REGISTRATION EXAMINATION

SAMPLE PAPER

AUTUMN 2004 (for examination sittings in 2005)

PART I (CLOSED BOOK)

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. There are 45 questions in this paper i.e. the paper is half the size of the
actual registration examination closed book paper.

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

5. The time allowance for this paper is 45 minutes.

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 SECTION I
(13 questions)

Directions for questions 1 to 13. Each of the questions or incomplete

statements in this section is followed by five suggested answers. Select the
best answer in each case.

1. When collecting her prescription Mrs F asks you to recommend

something to treat a dry cough, which she has had for over 3 months.
You suspect that the cough may be related to her regular medication.
Which one of the following medicines is most likely to have caused Mrs
F’s persistent dry cough?

A atenolol tablets 50 mg

B digoxin tablets 250 micrograms

C enalapril tablets 10 mg

D bendroflumethiazide tablets 2.5 mg

E isosorbide mononitrate SR tablets 60 mg

2. When dispensing a single item prescription for Mr O you find that you
are unable to supply the full quantity of tablets. You explain the situation
to Mr O, who is happy to call back later for the remaining tablets. The
Code of Ethics and Standards section of the Medicines, Ethics &
Practice guide advises that you also:

A inform Mr O verbally of the name and quantity of the medication

outstanding

B fix a label to the container of tablets stating that the supply is

incomplete

C fix a label to the container of tablets stating how many tablets are
outstanding

D give Mr O a written slip of paper asking him to call back for the
remaining tablets

E give Mr O a written slip of paper detailing the name and quantity

of the medication outstanding

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3. Mrs B suffers from chronic alcoholism, and has been admitted to
hospital after collapsing in the street. She is recovering well, but it is
suspected that she has been drinking alcohol while on the ward. When
you review her inpatient prescription chart you notice that she has just
been prescribed some new medicines. Which one of the following
medicines has the potential to interact with alcohol?

A cefalexin capsules

B diclofenac tablets

C paracetamol tablets

D metronidazole tablets

E Vitamin B Co Strong tablets

4. What is the total number of units of alcohol consumed after drinking a

pint of beer, followed by a small glass of red wine and a double measure
of whisky?

A 3

B 4

C 5

D 6

E 7

5. You are asked to run a workshop on clinically significant drug

interactions for a group of newly qualified junior doctors. During the
workshop you are asked to give examples of commonly used medicines
that inhibit hepatic enzymes. Which one of the following is a hepatic
enzyme inhibitor?

A cimetidine

B rifampicin

C phenytoin

D carbamazepine

E primidone

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6. A prescription for fentanyl ‘50’ patches is valid from the date on the
prescription for:

A 7 days

B 6 weeks

C 12 weeks

D 13 weeks

E 6 months

7. Mr G is admitted to hospital with suspected meningococcal meningitis.

He has no known drug allergies. Which one of the following parenteral
antibiotics is the most appropriate initial ‘blind’ therapy for Mr G?

A co-trimoxazole

B rifampicin

C cefradine

D benzylpenicillin

E erythromycin

8. Mrs L asks you to recommend something for her irritating dry cough.
She is otherwise well, and takes no regular medication. It would be
most appropriate for you to recommend a non-prescription product
containing:

A ammonium chloride

B dextromethorphan

C squill

D ipecacuanha

E guaifenesin

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9. What volume of Concentrated Chloroform Water BP is required to
prepare 200 mL of Chloroform Water BP?

A 2.5 mL

B 5 mL

C 10 mL

D 50 mL

E 100 mL

10. You arrive in your community pharmacy one morning to discover that a
delivery of medicines requiring refrigeration has been left out of the
fridge overnight by a member of staff. You note that the ambient
temperature in the pharmacy overnight was 12oC. Which one of the
following is the most appropriate course of action?

A dispose of all the medicines in the delivery

B return the medicines to the wholesaler

C put the medicines into the fridge now, but reduce their expiry
dates to 1 week

D put the medicines into the fridge now, and contact all the
manufacturers concerned for advice

E put the medicines into the fridge now, reasoning that they will be
fine

11. Mr B has been receiving 30 mg of morphine sulphate oral solution

every 4 hours. His doctor now wants to change him to 12 hourly MST
Continus (morphine sulphate sustained release) tablets. What daily
dose of MST Continus tablets will provide an equivalent dose of
morphine for Mr B?

