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?

Mr IJK presented to your clinic with a gradual onset of fatigue, anorexia, weight loss, orthostatic hypotension and chronic diarrhoea. Thyroid function tests were normal. Recent test results: Sodium                                               131   (135-145 mmol/L) Potassium                                         5.4  (3.5-5 mmol/L) Creatinine                                         124    (70-120 μmol/L) Urea                                                   7.1      (2.5-6.7 mmol/L) Glucose (fasting)                             3.5 mmol/L   (3.6-5.8 mmol/L) 8 am plasma cortisol                       1.71 microgram/dL (6-23 microgram/dL) Plasma ACTH                                    53.5 pmol/L (1.5-11.2 pmol/L) Which is the LEAST likely proposed differential diagnosis for Mr IJK?

Mr TY is in the hospice for palliative care. He has been taking morphine MR 70 mg BD for the past three weeks. The palliative care team have decided to now switch him to a syringe driver. Which option is the MOST APPROPRIATE?

Mrs BV (age 88 years, weight 49 kg, height 1.62 m) has been admitted to hospital from Hilltop Nursing Home. Her admission notes state she is “off legs” and has a worsening of confusion, with suspected urinary tract infection. Past medical history Alzheimer’s dementia Low blood pressure Previous left wrist fracture (20 years ago) Medication Paracetamol 1 g prn QDS Lactulose 10 mls BD Calcium carbonate 1.5 g / colecalciferol 400 units one tablet BD Fortisip Compact various flavours as directed by dietician Fortisip Yoghurt Style peach and orange as directed by dietician   Which statement is CORRECT?

Which is NOT an aim of deprescribing?

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?

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