Medspan's Pharmacy guide for OSCE

INSTANT PHARMACY MCQs & OSCEs For Future Canadian Pharmacists

Contents 1. Patient care (50.5/26)% Pharmacists, in partnership with patients and other health care professionals, use their unique knowledge and skills to meet patients’ drug and health related needs and to achieve optimal patient outcomes and patient safety.

2. Professional collaboration and team work.(4.5/9.5)% Professional Collaboration and Team Work Pharmacists work in collaboration with other health care professionals to optimize patient safety and improve health outcomes.

3. Ethical, legal and professional responsibilities.(10/9.5)% Ethical, Legal and Professional Responsibilities Pharmacists practise within legal requirements, demonstrate professional integrity and act to uphold professional standards of practice and codes of ethics.

4. Drug, therapeutic and practice information.(7/5)% Drug, Therapeutic and Practice Information Pharmacists assume responsibility for accessing, retrieving, evaluating and exchanging relevant information to ensure safe and effective patient care .

5. Communication and education.(2.5/38)% Pharmacists communicate with and provide education to groups and individuals in order to promote and support optimal patient care and wellbeing.

6. Drug distribution.(22.5/9.5)% Pharmacists manage the drug distribution system8 to ensure the safety, accuracy and quality of the supplied products .

7. Understanding management principles (3/2.5)% Understanding Management Principles, Pharmacists apply knowledge, principles and skills of management with the goal of optimizing patient care and inter-professional relationships.

INSTANT PHARMACY MCQs & OSCEs For Future Canadian Pharmacists

Patient care 1.1 Develop a trusting professional relationship with the patient where both parties are interacting in a way where the obligations, expected benefits, and consequences are clearly defined.  Establish and maintain rapport by using effective communication skills. Demonstrate a caring, empathetic, and professional attitude.  Elicit the patient’s needs, values and desired level of care and desired outcomes regarding drug therapy.  Assess the impact of factors that facilitate or impede the health of individual patients. and define mutual obligations, expected benefits, and consequences 1.2 Gather patient information.  Identify and use appropriate sources of information (e.g., patient, laboratory data, chart, electronic health record, profile, other health care professionals, etc.)  Actively listen and interpret the information provided (e.g., medical and social history, adverse drug reactions, allergies, medication use, etc.).  Assess the relevance of the information. 1.3 Assess the health status and concerns of the patient.  Use appropriate data, techniques and procedures to assess the patient’s health.  Use knowledge base to comprehend the scope and breadth of the patient’s health problem.and identify factors (e.g., risk factors, financial, lifestyle, nutrition) that impact on the therapeutic outcome. 1.4

Identify the patient’s desired therapeutic outcomes.  Integrate knowledge of the patient’s health status with knowledge of drug and non-drug treatment options.

INSTANT PHARMACY MCQs & OSCEs For Future Canadian Pharmacists

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Outline the benefits and/or consequences of the treatment options. Enable the patient to make choices.

Identify and prioritize actual and potential drug therapy problems to determine if: • The patient requires drug therapy but is not receiving it, • The patient is taking or receiving the wrong drug, • The patient is taking or receiving too little of the right drug, • The patient is taking or receiving too much of the right drug, • The patient is not taking or receiving the drug or is taking or receiving the drug inappropriately, • The patient is experiencing an adverse reaction to the drug, • The patient is experiencing a drug interaction (including drug-drug, drug-food,drug-laboratory test, drug-disease, or drug-blood product), • The patient is taking or receiving a drug for no medically valid indication or Substance abuse. 1.6 Develop a therapeutic plan.  Identify and assess treatment strategies including drug and nondrug measures3 using an evidence-informed4 approach. Select therapeutic options.  Recognize, solve and prevent actual and potential drug therapy problems.  Consult with the patient and, if necessary, health care professionals. 1.5

1.7 Support the implementation of the therapeutic plan.  Explain the rationale for the proposed treatment.  Provide patient education (e.g., counseling information and education on adherence issues, either verbal or written).  Assess patient’s understanding of the therapeutic plan 1.8

Monitor the patient’s progress and assess therapeutic outcomes.

