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?

Which statement regarding management of chronic obstructive pulmonary disease (COPD) is CORRECT?

Mr NOP (age 26 years) presents to your pharmacy for advice on a skin problem. He shows you the backs of his elbows on which are red, scaly demarcated plaques with silvery scales. He describes these as itchy, and you see small bleeding points where he says he has scratched. It has come on over the last couple of months, and he correlates this with a time of particular pressure at work. Which is the MOST APPROPRIATE first line treatment to offer?

Mrs GH (79 years old, weight 50 kg, height 1.59 m), attended the walk-in centre following a fall at home. She suffered bruising and musculoskeletal pain, but nothing was broken. Past medical history: Breast cancer 7 years ago Polymyalgia rheumatica Type 2 diabetes mellitus Drug history: Lansoprazole 30 mg daily Letrozole 2.5 mg daily Metformin 500 mg three times daily Prednisolone 5 mg daily Zopiclone 3.75 mg at night   What would be the gold standard assessment of Mrs GH’s fracture risk?

Mr WN has been taking lansoprazole 30mg OD for 6 weeks for uninvestigated dyspepsia. He returns to his GP for a review today and describes how his symptoms are still bothering him; he feels like the medication has not really helped. What is the MOST APPROPRIATE action?

Mr AB (question 2) is diagnosed with COPD and treated with an ipratropium bromide inhaler 40 micrograms QDS. This works well, but three years later he returns for a review. In the last few months he has experienced 2 exacerbations of COPD and has felt more breathless than usual. His FEV1 is checked and found to be 65% of his estimated. Which treatment would be the MOST APPROPRIATE to step up to?