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Mrs MA (31 years old, weight 65 kg, height 1.68 m) attends her GP surgery complaining of feeling tired, depressed, having difficulty concentrating, and tearful. Her GP orders some blood tests, the results of which are shown below. What would be the MOST APPROPRIATE course of action? T3                          2.5 pmol/L          (3.5 – 7.8) T4                          1.8 pmol/L          (9.0 – 25.0) TSH                       6.8 mU/L             (0.4 – 4.0) eGFR                     >90 ml/minute/1.73m2

Mr TR (age 62 years, weight 80 kg, height 1.70 m) comes into your community pharmacy for advice on his hips. He complains of these being painful and sometimes making a grating noise. The pain comes and goes, tending to be worse if he works overtime at work – he is employed as a postal worker and delivers mail on foot. What is the MOST LIKELY diagnosis?

When using erythropoietin to treat renal anaemia in chronic kidney disease, which statement is FALSE?

Mr JQ (age 56 years) has type 1 diabetes and has been in hospital for the last 3 days with a chest infection. This has cleared up significantly and he is now on oral antibiotics and looking forward to being discharged soon. This afternoon however he has complained of feeling sweaty, dizzy and ‘just awful’. It is 3 pm, 2 hours after he ate lunch. His capillary blood glucose is tested and found to be 3.10 mmol/L. It was noted that yesterday’s blood glucose mid-afternoon was 3.90 mmol/L. Other blood glucose readings have been within range. The list of medication he is currently prescribed in hospital is shown below.   Levemir FlexPen 100 units/ml                     20 units BD (8am and 6pm) NovoRapid FlexPen 100 units/ml               8 units TDS with meals Co-amoxiclav 625mg tablets                       TDS for 4 more days to complete 7 day course (Co-amoxiclav 1.2g IV now finished)   From the options given, what is the MOST APPROPRIATE course of action?

Mr TY (question 20) was taking his MR morphine capsules at 8am and 8pm. The time now is 2pm. At what time should his syringe driver be commenced?

Which of Mrs GH’s (question 6) medication would be LEAST LIKELY to contribute to her fracture risk?

Mrs IA (age 34 years) has been prescribed a new medication, leflunomide, for rheumatoid arthritis and comes to you to collect the prescription. Which is CORRECT regarding counselling points for Mrs IA?

Mr EW has been diagnosed with mild dementia with Lewy bodies and would like to start on treatment if possible. Which is MOST APPROPRIATE?

Mrs SF (age 52 years, weight 52 kg, height 1.54 m) comes to see you at the GP surgery for a medicine review. Recent test results: Sodium                                               137 (135-145 mmol/L) Potassium                                         4.1 (3.5-5.0 mmol/L) Magnesium                                       0.57 (0.7-1.0 mmol/L) Creatinine                                         110 (70-120 μmol/L) Urea                                                   6.0 (2.5-6.7 mmol/L) Drug history: Amlodipine 5 mg daily Apixaban 5 mg twice daily Citalopram 20 mg daily Lansoprazole 15 mg daily Levothyroxine 75 micrograms daily   Which medication is MOST LIKELY to be responsible for these results?

Mrs DL (age 72 years, weight 75 kg, height 1.62 m) has just been diagnosed with heart failure with reduced ejection fraction. She is clinically stable, apart from some oedema due to fluid retention, and would like to start on recommended treatment. Past medical history Type 2 diabetes mellitus Pernicious anaemia Medication Metformin 1 g BD Gliclazide M/R 30 mg OM Hydroxocobalamin 1 mg IM 3 monthly   Which prescription would be MOST APPROPRIATE for Mrs DL?