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?

Mrs LM (age 52 years) has presented to her GP with symptoms suggestive of an acute uncomplicated lower urinary tract infection. Past medical history: Rheumatoid arthritis Sjögrens syndrome Drug history: Methotrexate 20 mg once weekly on Wednesdays Folic acid 5 mg once weekly on Saturdays Naproxen 500 mg twice daily Carbomer 0.2 % eye gel Apply to both eyes when required, as directed Recent test results: Haemoglobin                                                   134 g/L                               (115 – 165 g/L) Platelets                                                           208 x 109/L                        (150 – 400 x 109/L) White cell count                                             15 x 109/L                           (4-11 x 109/L) eGFR                                                                  >90                                      (>90 ml/min/1.73m2)   Which is the MOST APPROPRIATE treatment option?

Mr YW (question 25) is noted to be sleepy, confused and is slurring his words. From the information provided, what is the MOST LIKELY diagnosis?

Mr PL has had a dual x-ray absorptiometry (DEXA) scan and has a T-score of -1.9. What does this indicate?