Pharmacology 💊

A 55 year old man on anti-hypertensives develops hyperkalaemia. What is the SINGLE most likely anti-hypertensive drug to cause it?

A 32 year old man on psychiatric medications complains of the inability to ejaculate. He is able to have an erection. What is the SINGLE most likely medication he is taking?

A 40 year old woman has repeated retching and intractable vomiting following an elective varicose veins ligation and stripping surgery a few hours ago. Her pain is well controlled but she feels extremely nauseous. What is the SINGLE most appropriate medication to administer?

A 34 year old man suffers from depression. He was recently started on sertraline by his GP. When can a therapeutic effect of sertraline be seen?

A 75 year old lady presented to the Emergency Department with complaints of abdominal pain, fatigue, nausea and vomiting. She also mentioned that she was feeling itchy and her urine seems darker than usual. She was recently treated for cellulitis by her GP and had completed a 10-day course of co-amoxiclav. She has no medication allergies and no history of any liver disease. She is a non-smoker and drinks approximately 5 units weekly. Ultrasound of her abdomen showed no evidence of biliary obstruction or gallstones. Her blood results show the following:

Alanine transferase (ALT) 154 IU/L (5-35)

Alkaline phosphatase (ALP) 289 IU/L (30-150)

Gamma-glutamyltransferase (GGT) 179 IU/L (8-60)

Bilirubin 70 micromol/L (3-17)

What is the SINGLE most likely cause of her presentation?

A 63 year old man presented with sudden onset of severe dyspnoea, orthopnea, raised jugular venous pressure and bilateral basal crackles three days after an episode of myocardial infarction. A diagnosis of acute congestive cardiac failure was made and intravenous furosemide was started. What is the SINGLE most likely electrolyte abnormality to be expected?

A 61 year old hypertensive woman was discharged 12 days following a myocardial infarction. Her hospital stay was complicated by a lower respiratory tract infection which she was an inpatient for 2 days. She was discharged on atorvastatin, aspirin, bisoprolol and amoxicillin. In addition, her usual losartan dose was increased recently by her GP a month ago. She re-presents to A&E with shortness of breath. She has been having shortness of breath and wheezing which is worse at night over the past week. She is a non-smoker. Auscultation of the chest reveals a polyphonic wheeze. A chest X-ray was done which is seen below:

Which is the SINGLE most likely reason for his wheeze?

A 74 year old terminally ill man with brain metastases is on palliative care and is being discharged from the hospital for end-of-life care at home to be looked after by his family. He suffers from multiple seizures and has been prescribed benzodiazepine for his seizures. Which is the SINGLE best route of benzodiazepine administration for this patient?

A 45 year old man has recently had an anterior resection of the rectum. Postoperatively, he was on oxycodone which controlled the pain. He started vomiting several times on the second day and a mild intestinal obstruction is suspected. He is not able to tolerate his medications orally. What is the SINGLE most appropriate management for his pain?

A 38 year old man with a history of bipolar disorder was brought into the Emergency Department by his wife with increased drowsiness, confusion and tremors. He was complaining of blurred vision earlier in the day with ringing in his ears. He has been taking lithium for his condition for the past two years. Urgent serum lithium was ordered and showed 1.3 mmol/L (0.6-1). What is the SINGLE most appropriate next immediate action?

A 48 year old woman fell down two flights of stairs and injured her ribs. X-ray of her chest reveals 4th and 5th rib fractures. Besides the complaint of pain, she is otherwise well and is planned for discharge. Her medical history includes bipolar disorder which she takes lithium regularly. What is the SINGLE most appropriate pain relief to discharge the patient with?

A 57 year old man with a history of hypertension, hypertriglyceridemia and obesity presents to the GP clinic complaining of tingling and burning pain in his feet. The pain is bilateral, symmetrical and worse at rest and improves on walking. He has never experienced a similar episode to this in the past and has no family history of neurological disease. He admits to not regularly taking his medications which include atorvastatin and amlodipine. Social history is positive for light social alcohol consumption and smoking. Physical exam is unremarkable except for a BMI of 31 kg/m2, blood pressure 150/95 mmHg and decreased pin prick sensation bilaterally up to the midfoot. Strength, vibration and position sense are normal. Reflexes are intact and distal pulses are present. What is the most appropriate treatment for his pain?

A 71 year old woman on multiple regular medications has had a recent fall and hit her head on the kitchen counter. She has a history of atrial fibrillation, diabetes mellitus, osteoporosis, hypercholesterolaemia, schizophrenia and depression. Her ECG shows atrial fibrillation. Her blood pressure is 110/70 mmHg. Her blood results show the following:

Sodium 120 mmol/L (135-145)

Potassium 3.6 mmol/L (3.5-5)

Urea 7 mmol/L (20-7)

Creatinine 140 μmol/L (70-150)

eGFR >90 mL/min

Glucose level 11.5 mmol/L

A CT scan reveals an intracranial haemorrhage. What is the SINGLE most likely medication that caused her to fall?

A 67 year old man with advanced prostate cancer is on long term treatment with oral tramadol hydrochloride for pain. He was admitted to the hospital for treatment by the medical team because of a 2 week history of productive cough and a high fever. During his admission, he becomes more unwell and is unable to tolerate oral medication. The medical team would like to determine the appropriate dose of subcutaneous morphine to administer for pain relief in the hospital. He would normally take a total of 600 mg of tramadol hydrochloride a day. What is the MOST appropriate total dose of background subcutaneous morphine to be administered over 24 hours?

