MCQs in Pharmacy Practice Second edition Edited by Lilian M Azzopardi BPharm (Hons), MPhil, PhD, MRPharmS Associate Professor and Head of Department. MCQs in Clinical Pharmacy. Edited by. Lilian M Azzopardi. BPharm (Hons), MPhil , PhD. Associate 00 Prelim Lecture Notes in Pharmacy Practice. Directions: Each group of questions below consists of five lettered headings followed by a list of numbered questions. For each numbered question select the .

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Mcqs In Pharmacy Practice Pdf

and colleagues entitled MCQs in Pharmacy Practice, which was published in The questions cover a wide range of therapeutic areas. The MCQs take. PDF | 5 minutes read | On Oct 15, , J. W. Foppe van Mil and others published Lilian M. Azzopardi (Ed), Further MCQs in Pharmacy. This book is an extension of an earlier publication, edited by the same author and published in Both books contain multiple choice questions (MCQs) that.

Both books contain multiple choice questions MCQs that challenge the knowledge of pharmacists in various ways. The open-book section and the provision of explanations to the answers will help readers pre-registration students as well as registered pharmacists to identify areas of strength and weakness in their pharmacy knowledge. For a pharmacist it is indeed fun to read trough this book and test his or her knowledge. Or would you know if wet skin lesions 1 indicate presence of a fungal infection, 2 always require referral or if 3 potassium permanganate soaks may be recommended? And lastly, what would you answer to the following options about Good Pharmacy Practice guidelines: 1 Have been established by the International Pharmaceutical Federation FIP , 2 comply with ISO, 3 consist of an audit process, 4 relate to pharmaceutical marketing or 5 entail field observation studies. Not only students without practice experience might find it hard to come up with the right answers. What is missing in this book is a definition of the knowledge-level that this book is supposed to test. In spite of the attempts of the European Association of Faculties of Pharmacy to harmonise the pharmacist education in Europe, there still are no common teaching goals, let alone common registration requirements in Europe.

Mickey Brown. Shiva Kumar Kamalapuram. Arun Kumar. Abdul Manan. Popular in Education. Optimizing Function-Mosby Motivation by Dr. Min Chan Myae. Julien Istrate. Wanjau Munyiri. Marian Ioan-Lucian. Gio Bengao.

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Tej Des. Elizabeth Djinis. Timothy Manning. Michael Adalikwu. Latasha Morrison. Arrive a little early for the examination and plan how much time to allocate for each question, allowing extra time for more difficult questions.

Open-book examinations The rarity of absolutes in pharmacy practice means that a variety of adjectives and adverbs are commonly used in its description, increasing the difficulty of answering MCQs. You should not assume they are clues — they may or may not be. The following are suggestions about how to tackle the questions in Test 1 of this book.

These pointers may be applied to the other tests in this publication. The questions are tackled in groups and a number of points are considered. However, some of the points discussed may certainly be adopted in answering other questions. Sometimes the open-book questions may even present more of a challenge than the closed-book questions. In the case of Test 1, which is an open-book examination, there is also advice about the best use of reference books within the time allowed for answering the MCQs.

More important is the fact that only one answer — one choice — is allowed. This is explained in the statement at the beginning of the questions.

Second book of multiple choice questions in pharmacy practice | News | Pharmaceutical Journal

Never underestimate the importance of reading the directions very carefully. Candidates who select more than one answer will not be given any marks, even if the choice includes the correct answer.

There is only one correct range for plasma theophylline concentrations. In Q13 the term is again superfluous and you should not be confused by it. However, if you do not know the action of the specific drug then a good suggestion would be to look at the disease and examine what action is required to address the particular ailment.

MCQs, contrary to what some students fear, are not meant to be tricky. Do not try to read between the lines but do read the statements very carefully. Many mistakes happen because the directions are not carefully followed. Questions 26—52 The tests are set so that there are questions with an openbook option, and another questions of the closed-book type. Questions in both formats may appear to be complex in their setting.

Devote enough time to understand the question clearly. Statements or advice that a heading may be used once, more than once or not at all mean exactly that. Very often only one statement is obviously related and it is safe to assume that the How to use this book xxxiii other answers are incorrect. In an open-book situation, expect a number of proprietary trade names or diseases. Although candidates are allowed to look up all the trade names in the textbooks available, in an examination this is not practical and sometimes impossible to achieve in the allocated time.

Check the active ingredients of a proprietary name only when necessary or when in doubt. You are expected to have a good knowledge of most brands and pharmaceutical manufacturers Q26— Diseases tend to present a distinct challenge to pharmacy practice examination candidates. Students often do their best to gain as much knowledge of drugs as possible, but when it comes to diseases they are confused.