A 30 mg bd

B 60 mg bd

C 90 mg bd

D 120 mg bd

E 180 mg bd

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12. Mrs J regularly collects her prescription for glibenclamide tablets 5 mg
daily from your pharmacy. On one occasion she asks you to
recommend a good treatment for the corns on her toes. Which one of
the following is the best course of action?

A recommend that Mrs J soaks her feet daily in surgical spirits

B advise Mrs J to use a pumice stone or nail file

C recommend Veracur Gel (formaldehyde 0.75%)

D recommend Scholl Corn Removal Pads (medicated disc system

containing salicylic acid)

E advise Mrs J to visit her GP or chiropodist as self-treatment is

not appropriate

13. Mrs D asks to buy chloroquine and proguanil tablets for malaria
prophylaxis. Which one of the following is the recommended period for
chloroquine and proguanil to be continued after leaving an area where
malaria is present?

A 1 week

B 2 weeks

C 3 weeks

D 4 weeks

E 6 weeks

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 SECTION II
(10 questions)

Directions for questions 14 to 23. For each numbered question select the
one lettered option above it 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 14 to 16 concern the following monitoring parameters:

A serum creatinine

B serum drug level

C blood pressure

D serum potassium

E viral load

Select, from A to E, of the parameters given above, which one is the most
important to be monitored for the following patients:

14. a 65-year-old man with cardiac impairment recently started on

diclofenac

15. a 15-year-old girl taking phenytoin

16. a 36-year-old woman taking Eugynon 30 (levonorgestrel plus

ethinylestradiol)

7
Questions 17 to 19 concern the following actions:

A advise the patient that the symptom(s) they have described

is/are not known to be caused by the medicine

B advise the patient to see their GP as the dose of the medicine

may need to be increased

C advise the patient to see their GP as the dose of the medicine

may need to be reduced

D advise the patient that they are experiencing a side effect of the
medicine. It is safe to continue taking the medicine, but they
may wish to see their GP for an alternative

E advise the patient to stop taking the medicine straight away, and
to see their GP as soon as possible

Select, from A to E, which one of the above applies to the following patients:

17. a patient taking levothyroxine tablets who complains of constipation

and ‘feeling sluggish’

18. a patient taking isosorbide mononitrate tablets who complains of cold

hands and feet

19. a patient taking clindamycin capsules who complains of diarrhoea

Questions 20 and 21 concern the following skin conditions:

A Acne vulgaris

B Herpes zoster

C Molluscum contagiosum

D Seborrhoea capitis

E Tinea corporis

Select, from A to E, which one of the above can be recognised by the

dermatological sign(s) described below:

20. isolated erythematous scaly lesions with defined edges, often round or
oval in shape

21. a vesicular rash, occurring unilaterally over the scalp and forehead,
extending to the eye

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Questions 22 and 23 concern the following activities:

A self audit

B peer audit

C external audit

D practice research

E Pharmaceutical Care

Select, from A to E, which one of the above best describes the following:

22. a community pharmacist visiting a local nursing home to review the

home’s Controlled Drug record keeping

23. a hospital pharmacist checking the endorsements s/he has made on

prescription charts against the regional standards, by going through
medical notes of patients that s/he has seen earlier in the year

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 SECTION III
(12 questions)

Directions for questions 24 to 35. 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 B C D E
1, 2, 3 1, 2 2, 3 1 3
only only only only

24. You run a training session for your pharmacy counter assistants on
threadworm infections. Regarding threadworm infections, which of the
following statements is/are true?

1 threadworms transfer from host to host while in the egg stage

2 patients infected with threadworms develop perianal itching due

to an allergic reaction to the substances in and surrounding the
worms' eggs

3 threadworms are visible in faeces as white or cream-coloured

thread-like objects

25. Which of the following apply/applies to patient medication records (PMR)

stored on the dispensary computer?