A 57 year old man with known squamous cell lung carcinoma has chronic right shoulder pain which had been well controlled with oral morphine in the past. He has now, however, been switched to a fentanyl patch to control his pain due to the nausea and vomiting side effects that he experienced from his morphine treatment. The patient claims that a few hours after he was switched to the fentanyl patch and given metoclopramide for his vomiting, his neck became weak and stiff. Other than his chronic pain medication, the patient takes no other medication or over-the-counter drugs. What is the SINGLE most likely cause of this patient’s neck stiffness?

A 34 year old female presents to Accident & Emergency with the complaint of right calf pain. Further questioning reveals that the patient had been started on the combined oral contraceptive pill (COCP) three weeks ago. She takes no other medications and has no other medical conditions. On examination, the patient’s right leg appears swollen below the knee. She was then given low molecular weight heparin (LMWH) subcutaneously. What is the SINGLE best description for the mechanism of action of low molecular weight heparin?

A 54 year old man with a history of an ischaemic stroke, sciatica and depression and presents to the GP with severe pain in his right ear, discharge and a fever. Otitis media with perforation is suspected. Erythromycin is prescribed as he is penicillin allergic. His regular medications include atorvastatin, clopidogrel, amitriptyline and sertraline. What is the SINGLE most appropriate action?

A 50 year old man presents to the GP clinic with breathlessness for the last 2 hours. He is a known case of asthma and is currently just using a salbutamol inhaler and inhaled corticosteroids to manage his symptoms. He is very anxious. On examination, the patient is afebrile, heart rate is 95 beats/minute, blood pressure is 110/70 mmHg, respiratory rate is 22 breaths/minute and SpO2 is 96%. His chest examination reveals a bilateral wheeze. The clinician prescribes him 50 mg of prednisolone to take for the next 5 days. He has refused using oral steroids in the past because he is concerned about the side effects that the steroids may cause. Which side effect is most likely to occur in this patient with the oral steroid use?

A 54 year old man has recently been diagnosed with stage 2 hypertension. His GP would like to start him on lisinopril to manage his hypertension. What is the SINGLE most appropriate blood test to request prior to initiation?

A 71 year old man with a history of hyperlipidaemia, diabetes mellitus type 2 and hypertension presents the Emergency Department with fever, productive cough. breathlessness and palpitations. A new onset atrial fibrillation is seen on a 12 lead ECG. She is prescribed bisoprolol to control atrial fibrillation. He is also prescribed apixaban. The patient’s usual medications include ramipril, simvastatin and metformin. He is penicillin allergic. A lower respiratory tract infection is also diagnosed and he is prescribed a 5 day course of oral clarithromycin. What is the SINGLE most appropriate action?

A 60 year old man presented to the GP practice with a 2-day history of breathlessness, wheezing and a non-productive cough. He started methotrexate three weeks ago for his rheumatoid arthritis and he takes several inhalers for his chronic obstructive pulmonary disease. Which is the SINGLE most appropriate next step in management?

A 61 year old man attends the GP surgery to discuss his results of a dual-energy X-ray absorptiometry (DEXA) scan. He has no previous fractures in the past. He is a smoker. His father had osteoporosis and had a hip fracture at 60 years of age. His DEXA scan shows a T-score of -2.7. His GP prescribes him alendronic acid. What is the most appropriate advice?

A 67 year old man attends the accident and emergency department with a productive cough, temperature and rigors. Chest radiograph demonstrates right upper zone consolidation and he is started on clarithromycin antibiotics as he is penicillin allergic. His CURB-65 score on admission is 2. His current medical treatment consists of ramipril 5mg once a day, metformin 1 g twice a day, simvastatin 40 mg at night. What adjustments to his medications should be made?

A 46 year old man finds it difficult to achieve an erection over the past two months. He is sexually active and has been with his girlfriend for 6 months. He was started on sertraline 3 months ago following a diagnosis of depression. He takes enalapril for hypertension. He used to take cannabis and used to be a heavy alcohol drinker but has been abstinent for a year. On examination, his testicular size is normal. His blood pressure is 125/80 mmHg. What is the SINGLE most likely cause of his symptoms?

A 57 year old man was admitted to the ward after a day procedure was completed. He has a past medical history of hypertension and Type 1 diabetes mellitus. On discharge, he requested a further supply of his regular insulin which he had run out of supply at home. He has the ClickSTAR pen and he shows you a photo of the empty insulin box at home:

Which is the SINGLE most appropriate prescription to supply?

A 72 year old man has been on warfarin for atrial fibrillation for the last 2 years. He is not on any other medication. Which SINGLE symptom would be the most alarming?

A 44 year old man having severe nausea and constipation was started on an anti-emetic. A few days later, he develops parkinsonian symptoms. Which medication is likely responsible for his symptoms?

A 41 year old woman has been having a discharge of milk from her nipples over the past few days. Her medications include risperidone as part of the management of her psychosis. What is the SINGLE most likely hormone responsible for her symptoms?

An 18 year old teenager would like to start contraception as she is sexually active. She does not want to use barrier methods. She has irregular menstrual cycles and can bleed for up to 8 days. She understands the risk of sexual transmitted infections without the use of barrier methods. She has a history of epilepsy and takes carbamazepine. She is a non-smoker and her blood pressure is 120/70 mmHg. She does not have a history of venous thromboembolism. What is the SINGLE most appropriate contraceptive to use?