There are so many thousands of diseases, where should one start? Which diseases should be revised for an MCQs examination? What depth of knowledge about diseases is expected?

In tackling these questions it is important to be very familiar with the textbooks used in the open-book examination. A book such as Martindale: the Complete Drug Reference may be useful but it is not essential and would only be used on a few occasions.

For this edition, the 57th edition March was used. Let us examine how, for example, Q32—34 could be tackled by the following steps: 1 2 3 Write the generic names next to A—E, starting with those that you are confident about. Find the ones you do not know, or are unsure of, in the BNF index at this stage, just note the page numbers.

Find the generic names by going through the pages, checking the list in alphabetical order, rather than going backwards and forwards, to save time.

In addition, get used to the newer editions of the textbooks. Practise using the indexes, appendices and footnotes and be familiar with the overall structure of the reference books used in an open-book session. First write the page numbers next to Q35—37, after finding them in the index preferably in alphabetical order to save time and then find the corresponding pages in the text. Although in Q32—34 you only had to look for the products A—E and match them with the specific diseases, in Q35—37, do not attempt to find the manufacturers A—E; look up the three products instead.

Q38—40 should be attempted in the same way as Q32— Practise these simple techniques, although they seem obvious when you know about them, as this type of question can cause confusion when met unawares and could be a challenge even to the diligent student who studied the facts but who had no practice with MCQs. The next group of questions refers more to diseases and biochemical tests Q41— These questions present more of a problem, not because of their difficulty but owing to the technique needed to make the best use of the reference books available.

In this case follow these steps: 1 Write the page numbers next to the choices A—E after consulting a drug index or formulary that you know How to use this book 2 3 xxxv carries precautions to be taken with the use of drugs, e.

In the BNF, look under cautions for levodopa — the second one listed is peptic ulceration, so put A next to Q For domperidone, there are only three lines of cautions, none listing any of the four conditions, so go straight on to consider fluvastatin. When consulting the index, always note down and look up the page marked in bold first. Under cautions for all statins, in the first few lines there is a statement advising a liver function test.

In an examination, if you are pressed for time, do not continue reading all the cautions but move on immediately to the next drug after marking C next to Q A good reminder is that a reference book in an open-book examination should be used just to support your knowledge and only in rare cases to find unknown data.

The availability of books in an examination does not replace the need for studying, particularly basic facts that require instant recall. Lack of this kind of preparation is often one of the reasons why some candidates perform worse in an open-book examination than in a closed-book one.

Do not expect to gather all the information during the examination — the questions are designed to ensure that only students who are well versed and properly trained in pharmacy practice will pass. Questions 53—83 These questions Q53—83 , which present a choice of answers grouped together, are a common format that sometimes perplexes students.

The system is not meant to confuse but is used xxxvi How to use this book to facilitate the marking procedure. In this book the directions are summarised in a box but this may not always be the case in examinations set by different boards.

Follow these steps to answer this type of question: 1 2 3 4 5 Summarise the directions if not already presented this way. Collate the answers. Match the collated answers with the letters A—E, as indicated in the directions. Write your chosen letter next to the question. The reverse is also true, that is, if you are asked to write numbers in a rare case or T and F, do not create your own summary.

Remember that answer papers are sometimes corrected by clerks, who are given strict rules for recording correct answers, which they are obliged to follow. More commonly today, the analysis is undertaken by computer, so not following the instructions may result in the answer being marked as incorrect, no matter what was written.

In Test 1 in this book, for example, Q53—83, i. It must be emphasised that, although all the information required to answer the questions correctly is available in the recommended textbooks, do not try to verify all the information. This is How to use this book xxxvii totally different from using the book to check a dosage regimen, a proprietary name or a caution. This should be interpreted that care should be taken with the use of digoxin. You may ask — should care not be taken with the use of all medicines, especially in the elderly?

Questions 58—63 refer to diseases. In addition to using formularies such as the BNF, in this case, you may need to refer to other textbooks such as Minor Illness or Major Disease see Bibliography to answer these types of questions.

In tackling Q61, the emphasis that the textbook places on detection combing for head lice signifies that this is the diagnostic process. This indicates how important it is that an authoritative book is used in an examination when you are allowed a choice of textbooks.

The use of such books will help you find the correct answer, even when the answer is not specifically stated as such but needs to be inferred. The textbook selected for use in openbook MCQs should have an extensive index for quick reference. Many textbooks give a summary but sometimes it is worth going beyond this. The whole text on the topic itself is, in some cases, only a short paragraph. Questions 64—71 concern drug use, contraindications, cautions and side-effects, which may all be found in formularies such as the BNF.

