1. A 26-year-old woman presents to the pharmacy with a 2-day history of thick white vaginal discharge and vulval itching. She has had similar symptoms before and is not pregnant. She has no pelvic pain, fever, abnormal bleeding or urinary symptoms.
Which ONE of the following is the most appropriate management?
A. Refer urgently to hospital for suspected pelvic inflammatory disease.
B. Treat as bacterial vaginosis with oral metronidazole only.
C. Consider treatment for uncomplicated vulvovaginal candidiasis and provide self-care advice.
D. Treat as uncomplicated cystitis with nitrofurantoin.
E. Advise no treatment is ever required.
2. A 28-year-old woman asks for treatment for suspected thrush. She has never had these symptoms before. She reports yellow-green offensive discharge, pelvic discomfort and bleeding after sex.
Which ONE of the following is the most appropriate pharmacist action?
A. Supply oral fluconazole immediately.
B. Supply clotrimazole pessary and advise return if not improved.
C. Recommend vaginal moisturiser only.
D. Treat as uncomplicated cystitis.
E. Refer to GP or sexual health service for assessment.
3. A 24-year-old woman attends after unprotected sex 36 hours ago. She is not using regular contraception. She has a BMI of 32 kg/m² and is taking carbamazepine for epilepsy.
Which ONE of the following is the most appropriate emergency contraception consideration?
A. Discuss copper intrauterine device as the most effective option and consider medicine interactions when advising on oral options.
B. Supply ulipristal acetate without asking about interacting medicines.
C. Reassure that emergency contraception is not useful after 24 hours.
D. Supply combined oral contraceptive as emergency contraception.
E. Advise waiting until her next period before taking action.
4. A 19-year-old woman taking a combined oral contraceptive pill reports vomiting 2 hours after taking her pill yesterday. She also had unprotected sex the same evening.
Which ONE of the following is the most appropriate pharmacist action?
A. Reassure that vomiting never affects oral contraceptive efficacy.
B. Advise stopping the pill until her next period.
C. Supply antibiotics to prevent pregnancy.
D. Assess the timing, pill type and need for additional precautions or emergency contraception using current guidance.
E. Advise taking two packs simultaneously for the next month.
5. A 35-year-old woman asks to restart the combined hormonal contraceptive pill. She has migraine with aura, smokes 15 cigarettes daily and has a BMI of 34 kg/m².
Which ONE of the following is the most appropriate advice?
A. Combined hormonal contraception is preferred because she is under 40.
B. Combined hormonal contraception is likely unsuitable and alternative contraception should be discussed.
C. Start combined hormonal contraception and add aspirin.
D. Use combined hormonal contraception only on days she has intercourse.
E. Migraine with aura is unrelated to contraceptive risk.
6. A 31-year-old woman using the progestogen-only pill reports taking one pill 16 hours later than usual. She had unprotected sex that morning.
Which ONE of the following is the most appropriate pharmacist action?
A. Reassure that progestogen-only pills have a 7-day missed pill window.
B. Advise taking emergency contraception automatically without asking pill type.
C. Stop the pill permanently.
D. Switch immediately to combined hormonal contraception without assessment.
E. Clarify the type of progestogen-only pill and follow missed-pill guidance, including emergency contraception assessment if indicated.
7. A 27-year-old woman has a copper intrauterine device fitted. Three weeks later she develops lower abdominal pain, fever, deep dyspareunia and abnormal vaginal discharge.
Which ONE of the following is the most appropriate action?
A. Arrange urgent assessment for possible pelvic inflammatory disease.
B. Reassure that pain and fever are expected for 6 months after fitting.
C. Advise removing the device herself.
D. Supply loperamide.
E. Treat as uncomplicated thrush without review.
8. A 32-year-old woman using depot medroxyprogesterone acetate asks about long-term adverse effects. She has been using it for 4 years and has risk factors for osteoporosis.
Which ONE of the following is the most appropriate pharmacist contribution?
A. Reassure that depot contraception has no bone-related considerations.
B. Advise taking it every week to improve bone health.
C. Stop immediately and use no contraception.
D. Recommend review of ongoing suitability, bone health risk and alternative methods if appropriate.
E. Add long-term oral corticosteroids.
9. A 17-year-old requests emergency contraception. She is accompanied by an older partner who answers most questions for her and refuses to leave the consultation room.
Which ONE of the following is the most appropriate pharmacist action?