1 the pharmacy must notify the Information Commissioner that they

have a PMR system

2 patients have immediate right of access to their records

3 a list of names and addresses of patients stored on the pharmacy

PMR system may be sold to a company marketing compliance
aids, provided that no medical details are included

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 Directions Summarised
A B C D E
1, 2, 3 1, 2 2, 3 1 3
only only only only

26. Staff working in a hospital technical services department who are

involved in the preparation of Total Parenteral Nutrition (TPN) and
cytotoxics are potentially at risk of which of the following?

1 repetitive stress injury to the upper limbs due to repeated

manipulations

2 bone-marrow suppression due to accidental exposure to

cytotoxic agents

3 Hepatitis C infection due to needle stick injuries

27. A 37-year-old woman comes into your pharmacy asking to buy the
‘morning after pill’. She had unprotected intercourse 48 hours ago, and
is not taking any other medicines. Which of the following statements
is/are true?

1 non-prescription emergency hormonal contraception is not

licensed for use in women over 35 years of age

2 non-prescription emergency hormonal contraception is not

effective 48 hours after unprotected intercourse

3 you must deal with requests for emergency hormonal

contraceptives personally

28. A client asks you to recommend a suitable nicotine replacement

therapy (NRT) product for him. Which of the following questions would
you need to ask him in order to make an appropriate recommendation?

1 does he have any existing health problems?

2 how many cigarettes does he smoke per day?

3 what is his pattern of smoking through the day?

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 Directions Summarised
A B C D E
1, 2, 3 1, 2 2, 3 1 3
only only only only

29. Mrs M has recently been diagnosed with type 2 (non-insulin-dependent)

diabetes mellitus, and her GP has prescribed gliclazide tablets for her.
Mrs M has been told that gliclazide can cause hypoglycaemia, and she
asks you to remind her what will happen if she does go ‘hypo’. Which of
the following is/are symptoms of hypoglycaemia?

1 anxiety

2 tremor

3 muscle cramps

30. Which of the following drug interactions can be classified as

pharmacodynamic, as opposed to pharmacokinetic?

1 nortriptyline inhibiting the uptake of epinephrine (adrenaline) into

adrenergic neurones

2 magnesium trisilicate mixture reducing the absorption of digoxin

3 aspirin inhibiting the tubular secretion of methotrexate

31. Which of the following statements about labelling is/are correct?

1 it is a legal requirement for “chemists’ nostrums” to be labelled

with a P in a rectangle

2 it is a legal requirement for the manufacturer’s pack of a

prescription-only medicine to show the letters POM in capitals
within a rectangle

3 it is a legal requirement for general sale list (GSL) products

containing paracetamol to be labelled with the words “contains
paracetamol” unless “paracetamol” is included in the name of
the product

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 Directions Summarised
A B C D E
1, 2, 3 1, 2 2, 3 1 3
only only only only

32. The following patients present at your pharmacy with classic symptoms
of each condition. They have no visual disturbances or pain within the
eye, and none of the patients have suffered from the condition before.
Which of these patients should be advised to see their GP immediately?

1 a woman with ptosis of the right eyelid

2 a man with the a sub-conjunctival haemorrhage

3 a woman with allergic conjunctivitis

33. Regarding NHS Direct / NHS 24 (Scotland), which of the following

statements is/are true?

1 NHS Direct / NHS 24 (Scotland) provide evidence-based

information for healthcare professionals and the public

2 all calls by members of the public to NHS Direct / NHS 24

(Scotland) are routinely followed up with a letter to the patients’
GPs

3 nurse advisers use decision support software to assist them in

making an assessment and in giving advice

34. Mrs J suffers from frequent migraine attacks, and her GP has decided to
prescribe prophylactic treatment for her. Which of the following
medicines is/are recommended for the prevention of migraine
headaches?

1 propranolol

2 pizotifen

3 sumatriptan

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 Directions Summarised
A B C D E
1, 2, 3 1, 2 2, 3 1 3
only only only only

35. Mr F asks for your advice. He suffers from hay fever, but as he works
as a night security guard he asks if you “can recommend an
antihistamine that won’t make me drowsy”. He is otherwise well and
takes no regular medication. Which of the following would it be
appropriate for you to recommend?