It is important to look under the drug names rather than try to find information by looking for a disease or symptom. Multiple choice questions are increasingly used to test knowledge and understanding objectively at an undergraduate level and in licensing exams. They can be formative as selfassessment exercises with feedback and are particularly useful for revision purposes and as a means of identifying an area for further study. It will be a very useful text both for pharmacy preregistration examination candidates and for practising pharmacists.

Professor Claire Anderson School of Pharmacy, Faculty of Science, University of Nottingham, United Kingdom April Foreword to the first edition To practise pharmacy effectively and accountably, it is critical for practitioners to have a sound, contemporary and comprehensive database.

In addition to the many good references in textbooks and the periodical literature, there is a certain amount of knowledge that we have to keep current in our memory and daily dialogue. An appropriate balance must be struck by our reliance on memory and our capacity to find, analyse and apply useful knowledge to effective clinical decision making. Simply put, CPD reflects the fact that, for pharmacy professionals to practise with responsibility and accountability, each one must structure a plan and implement mechanisms by which they can maintain their individual competence.

It also indicates a willingness of the individual practitioner to build a portfolio of formal and informal educational processes in which they are continuously engaged to ensure competence. They are also willing to have this portfolio reviewed by their peers and perhaps, regulatory bodies, to establish a formal recognition of competence by external parties.

Our profession will be examining these precepts over the coming years as a necessary evolution of our thinking around continuing education, public accountability and personal professional development. Engaging in review of important developments in the field of pharmacy and the disciplines that support its knowledge x Foreword to the first edition system is a personal responsibility that all practitioners must take seriously.

This is particularly true at this time in the evolution of our profession. As we globally embrace the precepts of pharmaceutical care, as we find an appropriate balance between knowing our products, our patients and their disease states, it is increasingly critical to constantly review new findings as well as legacy principles.

One way of doing that is self-assessment. MCQs in Pharmacy Practice is an important effort to engage individual pharmacists in such self-assessment. The authors of this text have identified a way by which individual pharmacists, who are committed to their own continuing professional development, can apply a systematic way of involving themselves in self assessment.

This text provides a guided way of asking important questions, pointing out salient features of rational drug therapy and stimulating deeper thinking through a variety of exercises. Pharmacists who work their way through this book will assuredly gain in their knowledge and skills.

More importantly, they will be able to identify those areas in which they may need deeper study. But going through only this text will not ensure practice competence. By blending these Foreword to the first edition xi efforts with structured self-assessment, such as that offered by MCQs in Pharmacy Practice, the individual practitioner will have taken major steps in ensuring individual competence.

This timeframe gave assessors of professionals practising in the health field time to follow the evolvement of the different forms of MCQs. Six years ago, adopting a multiple choice format as opposed to the traditional essaytype was a daring task with all its implications on how much fairer the new system was over the traditional one. The newer types of MCQs demand appreciation of the subject whereby knowledge accrued is tested by having to judge whether the first of two statements is true and decision-making skills are required to decide whether the second statement is a correct explanation of the first.

Another format which has the advantage not only of testing factual knowledge but also that of mimicking realistic clinical situations is where the student has not only to select the route or product to use but also to be able to indicate the next best option while identifying which other option would be least suitable. Such questions are ably set while still allowing for an unbiased assessment.

The extension of the types of setting, albeit more demanding on the contributors, make the second edition of MCQs in Pharmacy Practice truly comprehensive in style. Such questions also provide the student with a refreshing exercise in mind juggling with pharmaceutical principles.

The editor has therefore updated the information in the questions to reflect that in the current BNF, so as to ensure that the questions are practical and contemporary. The answers given to the questions, which again form an essential part of this edition have been meticulously updated by Lilian M Azzopardi, recently appointed Head of Department of Pharmacy in the Faculty of Medicine and Surgery. In this capacity Lilian Azzopardi acts as chairperson of the examination boards in pharmacy practice including the final examination which is in an MCQ format that leads to registration as a pharmacist.

As Dean of the Faculty of Medicine and Surgery, to which the department of pharmacy belongs, I could read in this text the meticulousness and diligence that are so characteristic of the attributes that Professor Azzopardi possesses.

Students were then examined separately in these different disciplines. It is only fairly recently that pharmacy practice and pharmaceutical care have been introduced as integral parts of the pharmacy curriculum. Attempts at finding the best way to test the competence of pharmacy students were made at roughly the same time.

A perfectly fair examination is one in which students are objectively and accurately assessed with regard to their comprehension, analysis, evaluation and application of all the material with which they have been presented during their course of studies. Multiple choice questions have been accepted as such an objective measure in most areas, including those related to professional practice. Pharmacy practice has, until very recently, been examined through the traditional essay type of question.