A 54 year old man presents to the Emergency Department with abdominal pain, fever, vomiting and diarrhoea for the past 2 days. He passed 7 watery stools in the past 24 hours. He has a history of depression, hypertension, and non-insulin independent type 2 diabetes. His medications include sertraline, losartan and metformin. His blood pressure is 140/90 mmHg, temperature is 38.6°C and pulse rate is 90 beats/minute. His blood results done in the department show the following:

White cell count (WCC) (total) 17 x 10^9/L (4-11)

eGFR > 60

Urea 15 mmol/L (2.0-7)

Creatinine 191 (70-150)

What is the SINGLE most appropriate action?

A 37 year old man finds it difficult to achieve an erection over the past few months. He has been married to his wife for 6 years and has two children. He rarely gets morning erections. He has no medical history of nate other than depression which he started taking sertraline 5 months ago. On examination, his testicular size is normal. What is the SINGLE most likely cause of his symptoms?

A 95 year old man presented to the Emergency Department along with his wife and his daughter with complaints of his sudden behavioural change which started two days ago. His daughter mentioned that he started barging into her room claiming that aliens have invaded his bedroom. He has also been telling his wife that he enjoys the conversations he has been having with the Queen of England who calls him on his mobile to chat. When they try to reason with him, he becomes irritable and insists that what he saw and heard were true. He was recently treated for an infective COPD exacerbation by his GP a week ago. Which is the SINGLE most likely medication that could have caused his presenting symptoms?

A 37 year old female patient has been taking doxycycline 100mg daily for acne for the past two weeks. She complains of feeling nauseous and having frequent diarrhoea since starting the medication. She has no known allergies and occasionally buys paracetamol over the counter. What is the SINGLE most appropriate advice to be given to this patient?

A 55 year old man with chronic liver failure is planning to start on a new medication which is lipid soluble. The medication strongly binds to albumin and undergoes hepatic first pass metabolism. What adjustments are important to make to avoid drug toxicity?

A 67 year old man has been having a cough which started 4 weeks ago. He has a fever and complains of feeling fatigue. His medical history includes taking methadone for opioid dependence. On examination, there are coarse crackles on the lower left lung. He has a temperature of 38.1°C, a respiratory rate of 20 breaths/minute and a heart rate of 80 beats/minute. His blood pressure is 130/80 mmHg. He has had an anaphylaxis episode 20 years ago when he took penicillin. What is the SINGLE most appropriate medication to prescribe?

A 33 year old man visits his GP surgery as he has been suffering from depression for the past year. He has attended the GP surgery multiple times and has been referred for group cognitive behaviour therapy and introduced to self help methods which he feels have helped his depression. However, he still feels he needs more help as he has frequent low moods and has very little interest in daily activities. His GP has agreed to start him on a selective receptor reuptake inhibitor (SSRI). Which statement regarding SSRIs is correct?

A 72 year old woman presents to the GP surgery with complaints of weakness and intense pain on the left side of her face. Her symptoms started 4 days ago. On examination, there are blisters on her left ear canal. She has been started on a course of aciclovir three days ago but is still unable to sleep due to the pain. What is the SINGLE most appropriate medication to add on?

A 41 year old man with schizophrenia has been having a sore throat, fever, muscle aches, chills and a headache for the past 4 days. He has a temperature of 39.5°C. His regular medications include clozapine. What is the SINGLE most appropriate investigation to perform?

A 30 year old man is referred to the local community addiction team for assessment and treatment. He has been taking heroin for a number of years and would like help for his opioid dependence. Which is the SINGLE most likely medication to be offered to him as first-line for community-based detoxification?

A 75 year old man has recently been diagnosed with heart failure with reduced ejection fraction. He started on ramipril in the clinic as part of the management. His blood pressure is 155/98 mmHg. His blood test done a week ago shows the following:

Haemoglobin 131 g/L (130-180)

White cell count 8 x 10^9/L (4-11)

Platelets 310 x 10^9/L (150-400)

Sodium 136 mmol/L (135-145)

Potassium 3.8 mmol/L (3.5-5)

Urea 6 mmol/L (20-7)

Creatinine 89 μmol/L (70-150)

eGFR >90 mL/min

What is the SINGLE most appropriate test to perform?

A 69 year old man presents has a history of stage 4 prostate cancer. He has been having back pain over the past year which is well controlled with oral morphine. Over the past few weeks, his morphine dose was increased as his back pain was worsening. Since then he has started vomiting and feeling nauseous. The oral morphine was ceased and replaced with a fentanyl patch and he was started on metoclopramide by the palliative team. A few weeks after the change of medications, he develops neck stiffness, high fevers, pallor, excessive sweating and muscle rigidity. What is the SINGLE most likely cause of these symptoms?

A 74 year old woman presented to the Emergency Department with agitation and disorientation. Her daughter mentioned that she noticed her mother being more confused in the last few days, and this morning she lost her balance and almost tripped in the kitchen. She is taking several medications, including aspirin, atorvastatin, sertraline, bisoprolol and colecalciferol On examination, her blood pressure is 120/70 mmHg, her heart rate is 65 bpm and her ECG is normal. Her blood results show the following:

Sodium 122 mmol/L (135-145)

Potassium 4.1 mmol/L (3.5-5)

Creatinine 130 μmol/L (70-150)

Which is the SINGLE most likely medication that caused her symptoms?

A 39 year old trans woman (male to female) has been experiencing a diffuse pattern of hair loss for the past 3 months. She is followed up closely under the specialist adult Gender Identity Clinic and has been prescribed oestrogen and spironolactone over the past year. She also takes omeprazole for heartburn, co-codamol for a back injury and metformin for type 2 diabetes. Which medication is likely the reason for her hair loss?

