Test yourself: the 2022 CPD and Learning quiz

Take our end-of-year quiz to test your learning and reflect on areas that you may need to focus on ahead of revalidation.
collage of keloid scar, diabetes pin prick test,

It has been another busy year for The Pharmaceutical Journal, from the publication of the ‘pharmacogenomics’ digital special to our continued focus on green pharmacy and minimising the impact of medicines on the environment; we continue to publish forward-facing resources that support pharmacists in their learning and development. 

Our end-of-year quiz is broken down by clinical area, giving our readers the chance to reflect and identify any areas that may benefit from focused learning ahead of revalidation. Work your way through the quiz by expanding the questions in the answer boxes below. When you have answered all the questions, select ‘Finish Quiz’ at the bottom of the page to see your score. 

Liver disease

Liver function tests (LFTs) are ordered to inform a new diagnosis of liver injury, worsening of a diagnosed condition, or to monitor the progression of a liver disease. LFTs are not used in isolation, but are interpreted together and in conjunction with past medical history, the presence of other signs and symptoms of liver disease and any relevant scans or biopsies. Expand question 1 to test your knowledge.

healthcare worker inserting needle into vein in arm

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  1. Match the abnormal liver function test results with the most likely cause.

    Sort elements
    • Raised aspartate aminotransferase and alanine aminotransferase that is >18 x upper normal limit
    • Isolated rise in gamma-glutamyl transferase, all other tests are within range
    • Raised aspartate aminotransferase (AST) and alanine aminotransferase (ALT), with an AST:ALT ratio of 3:1 and raised gamma-glutamyl transferase
    • Isolated rise in bilirubin, all other tests are within range
    • Raised gamma-glutamyl transferase, alkaline phosphatase and bilirubin
    • Gilbert’s syndrome
      • Alcoholic hepatitis
        • Paracetamol overdose
          • Cholestasis
            • Patient is taking phenytoin

            This question is from ‘Liver function tests: indication and interpretation’. Please refer to the original article if you would like to know more.

            Neurological conditions

            Anti-seizure medicines (ASMs) were, until recently, referred to as ‘anti-epileptic drugs’. The change in terminology reflects that these drugs treat seizures, not the underlying condition. It is important to consider the possible side effects when treating patients with ASMs. Expand question 2 to test your knowledge.

            ISM / SCIENCE PHOTO LIBRARY

            1. Stevens-Johnson syndrome (pictured above) is a serious cutaneous reaction that can be caused by certain medicines. Please select the two anti-seizure medicines from this list that are most likely to cause this reaction.

              • 1.
              • 2.
              • 3.
              • 4.
              • 5.

            This question is from ‘Epilepsy: management’. Please refer to the original article if you would like to know more.

            Diabetes

            Diabetic ketoacidosis (DKA) is the leading cause of death among children and young to middle-aged adults with type 1 diabetes mellitus. Recognising the symptoms of hyperglycaemia and DKA could help prevent morbidity and mortality associated with this condition. Expand question 3 to test your knowledge.

            1. What consequence of increased gluconeogenesis and glycogenolysis (see image above) results in the quartet of symptoms commonly known as the 'four Ts’ (toilet, thirsty, tired, thinner) that are common symptoms of diabetic ketoacidosis?

            This question is from ‘Diabetic ketoacidosis in adults: identification, diagnosis and management’. Please refer to the original article if you would like to know more.

            Pain management

            Pictured is the visual analogue scale (VAS), which can be used to assess pain intensity in the postoperative period. The VAS uses a scale from 0 (no pain) to 10 (worst pain imaginable) and can be used to assess pain over the previous 24 hours or over a longer time period​. Expand question 4 to test your knowledge.

            1. Numerical tools may be inappropriate at evaluating pain in certain patients, in which of the following patients should an alternative strategy be used? Select all answers that apply.

              • 1.
              • 2.
              • 3.
              • 4.
              • 5.