This has led, at times, to the feeling that the overall assessment of this discipline could be a subjective one. The MCQ system tries to eliminate the subjective element in an examination and is now well established as a fair mode of assessment. The availability of a pharmacy practice text based on the MCQ system now provides pharmacy students with the opportunity of assessing themselves xvi Preface to the first edition in the discipline and finding out whether they have mastered it.

Dr Azzopardi and her collaborators are to be congratulated in having managed to produce this text. It should be a welcome addition to the standard texts students use during the years spent in training to become pharmacists.

Milton Keynes: In both areas, access to assessment tasks that allow for self-assessment of knowledge across a broad range of domains is important. MCQs in Pharmacy Practice 2nd edn contains a broad range of multiple-choice questions that provide feedback on what is known and where knowledge is lacking. This information is useful to many potential users — the pharmacy undergraduate, the preregistrant, the university professor and the practising pharmacist.

At all levels, understanding the limitations in our knowledge and abilities is a critical step in the learning process. Learning that is based on individual knowledge gaps is more likely to be effective and the learner is more motivated. MCQs in Pharmacy Practice 2nd edn is a simple-touse, useful, unintimidating text that enables users to determine the extent of their knowledge, to identify knowledge gaps and to test their ability to analyse information and to make decisions. This text is primarily aimed at preparing students to sit for multiple choice question MCQ examinations in pharmacy and would therefore be a valuable study tool for students preparing for registration and would also assist in preparation xviii Introduction for other types of examination, such as oral examinations.

It provides students and pharmacists with an excellent resource to test their knowledge and to highlight areas where they require further work. In the undergraduate setting there are many opportunities throughout the curriculum for students and professors to utilise MCQs to assess knowledge in particular areas. MCQs in Pharmacy Practice 2nd edn would therefore make a useful prescribed text to guide self-directed study for undergraduate pharmacy students.

Continual, regular assessment of students provides a form of feedback to students on the level of knowledge gained and areas where additional work is needed. This text would be of equal value if sections of the text were given to students as regular formative assessment or if students used the text as a study guide. The primary aim of professional development in pharmacy is to develop and maintain competencies, which improve standards of care and health outcomes for patients.

Knowledge is a critical element in this process and community pharmacists invest significant time and money undertaking CPD. One of the major barriers to effective CPD is motivation to undertake further learning reflected in reasons given for lack of engagement with CPD, such as lack of time, cost and lack of engagement with educational formats.

A contributing factor to this lack of engagement is the inability to match individual learning needs with educational offerings.

These questions provide an excellent tool to enable practising pharmacists to assess their own knowledge in a variety of relevant areas. Once gaps in knowledge are identified, it is a simpler process to undertake selfdirected learning that addresses deficiencies and CPD is therefore more stimulating and meaningful and likely to lead to a change in practice. Multiple choice questions are time consuming and difficult to develop in a manner that ensures appropriate assessment of knowledge and critical thinking skills.

The questions in MCQs in Pharmacy Practice 2nd edn are of an excellent standard and Introduction xix the format, variety and structure make it an essential resource for the pharmacy profession. I am most grateful to the contributing authors: I would like to thank pharmacists Alison Anastasi and Louise Azzopardi for their participation in reviewing the material. Thanks also go to staff and students at the Department of Pharmacy especially Amanda Calleja and staff at the Faculty of Medicine and Surgery.

In she took up a position at the Department of Pharmacy, University of Malta as a teaching and research assistant. Professor Azzopardi completed an MPhil on the development of formulary systems for community pharmacy in , and in she gained a PhD. Her thesis led to the publication of the book Validation Instruments for Community Pharmacy: She worked together with Professor Anthony Serracino Inglott who was a pioneer in the introduction of clinical pharmacy in the late sixties.

Professor Azzopardi is currently an associate professor in pharmacy practice at the Department of Pharmacy, University of Malta and is responsible for coordinating several aspects of teaching of pharmacy practice, including clinical pharmacy for undergraduate and postgraduate students, as well as supervising a number of pharmacy projects and dissertations in the field.

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She is an examiner at the University of Malta for students following the course of pharmacy and is an assessor in determining suitability to practice. She was a member of the Pharmacy Board, the licensing authority for pharmacy in Malta for a number of years and Registrar of the Malta College of Pharmacy Practice, which is responsible for continuing education.

She has practised clinical pharmacy in the hospital setting and she practises in community pharmacy. She has been invited to give lectures and short courses in this area in several universities.