A 10 month old child who weighs 10 kilograms has been diagnosed with a urinary tract infection. He has been prescribed trimethoprim at a dose of 4mg/kg to be given twice daily. The preparation of trimethoprim is 50mg/5ml. What dose will you advise the parents to give to the child?

A 72 year old woman who is taking loop diuretics is suffering from palpitations and muscle weakness. What is the SINGLE most likely electrolyte imbalance to be found?

A 44 year old man weighing 80 kg presented for an operative procedure and was given 20 ml of 1% lidocaine without epinephrine prior to the procedure. If the maximum allowed dose is 4mg/kg, how much more of 1% lidocaine can he be given?

A 65 year old man was admitted to the ward after an elective procedure for observation. The nurse hands you his regular medications to be prescribed whilst he remains in hospital. One of his medications to be prescribed is shown in the image below:

He tells you that he takes 78 units every night to keep his blood sugars controlled. Which is the SINGLE most appropriate prescription to be added onto his medication chart for the nurses to administer this medication?

A 38 year old man with a history of Crohn’s disease was started on a course of prednisolone by his GP. He also takes azathioprine regularly for maintenance and paracetamol for occasional pain. His symptoms have been improving. On examination, he feels well with a temperature of 37.2°C, but his blood results show the following:

Haemoglobin 131 g/L (130-180)

White cell count 18 x 10^9/L (4-11)

Platelets 330 x 10^9/L (150-400)

Which of the following is the SINGLE most likely contributor to the blood result?

A 33 year old man presents to the GP surgery with complaints of a sudden onset of abdominal pain since two days ago and feeling slightly drowsy. He denies any fever or vomiting but admits to almost throwing up this morning. He also noticed that his urine today was darker than usual. He is a non-smoker and takes sodium valproate for his epilepsy. His blood pressure is 125/85 mmHg, BMI is 23 and he is apyrexial. What is the SINGLE most appropriate investigation to be carried out?

• A 30 year old man was admitted for a day procedure for a minor operation. He was given adrenaline and lidocaine locally by injection prior to the procedure. What is the SINGLE most appropriate reason for prescribing the combination with adrenaline?Doctor Daniel

A 58 year old man with a history of hypertension, diabetes mellitus and previous transient ischaemic attack presented to the Emergency Department with complaints of diffuse muscle pain and weakness in his lower limbs for the past four days. His medications include ramipril, aspirin, bisoprolol, metformin and simvastatin. His urine was positive for myoglobin and investigations showed the following:

Urea 10 mmol/L (2.5-7)

Creatinine 280 μmol/L (60-120)

Creatine kinase 3080 U/L (45-260)

Which is the SINGLE most likely cause of the presentation and therefore should be stopped?

A 32 year old man has recently been laid off work due to his drinking habits. He drinks half a litre of vodka (ABV 40%) and a pint of beer (3.5%) in a week. How many units of alcohol is he drinking in a week?

A 65 year old with a diagnosis of terminal prostate cancer with bone metastasis has his pain usually well controlled with a fentanyl patch. He is on the palliative register. For the past several weeks, he has shooting pains radiating down both his arms to his hands. He describes it as a stabbing pain. What is the SINGLE most appropriate pain relief?

A 58 year old man weighing 100 kg presented for an operative procedure and was given 30 ml of 0.5% lidocaine without epinephrine prior to the procedure. If the maximum allowed dose is 3 mg/kg, how much more of 0.5% lidocaine can he be given?

A 22 year old woman who is allergic to ciprofloxacin was prescribed 2 days of rifampicin for prophylaxis as her roommate was diagnosed with meningococcal meningitis. She has been taking combined oral contraception for the past year and is sexually active. She does not wish the become pregnant. Which is the SINGLE most appropriate advice to give to her?

A 71 year old man has been having recurrent falls over the past 6 months. He feels dizzy when he stands up from a sitting position. His clinic blood pressure is 110/70 mmHg when sitting. His standing blood pressure is 88/60 mmHg. His medical history includes insomnia, diabetes mellitus type 2, hypertension, and lumbar disc herniation. His medications include zopiclone, ramipril, metformin, amitriptyline and sitagliptin. Which of his medications would be suitable to stop to reduce the risk of falls?

A 28 year old asthmatic presented to the Emergency Department as he became very unwell over the last few days. His symptoms are worsening and he feels the salbutamol inhalers are no longer effective in helping him breathe. On examination, he has a widespread wheeze on auscultation. There are intercostal recessions and the use of accessory muscles. His oxygen saturation was 88% and his respiratory rate was 30 breaths/minute. Oxygen was immediately commenced and intravenous hydrocortisone was administered. He was given back to back nebulisers with salbutamol and ipratropium. As he was deteriorating, intravenous magnesium sulfate was given. Due to ongoing poor response, he was then given intravenous salbutamol and commenced an intravenous aminophylline. His blood results show the following:

Sodium 136 mmol/L (135-145)

Potassium 3.0 mmol/L (3.5-5.0)

Urea 5 mmol/L (2-7)

Creatinine 90 μmol/L (70-150)

Which medication is the SINGLE most likely cause for his low potassium?

A 5 year old boy was rushed to the emergency department unconscious after he had taken methadone belonging to his sister. He was given naloxone and he regained consciousness. After a while he started getting drowsy again. What is the SINGLE most likely reason for his drop in level of consciousness?

A 40 year old man presented to the Emergency Department with severe sickle cell crisis pain. He complains of pain in his chest and his temperature is 38°C. He has not taken any analgesia for the pain and was given a bolus dose of oral morphine, paracetamol and ibuprofen. After 30 minutes, he was still in severe pain. Which is the SINGLE most appropriate next course of action?

