Set 1: For each patient, select the most appropriate management option.

A. Reassure and supply only a salbutamol inhaler annually
B. Arrange urgent same-day assessment for acute severe asthma
C. Stop inhaled corticosteroid because symptoms are intermittent
D. Start oral antibiotics for all wheeze
E. Switch to long-acting beta-agonist monotherapy
F. Review asthma control, inhaler technique and adherence, and optimise anti-inflammatory treatment
G. Start long-term oral prednisolone without review
H. Treat as COPD without objective testing

1. A 27-year-old woman with asthma requests her fourth salbutamol inhaler in 5 months. She wakes at night with wheeze twice weekly and admits she often forgets her preventer inhaler. She is not currently breathless at rest.

Which option is most appropriate?

2. A 19-year-old man with asthma is unable to complete sentences, has a respiratory rate of 32/min, heart rate 126/min and oxygen saturation 91% on air. He has used his reliever repeatedly with little benefit.

Which option is most appropriate?

Set 2: For each patient, select the most appropriate pharmacist intervention.

A. Increase salbutamol use and delay review
B. Start propranolol for tremor
C. Start regular oral prednisolone as first-line maintenance
D. Avoid LABA monotherapy and ensure inhaled corticosteroid-containing treatment
E. Stop all asthma medicines in pregnancy
F. Supply codeine linctus
G. Start tiotropium without assessing inhaler technique
H. Counsel on mouth rinsing/spacer use and assess for inhaled corticosteroid-related candidiasis

3. A 36-year-old man with asthma has been prescribed salmeterol inhaler alone because he dislikes steroid inhalers. He still has symptoms most days.

Which option is most appropriate?

4. A 58-year-old woman using high-dose inhaled corticosteroid reports hoarse voice and white plaques in her mouth. She rarely rinses her mouth after inhaler use.

Which option is most appropriate?

Set 3: For each patient, select the most appropriate option.

A. Consider adding inhaled corticosteroid as part of triple therapy after reviewing exacerbation history and eosinophils
B. Start long-term oral corticosteroids for stable COPD
C. Stop all bronchodilators
D. Start beta-blocker as first-line COPD therapy
E. Treat all COPD breathlessness with antibiotics only
F. Start montelukast as first-line COPD therapy
G. Treat as COPD exacerbation and consider short-course oral corticosteroid with bronchodilator optimisation
H. Use oxygen at high concentration long term without assessment

5. A 69-year-old man with COPD uses LAMA/LABA therapy. He has had three moderate exacerbations in the last year requiring oral steroids and antibiotics. His blood eosinophils are raised and he has no history of pneumonia.

Which option is most appropriate to consider?

6. A 72-year-old woman with COPD has worsening breathlessness, increased sputum volume and wheeze over 48 hours. She is more breathless than usual but not confused or cyanosed. Her oxygen saturation is 93% on air.

Which option is most appropriate?

Set 4: For each patient, select the most appropriate recommendation.

A. Avoid all exercise because COPD causes breathlessness
B. Supply home oxygen for anyone who asks
C. Refer for pulmonary rehabilitation if functionally limited by COPD breathlessness
D. Encourage smoking cessation and explain oxygen fire risk before any home oxygen consideration
E. Use oxygen to reduce anxiety only
F. Stop vaccinations because COPD is not infection-related
G. Recommend codeine for chronic breathlessness
H. Advise smoking is safe if oxygen is used outdoors only

7. A 67-year-old man with COPD has reduced exercise tolerance and avoids leaving the house because of breathlessness. He is clinically stable and asks what non-medicine intervention could help function.

Which option is most appropriate?

8. A 61-year-old woman with severe COPD asks about home oxygen but continues to smoke 15 cigarettes daily. She says she can “just avoid smoking near the cylinder”.

Which option is most appropriate?

Set 5: For each patient, select the most appropriate management option.

A. Treat as uncomplicated allergic rhinitis
B. Start oral fluconazole
C. Supply salbutamol only
D. Urgent hospital assessment for possible severe pneumonia or sepsis
E. Reassure and review in 6 months
F. Treat with loperamide
G. Start long-term oral corticosteroids
H. Consider community treatment for low-severity pneumonia if suitable, with safety-netting

9. An 84-year-old man has fever, productive cough, new confusion, respiratory rate 31/min and oxygen saturation 89% on air. He has coarse crackles at the right base and looks clammy.