She has been a member of scientific committees for European conferences and chaired a number of oral communication sessions reporting research work in the field of pharmacy practice. She has received funding for her research projects from national institutions and in completed a project funded by the European Union on automated dispensing of pharmaceuticals and pharmacist interventions, of which she was project coordinator for the University of Malta.

In Professor Azzopardi was appointed head of the department of pharmacy at the University of Malta. It covers common general pharmacy practice interventions and operations and other topics commonly featured in examinations, such as simple pharmaceutical calculations, doses, strengths, nomenclature, abbreviations, dosage forms, specialities, trade and generic names, biochemical tests, classification, side-effects, and common diseases.

Some recent advances in pharmacy practice are also included.

It is recommended that students use this book in their final preparatory stage before sitting for qualifying, licensing or registration examinations so that they are aware of the nature of the questions likely to be posed and how best to approach the examination. This series of MCQ tests is aimed at preparing candidates for their registration examination, whether this is carried out by the state board, the pharmaceutical society or the university.

This book consists of examination-type MCQs of which are new questions and over 30 new drug entities are included. The questions are practice oriented and are intended to assess knowledge, evaluative and analytical skills, and ability to apply that knowledge in clinical practice. The book consists of two parts. In the second part, the closed-book section, MCQs are directed towards basic skills and knowledge with which the student is expected to be fully familiar.

Each test consists of questions which should be completed in two hours. In each test, different formats of MCQs are adopted. Each format is introduced with directions for answering the MCQs. In each test, case-based and free-standing questions are included. Answers with brief explanations are given at the end of each test.

For each test, write the number of the question and your answer on a separate sheet of paper, then after going through all the questions in the test, compare your answers with those in the book. Attempt one open-book test and one closed-book test so as to mimic examination conditions. Refer to Appendix D for feedback on those questions you did not answer correctly. Information on the proprietary names listed in the book is given in Appendix A. Appendix B includes definitions of medical terms included in the book, while Appendix C lists abbreviations and acronyms.

The recommended textbooks for the open-book section are: Azzopardi LM Validation Instruments for Community Pharmacy: Pharmaceutical Care for the Third Millennium. Binghamton, New York: Pharmaceutical Products Press. Edwards C, Stillman P Minor Illness or Major Disease? The Clinical Pharmacist in the Community, 4th edn.

Pharmaceutical Press. Joint Formulary Committee British National Formulary, London: Medicines, Ethics and Practice: Royal Pharmaceutical Society of Great Britain, Nathan A Non-prescription Medicines, 3rd edn. How to use this book xxix This book is mainly meant for those sitting the final test before being registered as pharmacists.

The syllabus and specific requirements regarding eligibility to sit for the examination have been carefully laid down by the relevant authorities but the aim is always the same: The format of the examination itself has been selected to test these standards thoroughly.

These preregistration examinations are a necessary obstacle to overcome in becoming a professional pharmacist, in whose hands patients are safe and who is a credit to the profession.

The MCQs method of assessing students is here to stay. MCQs are no longer regarded as an examination that constitutes a final handshake for those who have completed four years at university, passed all the tests, practised in the pharmacy service, gained experience and have received a good report from their mentor pharmacist.

Indeed, a poor performance in this assessment may result in overall failure. MCQs in pharmacy practice do not simply examine facts. Some students expect MCQs to test only factual knowledge. Starting with dress, there is a tendency to match your psychological outlook and actions to the way you are dressed. Some students approach MCQ tests casually, as if this type of examination were not as serious an undertaking as any other.

Dress smartly but comfortably and conservatively. Avoid clothes that make you feel too relaxed, such as casual jackets or leisure wear. Arrive a little early for the examination and plan how much time to allocate for each question, allowing extra time for more difficult questions.

Open-book examinations The rarity of absolutes in pharmacy practice means that a variety of adjectives and adverbs are commonly used in its description, increasing the difficulty of answering MCQs. You should not assume they are clues — they may or may not be. The following are suggestions about how to tackle the questions in Test 1 of this book. These pointers may be applied to the other tests in this publication. The questions are tackled in groups and a number of points are considered.

MCQs in Pharmacy Practice, 2nd Edition

However, some of the points discussed may certainly be adopted in answering other questions. Sometimes the open-book questions may even present more of a challenge than the closed-book questions.

In the case of Test 1, which is an open-book examination, there is also advice about the best use of reference books within the time allowed for answering the MCQs. How to use this book xxxi Questions 1—25 Several questions contain the statement: More important is the fact that only one answer — one choice — is allowed.

This is explained in the statement at the beginning of the questions. Never underestimate the importance of reading the directions very carefully.

