Mrs. PR, 58 years old, has a history of rheumatoid arthritis and takes the following medication:  Hydroxychloroquine 200 mg twice a day  Leflunomide 20 mg once a day Sulfasalazine 1 g twice a day  Mrs. PR visits the ophthalmologist for an eye examination following changes in her vision and is found to have developed advanced retinopathy. She is referred to the rheumatologist for review.  What is the MOST APPROPRIATE course of action? 

Which excipient is MOST LIKELY to cause gastrointestinal discomfort and/or diarrhoea when contained in a medication for a child? 

A 45-year-old male with treatment-resistant depression has been prescribed phenelzine, a monoamine oxidase inhibitor (MAOI). He presents to the emergency department with a severe throbbing headache, palpitations, sweating, and a blood pressure of 200/120 mmHg. He mentions that earlier in the day, he attended a wine and cheese tasting event.  What is the MOST LIKELY cause of this patient’s symptoms? 

Questions 6 to 10 relate to the following case:  Mr. CP, 80 years old, is admitted to hospital with a severe non-infective exacerbation of chronic obstructive pulmonary disease (COPD). He currently takes the following medications:   Salbutamol 100 micrograms/dose evohaler: 2 puffs when required  Trelegy 92/55/22 micrograms/dose 1 puff once daily   He is initiated on intravenous (IV) aminophylline in hospital with a stat. dose of 250mg followed by an IV infusion of 300 micrograms/kg/hour. He is a current smoker and weighs 69 kg.  

Baby A is prescribed propranolol oral solution for infantile haemangioma. Baby A weighs 3.9 kg and the starting dose is 1mg/kg daily in 3 divided doses.   Which product and label would be MOST APPROPRIATE to dispense for baby A? 

Ms. CJ, 37 years old, is admitted to hospital by the GP with fatigue and generally feeling unwell for the past 2 days.  Her medications include:  Etodolac modified release 600 mg once a day Paracetamol 1 g four times a day  Sulfasalazine 1 g three times a day   Her blood results are:  Biochemistry:  Sodium 138 mmol/L (137-144)  Potassium 4.8 mmol/L (3.5-4.9)  Urea 4.3 mmol/L (2.5-7.0)  Creatinine 109 micromol/L (60 – 110)    Haematology:  Hb 109 g/L (115-165)  Platelets 25 x 109/L (150-400)  WBC 1.98 x 109/L (3-10)  Neutrophils 1.01 x 109/L (1.5-7.0)    What is the MOST LIKELY diagnosis? 

Which would be the MOST APPROPRIATE tool to investigate the incident? 

Following further investigation of her unprovoked PE, Mrs. JN is diagnosed with antiphospholipid syndrome.   Which anticoagulant would be MOST APPROPRIATE for Mrs. JN now? 

Questions 21 to 40 are individual questions and do not relate to any previous case. 

Match each term with its meaning or definition.