1 cetirizine hydrochloride tablets

2 loratadine tablets

3 chlorphenamine tablets

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 SECTION IV
(10 questions)

Directions for questions 36 to 45. The following questions consist of a

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
First Second
Statement Statement
A True True 2nd statement is a correct explanation of the first
B True True 2nd statement is NOT a correct explanation of the first
C True False
D False True
E False False

Questions 36 to 38 concern Mr J who is 28 years old and has attended the

day surgery unit at your hospital for a minor orthopaedic operation. After the
operation he arrives at the pharmacy with a prescription for:

• diclofenac e/c 50 mg tablets, one to be taken three times a day for 5

days
• co-amoxiclav 500/125 tablets, one to be taken twice daily for 5 days

36.
FIRST STATEMENT SECOND STATEMENT

Unless Mr J is exempt from paying Co-amoxiclav tablets incur 2

National Health Service prescription charges
prescription charges, he will be
required to pay 3 charges

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 Directions Summarised
First Second
Statement Statement
A True True 2nd statement is a correct explanation of the first
B True True 2nd statement is NOT a correct explanation of the first
C True False
D False True
E False False

37.
FIRST STATEMENT SECOND STATEMENT

You should contact the prescribing The dosage frequency for oral
doctor to query the dose of co-amoxiclav is usually eight hourly
co-amoxiclav

38.
FIRST STATEMENT SECOND STATEMENT

Mr J should be advised that Indigestion medicines prevent the

indigestion medicines should not gastro-intestinal absorption of
be taken at the same time of day diclofenac
as the diclofenac tablets

39.
FIRST STATEMENT SECOND STATEMENT

Keeping records of dispensing Regular review of dispensing errors

errors is an element of clinical allows continuous quality
governance improvement

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 Directions Summarised
First Second
Statement Statement
A True True 2nd statement is a correct explanation of the first
B True True 2nd statement is NOT a correct explanation of the first
C True False
D False True
E False False

Questions 40 and 41 concern Mrs W who regularly takes furosemide tablets

40 mg each day, and enalapril tablets 10 mg each day. At a routine
appointment her GP checks her serum electrolytes; the results are shown
below:

sodium 139 mmol/L

potassium 4.1 mmol/L
calcium 2.4 mmol/L

40.
FIRST STATEMENT SECOND STATEMENT

In view of the electrolyte results, The serum sodium level is above

Mrs W’s dose of furosemide should the usual range
be increased

41.
FIRST STATEMENT SECOND STATEMENT

In view of the electrolyte results, a Loop diuretics can cause

potassium sparing diuretic should potassium depletion
be added to Mrs W’s regimen

42.
FIRST STATEMENT SECOND STATEMENT

A patient’s supply of diamorphine Diamorphine is a Schedule 2

injections that are no longer Controlled Drug
required should not be accepted
back by the supplying pharmacist

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 Directions Summarised
First Second
Statement Statement
A True True 2nd statement is a correct explanation of the first
B True True 2nd statement is NOT a correct explanation of the first
C True False
D False True
E False False

Question 43 concerns Mrs L who asks to buy a bottle of aspirin tablets

300 mg for her son who is 14 years old. He has symptoms of an upper
respiratory-tract infection with a high temperature and musculoskeletal pain,
but is otherwise fit and well.

43.
FIRST STATEMENT SECOND STATEMENT

It would be appropriate for Mrs L’s The risk of Reye’s syndrome

son to take aspirin associated with aspirin use is
limited to children under 12 years

Question 44 concerns Mr P, who is in his 20s and asks to buy a packet of

Zantac 75 (ranitidine) tablets for dyspepsia. On questioning, Mr P tells you
that he regularly takes ketoprofen capsules, but is otherwise well.

44.
FIRST STATEMENT SECOND STATEMENT

It is appropriate for you to sell Mr P Non-prescription H2-receptor

a pack of Zantac 75 tablets antagonists are effective for the
short term relief of dyspepsia

Question 45 concerns the supply of products for the control of fertility,

conception or termination of pregnancy.

45.
FIRST STATEMENT SECOND STATEMENT

A patient must not be deprived of A pharmacist may not object to

treatment because of the personal dispensing particular treatments on
convictions or religious beliefs of a the grounds of conscience
pharmacist

END OF QUESTIONS

Now go back and check your work

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