In this case, the directions state: Candidates who select more than one answer will not be given any marks, even if the choice includes the correct answer. There is only one correct range for plasma theophylline concentrations. In Q13 the term is again superfluous and you should not be confused by it. However, if you do not know the action of the specific drug then a good suggestion would be to look at the disease and examine what action is required to address the particular ailment.

MCQs, contrary to what some students fear, are not meant to be tricky. Do not try to read between the lines but do read the statements very carefully. Many mistakes happen because the directions are not carefully followed. Questions 26—52 The tests are set so that there are questions with an openbook option, and another questions of the closed-book type. Questions in both formats may appear to be complex in their setting.

Devote enough time to understand the question clearly. Statements or advice that a heading may be used once, more than once or not at all mean exactly that.

Very often only one statement is obviously related and it is safe to assume that the How to use this book xxxiii other answers are incorrect. In an open-book situation, expect a number of proprietary trade names or diseases. Although candidates are allowed to look up all the trade names in the textbooks available, in an examination this is not practical and sometimes impossible to achieve in the allocated time.

Check the active ingredients of a proprietary name only when necessary or when in doubt. You are expected to have a good knowledge of most brands and pharmaceutical manufacturers Q26— Diseases tend to present a distinct challenge to pharmacy practice examination candidates.

Students often do their best to gain as much knowledge of drugs as possible, but when it comes to diseases they are confused. There are so many thousands of diseases, where should one start? Which diseases should be revised for an MCQs examination? What depth of knowledge about diseases is expected?

In tackling these questions it is important to be very familiar with the textbooks used in the open-book examination.

A book such as Martindale: For this edition, the 57th edition March was used. Let us examine how, for example, Q32—34 could be tackled by the following steps: Find the ones you do not know, or are unsure of, in the BNF index at this stage, just note the page numbers.

Find the generic names by going through the pages, checking the list in alphabetical order, rather than going backwards and forwards, to save time.

In addition, get used to the newer editions of the textbooks. Practise using the indexes, appendices and footnotes and be familiar with the overall structure of the reference books used in an open-book session. First write the page numbers next to Q35—37, after finding them in the index preferably in alphabetical order to save time and then find the corresponding pages in the text.

Although in Q32—34 you only had to look for the products A—E and match them with the specific diseases, in Q35—37, do not attempt to find the manufacturers A—E; look up the three products instead. Q38—40 should be attempted in the same way as Q32— Practise these simple techniques, although they seem obvious when you know about them, as this type of question can cause confusion when met unawares and could be a challenge even to the diligent student who studied the facts but who had no practice with MCQs.

The next group of questions refers more to diseases and biochemical tests Q41— These questions present more of a problem, not because of their difficulty but owing to the technique needed to make the best use of the reference books available.

In this case follow these steps: Q41 liver function tests; Q42 epilepsy; Q43 thyroid function; Q44 peptic ulcer. In the BNF, look under cautions for levodopa — the second one listed is peptic ulceration, so put A next to Q For domperidone, there are only three lines of cautions, none listing any of the four conditions, so go straight on to consider fluvastatin. When consulting the index, always note down and look up the page marked in bold first.

Under cautions for all statins, in the first few lines there is a statement advising a liver function test. In an examination, if you are pressed for time, do not continue reading all the cautions but move on immediately to the next drug after marking C next to Q A good reminder is that a reference book in an open-book examination should be used just to support your knowledge and only in rare cases to find unknown data.

The availability of books in an examination does not replace the need for studying, particularly basic facts that require instant recall. Lack of this kind of preparation is often one of the reasons why some candidates perform worse in an open-book examination than in a closed-book one. Do not expect to gather all the information during the examination — the questions are designed to ensure that only students who are well versed and properly trained in pharmacy practice will pass.

Questions 53—83 These questions Q53—83 , which present a choice of answers grouped together, are a common format that sometimes perplexes students.

The system is not meant to confuse but is used xxxvi How to use this book to facilitate the marking procedure. In this book the directions are summarised in a box but this may not always be the case in examinations set by different boards. Follow these steps to answer this type of question: Collate the answers.

Match the collated answers with the letters A—E, as indicated in the directions. Write your chosen letter next to the question. The reverse is also true, that is, if you are asked to write numbers in a rare case or T and F, do not create your own summary. Remember that answer papers are sometimes corrected by clerks, who are given strict rules for recording correct answers, which they are obliged to follow.

More commonly today, the analysis is undertaken by computer, so not following the instructions may result in the answer being marked as incorrect, no matter what was written. In Test 1 in this book, for example, Q53—83, i. It must be emphasised that, although all the information required to answer the questions correctly is available in the recommended textbooks, do not try to verify all the information.

This is How to use this book xxxvii totally different from using the book to check a dosage regimen, a proprietary name or a caution. The BNF states under cautions: This should be interpreted that care should be taken with the use of digoxin.