A. Refuse all care because she is under 18.
B. Ensure a private consultation where possible and assess safeguarding, consent and Fraser competence.
C. Provide contraception without asking any questions.
D. Discuss her details openly with her partner.
E. Advise emergency contraception is unavailable to under-18s.
10. A 46-year-old woman reports heavy menstrual bleeding for 8 months with flooding and clots. She is tired and has known fibroids. She has no possibility of pregnancy.
Which ONE of the following is the most appropriate initial pharmacist contribution?
A. Reassure that heavy bleeding is always normal before menopause.
B. Recommend long-term oral iron without further assessment.
C. Advise clinical review to assess bleeding cause, anaemia and treatment options.
D. Start oral antibiotics.
E. Treat as uncomplicated thrush.
11. A 29-year-old woman has severe dysmenorrhoea, deep dyspareunia and pelvic pain that is worse before menstruation. Symptoms have gradually worsened over 2 years.
Which ONE of the following condition should be considered?
A. Uncomplicated cystitis.
B. Bacterial vaginosis.
C. Acute pyelonephritis.
D. Endometriosis.
E. Hyperemesis gravidarum.
12. A 33-year-old woman has irregular periods, acne and hirsutism. She has gained weight over several years and has difficulty conceiving.
Which ONE of the following is the most likely diagnosis?
A. Polycystic ovary syndrome.
B. Acute pelvic inflammatory disease.
C. Ovarian torsion in all cases.
D. Uncomplicated vulvovaginal candidiasis.
E. Stress urinary incontinence.
13. A 42-year-old woman has sudden severe unilateral pelvic pain, nausea and vomiting. She has a known ovarian cyst.
Which ONE of the following is the most appropriate action?
A. Treat as period pain with ibuprofen only.
B. Recommend vaginal antifungal treatment.
C. Advise routine GP review in 4 weeks.
D. Treat as uncomplicated cystitis.
E. Arrange urgent assessment for possible ovarian torsion.
14. A 55-year-old woman has postmenopausal bleeding 18 months after her last period. She is not taking hormone replacement therapy.
Which ONE of the following is the most appropriate management?
A. Reassure because bleeding is expected after menopause.
B. Supply tranexamic acid without review.
C. Refer for urgent assessment of postmenopausal bleeding.
D. Treat as vaginal thrush.
E. Advise waiting for three further episodes before seeking care.
15. A 53-year-old woman has hot flushes, night sweats and vaginal dryness affecting sleep and quality of life. She has no history of breast cancer, venous thromboembolism or unexplained vaginal bleeding.
Which ONE of the following is the most appropriate pharmacist contribution?
A. Advise HRT is never used for menopausal symptoms.
B. Discuss lifestyle measures and advise clinical review to consider HRT or non-hormonal options based on individual risk.
C. Start long-term antibiotics.
D. Treat symptoms as urinary tract infection.
E. Recommend stopping all vaginal moisturisers.
16. A 60-year-old woman with vaginal dryness, soreness and pain during sex asks about local treatment. She has no unexplained bleeding and no symptoms of infection.
Which ONE of the following is the most appropriate option to discuss?
A. Oral ciprofloxacin.
B. High-dose oral corticosteroids.
C. Long-term oral fluconazole.
D. Vaginal moisturisers, lubricants and possible local vaginal oestrogen after appropriate assessment.
E. Emergency contraception.
17. A 30-year-old woman is 8 weeks pregnant and has unilateral pelvic pain, shoulder tip pain and light vaginal bleeding. She feels dizzy.
Which ONE of the following is the most appropriate action?
A. Arrange emergency assessment for possible ectopic pregnancy.
B. Reassure and advise routine antenatal booking.
C. Supply mefenamic acid and review in one week.
D. Treat as uncomplicated cystitis.
E. Advise waiting for a home pregnancy test in 2 weeks.
18. A 24-year-old woman is 10 weeks pregnant and has persistent vomiting, inability to keep fluids down, weight loss and ketones in her urine.
Which ONE of the following is the most appropriate action?
A. Reassure because vomiting in pregnancy never needs treatment.
B. Recommend stopping all fluids.
C. Supply loperamide.
D. Treat as uncomplicated reflux only.
E. Arrange medical assessment for possible hyperemesis gravidarum and dehydration.
19. A 36-year-old woman who is 32 weeks pregnant has severe headache, visual disturbance and swelling of her face and hands. Her blood pressure at a community check is 162/104 mmHg.