A 49 year old woman on treatment for longstanding rheumatoid arthritis has recently developed a dry cough. She also gives a history of becoming dyspnoeic on mild exertion. In the hospital, her oxygen saturation was found to be 88% on room air. A chest X-Ray was done and shows diffuse bilateral interstitial infiltrates. An extensive infection screen is negative and her symptoms are suspected to be drug-induced. Which SINGLE drug is most likely to have caused this adverse effect?

A 60 year old gentleman presents to his general practitioner with the complaint of difficulty in breathing and a heavy chest at night. His past medical history is significant for a recent diagnosis of hypertension, ischaemic heart disease, stable angina and hyperlipidaemia. He currently takes aspirin, antihypertensives, anti-anginal medication and a statin and claims full compliance with his medications. The patient does not smoke. Auscultation of his chest reveals a slight expiratory wheeze heard bilaterally throughout the lung fields. What is the SINGLE most likely medication responsible for this patient’s symptoms?

A 56 year old man has recently stopped smoking. He used to smoke 12 cigarettes a day. His medical history includes diabetes mellitus type 2, hypertension, hypercholesterolaemia, parkinsonism and schizophrenia. His regular medications include atorvastatin, amlodipine, metformin, procyclidine and clozapine. Which medication dose should be lowered?

A 19 year old teenager had recent unprotected sexual intercourse a day ago. She would like to use an oral emergency contraceptive pill. What is the mode of action of the progestogen-only emergency contraceptive pill is likely to benefit this young woman?

A 68 year old male patient is on Ramipril 10mg daily and Bendroflumethiazide 2.5mg daily for hypertension. He has come for his routine checkup with a blood pressure of 135/85 mmHg. His blood tests shows:

Serum potassium level 5.9 mmol/L

Serum sodium 126 mmol/L

Serum creatinine 79 μmol/L

What is the SINGLE most likely side effect of thiazide diuretics which contributed to his blood results?

A 60 year old man with a history of type 2 diabetes mellitus presents for his annual review at the GP surgery. He reports being in a low mood and he finds himself very tired and irritable at work but associates this with the stress of commuting since having to return to the office. His HbA1c is 48 mmol/mol and he has been getting on well with his long-term medicines which include metformin and atorvastatin. He is maintaining his vegan diet and is exercising regularly. Which is the SINGLE most appropriate action?

A 61 year old man with a history of hypercholesterolaemia, osteoarthritis, depression and previous myocardial infarction presents to the GP surgery with complaints of muscle aches and pain in his upper arms, shoulders and legs for the past few weeks. His regular medications include paracetamol, sertraline, ticagrelor, bisoprolol and atorvastatin. Which medication is the SINGLE most likely cause of his presentation?

A drug is undergoing a trial assessing both the oral and the intravenous routes of administration. The graph below demonstrates the rate of absorption for both routes of administration. What is the SINGLE most likely reason for this to occur?

A 33 year old lady who is an opiate drug addict presents to the local community addiction team for assessment as she wants to quit her drug abuse problem. She is supported well by her friends and family. What is the SINGLE most appropriate treatment to combat withdrawal symptoms?

A 26 year old man presented with tremors and agitation. He confessed that he has been feeling apathetic and withdrawn for the last few months. He admits to using cocaine, opiates and other illicit drugs for about three years but has recently tried to stop when his brother visited him two weeks ago. He has had a few episodes of supraventricular tachycardia and is finding it difficult to sleep through the night. On examination, pink needle marks are noticed on both of his arms. What is the single MOST appropriate medication to alleviate his symptoms?

A 30 year old lady comes to the emergency department with palpitations and chest pain. ECG shows sinus tachycardia. Her pulse rate is 110 beats/minute. She has a history of asthma and her GP recently changed her medications. What is the SINGLE most appropriate management?

A 45 year old homeless man is concerned about his orange-coloured sweat. He also noticed that his urine had a similar orangish-red hue. He was diagnosed with pulmonary tuberculosis two months ago, and thus far, has been compliant with the 6-month course of treatment prescribed. His GP requested a liver function test and a full blood count as he has been feeling unwell for the 2 weeks.

Haemoglobin 160 g/L (130-180)

Platelets 290 x 10^9/L (150-400)

Gamma glutamyl transferase (GT) 40 U/L (8-60)

Aspartate transaminase (AST) 60 U/L (5-35)

Alanine transferase (ALT) 49 U/L (5-35)

His previous liver enzymes were in the normal range. What is the SINGLE most likely cause of his symptoms and deranged liver function test?

A 48 year old man with renal cell carcinoma had radiotherapy for metastatic spinal cord compression at the 11th thoracic vertebra 4 weeks ago. He has retained sensation of his legs but is unable to stand due to muscle weakness and pain. He has pain around his lower trunk which is relieved by regular oral morphine however he has been increasingly distressed due to his painful muscle spasms on his right leg. What is the SINGLE most appropriate management to treat his symptoms?

A 77 year old man has been feeling confusing over the past 7 days. He takes a number of medications for his health conditions. His blood test reveals the following:

Haemoglobin 131 g/L (130-180)

White cell count 9 x 10^9/L (4-11)

Platelets 350 x 10^9/L (150-400)

Sodium 121 mmol/L (135-145)

Potassium 3.9 mmol/L (3.5-5)

Urea 5 mmol/L (20-7)

Creatinine 80 μmol/L (70-150)

eGFR 90 mL/min (>90)

What medication is likely the reason for his symptoms?