            This question is from ‘Management of postoperative pain’. Please refer to the original article if you would like to know more.

            Respiratory diseases

            As with every consumable resource, there is an environmental cost to all types of inhaler and it is important that prescribing decisions are made that maximise individual patient clinical benefit while considering ways to safely minimise the environmental impact. Expand question 5 to test your knowledge.

            set of asthma inhalers

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            1. Fill in the blanks.

              • There are several patient groups who may be suitable for review to potentially switch inhaler devices. Individual patients should be prioritised for review rather than attempting a blanket inhaler switch policy; this includes those with poor , poor , poor , excessive short-acting beta-agonist use and those prescribed mixed types of inhaler devices.

            This question is from ‘Best practice principles for inhaler prescribing’. Please refer to the original article if you would like to know more.

            Dermatology

            A keloid scar, or keloid, is a dermal fibroproliferative growth caused by pathologic wound healing following injury to the skin — for example, from ear piercings, burns, acne scarring and surgical wounds. Expand question 6 to test your knowledge.

            1. Look at the three images of different scar types above and match them with the correct definition.

              Sort elements
              • Hypertrophic scar
              • Normotrophic scar
              • Keloid scar
              • A
                • B
                  • C

                  This question is from ‘Keloid scars: recognition and management’. Please refer to the original article if you would like to know more.

                  Cancer

                  Immune checkpoint inhibitors are a novel class of cancer therapy that have improved the treatment of a broad range of cancers, including renal and bladder cancers. Expand question 7 to test your knowledge.

                  healthcare worker inserting chemotherapy drip into patient's arm

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                  1. Which two of the following statements about immune checkpoint inhibitor adverse event timescales are correct?

                    • 1.
                    • 2.
                    • 3.
                    • 4.
                    • 5.

                  This question is from ‘Renal cancer: management‘. Please refer to the original article if you would like to know more.

                  Genetic disorders

                  Around 1 in 250 people have an inherited condition called heterozygous familial hypercholesterolaemia, which results in a raised level of cholesterol from birth and a significantly increased risk of early heart disease. Expand question 8 to test your knowledge.

                  1. Fill in the blanks.

                    • Heterozygous familial hypercholesterolaemia is an autosomal inherited condition where parent with an altered gene has a % chance of passing on that altered gene to each of their children.

                  This question is from ‘Familial hypercholesterolaemia: identification and management‘. Please refer to the original article if you would like to know more.

                  Haematology

                  Pernicious anaemia is an autoimmune condition that affects the stomach; however, it is the resultant vitamin B12 deficiency that causes the symptoms commonly associated with the condition. Expand question 9 to test your knowledge.

                  Blood smear, hypersegmented neutrophils, pernicious/megaloblastic anemia, iron deficient anemia, Wright's stain, 500X. Light micrograph

                  ALVIN TELSER / SCIENCE PHOTO LIBRARY

                  1. Which of the following options are most likely to cause pernicious anaemia and a resulting vitamin B12 deficiency via malabsorption? Select all answers that apply.

                    • 1.
                    • 2.
                    • 3.
                    • 4.
                    • 5.

                  This question is from ‘Pernicious anaemia: recognition, diagnosis and management‘. Please refer to the original article if you would like to know more.

                  Rheumatology

                  Gout is a common form of arthritis but, despite being easily treatable, often goes undiagnosed or undertreated. It typically presents as an acute onset of a severely painful red and swollen joint(s). Expand question 10 to test your knowledge.

                  hand of someone with gout

                  BIOPHOTO ASSOCIATES / SCIENCE PHOTO LIBRARY

                  1. Gout is caused by the build-up of which metabolic by-product in the joints?

                    • 1.
                    • 2.
                    • 3.
                    • 4.
                    • 5.

                  This question is from ‘Treatment and management of gout: the role of pharmacy‘. Please refer to the original article if you would like to know more.

