Answer ALL questions. For each question, there is ONE correct answer. Use the answer grid provided for ALL your answers.

Transcription

1 UNIVERSITY OF EAST ANGLIA School of Pharmacy Main Series UG Examination FOUNDATIONS IN PHARMACY PRACTICE PHA-4001Y Time allowed: 2 hours Part ONE Answer ALL questions. For each question, there is ONE correct answer. Use the answer grid provided for ALL your answers. Part TWO Answer TWO of the FOUR questions. Use a SEPARATE answer book for EACH question in Part TWO. Each question has the same value. The marks distribution is shown as a percentage for each section of the question. Answer ALL parts of each of the individual questions you select. The mark allocation for the paper is: Part ONE carries 50% of the total mark. Part TWO carries 50% of the total mark. You are advised to spend approximately 1 hour on Part ONE and 1 hour on Part TWO. The paper consists of 11 pages in total. The following is provided: Multiple choice answer grid. Dictionaries are not permitted in this examination. Notes are not permitted in this examination. Do not take this question paper out of the examinations room. Do not turn over until you are told to do so by the Invigilator. (PHA-4001Y) Module Contact: Dr James Desborough, PHA Copyright of the University of East Anglia Version 1

2 2 PART ONE SECTION A TYPE 1 MCQ Answer ALL questions. For each question, select the BEST answer. Use the answer grid provided for ALL your answers. 1. Which ONE of the following is a component of the Transtheoretical model? Personality traits Subjective norm Behavioural intention Seriousness Contemplation 2. Which ONE of the following aspects of a randomised controlled study would result in the LEAST amount of bias in the study outcomes? More than 20 outcomes statistically tested at the end of the study The study sample population is only from one geographic location of the UK The intervention group having more contact with healthcare professionals than the control group Both the study participants and the treating clinicians being blind to the group allocation At baseline the study groups have different average ages and proportion of males 3. Which ONE of the following is the social class of someone who is unemployed? I II III IV V 4. Which ONE of the following best describes the scenario where a patient does NOT take their medication because they struggle to swallow the tablets? Concordance Primary intentional non-adherence Primary unintentional non-adherence Secondary intentional non-adherence Secondary unintentional non-adherence

3 3 5. Which ONE of the following did NOT occur as a result of the introduction of the NHS in 1948? Increase in prescriptions A reduction in OTC sales A move for the pharmacist to be more on the counter than the dispensary Greater reliance on NHS funding for community pharmacy Reduced independent decision making 6. Miss PT, comes in to your pharmacy complaining of suffering from hayfever. Which drug is the MOST suitable treatment for her condition? Aspirin Chlorphenamine Citalopram Ibuprofen Metronidazole 7. Which ONE of the following alternative and complementary therapies are described as manipulation techniques to restore normal joint movement and or blood flow, nerve conduction and organ function? Body therapies Crossovers Energy therapies Nutritional therapies Structural therapies 8. Mr WX tells you he has an allergic reaction to penicillin, which ONE of the following drugs should be avoided? Amoxicillin Aspirin Clarithromycin Hydrocortisone Metronidazole TURN OVER

4 4 9. In which ONE of the following situations would it be legally appropriate to sell a Pharmacy (P) medicine from? A petrol station under the supervision of a pharmacist A registered pharmacy premises by a trained counter assistant with no pharmacist present A registered pharmacy premises by a pharmacist A market stall under the supervision of a pharmacist A registered pharmacy premises by a pre-registration pharmacist prior to the pharmacist arriving for the day 10. Dr SJ wants to start a patient on gliclazide, he asks you how it works. Which ONE of the following is the most appropriate explanation? It selectively inhibits serotonin reuptake It inhibits sodium reabsorption in the nephron It binds to opioid receptors in the central nervous system It inhibits bacterial protein synthesis It augments insulin secretion 11. Which ONE of the following is most likely to help minimise errors in a pharmacy? A hard floor surface Signage to direct patients where to collect prescriptions or go to for advice Bright lights in part of the dispensary The radio on in the back of the dispensary Temperature maintained below 16 C 12. Dr JD wants to start a patient on senna tablets and he asks you how it works. What ONE of the following is the most appropriate explanation? It prevents noradrenaline uptake in the central nervous system It suppresses production of prostaglandins It stimulates colonic nerves It is a competitive inhibitor of HMG-CoA reductase It blocks H2 receptors