A 65 year old man had a mechanical fall in the grocery shop resulting in a fractured humerus. He has been scheduled for an open reduction internal fixation of his fracture, and the anaesthetist has requested that the patient be kept nil per oral after midnight. His medical history includes Parkinson’s disease and he is managed on SinemetR (co- careldopa) Which of the following is the patient most likely to develop, as a result of this medication being withheld?

Which of the following drugs can cause bronchoconstriction?

A 68 year old woman presents to her GP with a history of frequent falls. She has only minor injuries from the falls. She complains of feeling dizzy a few seconds to minutes prior to falling down. She is mobile with a walking stick and lives alone. Her past medical history includes urge urinary incontinence, depression, hypertension and a previous myocardial infarction. Her regular medications include amitriptyline, amlodipine, bisoprolol, ramipril and axybutynin. What is the SINGLE most likely cause of her recurrent falls?

A 39 year old woman with hyperthyroidism has been started on carbimazole. What dangerous side effect should the patient be informed about?

A 33 year old woman attends the clinic concerned as she just found out she is pregnant. Her last menstrual period was 7 weeks ago. She tested positive on a pregnancy test this morning. She takes 150 mg of sertraline a day to treat her mild to moderate depression. She would like to stop her sertraline because she is pregnant. What is the SINGLE most appropriate advice?

A 48 year old man after surgical removal of mandibular cancer presents with perioral paresthesia and severe perioral pain which is not relieved by oral morphine and ibuprofen. The skin is also very tender to touch. What is the SINGLE most appropriate next step in management to relieve the pain?

A 35 year old man with a history of alcohol abuse has oedema and ascites demonstrated by shifting dullness. Spider naevi are noted on his trunk. Paracentesis shows clear fluid. He has a temperature of 37.2°C, a pulse of 85 beats/minute, a blood pressure of 119/85 mmHg and a respiratory rate of 20 breaths/minute. What is the SINGLE most appropriate medication to start?

A 60 year old man developed ankle swelling shortly after starting antihypertensive medication. What is the SINGLE most likely antihypertensive medication which could account for his symptoms?

A 25 year old man has been suffering from breathlessness and wheezing for the last three months. In the last two weeks, his symptoms have worsened and he has been using his blue inhaler more frequently during the day. He also complains of difficulty sleeping at night due to excessive coughing and breathlessness. According to the British Thoracic Society, which is the SINGLE most appropriate medication to be prescribed?

A 55 year old man has a recent lower respiratory tract infection and an injured back. The GP prescribed him an antibiotic, pain relief medications and muscle relaxants. His past medical history includes hypertension of which his dose of amlodipine was increased a month ago. He has a mechanical aortic valve implant inserted 15 years ago for which he takes warfarin. A week after taking the newly prescribed medications, his INR rises to 5.9. His INR was previously stable within his target range which is 3-4. Which medication is responsible for his increased INR?

A 33 year old woman has been prescribed metronidazole in a clinic for an infection. She is a smoker. Her medical history includes taking regular naproxen for a shoulder injury. She takes regular combined oral contraception. What is the SINGLE most appropriate advice?

A 28 year old man presented to the Emergency Department complaining of severe epigastric pain and vomiting. He mentioned that he started feeling unwell about 6 hours ago. He admits that he had a heated argument with his wife two days ago which led him to consume a large amount of alcohol and a bottle of pills. He had recently been diagnosed with depression and was started on an antidepressant two weeks ago. His ECG was normal and further investigations show the following:

Bilirubin 38 μmol/L (3-17)

Alkaline phosphatase 280 U/L (30-150)

Alanine aminotransferase 95 U/L (5-35)

Prothrombin time 18 (10-14)

Blood glucose 5.5 mmol/L

Which is the SINGLE most likely medication contained in the bottle of pills that was taken?

A 10 year old boy diagnosed with chronic bronchial asthma presents for a follow-up visit. In addition to a fixed-dose regimen of moderate-dose inhaled budesonide and inhaled formoterol, which he has been on for a while, theophylline 125 mg was added to his treatment a week ago. Both him and his parents report that the addition of the new drug has reduced the number of exacerbations of asthma, and his peak flow diary reflects the same. Based on a low plasma concentration of theophylline, the consultant has requested you to increase the patient’s dose of theophylline by 25% and arrange for a review in a week. Which of the following is the most appropriate dose for this patient?

A 55 year old man who has metastatic cancer presents to the Emergency Department with his wife. On examination, he was found to have ascites with shifting dullness, and spider naevi were visible. His albumin level was low. Which is the SINGLE most appropriate medication to prescribe?

A 44 year old woman attends your clinic to review her asthma medications following her hospital appointment with the respiratory specialist nurse. She is currently prescribed Slo- Phyllin 250 mg twice daily but her asthma symptoms are not well controlled. Upon assessing the patient, her blood results and the recommendation by the specialist, her dose  of theophylline needs to be increased by 20%. The prescribing system gives a range of doses based on the strengths available. Which of the following is the most suitable prescription for this patient?

A 22 year old woman comes to see her general practitioner after having unprotected sex 2 days ago. She has been told by her friend about the copper intrauterine device (UCD). She asks if he could explain the mechanism of which this will prevent her from becoming pregnant. What is the SINGLE most appropriate mechanism of action of a copper intrauterine device to prevent pregnancy after unprotected sex?

A 65 year old man with hypertension develops gingival hyperplasia. What is the SINGLE most likely medication causing the gingival hyperplasia?