                  Patient safety

                  The most common electrolytes in tissues and fluids in the human body (such as blood, urine and sweat) are sodium, potassium, calcium, phosphate and magnesium. Hyperkalemia (i.e. higher than normal potassium) can be caused by medicines that cause retention of potassium. Expand question 11 to test your knowledge.

                  patient's arm in hospital bed with iv drip

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                  1. Hyperkalaemia can be caused by medicines that cause retention of potassium. Match the following medicines that can cause hyperkalaemia with their indications.

                    Sort elements
                    • Hypertension, heart failure, secondary prevention following myocardial infarction
                    • Hypertension, heart failure
                    • Prevention and treatment of venous thromboembolism
                    • Ascites, heart failure
                    • Angiotensin-converting enzyme inhibitors (e.g. ramipril)
                      • Angiotensin II receptor antagonists (e.g. candesartan)
                        • Aldosterone receptor antagonists (e.g. spironolactone, eplerenone)
                          • Low-molecular-weight heparins (e.g. enoxaparin)

                          This question is from ‘Electrolyte disturbances: causes and management‘. Please refer to the original article if you would like to know more.

                          Medicines information

                          Advanced therapy medicinal products are a new class of medicinal products, which includes gene therapies, somatic cellular products and tissue engineered products​. These medicines give hope for the management of diseases, such as B cell acute lymphoblastic leukaemia, that currently have limited or no therapeutic options. Expand question 12 to test your knowledge.

                          hand holding pipette squeezing liquid into test tubes

                          TEK IMAGE/SCIENCE PHOTO LIBRARY

                          1. What is the most commonly used advanced therapy medicinal product in the UK?

                            • 1.
                            • 2.
                            • 3.
                            • 4.
                            • 5.

                          This question is from ‘Advanced therapy medicinal products: a comprehensive overview for pharmacy professionals‘. Please refer to the original article if you would like to know more.

                          Pharmacogenomics

                          Pharmacogenomics investigates the effects of inherited gene differences on the pharmacodynamics and pharmacokinetics of medicines. The nomenclature used in pharmacogenomics can seem complex but is relatively easy to understand once applied to a specific example. Expand question 13 to test your knowledge.

                          1. A DPYD variant is shown above. Order the following nomenclature labels that are missing from the figure directionally left to right.

                            • Nucleotide position within the gene
                            • The nucleotide that has been substituted and is now present in the gene
                            • The coding region of the gene
                            • The 'reference' nucleotide — which is no longer present
                            • The gene symbol

                            View:

                          This question is from ‘DPYD genetic testing and the future of pharmacogenomic testing in routine care‘. Please refer to the original article if you would like to know more.

                          Women’s health

                          Premature ovarian insufficiency is a condition whereby the ovaries stop functioning before the age of 40 years. The severity and frequency of symptoms varies from person to person, but symptoms can include hot flushes, headaches, mood changes, irritability and lowered libido. Expand question 14 to test your knowledge.

                          Shutterstock.com

                          1. The risk factors associated with premature ovarian insufficiency differ by ethnicity, true or false?

                            • 1.
                            • 2.

                          This question is from ‘Premature ovarian insufficiency: diagnosis and management‘. Please refer to the original article if you would like to know more.

                          Quality improvement

                          Quality improvement (QI) requires a coordinated approach to solving a problem, and the people involved need to be equipped with the necessary skills and resources. A range of QI tools, methods and approaches have been developed over time. Expand question 15 to test your knowledge.

                          healthcare staff sat around meeting table

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                          1. One approach to quality improvement allows solutions to be tested on a smaller scale, giving the opportunity to see whether the proposed change will succeed before a full implementation.

                            Put the steps of this approach in the correct order.

                            • Study
                            • Act
                            • Plan
                            • Do

                            View:

                          This question is from ‘Quality improvement in pharmacy practice‘. Please refer to the original article if you would like to know more.

                          Last updated
                          Citation
                          The Pharmaceutical Journal, PJ, December 2022, Vol 309, No 7968;309(7968)::DOI:10.1211/PJ.2022.1.167176

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