Which ONE of the following is the most appropriate action?
A. Advise rest and routine midwife review next month.
B. Supply ibuprofen.
C. Arrange urgent maternity assessment for possible pre-eclampsia.
D. Treat as migraine without further assessment.
E. Advise increasing salt intake.
20. A pregnant woman at 29 weeks reports regular painful contractions, pelvic pressure and fluid leaking from the vagina.
Which ONE of the following is the most appropriate advice?
A. Reassure because labour cannot occur before 37 weeks.
B. Arrange urgent maternity assessment for possible preterm labour or membrane rupture.
C. Recommend pelvic floor exercises only.
D. Supply antifungal treatment.
E. Advise waiting until the next routine antenatal appointment.
21. A 28-year-old pregnant woman asks to buy ibuprofen for back pain at 30 weeks’ gestation. She has no red flags.
Which ONE of the following is the most appropriate pharmacist action?
A. Supply ibuprofen because it is preferred in late pregnancy.
B. Recommend doubling paracetamol dose.
C. Supply aspirin for pain relief.
D. Recommend naproxen instead.
E. Avoid OTC ibuprofen in the third trimester and advise safer analgesia or clinical advice.
22. A 37-year-old woman with epilepsy is planning pregnancy. She takes sodium valproate and asks whether she can continue it because she has been seizure-free for years.
Which ONE of the following is the most appropriate pharmacist action?
A. Reassure that valproate has no pregnancy-related risks.
B. Advise stopping valproate immediately without specialist input.
C. Urgently signpost to specialist review because valproate has major pregnancy safety concerns.
D. Replace valproate with folic acid only.
E. Advise pregnancy is contraindicated forever.
23. A 31-year-old woman is breastfeeding and asks for pain relief after an uncomplicated vaginal delivery. She has no contraindications and the baby is healthy.
Which ONE of the following is the most appropriate first-line analgesic option?
A. Paracetamol, with ibuprofen also commonly suitable if there are no contraindications.
B. Codeine as first-line in all breastfeeding patients.
C. Aspirin at high dose.
D. Methotrexate.
E. Sodium valproate.
24. A breastfeeding woman has a painful, red, swollen area of the breast with fever and flu-like symptoms. She is worried she must stop feeding.
Which ONE of the following is the most appropriate advice?
A. Stop breastfeeding permanently.
B. Seek clinical assessment for mastitis and continue milk removal if possible.
C. Apply topical steroid only and avoid assessment.
D. Treat as vaginal candidiasis.
E. Take loperamide.
25. A 34-year-old woman develops low mood, loss of interest, guilt and poor sleep 6 weeks after delivery. She reports thoughts that her family would be better off without her.
Which ONE of the following is the most appropriate action?
A. Reassure that all postnatal mood symptoms resolve without review.
B. Recommend herbal treatment only.
C. Delay assessment until the 6-month baby check.
D. Arrange urgent assessment of postnatal depression and suicide risk.
E. Advise stopping breastfeeding immediately.
26. A 25-year-old pregnant woman has dysuria and urinary frequency. A urine test suggests lower urinary tract infection. She is systemically well with no flank pain or fever.
Which ONE of the following is the most appropriate management principle?
A. Treat and follow pregnancy-specific guidance because UTIs in pregnancy require active management.
B. Reassure that UTIs in pregnancy never require antibiotics.
C. Use trimethoprim automatically in the first trimester without considering folate status.
D. Treat with ciprofloxacin as first-line.
E. Delay treatment until after delivery.
27. A 44-year-old woman has dysuria and frequency. She also has fever, rigors, loin pain and nausea.
Which ONE of the following is the most appropriate action?
A. Treat as uncomplicated lower UTI with self-care only.
B. Supply vaginal antifungal treatment.
C. Recommend cranberry capsules only.
D. Give delayed antibiotics and review in 2 weeks.
E. Arrange urgent clinical assessment for possible pyelonephritis.
28. A 68-year-old postmenopausal woman has recurrent UTIs and symptoms of vaginal dryness and soreness. She asks whether anything other than repeated antibiotics may help.
Which ONE of the following is the most appropriate consideration?
A. Avoid discussing vaginal symptoms.
B. Recommend long-term ciprofloxacin without review.
C. Consider assessment for genitourinary syndrome of menopause and possible vaginal oestrogen if appropriate.
D. Stop all fluid intake.
E. Treat with oral fluconazole indefinitely.
29. A 72-year-old man presents with new painless visible haematuria. He has no dysuria or fever and is an ex-smoker.
Which ONE of the following is the most appropriate action?