INSTANT PHARMACY MCQs & OSCEs For Future Canadian Pharmacists

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Recognize the important clinical indicators (e.g., signs and symptoms, laboratory tests, adverse effects).  Identify and apply monitoring/ intervention techniques and timelines.  Specify outcomes with measurable therapeutic end points.  Discuss with the patient the ongoing responsibilities of the pharmacist, patient and other health care professionals.  Assess tolerance and safety of therapy.  Assess adherence to therapy.  Conduct follow-up consultation(s) to evaluate the therapeutic effectiveness 1.9 Document and share within the circle of care5appropriate findings of patient information assessment, recommendations made and actions taken.  Identify the purpose of the documentation.  Maintain the patient’s health record. Document identified drug therapy problems.  Prioritize and document the intervention, patient’s outcome, recommendations and follow-up.  Document communication with patient and health care professionals. COMPETENCY 1 : PEBC Model Questions For Patient Care (50.50%=150/300)

Facts & Tips: Tthe actual exams are conducted for two subsequent sittings and candidates have to answers 150 MCQs within 3.75 hours in each day. So there are overall 300 MCQs type A and K types of questions including a trial set of questions and you have to answer all the questions even though the trial one doesn’t carry any marks. 1. RY is an 85 year old male who lives alone and currently takes 12 different medications. For the past 2 weeks he has telephoned to ask the pharmacist what dose of diuretic he should be taking (this medication looks similar to another tablet that he takes). He calls again today with the same question. After answering his question, the most appropriate pharmacist action should be to:

a. call RY’s family doctor to suggest changing the diuretic to something that looks different. b. suggest that RY have the labels on his prescription bottles changed to a bigger font for easier

INSTANT PHARMACY MCQs & OSCEs For Future Canadian Pharmacists

reading. c. recommend that the pharmacy use a blister packaging dosette to dispense RY’s medications. d. suggest that RY write down the answer to his question so that he does not need to phone again. e. recommend that RY have his hearing and vision tested at his next physician visit. 2. TG, a 62 year old male patient, arrives at the ambulatory pharmacy and asks for advice regarding a severe, pounding headache. During the assessment, he reports a home blood pressure reading of 165/90 mm Hg. TG also reports a sulfonamide allergy (dizziness and nausea). Details regarding TG’s allergic reaction should be reported in which section of the pharmacist’s note? a.Subjective b.Objective c.Assessment d.Plan e.Follow-up 3. JQ is a 67 year old male with type 2 diabetes that is controlled with insulin. Today, JQ’s wife calls the pharmacist to inquire what to do regarding JQ’s very low blood glucose reading (2.8 mmol/L). She also notes that he seems to be confused. JQ’s wife should be instructed to: a. take JQ immediately to the nearest emergency department. b. have JQ eat a carbohydrate-rich meal and retest in 1 hour. c. give JQ a 15-20 gram glucose supplement and retest in 15 minutes. d. purchase a glucagon kit from the nearest pharmacy and administer it. e. retest JQ’s blood glucose level in 1 hour and phone back if it remains low. 4. RF is an 80 year old female who developed CDAD (Clostridium difficile-associated diarrhea) after recent treatment of a urinary tract infection with ciprofloxacin. She is admitted to hospital with profound diarrhea (8 watery bowel movements per day), fever and severe abdominal pain. Based on her symptoms, which of the following is the most appropriate therapy choice for her? a. Oral metronidazole b. Intravenous metronidazole c. Oral cholestyramine d. Oral vancomycin e. Intravenous vancomycin 5. CC, a 72 year old female, complains to the pharmacist that her stomach has been bothering her recently. Current medications include: levothyroxine 0.1 mg daily (x 30 years), acetaminophen 500 mg qid (x 5 months), atorvastatin 40 mg hs (x 4 years), ibuprofen 400 mg tid prn joint pain (x 2 months) and zopiclone 3.75 mg hs prn (x 3 months). Which of the following drug therapy problems is most likely contributing to CC’s recent symptoms?