Which option is most appropriate?

10. A 39-year-old woman has cough, fever and pleuritic chest pain. She is alert, oxygen saturation is 97% on air, respiratory rate is 18/min and blood pressure is normal. She has focal crackles and no significant comorbidity.

Which option is most appropriate?

Set 6: For each patient, select the most appropriate action.

A. Treat with simple analgesia and no safety-netting
B. Urgent assessment for possible pulmonary embolism
C. Start antibiotics for all pleuritic pain
D. Reassure because normal temperature excludes serious disease
E. Supply OTC cough mixture only
F. Emergency assessment for possible pneumothorax
G. Start oral prednisolone for all pleuritic chest pain
H. Delay review until symptoms have persisted for 6 weeks

11. A 43-year-old woman has sudden pleuritic chest pain and breathlessness 2 weeks after knee surgery. Her heart rate is 118/min and oxygen saturation is 93% on air. One calf is swollen and tender.

Which option is most appropriate?

12. A tall 22-year-old man develops sudden unilateral pleuritic chest pain and shortness of breath while sitting at home. Breath sounds are reduced on one side. He has no fever.

Which option is most appropriate?

Set 7: For each patient, select the most appropriate action.

A. Urgent referral for possible lung cancer
B. Treat as uncomplicated viral cough
C. Supply OTC cough suppressant only
D. Start oral amoxicillin without review
E. Assess urgently for possible active tuberculosis and infection control advice
F. Reassure because symptoms are chronic
G. Start inhaled corticosteroid only
H. Treat as hay fever

13. A 31-year-old man has cough for 6 weeks, night sweats, weight loss and intermittent haemoptysis. He recently arrived from a country with high TB incidence.

Which option is most appropriate?

14. A 66-year-old man who smoked for 40 years has persistent cough, weight loss and two episodes of haemoptysis. He has no fever and no previous asthma diagnosis.

Which option is most appropriate?

Set 8: For each patient, select the most appropriate pharmacist contribution.

A. Switch devices without involving the patient
B. Increase dose without checking technique
C. Check inhaler technique and consider spacer use with pressurised metered-dose inhaler
D. Stop inhaler because technique is poor
E. Use dry powder inhaler in all patients regardless of inspiratory flow
F. Recommend nebulisers for all stable asthma patients
G. Choose a device the patient can use reliably after assessing technique, dexterity and inspiratory flow
H. Prescribe multiple different device types without counselling

15. A 9-year-old child with asthma uses a pressurised metered-dose inhaler but actuates it after inhaling. His symptoms improve when the pharmacist demonstrates use with a spacer.

Which option is most appropriate?

16. An 81-year-old woman with COPD has arthritis in her hands and poor inspiratory flow. She struggles with her current dry powder inhaler and frequently misses doses.

Which option is most appropriate?

Set 9: For each patient, select the most appropriate option.

A. Send sputum for culture and seek clinical review for infective bronchiectasis exacerbation
B. Continue modified-release medicines without considering absorption or administration issues
C. Treat all sputum changes with oral fluconazole
D. Reassure because daily sputum is never clinically relevant
E. Start long-term macrolide without specialist review or monitoring
F. Avoid airway clearance techniques
G. Stop pancreatic enzymes in cystic fibrosis if weight is low
H. Review adherence to airway clearance, pancreatic enzymes and specialist CF medicines

17. A 74-year-old woman with bronchiectasis has increased sputum volume, thicker green sputum and worsening breathlessness. She has previously grown Pseudomonas in sputum.

Which option is most appropriate?

18. A 19-year-old man with cystic fibrosis has weight loss, greasy stools and reduced adherence to pancreatic enzymes. He also admits skipping airway clearance because of university commitments.

Which option is most appropriate?

Set 10: For each patient, select the most appropriate pharmacist action.