A. Reassure because visible haematuria is common with ageing.
B. Supply nitrofurantoin without assessment.
C. Recommend prostate supplements.
D. Refer urgently for assessment of possible urinary tract malignancy.
E. Advise drinking cranberry juice only.
30. A 66-year-old man has lower urinary tract symptoms with nocturia, weak stream and hesitancy. He also reports new bone pain and unexplained weight loss.
Which ONE of the following is the most appropriate pharmacist action?
A. Treat as uncomplicated benign prostatic enlargement only.
B. Refer for medical assessment because red flags may suggest prostate cancer.
C. Supply a decongestant.
D. Advise fluid restriction during the whole day.
E. Recommend OTC testosterone.
31. A 70-year-old man with benign prostatic enlargement starts tamsulosin. He asks what adverse effect he should be aware of when standing up.
Which ONE of the following is the most appropriate counselling point?
A. It may cause postural dizziness or hypotension, especially when starting treatment.
B. It commonly causes severe hyperglycaemia.
C. It prevents all falls.
D. It must be taken with sildenafil without review.
E. It causes permanent urinary retention in all patients.
32. A 76-year-old man with nocturia and urinary frequency is prescribed oxybutynin. He has dementia and chronic constipation.
Which ONE of the following is the most appropriate pharmacist action?
A. Recommend increasing oxybutynin dose.
B. Reassure that anticholinergic effects do not occur in older adults.
C. Add another antimuscarinic.
D. Review suitability because anticholinergic effects may worsen cognition and constipation.
E. Stop all bladder treatment permanently without review.
33. A 69-year-old woman reports urinary leakage when she coughs, laughs or lifts shopping. She has no urgency, dysuria, haematuria or recurrent infections.
Which ONE of the following is the most appropriate initial management advice?
A. Supervised pelvic floor muscle training should be considered.
B. Long-term antibiotics are first-line.
C. Fluid restriction to 250 mL/day is recommended.
D. Oxybutynin is always first-line for stress incontinence.
E. Urgent cancer referral is needed in all cases.
34. A 58-year-old woman has urgency, frequency and urge incontinence. She has tried bladder training but remains symptomatic. Oxybutynin is being considered.
Which ONE of the following should be reviewed before treatment?
A. Whether she has ever had hay fever.
B. Whether symptoms improve after exercise only.
C. Whether she can take it with antibiotics.
D. Whether she has normal vitamin D level.
E. Anticholinergic burden, constipation, glaucoma risk and cognitive effects.
35. A 78-year-old man presents to the pharmacy with severe suprapubic pain and inability to pass urine for 10 hours. He has known benign prostatic enlargement.
Which ONE of the following is the most appropriate action?
A. Supply tamsulosin and advise review in 1 month.
B. Recommend cranberry capsules.
C. Arrange urgent medical assessment for acute urinary retention.
D. Advise restricting fluids for 24 hours.
E. Treat as uncomplicated cystitis.
36. A 23-year-old man presents with sudden severe testicular pain, nausea and a high-riding testicle. Symptoms started 2 hours ago.
Which ONE of the following is the most appropriate action?
A. Treat as uncomplicated epididymitis and review in 1 week.
B. Recommend simple analgesia only.
C. Supply antibiotics for 3 days.
D. Arrange emergency assessment for possible testicular torsion.
E. Reassure if pain improves slightly.
37. A 29-year-old man has testicular pain, dysuria and urethral discharge. Symptoms developed gradually over 3 days. He has had a new sexual partner.
Which ONE of the following is the most appropriate management?
A. Diagnose torsion without assessment.
B. Refer to sexual health or urgent clinical assessment for suspected epididymo-orchitis or STI.
C. Recommend antifungal cream only.
D. Advise no partner notification is needed.
E. Treat with loperamide.
38. A 27-year-old woman is diagnosed with chlamydia. She asks whether her partner needs treatment if he has no symptoms.
Which ONE of the following is the most appropriate advice?
A. Asymptomatic partners do not need assessment.
B. Partner notification and treatment are important to prevent reinfection and onward transmission.
C. Only female partners require testing.
D. Symptoms must be present before treatment.
E. Barrier contraception has no role after diagnosis.
39. A 30-year-old woman has lower abdominal pain, fever, deep dyspareunia and cervical motion tenderness. Pelvic inflammatory disease is suspected.