A 55 year old woman presents to the GP with complaints of ongoing pain in her right ear and the right side of her face. She was treated with a 7-day course of aciclovir 4 weeks ago as she presented with a blistering painful rash in her ear and ipsilateral facial palsy. She struggles to sleep due to the pain. She has tried paracetamol and ibuprofen but does not find them useful in managing the pain. What is the SINGLE most appropriate medication to add on?

A 64 year old man diagnosed with a nasopharyngeal carcinoma 6 months ago is having recent difficulty swallowing his tablets. He takes regular morphine sulphate 20 mg twice a day for his localised pain as part of his palliative care plan. He has minimal side effects from the use of oral morphine which manages the pain well. His last blood test shows no liver or renal impairment. What is the SINGLE most appropriate action?

A 37 year old man presents to the psychiatric clinic with low mood and a loss of interest in his daily activities. He has no eye contact and denies any suicidal ideation. He is a known schizophrenic and has been taking clozapine for the past few months. He has gained about 12 kg since starting the treatment. Which is the SINGLE most appropriate antidepressant for him?

A 44 year old man attends the GP surgery complaining of an itchy penis over the past 2 months. He has a history of type 2 diabetes mellitus and familial hypercholesterolaemia. He takes regular metformin, gliclazide, dapagliflozin and atorvastatin. His last HbA1c is reported as 41 mmol/mol (<48). On examination, there is mild erythema on the glans of penis and prepuce. What is the SINGLE most appropriate medication to stop?

A patient has recently been diagnosed with Bipolar Disorder and is to be put on Lithium therapy. Her renal function and liver function tests are normal. What is the SINGLE other test you need to do before commencing her on Lithium?

A 22 year old asthmatic lady presents to the GP surgery with complaints that her symptoms have worsened in the last few weeks. She is finding herself feeling more breathless and wheezy especially early in the morning when she has just woken up. She admits to using her salbutamol inhaler at least five times a week on average. She still takes her beclamethasone inhaler twice a day and her demonstrated inhaler technique is correct. On examination, her heart rate is 80 beats/minute, respiratory rate is 18 breaths/minute, temperature is 37.3°C and BMI 28. According to the British Thoracic Society (BTS) guideline, which is the SINGLE most appropriate medication to add on?

A 66 year old woman has been having recurrent falls throughout the last 3 months. She feels dizzy a few seconds before she falls onto the ground. She commonly falls after getting up from her chair. She has a history of atrial fibrillation, diabetes mellitus, osteoporosis, hypercholesterolaemia, schizophrenia and depression. She takes several regular medications. Her ECG shows atrial fibrillation. Her blood pressure is 110/70 mmHg. Her blood test show the following:

Sodium 126 mmol/L (135-145)

Potassium 4.8 mmol/L (3.5-5)

Urea 6 mmol/L (20-7)

Creatinine 88 μmol/L (70-150)

eGFR >90 mL/min

Which is the SINGLE most likely medication resulting in her clinical presentation?

A 45 year old man has his pain controlled an oral morphine 60 mg twice daily following abdominal surgery. He has recently, however, been unable to take oral medication. What is the SINGLE most appropriate management for this patient?

A 45 year old man with known type 1 diabetes mellitus has an ulcer on his right ankle with agonising burning pain. The pain has been gradually worsening over the past few months. The pain is worse when he walks and during late hours of the night. He has regular inspection of his feet and has normal sensation and palpable pulses. His glucose levels have not been well controlled over the past year, and he is currently undergoing investigations for diabetic retinopathy and diabetic nephropathy. What is the SINGLE most appropriate management for his pain?

A 21 year old man presents with a red, circular shaped rash on his arm. He was prescribed Fucidin cream for 7 days to be applied but the rashes did not improve. He is complaining of itch around the area where the rashes appear. What is the SINGLE next best choice of medication to be prescribed?

A 32 year old asthmatic woman is on a series of regular medication to manage her disease. She uses two inhalers on a regular basis and one inhaler that she takes when needed. During her appointment today, she complains that she is starting to experience twitching and tremors of her hands after taking one of her medications. From the following list, which is the SINGLE most likely medication causing her symptoms?

A 69 year old man has been having recurrent falls over the past 3 months. He loses balance and falls down. He also complains of slow reaction times. His clinic blood pressure is 130/80 mmHg when sitting. His standing blood pressure is 125/75 mmHg. His medical history includes insomnia, hypertension, bipolar disorder and hay fever. His medications include zopiclone, ramipril, felodipine, lithium, and intermittent use of cetirizine. Which of his medications would likely cause his falls?

A 36 year old university biochemistry lecturer has been recently given the diagnosis of schizophrenia by her psychiatrist. She has been started on antipsychotic medication. She would like to know how they work and which neurotransmitter is mainly affected. Which is the main neurotransmitter affected?

A 60 year old man presents to his GP complaining of headaches and tiredness over the past month. He is known to have hypertension and congestive cardiac failure for which he takes ramipril, amlodipine and furosemide. He has a history of recurrent deep venous thrombosis and takes a regular prophylactic dose of apixaban. He practices a healthy lifestyle by ensuring he gets an adequate amount of exercise and has removed excessively salty foods from his diet. Blood tests were ordered which shows the following:

Haemoglobin 131 g/L (130-180)

White cell count 10 x 10^9/L (4-11)

Neutrophils 2.1 x 10^9/L (2-7.5)

Platelets 250 x 10^9/L (150-400)

Sodium 126 mmol/L (135-145)

Potassium 3.5 mmol/L (3.5-5.0)

Urea 3.2 mmol/L (20-7.0)

Creatinine 81 μmol/L (70-150)

eGFR >60 mL/min

What is the SINGLE most likely cause for this patient’s hyponatremia?

