmacy to ask you to recommend
treatment for her haemorrhoids. Her GP has previously prescribed AnugesicHC 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
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
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
5
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
6
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)
7
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
17.
B
1, 2
only
C
2, 3
only
D
1
only
E
3
only
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
8
Directions Summarised
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?
19.
20.
1
acetylcysteine
2
naloxone
3
activated charcoal
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
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
9
Directions Summarised
A
1, 2, 3
21.
22.
23.
B
1, 2
only
C
2, 3
Only
D
1
only
E
3
only
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
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
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%
10
Directions Summarised
A
1, 2, 3
24.
B
1, 2
only
C
2, 3
only
D
1
only
E
3
only
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
11
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
Directions Summarised
A
B
C
D
E
First
Statement
True
True
True
False
False
Second
Statement
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
SECOND STATEMENT
You cannot lawfully provide the
emergency supply for Miss D
Co-amoxiclav tablets are not included
in the Dental Practitioners’ Formulary
12
Directions Summarised
A
B
C
D
E
First
Statement
True
True
True
False
False
Second
Statement
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 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
SECOND STATEMENT
Mrs E is receiving the correct dose of
gentamicin
When treating endocarditis the onehour (‘peak’) serum concentration for
gentamicin should be 3-5 mg/litre and
the pre-dose (‘trough’) concentration
should be less than 1 mg/litre
13
Directions Summarised
A
B
C
D
E
First
Statement
True
True
True
False
False
Second
Statement
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 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:
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
FIRST STATEMENT
SECOND STATEMENT
You should contact Miss K’s GP to
recommend that the dose of
rizatriptan is halved
The
plasma
concentration
of
rizatriptan is increased by propranolol
14
Directions Summarised
A
B
C
D
E
First
Statement
True
True
True
False
False
Second
Statement
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 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
Title, Forename, Surname &
Address
Age
66
D.o.B
Please don’t stamp
age box
24/10/1943
Number of days’ treatment
N.B. Ensure dose is stated
MR NEIL PLATT
1 THE GROVE
ANYWHERE
TOWNSHIRE
AN1 2CD
1234567890
Endorsements
Codalax suspension
10 mL on
1 x 500 mL
Signature of Prescriber
Date
K Kennedy
For
Dispenser
No. of
Presns.
on form
NHS
5/10/10
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
SECOND STATEMENT
You will not be reimbursed for this
prescription if dispensed
NHS prescriptions for Codalax
suspension must be endorsed ‘SLS’
15
Directions Summarised
A
B
C
D
E
First
Statement
True
True
True
False
False
Second
Statement
True
True
False
True
False
2nd statement is a correct explanation of the first
2nd statement is NOT a correct explanation of the first
29.
FIRST STATEMENT
SECOND STATEMENT
A person preparing an intravenous
infusion of Onkotrone should wear
protective clothing and eye protection
Onkotrone is a cytotoxic agent
30.
FIRST STATEMENT
SECOND STATEMENT
A registered pharmacy can legally only
supply medicinal products to a GP
practice if it has a wholesale dealer’s
licence
The Medicines Act 1968 requires all
persons who engage in wholesale
dealing to possess a wholesale dealer’s
licence
16
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.
17
32(Calc).
You are asked to advise on the dose of aminophylline for a one-yearold 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
You may use this space for your rough working.
18
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
9g
D
10.5 g
E
17.5 g
You may use this space for your rough working.
19
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.
20
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
You may use this space for your rough working.
21
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
You may use this space for your rough working.
22
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
You may use this space for your rough working.
23
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.
24
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
Directions Summarised
A
1, 2, 3
40(Calc).
B
1, 2
only
C
2, 3
only
D
1
only
E
3
only
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
You may use this space for your rough working.
END OF QUESTIONS
Now go back and check your work
25