Which ONE of the following is the most appropriate action?
A. Supply thrush treatment only.
B. Reassure if discharge is absent.
C. Delay assessment until her next cervical screening appointment.
D. Treat as uncomplicated cystitis.
E. Arrange urgent sexual health or medical assessment and appropriate antibiotic treatment.
40. A 52-year-old woman reports thin grey-white vaginal discharge with a fishy odour, especially after sex. She has no vulval itching, pelvic pain or fever.
Which ONE of the following is the most likely diagnosis?
A. Vulvovaginal candidiasis.
B. Bacterial vaginosis.
C. Acute pyelonephritis.
D. Endometriosis.
E. Ectopic pregnancy.
41. A 40-year-old woman has recurrent heavy menstrual bleeding. She is already using a copper intrauterine device and has become iron deficient. She asks about longer-term options.
Which ONE of the following may be considered after assessment?
A. Levonorgestrel-releasing intrauterine system if suitable.
B. Long-term oral antibiotics.
C. Emergency contraception monthly.
D. Oxybutynin.
E. Tamsulosin.
42. A 47-year-old woman has irregular heavy bleeding between periods and bleeding after sex. Her cervical screening is overdue.
Which ONE of the following is the most appropriate action?
A. Treat as normal perimenopause without assessment.
B. Supply tranexamic acid only.
C. Arrange clinical assessment because intermenstrual and postcoital bleeding require review.
D. Recommend emergency contraception.
E. Treat as uncomplicated UTI.
43. A 56-year-old woman taking systemic HRT has new unexplained vaginal bleeding after previously being stable on treatment.
Which ONE of the following is the most appropriate pharmacist advice?
A. Ignore bleeding if she is taking HRT.
B. Stop all medicines and avoid medical review.
C. Treat as thrush.
D. Increase the oestrogen dose.
E. Seek clinical review because new or persistent bleeding on HRT requires assessment.
44. A 36-year-old woman using tamoxifen after breast cancer treatment asks to buy a combined hormonal contraceptive pill.
Which ONE of the following is the most appropriate pharmacist action?
A. Supply because tamoxifen improves contraceptive safety.
B. Advise clinical review for suitable non-oestrogen contraception.
C. Recommend combined hormonal contraception as first-line.
D. Advise no contraception is needed.
E. Suggest emergency contraception as routine contraception.
45. A 31-year-old woman takes rifampicin for tuberculosis. She uses combined oral contraception and asks whether it still works.
Which ONE of the following is the most appropriate advice?
A. Rifampicin has no effect on hormonal contraception.
B. Take the pill at night to avoid interaction.
C. Double the combined pill dose without review.
D. Rifampicin can reduce hormonal contraceptive efficacy; discuss reliable alternative contraception.
E. Stop tuberculosis treatment.
46. A 65-year-old man asks for sildenafil for erectile dysfunction. He uses glyceryl trinitrate spray for angina.
Which ONE of the following is the most appropriate pharmacist action?
A. Supply sildenafil and advise using extra GTN if dizzy.
B. Recommend taking sildenafil at the same time as GTN.
C. Do not supply and refer for clinical advice because nitrates and sildenafil can cause severe hypotension.
D. Supply tadalafil instead because it has no interaction.
E. Advise stopping GTN permanently.
47. A 22-year-old woman has dysuria and urinary frequency. She has also noticed vaginal discharge and pelvic discomfort after unprotected sex with a new partner.
Which ONE of the following is the most appropriate action?
A. Refer to sexual health or GP assessment because STI or PID should be considered.
B. Treat as uncomplicated lower UTI without asking about sexual health.
C. Supply sodium citrate only.
D. Recommend no treatment or review.
E. Diagnose overactive bladder.
48. A 70-year-old man with urinary symptoms is taking pseudoephedrine for a cold. He reports worsening hesitancy and reduced urinary flow since starting it.
Which ONE of the following is the most appropriate pharmacist contribution?
A. Increase pseudoephedrine dose.
B. Review pseudoephedrine use because sympathomimetics can worsen urinary retention in susceptible men.
C. Add oxybutynin.
D. Reassure that decongestants improve urine flow.
E. Recommend fluid restriction for one week.
49. A 64-year-old woman has recurrent urinary urgency and frequency. She has visible blood in the urine but no pain or fever.
Which ONE of the following is the most appropriate action?