You may ask — should care not be taken with the use of all medicines, especially in the elderly? Questions 58—63 refer to diseases. In addition to using formularies such as the BNF, in this case, you may need to refer to other textbooks such as Minor Illness or Major Disease see Bibliography to answer these types of questions.

In tackling Q61, the emphasis that the textbook places on detection combing for head lice signifies that this is the diagnostic process. This indicates how important it is that an authoritative book is used in an examination when you are allowed a choice of textbooks.

The use of such books will help you find the correct answer, even when the answer is not specifically stated as such but needs to be inferred. The textbook selected for use in openbook MCQs should have an extensive index for quick reference. Many textbooks give a summary but sometimes it is worth going beyond this. The whole text on the topic itself is, in some cases, only a short paragraph. Questions 64—71 concern drug use, contraindications, cautions and side-effects, which may all be found in formularies such as the BNF.

It is important to look under the drug names rather than try to find information by looking for a disease or symptom. These should be analysed as if the patient were presenting at the pharmacy. In this case, start with the diagnosis — here it is clearly a case of verruca. Once this step has been taken, the correct diagnosis can be confirmed by quick reference to a note on verrucas given, for example, in Minor Illness or Major Disease. Questions 84—88 Questions 84—88 appear to be more complex than the rest.

The choices C, D or E are simple true or false answers to the statements. The choice between A and B, however, depends on whether the second statement is an explanation of the first statement. In this book, the questions in this section carry clear directions and even a summary to help you understand how to tackle them. This may not be the case in all board examinations, so practise how to summarise complex directions.

The aim of the questions is to test your ability to reach logical conclusions. The correctness of the statements can be verified in the textbooks but the logic of the sequence cannot.

This type of question is becoming more popular with examiners because it tests an important aspect of pharmacy practice, namely logical argument from data that can be extracted from books but which then has to be interpreted in the practical setting. Questions 89— The dispensing of prescriptions is considered to be a primary function in pharmacy practice.

This is tackled in the final part of the test Q89— The answer to this part is in the How to use this book xxxix prescription presented bd in the question itself. This instance is a clear example pointing to the need to read the prescription carefully Q89— In the case of the prescription relating to Daktacort Q91—94 , for candidates not familiar with its use, it is important to identify the active ingredients.

Daktacort is listed in the BNF under hydrocortisone but its main use is as an antifungal agent. The need to apply the cream sparingly results from the steroid content and its use twice rather than three times daily comes from the information on the prescription bd. Some proprietary names may not be familiar to certain candidates, because an effort has been made to make this book suitable for different countries. If you do not recognise the brand name, use Appendix A, where the active ingredients of all proprietary products listed in the book are included.

Finally, to conclude these pointers on the open-book questions, let us look at the statistics for Test 1 presented in Appendix D.

These statistics were recorded following the tests carried out by a sample of final-year students after a five-year university course which included the preregistration period.

In Test 1, the questions that were answered incorrectly by the highest number of students were 54, 58, 61, 62 and 86, whereas the ones most often answered correctly were 1, 14, 17, 22, 25, 26, 27, 29, 30, 32, 33, 39, 45, 60, 67, 68, 81, 89, 91 and Questions answered incorrectly were often those that required some logical thinking. A good lesson to conclude this section, therefore, is that no textbook should replace logical thinking, even during an open-book examination.

Closed-book examinations Most of the advice given for the open-book examinations should also be kept in mind for the closed-book tests. It is xl How to use this book essential to revise the major classes of drugs, comparing the use, unwanted effects, contraindications and alternative products available.

In this section, Test 5 is used as the example to highlight the following areas for quick revision: A good look at the index of this book indicates the items commonly encountered in examinations. The index is an exhaustive one and is divided into proprietary names, generic names, subject areas and conditions.

A self-assessment exercise is to check that you have adequate knowledge of examples of the topics listed above and then attempt the tests. A review of the drugs in the index provides examples of medicines that certainly need attention.

You should be familiar with the action, classification, side-effects, clinically significant drug interactions, contraindications and cautions of a number of classes of drugs, such as: Check that you know the meaning of the conditions listed in Appendix B and make lists of medicines that are indicated and contraindicated or that may precipitate the condition. Finally, examining the statistics for Test 4 regarding questions that were answered incorrectly by the largest number of candidates, it can be concluded that nothing can replace practical observation during the in-service training in a pharmacy, for example, knowledge of the expiration date of extemporaneous preparations is information that is acquired during practice sessions Q3.

The use of medicines for prophylaxis, rather than for treatment, is often confused by candidates, as can be seen from the statistics for Q59, where allopurinol was mistaken for treatment of gout when it is indicated for prophylactic use.