5 5 13. In which ONE of the following situations is it NOT acceptable to supply a product outside a Medicines and Healthcare Regulatory Authority (MHRA) license? When a medicine is made up to a special formula for an individual patient When a doctor decides to use a medicine off label for an individual patient When there is an exceptional circumstance for example Ebola outbreak When a nurse assembles a medicine for a patient in the course of their treatment When a doctor assembles a large scale batch of medicines for a number of patients ready for when it is needed 14. Miss KJ has recently been diagnosed with eczema and started on Diprobase cream. Which ONE of the following would be the most appropriate advice to give? Apply thinly Do not use on face or genital regions Do not apply for more than 7 days Apply in the direction of hair growth This can cause sensitivity to sunlight 15. The results of a randomised controlled trial found that 50 out of 100 patients in the control arm died and 45 out of 100 patients in the intervention arm died. Which ONE of the following is incorrect? The relative risk is 0.9 The relative risk reduction is 10% The absolute risk reduction is 5% The number needed to treat is 10 The intervention increases the rate of event free patients from 50% to 55% 16. Which ONE of the following community pharmacy services would need to be locally commissioned? Medicine Use Review Needle and syringe programme Disposal of medicines Repeat dispensing Stoma Appliance Customisation TURN OVER

6 6 17. Which ONE of the following should be conducted last when holding a consultation with a patient about their medication? Safety netting Negotiate a shared agenda Agree a shared decision Ask about social history Explain how the medication works 18. Which ONE of the following patients would be most suitable for aspirin therapy? A 14 year old with a high temperature A 19 year old with pain and already using ibuprofen A 25 year old with high temperature and excessive alcohol use A 40 year of with pain and a history of peptic ulcers A 45 year old with pain caused by gout 19. Which ONE of the following activities does NOT involve clinical pharmacy services in a hospital? Audit of missed doses on a drug chart Taking drug histories for new patients Investigating and testing defective medicines Reporting adverse drug events Updating hospital guidelines on warfarin prescribing 20. Which ONE of the following is a description of incidence in epidemiology? A measurement of death rate from a particular disease in a population in a certain period of time All cases of a disease in a given population over a certain age All cases of a disease in a given population The number of new cases of a particular disease arising in a population in a certain period of time A measurement of health inequalities in a given population over a certain period of time

7 7 21. Mr HG has been started on some new medication and he cannot remember which one he needs to take with a full glass of water, 30 minutes before eating and that he must sit or stand up when taking it. Which ONE of the following medicines do these instructions apply to? Alendronic acid Bendroflumethiazide Bisoprolol Gliclazide Simvastatin 22. Which ONE of the following is NOT legally required in a record for a private prescription? Patient s name Cost of the private prescription Date on prescription Name and quantity of medicine Prescriber s name 23. Miss WT tells you she has been experiencing cold hands and feet since starting her new medication. Which ONE of the following drugs is the most likely cause of the symptoms? Amoxicillin Bisoprolol Citalopram Ferrous sulphate Simvastatin 24. Which ONE of the following best describes horizontal equity within the NHS? Ensuring that budgets between healthcare providers in the same region are equitably allocated Ensuring that budgets between hospitals spend more money on serious conditions and less on routine conditions Ensuring that budgets between NHS regions are equitably allocated Ensuring that patients with the same medical condition have equal access to services irrespective of their location or situation Ensuring that GP medical practices are given the same allocation of funding per patient TURN OVER

8 8 25. Mr TH tells you that he is experiencing a dry mouth, blurred vision and constipation since starting his new medication. Which ONE of the following drugs is the most likely cause of the symptoms? Amitriptyline Bendroflumethiazide Hydrocortisone Levothyroxine Simvastatin

9 9 SECTION B TYPE 2 EXTENDED MATCHING QUESTIONS NHS bodies (F) (G) (H) Care Quality Commission (CQC) Clinical Commissioning Groups (CCGs) Health Education England (HEE) Health and Wellbeing Boards Monitor NHS Business Services Authority NHS England Public Health England (PHE) Select the name of the NHS body which matches each of the descriptions below. Each option may be used once, more than once, or not at all. 26. They regulates all health and adult social care services in England, including those provided by the NHS, local authorities, private companies or voluntary organisations 27. They usually consist of a group of general practices working together to buy services for their patients 28. An independent body at arm s length to the government which provides leadership for improving health outcomes and driving up the quality of care TURN OVER

10 10 Formulary medicines (F) (G) Chlorphenamine Domperidone Ferrous sulphate Lactulose Metronidazole Ranitidine Senna For each patient described, select the MOST appropriate drug to treat their condition or symptoms. Each option may be used once, more than once, or not at all. 29. Mr JS who is suffering from nausea and vomiting. 30. Mr PT who has been diagnosed with a NSAID induced ulceration after a recent course of ibuprofen. END OF PART ONE