A. Treat as overactive bladder without investigation.
B. Supply oxybutynin immediately.
C. Recommend pelvic floor exercises only.
D. Refer for assessment because visible haematuria requires investigation.
E. Reassure if symptoms are intermittent.
50. A 29-year-old woman asks for emergency contraception after unprotected sex 4 days ago. She is breastfeeding and wants the most effective method.
Which ONE of the following is the most appropriate advice?
A. No emergency contraception is available after 72 hours.
B. Use combined oral contraception as emergency contraception.
C. Wait for the next period.
D. Use vaginal antifungal treatment.
E. Discuss copper intrauterine device as the most effective option and assess suitability for oral methods.
Malignant Disease and Immunosuppresion Questions
Answers and Rationale
1. C
Fever and rigors within days of chemotherapy should be treated as possible neutropenic sepsis until proven otherwise. This is an oncology emergency requiring immediate assessment and empirical treatment.
2. A
Pain, swelling or burning at the cannula site during vesicant or irritant chemotherapy may indicate extravasation. The infusion should be stopped and local extravasation policy followed immediately.
3. E
Chemotherapy-induced mucositis can affect nutrition, hydration, infection risk and ability to take oral medicines. Assessment and supportive care are needed, especially if swallowing is difficult.
4. D
Rising potassium, phosphate and urate with acute kidney injury soon after chemotherapy for a high-grade malignancy suggests tumour lysis syndrome. This requires urgent management.
5. B
Confusion, constipation, thirst and fatigue with markedly raised calcium suggest hypercalcaemia of malignancy. This requires urgent assessment and treatment such as rehydration and antiresorptive therapy where appropriate.
6. E
Cancer history with new severe back pain, limb weakness and bladder symptoms suggests metastatic spinal cord compression. This is an emergency requiring immediate assessment.
7. A
Facial swelling, distended neck veins, breathlessness and positional headache in lung cancer suggest superior vena cava obstruction. This requires urgent oncology assessment.
8. C
Rituximab can increase infection risk, partly through B-cell depletion and hypogammaglobulinaemia. Fever and respiratory symptoms require prompt clinical assessment.
9. D
Checkpoint inhibitors can cause immune-mediated colitis. Persistent diarrhoea, abdominal pain or blood in stool requires urgent oncology assessment because severe colitis can be life-threatening.
10. B
New cough, dyspnoea and hypoxia in a patient receiving immune checkpoint inhibitor therapy may indicate immune-mediated pneumonitis. This needs urgent assessment and treatment interruption may be required.
11. D
Chemotherapy-induced nausea and vomiting is often prevented more effectively by scheduled prophylactic antiemetics than by waiting until vomiting starts. Adherence to the antiemetic plan is important.
12. A
Anthracyclines such as doxorubicin can cause cardiotoxicity, including cardiomyopathy and heart failure. New breathlessness and ankle swelling should prompt assessment.
13. B
Vincristine can cause peripheral and autonomic neuropathy. Tingling, loss of fine motor function and constipation are consistent with vincristine neurotoxicity.
14. E
Painful redness and swelling of palms and soles during capecitabine treatment suggests hand-foot syndrome. The oncology team should review severity and whether dose interruption or supportive care is needed.
15. C
Severe early toxicity with capecitabine, including diarrhoea, mucositis and dehydration, may indicate serious fluoropyrimidine toxicity. Urgent oncology assessment is needed.
16. B
Tamoxifen increases venous thromboembolism risk. Unilateral calf swelling with pleuritic chest pain could indicate DVT and pulmonary embolism, requiring urgent assessment.
17. D
Aromatase inhibitors reduce oestrogen and can accelerate bone loss. Bone density assessment, calcium and vitamin D status and fracture prevention may be needed.
18. A
Androgen deprivation therapy can cause hot flushes, sexual dysfunction, metabolic effects and bone loss. Monitoring and supportive management should be discussed.
19. E
Live vaccines may be contraindicated during chemotherapy or significant immunosuppression. Specialist advice is needed before administration and timing may need planning.
20. C
Folinic acid rescue is used in specific methotrexate regimens to reduce toxicity to normal cells. It does not replace renal function monitoring or methotrexate level monitoring where required.
21. E
Biologic immunosuppression can make live vaccines unsafe. Vaccination decisions should be planned with the specialist team, considering timing and immune status.