A. Recommend alcohol at night to improve sleep
B. Increase opioid dose to improve breathing pattern
C. Review sedating medicines and respiratory depression risk urgently
D. Assess for obstructive sleep apnoea and advise referral due to daytime sleepiness and driving risk
E. Supply codeine linctus routinely
F. Reassure because snoring is always harmless
G. Start benzodiazepine for all insomnia
H. Ignore driving risk if the patient has not crashed

19. A 52-year-old lorry driver has loud snoring, witnessed apnoeas, morning headaches and severe daytime sleepiness. He has nearly fallen asleep while driving.

Which option is most appropriate?

20. A 68-year-old woman with COPD takes morphine modified-release and diazepam. Her family say she is increasingly drowsy and breathing slowly. Her oxygen saturation is lower than usual.

Which option is most appropriate?

Respiratory Questions

Answers and Rationale

1. F
Frequent salbutamol requests, night waking and poor preventer adherence suggest uncontrolled asthma and increased exacerbation risk. The priority is to review control, inhaler technique and adherence, then optimise anti-inflammatory treatment.

2. B
Inability to complete sentences, tachypnoea, tachycardia and low oxygen saturation suggest acute severe asthma. This needs urgent same-day assessment rather than routine inhaler adjustment.

3. D
Long-acting beta-agonist monotherapy is unsafe in asthma. Asthma treatment should include inhaled corticosteroid-containing therapy unless there is a specific specialist plan.

4. H
Hoarseness and white oral plaques suggest inhaled corticosteroid-associated candidiasis. Mouth rinsing, spacer use and inhaler technique should be reviewed, with treatment considered if candidiasis is confirmed.

5. A
Frequent COPD exacerbations despite LAMA/LABA and raised eosinophils suggest the patient may benefit from inhaled corticosteroid-containing triple therapy, after considering pneumonia risk and individual factors.

6. G
Increased breathlessness, sputum volume and wheeze suggest a COPD exacerbation. Short-course oral corticosteroids may be appropriate alongside bronchodilator optimisation, with antibiotics considered if sputum is purulent.

7. C
Pulmonary rehabilitation can improve exercise capacity, symptoms and quality of life in people functionally limited by COPD breathlessness. It should be considered when the patient is stable enough to participate.

8. D
Smoking is a major fire risk with oxygen. Smoking cessation and a proper oxygen assessment are essential before home oxygen is considered.

9. D
Confusion, tachypnoea, hypoxia, fever and focal chest signs in an older adult suggest severe pneumonia or sepsis. Hospital assessment is required.

10. H
This patient appears clinically stable with possible low-severity community-acquired pneumonia. Community treatment may be suitable if risk assessment supports it, with clear safety-netting.

11. B
Sudden pleuritic chest pain, breathlessness, tachycardia and unilateral calf swelling after surgery strongly suggest pulmonary embolism. Urgent assessment is required.

12. F
Sudden unilateral pleuritic chest pain, breathlessness and reduced breath sounds suggest pneumothorax. This requires emergency assessment.

13. E
Chronic cough, night sweats, weight loss, haemoptysis and epidemiological risk suggest active tuberculosis. Urgent assessment and infection control advice are needed.

14. A
Haemoptysis with persistent cough, weight loss and smoking history is a red flag for lung cancer. Urgent referral is needed.

15. C
Poor coordination with a pressurised metered-dose inhaler can reduce drug delivery. Technique review and spacer use can improve inhaler effectiveness.

16. G
Device choice should consider inspiratory flow, dexterity, cognition, preference and ability to use the device correctly. A device the patient can use reliably is more important than theoretical device preference.

17. A
In bronchiectasis, increased sputum volume, purulence and breathlessness suggest infective exacerbation. Previous Pseudomonas makes sputum culture and clinical review especially important.

18. H
Cystic fibrosis management relies on adherence to airway clearance, pancreatic enzymes, nutrition and specialist medicines. Greasy stools and weight loss suggest inadequate enzyme use or absorption issues requiring review.

19. D
Snoring, witnessed apnoeas, morning headaches and severe daytime sleepiness suggest obstructive sleep apnoea. Driving risk is significant, especially for a lorry driver, so referral and safety advice are needed.

20. C
COPD plus opioids and benzodiazepines increases respiratory depression risk. Increasing drowsiness, slow breathing and lower oxygen saturation require urgent medicines review and clinical assessment.

Here are 20 extended matching questions designed to mimic the GPHC exam itself. At the bottom of the page you will find answers and rationale for each question.