11 11 PART TWO Answer TWO of the FOUR questions. Use a SEPARATE answer book for EACH question. 31. Answer ALL parts (a) to (c). (a) With the aid of a diagram, describe how a randomised controlled trial (RCT) would be designed to test the impact of a new drug to reduce heart attacks. [40%] (b) With the aid of a diagram, describe how a cohort study would be designed to identify the factors associated with heart attacks. [30%] (c) With the aid of a diagram, describe a case controlled study would be designed to identify the factors associated with heart attacks. [30%] 32. Answer BOTH parts. (a) Describe the health belief model in the context of a lung cancer screening programme for smokers. [60%] (b) Define cognitive dissonance and describe a dissonance shaping strategy to communicate to a patient that continuing to smoke will harm their health. [40%] 33. The legislative framework surrounding pharmacy includes criminal, civil and administrative law. Using examples from the media provide definitions of each, describe how they are administered and the burden of proof required for successful outcome. [100%] 34. Answer BOTH parts. Politicians argue whether health inequalities are explained by the Materialist Model or the Behavioural/cultural Model. (a) Describe both of the models above and provide evidence to support them. [70%] (b) Describe the role community pharmacy can have in reducing health inequalities linking it to at least THREE different services. [30%] END OF PAPER

12 School of Pharmacy Examination Feedback Summary Module Name Foundations in Pharmacy Practice Module Code PHA-4001Y Year 2015/16 Overall marks Mean mark: 61.79% Max. mark : 82.83% Min. mark: 16.67% Grade distribution: 1 st Fail 28% 37% 20% % 15% MCQ (Questions x to y): Mean mark: 63.76% Max. mark : 90% Min. mark: 23.33% Comments: Question:31 No. of attempts 65 Comments: This question explored evidence based medicine and required students to explain with the aid of diagrams how you would conduct a RCT, Cohort study and case controlled study in relation to heart attacks. Students were generally very good a drawing a generic RCT design and explained this well. Good students linked the standard RCT design components to a specific trial relating to heart attacks. Excellent students considered specific issues with sampling (e.g. at risk population) and methods of randomisation. Students were less confident with cohort and case controlled studies. In Cohort studies students needed to identify the prospective nature of the study design and correctly link risk factors to outcomes (in this case heart attacks). Once again good students were able to draw the generic design and describe all its specific components linked to identifying risk factors for heart attacks. For case controlled studies these are usually retrospective and students confused cases (those who have suffered heart attacks) from potential risk factors. Good students linked the generic study design to the example of identifying risk factors related to heart attacks. Question:32 No. of attempts 38 Comments: The responses to this question were on the whole of a high standard. Particular examples of excellence i.e. answers exceeding 70% were the appropriate incorporation of elements from lectures other than those directly related to the health belief model for example some students commented on the type of approach that might be adopted to influence behaviour at the different stages of the health belief model such as citing the mass media approach at the stages of susceptibility and seriousness whilst the bespoke recommendation stage would come from the healthcare professional such as a pharmacist or general practitioner. There were also appropriate examples of the potential barriers and benefits of screening. There were some weaker responses to this question and the most frequent error made was the failure to describe the HBM in the context of cancer screening. What some candidates did was describe it in the context of smoking cessation so incorrect examples of barriers that were written included stress of giving up smoking, potential weight gain due to comfort eating. Incorrect benefits cited were improved health, saving money by not having to purchase cigarettes. These poorer responses were in the minority and I was generally very pleased and impressed by the quality of responses. Question:33 No. of attempts 50 Comments: In this questions I was looking for students to outline criminal, civil and administrative law and cite high profile examples of cases. School of Pharmacy Summative exam feedback (V1) January 2013 Page 1 of 2

13 Good students correctly identified the differences between the laws; the parties involved, where the cases are heard and the punishments involved. When they discussed civil law they also outlined the factors that need to be considered when bringing a civil case for negligence. They identified and discussed suitable high profile cases relevant to the appropriate laws. Question:34 No. of attempts 17 Comments: The majority of students who attempted this question had a good understanding of the behavioural/cultural and materialist models of health inequalities. To receive top marks students needed to relate these models to evidence that shows their effectiveness. In the second part all students identified sensible services that could be offered from community pharmacy to reduce health inequalities but struggled to make the link to equity of service provision in sufficient detail. School of Pharmacy Summative exam feedback (V1) January 2013 Page 2 of 2