22. B
Tacrolimus is highly interaction-prone. Clarithromycin and grapefruit can increase tacrolimus exposure, raising risks such as nephrotoxicity, neurotoxicity and hyperkalaemia.
23. C
Ciclosporin can cause nephrotoxicity and hypertension. Rising creatinine and blood pressure require review of levels, renal function, interactions and transplant status.
24. A
Mycophenolate is teratogenic and requires strict pregnancy prevention and specialist management before conception. The transplant team should be involved urgently.
25. D
After several weeks of systemic corticosteroids, abrupt stopping can cause adrenal insufficiency. A tapering plan and review of ongoing indication are required.
26. A
Co-trimoxazole may be used to prevent Pneumocystis jirovecii pneumonia in selected immunosuppressed patients. Monitoring for adverse effects and interactions remains important.
27. E
Immunosuppression increases the risk of severe shingles and complications. Prompt assessment and antiviral treatment may be needed, depending on severity and timing.
28. B
Alopecia risk varies by chemotherapy regimen. Supportive measures, including scalp cooling where appropriate, can be discussed before treatment starts.
29. C
Opioids commonly cause constipation, and this should be anticipated when regular morphine is started. A stimulant and/or osmotic laxative may be required.
30. D
Modified-release opioids provide background analgesia, while immediate-release opioids treat short episodes of breakthrough pain. Both have distinct roles in cancer pain management.
31. B
Drowsiness, respiratory depression and pinpoint pupils suggest opioid toxicity. Urgent assessment, supportive care and naloxone may be required depending on the clinical situation.
32. D
Head and neck radiotherapy can cause mucositis, painful swallowing, thick secretions, dehydration and nutritional compromise. Supportive care and multidisciplinary review are important.
33. A
Severe thrombocytopenia with active bleeding requires urgent assessment. Platelet transfusion or treatment interruption may be needed depending on severity and clinical context.
34. E
Symptomatic anaemia during chemotherapy can cause dizziness, exertional chest symptoms and reduced function. Urgent assessment is needed to consider transfusion and identify the cause.
35. C
A changing, enlarging, irregular or bleeding mole is suspicious for melanoma. Urgent clinical assessment is required.
36. D
A new hard breast lump with nipple inversion is a red flag for breast cancer. Painless symptoms can still be malignant and require urgent assessment.
37. A
Persistent cough, haemoptysis, weight loss and heavy smoking history are concerning for lung cancer. Urgent referral is appropriate.
38. C
Change in bowel habit, rectal bleeding and weight loss are red flags for colorectal cancer. The patient requires urgent clinical assessment.
39. B
Painless visible haematuria in an older ex-smoker is concerning for urinary tract malignancy. It should be referred for assessment rather than treated empirically.
40. E
Persistent painless lymphadenopathy with night sweats and weight loss suggests possible lymphoma. Urgent clinical assessment is needed.
41. C
Checkpoint inhibitors can cause endocrine immune-related adverse effects, including adrenal insufficiency. Fatigue, postural hypotension, hyponatraemia and low cortisol are concerning.
42. B
High fever and systemic illness after intravesical BCG may indicate systemic BCG infection or a serious adverse reaction. Urgent medical assessment is required.
43. B
Nilotinib can prolong QT interval, and clarithromycin can increase QT risk and interact pharmacokinetically. The combination requires careful review.
44. D
St John’s wort is an enzyme inducer and can reduce exposure to some cancer medicines. It should not be started without specialist advice.
45. A
Aromatase inhibitors can cause joint symptoms and hot flushes, but adherence is important for recurrence risk reduction. The oncology team can consider supportive measures or alternatives.
46. D
Oral chemotherapy is hazardous and should be returned through appropriate cytotoxic waste pathways. It should not be disposed of in household waste or shared.
47. C
Antibacterial prophylaxis reduces risk but does not eliminate infection. Fever during neutropenia remains an emergency requiring urgent assessment.
48. E
Diarrhoea, reduced intake and dizziness during oral chemotherapy may indicate significant toxicity and dehydration. The oncology team should advise on holding treatment and assessment.
49. A
Vaccinating household contacts can protect immunosuppressed patients by reducing exposure risk. However, some live vaccine precautions may apply and should be checked.
50. B
Asplenia increases risk of severe infection from encapsulated organisms. Vaccination, antibiotic advice and urgent assessment for fever are important safety measures.
Here are 50 multiple-choice questions designed to mimic the GPHC exam itself. At the bottom of the page you will find answers and rationale for each question.