INSTANT PHARMACY MCQs & OSCEs For Future Canadian Pharmacists

a. Too high a dosage of atorvastatin b. Too high a dosage of zopiclone c. Need for cytoprotection with ibuprofen d. Drug interaction between atorvastatin and zopiclone e. Too low a dosage of levothyroxine 6. Which of the following medications is the most appropriate choice for treatment of neuropathic rather than nociceptive pain? a. Nabilone b. Tramadol c. Ibuprofen d. Meperidine e. Nortriptyline 7. Appropriate auxiliary labelling for clarithromycin suspension includes which of the following? a. Shake well before using. b. Take with plenty of fluids. c. Avoid prolonged exposure to sunlight. d. Keep refrigerated. e. May cause discolouration of urine. 8. The pharmacist fills a prescription for sumatriptan 100 mg tablets for a patient with migraine. Appropriate information to provide to the patient includes which of the following? a. If the sumatriptan does not relieve the headache within four hours, ergotamine may be used. b. If no relief is achieved in two hours, sumatriptan may be repeated. c. If the headache is partially relieved with a single tablet, the dose may be repeated after two hours. d. The maximum dosage of sumatriptan 100 mg in any 24 hour period is six tablets. e. If relief is not achieved, no other medication can be used for at least 24 hours. 9. JG has been taking metoclopramide 20 mg, po q6h for the past 3 days as part of her chemotherapy regimen. She normally takes 4 doses daily, with each meal and at bedtime. This morning, she forgot to take her morning dose before leaving home for a hospital check-up. When she arrives at the clinic, she asks the pharmacist what she should do about her missed dose, as she expects to be home again around 11:00 am. The pharmacist should advise JG to: a. take the missed dose immediately when she gets home and continue as scheduled. b. take two doses at lunchtime to make up for the missed dose. c. skip the missed dose and take the next scheduled dose at lunchtime. d. skip today’s medication and resume her normal schedule tomorrow. e. space 4 doses into the remaining hours between when JG gets home and her bedtime. 10. EK is a 25 year old female who presents to the pharmacy requesting Plan B® (levonorgestrel) for emergency contraception following an episode of unprotected sex 12

INSTANT PHARMACY MCQs & OSCEs For Future Canadian Pharmacists

hours ago. After speaking with EK, the pharmacist decides she is a good candidate to receive Plan B®. The pharmacist should include which of the following counselling information for EK? a. Take one tablet daily for 3 consecutive days. b. Plan B® works mainly by dislodging an implanted fertilized egg from the endometrium. c. A pregnancy test should be done 5 days after completing Plan B®. d. Plan B® will protect EK from pregnancy due to unprotected intercourse until her next menses. e. EK may experience spotting a few days after taking Plan B®. 11. In a pharmacist’s interview of a patient seen in an asthma clinic, which of the following findings should be documented in the “plan” section of the SOAP format notes? a. Nocturnal symptoms. b. Pulmonary test results. c. Smoking history. d. Dyspnea on exertion. e. Follow-up monitoring. 12. For a child with asthma, which of the following factors is an indicator of poor control? a. Number of colds experienced each year. b. Need for salbutamol prior to exercise. c. Awakening at night with asthma symptoms. d. Keeping one canister of salbutamol at home and one at school. e. Number of parents or siblings who have asthma. 13. Which of the following pathogens is most commonly implicated in acute bacterial rhinosinusitis? a. E. coli b. S. aureus c. S. pneumoniae d. S. viridans e. N. meningitidis 14. Which of the following liver enzymes is the first to be elevated in a case of an acetaminophen overdose? a. Lactate dehydrogenase (LDH) b. Alanine transaminase (ALT) c. Aspartate transaminase (AST) d. Alkaline phosphatase (ALP) e. Gamma glutamyl transpeptidase (GGT) 15. AJ is a 24 year old, married female, who is planning to become pregnant in the near future. AJ has no medical conditions, no allergies, and is not currently taking any medications. What vitamin supplement should the pharmacist recommend to AJ to prevent neural tube defects in her baby?

INSTANT PHARMACY MCQs & OSCEs For Future Canadian Pharmacists

a. Niacin b. Vitamin D c. Folic acid d. Pyridoxine e. Ferrous sulphate 16. A 27 year old patient presents to a community pharmacy for the first time and tells the pharmacist that he experienced an allergy to a penicillin product as a child. His symptoms included hives, wheezing and facial swelling, which resulted in hospitalized care. Which of the following is the most important reason for a community pharmacist to document this type of information in a patient’s medication profile record? a. To provide drug allergy information to the patient’s insurance provider b. To encourage the patient to fill future prescriptions at this pharmacy c. To advertise relevant pharmacy products or services to appropriate patients d. To enhance continuity of patient care regardless of the prescriber e. To provide a record of cognitive services for insurance reimbursement 17. For a patient who receives a chemotherapy regimen containing cisplatin, which of the following is a significant adverse effect of cisplatin? a. Ototoxicity b. Hepatotoxicity c. Photosensitivity d. Pulmonary fibrosis e. Lipid abnormalities 18. Cyclosporine is known to inhibit cytochrome P450 isoenzyme 3A4. Which of the following medications could have elevated serum concentrations due to inhibition of metabolism by concurrent metronidazole? a. Amoxicillin b. Atorvastatin c. Metoprolol d. Furosemide e. Levothyroxine