A 45 year old man underwent surgery to remove all four of his wisdom teeth. He was complaining of nausea and had two episodes of vomiting after the operation and was given metoclopramide to help with the symptoms. He felt better and managed to take his regular medications which were co-careldopa and atorvastatin. The following day, he complained of being stiff in the neck and had increased muscle rigidity. He is apyrexial and his vitals are stable. What is the SINGLE most appropriate treatment to prescribe?

A 24 year old woman was prescribed amoxicillin for an episode of otitis media. She has been using the combined oral contraceptive pill as a form of contraception for the past two years. What is the SINGLE most appropriate advice to give her with regards to antibiotic use and taking the COCP?

A 30 year old lady presents to the GP surgery with complaints of constipation for the last 3 days. She usually passes motion every other day. She admits to having been taking codeine phosphate regularly for pain relief from her dental abscess for the last five days. On examination, her abdomen is soft. A digital rectal examination reveals faecal impaction and hard stools. What is the most appropriate INITIAL step in management?

A 28 year old man with frequent seizures presents to the GP surgery with a letter from the epilepsy clinic. A recommendation to commence on sodium valproate was made. He has no known allergies and is not taking any regular medications. He is a non-smoker and drinks alcohol only on special occasions. His blood pressure is 125/85 mmHg, pulse rate is 80 bpm and BMI is 22. What is the SINGLE most appropriate test to be carried out before prescribing this medication?

A 75 year old man is visited by his GP in his home for complaints of abdominal discomfort and diarrhoea for the past 3 days. He passed 5 watery stools in the past 24 hours. He feels unwell and tired. He has a history of anxiety, hypertension, atrial fibrillation, recurrent gout, and recently diagnosed polymyalgia rheumatica. His regular medications include citalopram, indapamide, corticosteroids, warfarin and allopurinol. His blood pressure is 130/65 mmHg and pulse rate is 90 beats/minute. His temperature is 37.6°C. What is the SINGLE most appropriate drug to temporarily stop?

A 78 year old woman with a background of multiple myeloma has been recently started on oral morphine to manage her pain in the hospital. She is currently using 10 mg every 4 hours for the past few days. What is the SINGLE most appropriate slow-release morphine sulphate dose to discharge her on?

An 18 year old female is rushed into Accident & Emergency following the ingestion of 33 tablets of paracetamol. Her mother mentions that her daughter was devastated at not getting into the university of her choice. The patient’s parents found her unconscious on her bedroom floor two hours later. Physical examination reveals a Glasgow coma scale (GCS) score of 11/15. Blood sampling was done two hours later and showed a plasma paracetamol level that is above the treatment line. A decision was subsequently made to commence intravenous N-acetylcysteine treatment. Which of the following is the SINGLE best description for the mechanism of action of N-acetylcysteine?

A 24 year old woman was prescribed azithromycin for a sexually transmitted infection. She has been using a form of contraception for the past year. Which SINGLE most likely contraceptive method is likely to be affected by azithromycin?

A 41 year old man with schizophrenia has been having a sore throat, fever, muscle aches, chills and a headache for the past 4 days. He has a temperature of 39.5°C. His regular medications include clozapine. What is the SINGLE most appropriate investigation to perform?

A 39 year old man has been taking azathioprine for the management of his Crohn’s disease. He recently had a flare-up of his Crohn’s disease 2 weeks ago, which required oral prednisolone. His symptoms have improved after the initiation of prednisolone. His blood test done 2 days ago shows:

Haemoglobin 130 g/L (130-180)

White cell count 15 x 10^9/L (4-11)

Platelets 550 x 10^9/L (150-400)

Ferritin 80 ng/ml (20-300)

What is the SINGLE most likely reason for his abnormal blood results?

An 18 year old teenager would like to start contraception as she is sexually active. She does not want to use barrier methods. She has regular 28-day menstrual cycles. Her menstrual bleeds can last for 4 days. She understands the risk of sexual transmitted infections without the use of barrier methods. She has a history of epilepsy and takes carbamazepine. She is a non-smoker. She does not have a history of venous thromboembolism. What is the SINGLE most appropriate contraceptive to use?

A 74 year old man has been taking Warfarin 7mg daily for the treatment of left arm DVT with an INR target of 2-3 for the past two years. He also takes Furosemide 40 mg daily. Diprobase cream and Co-dydramol when required for pain relief. He is usually compliant with his medications. What is the SINGLE most important adverse effect the patient should be careful with?

A 15 year old female patient presents to your general practitioner (GP) practice with a history of heavy menstrual bleeding. She has a regular 28-day menstrual cycle and she has no family history of bleeding or clotting disorders. She recently read an article in a magazine about the dangers of combined oral contraceptives and prefers not to take any type of contraceptive pill, however, she is not sexually active and does not need any form of contraception. A decision is made to prescribe tranexamic acid for her. Which of the following is the mechanism of action of tranexamic acid in menorrhagia?

A 30 year old woman presents with feelings of apathy. She discloses to using cocaine and opiates for about three years but had recently stopped completely when her mother came to visit about two weeks ago. She confesses her thoughts of starting to use again but is very keen to continue staying away from those drugs. Her urine test showed no trace of opioids. What is the single MOST appropriate medication to be prescribed?

A 45 year old diabetic man had recently started taking anti-hypertension therapy. 6 months later his fasting blood glucose is 14 mmol/L. What is the SINGLE most likely medication that would have caused this?