Some questions require reasoning rather than just recall of information, such as Q80 and Q90—92, Q Practise reasoning out answers when undertaking self-assessment questions before the examination. It is advisable to tackle these questions first, as they ought to be answered easily, allowing more time for the questions where reasoning is required. Appendix D indicates which questions were the hardest. This should serve as a guide and can give feedback on how you would compare with colleagues in a qualifying or licensing and registration examination.

Note Use of names for medicinal substances The recommended International Non-proprietary Name rINN is used throughout the book, except when the terms used are adrenaline and noradrenaline. For further reference, see the British National Formulary. Dosage forms In the answers to questions and in Appendix A, when no mention of a dosage form e. Select the best answer in each case. Questions Which of the following is NOT involved in the presentation of seasonal allergic rhinitis?

Questions For optimum response, plasma theophylline concentration should be maintained at: Questions Cilest differs from Yasmin in that it: A B C D E Q23 is used in hormone replacement therapy is available for transdermal drug delivery has to be taken twice daily contains norgestimate can be used in patients with venous thromboembolic disease What is the most appropriate treatment that could be dispensed overthe-counter for irritation caused by contact dermatitis?

Each group of questions below consists of five lettered headings followed by a list of numbered questions. For each numbered question select the one heading that is most closely related to it. Each heading may be used once, more than once, or not at all. Questions 26—28 concern the following vaccines: Questions Select, from A to E, which one of the above: Q26 covers against hepatitis A and B Q27 is a live attenuated vaccine available for oral administration Q28 contains the H and N component of the prevalent strains as indicated by the World Health Organization Questions 29—31 concern the following products: Q29 constipation Q30 abnormal vaginal bleeding Q31 paraesthesia Questions 32—34 concern the following products: Q32 porphyria Q33 diabetes Q34 myasthenia gravis Questions 35—37 concern the following manufacturers: Questions Select, from A to E, the product that is presented in the following dosage forms: Q38 oral rinse Q39 nasal spray Q40 ear drops Questions 41—44 concern the following drugs: Q41 should prompt liver function tests before initiating treatment Q42 should be used with caution in patients with epilepsy Q43 requires monitoring of thyroid function Q44 should be used with caution in patients with diabetes mellitus Questions 45—48 concern the following strengths: Decide which of the responses is are correct.

Then choose: Questions Symptoms of tinea pedis include: Questions Chickenpox: The following questions consist of a first statement followed by a second statement. Decide whether the first statement is true or false. Decide whether the second statement is true or false. Paclitaxel is used in primary ovarian cancer.

Q85 The combination of antibacterial agents in co-trimoxazole presents a synergistic activity. Co-trimoxazole is associated with rare but serious side-effects. Q86 Pethidine is a less potent analgesic than morphine. Pethidine is not suitable for severe, continuous pain. Q87 All tetracyclines are effective against Neisseria meningitidis.

Tetracyclines are used in acne. Q88 Zafirlukast is a leukotriene-receptor antagonist. Zafirlukast is used in the treatment of an acute severe asthma attack. Questions 89— 21 Questions 89— Directions: These questions involve cases.

Read the prescription or case and answer the questions.

Questions 89— Xenical capsules 1 caps b. Q89 m. In which condition is the product used? Questions Questions 91— Daktacort cream b. Q91 Q93 m. The active ingredient s of Daktacort is are: Q95 The duration of treatment that has been prescribed is usually: Fucidin H contains fusidic acid and hydrocortisone; Daktacort contains miconazole imidazole antifungal and hydrocortisone; Canesten HC contains clotrimazole imidazole antifungal and hydrocortisone.

Otosporin contains hydrocortisone in combination with two antibacterial agents, namely neomycin and polymyxin. A2 E Headache accompanied by loss of consciousness, neck stiffness and neurological signs such as paraesthesia and slurred speech requires referral. A3 B Nifedipine is a calcium-channel blocker of the dihydropyridine group.

It relaxes smooth muscle and dilates both coronary and peripheral arteries by interfering with the inward displacement of calcium-channel ions through the active cell membrane.

Unlike verapamil, nifedipine can be given with betablockers. Long-acting formulations of nifedipine are preferred in the long-term treatment of hypertension. A4 C In response to the presence of antigenic stimuli, in seasonal allergic rhinitis hay fever , mast cells and basophils are sensitised and inflammatory mediators, such as leukotrienes and prostaglandins, are released. Osteocytes are bone cells involved in bone formation.

Answers D Information required in patient medication records includes name, age and gender of the patient, diagnosis, current medication therapies, and medication allergies.

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