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CPD & Learning

Highlights of CPD and learning in 2017

learning cpd lead image 17

Try our quiz, with questions taken from this year’s learning and CPD articles, and check your knowledge of subjects ranging from sepsis and skin cancer to coeliac disease.

This year, The Pharmaceutical Journal and sister title Clinical Pharmacist have published articles that cover a wide range of clinical topics, from depression in adults to rashes in children. Our coverage reflects both the clinical challenges pharmacists face, as well as further development of key skills relevant to practice.

Our quiz highlights some of 2017’s most important topics. You can refresh your knowledge by reading these articles in full and access our complete library of CPD articles at The answers to this year’s quiz can be found at the bottom of this article.

1. Microbiology
2. Mental health
3. Neonatal and paediatric care
4. Cardiology & nephrology
5. Foot care
6. Oncology
7. Ear, nose and throat
8. Diabetes
9. Medicines
10. Infectious diseases
11. Foot care
12. Skin cancer
13. Emergency medicine
14. Dementia
15. Immunology


1. Microbiology

Clostridium difficile is a spore-producing Gram-positive anaerobic bacterium, and a common cause of healthcare-associated infection. In England and Wales, from 2008 to 2016, infection rates have fallen year-on-year and are now around 3,000 cases per quarter. This reduction in case rate has been largely attributed to changes in infection prevention and control and in antimicrobial stewardship. Public Health England guidance recommends which of the following pharmacological treament options as first-line agents for non-severe C. difficile infection?

A: Oral vancomycin
B: Intracolonic vancomycin
C: Oral metronidazole
D: Intravenous immunoglobulin

From: Clostridium difficile: diagnosis and treatment update

2. Mental health

National Institute for Health and Care Excellence (NICE) guidelines on depression use the Diagnostic and Statistical Manual of Mental Disorders (DSM-4) criteria to standardise the diagnosis and treatment of depression. For a diagnosis of depression to be made against the DSM-4 criteria, at least how many of the symptoms must have been present during the same two-week period and must represent a change from previous functioning?

A: 4
B: 5
C: 6
D: 7

From: Depression in adults: recognition and management

3. Neonatal and paediatric care

Rashes in children

Source: CDC

Rashes in children are common and may be difficult to differentiate by appearance alone; therefore, it is important to consider the entire clinical presentation in order to make the appropriate diagnosis.

A mother presents with a four-day-old newborn baby who has developed a blotchy red skin reaction on the anterior trunk and legs (see image). The lesions are firm, 1–3mm, yellowy/white papules/pustules on a red swollen base. Which of the following would you diagnose?

A: Prickly heat / heat rash
B: Milia
C: Hand, foot and mouth
D: Erythema toxicum

From: Rashes in children

4. Cardiology & nephrology

Chronic oedema is increasingly recognised as a common condition and can be defined as soft tissue swelling that has been present for three months or more. Peripheral oedema is a recognised adverse effect of calcium channel blockers (CCBs) with up to 50% of patients on CCBs developing oedema. Which of the following two CCBs are ‘very commonly’ associated with an increased incidence of peripheral oedema?

A: Felodipine and lercanidipine
B: Amlodipine and diltiazem
C: Amlodipine and verapamil
D: Felodipine and diltiazem

From: Chronic oedema: treatment and the impact of prescribed medicines

5. Foot care

Foot care

Source: Lorraine Jones

Fungal nails become unsightly, thickened and crumbly, and may become painful within an enclosed shoe owing to pressure from the upper onto the nails. Over-the-counter (OTC) treatments can be recommended to patients, which should be used early in the infection. Which of the following statements on considerations when recommending antifungal nail lacquers is false?

A: Topical treatments do not work well in conjunction with oral treatments
B: Over-the-counter (OTC) treatments rarely work when the whole nail is affected
C: Topical paint does not reach the deeper layers of the nail and is not as effective as oral medication
D: Treatment requires good compliance as fungal infection can continue for 6–12 months

From: Management and treatment options for common foot conditions

6. Oncology

Multiple myeloma is a haematological cancer characterised by the overproduction of abnormal plasma cells in the bone marrow. For older patients over 70 years of age and ineligible for an autologous stem cell transplant, the National Institute for Health and Care Excellence (NICE) has licensed and approved which of the following drugs as the induction regimen of choice when used in combination with an alkylating agent and corticosteroid?

A: Bortezomib
B: Thalidomide
C: Lenalidomide
D: Dexamethasone

From: Multiple myeloma: pharmacological management

7. Ear, nose and throat

Ear, nose and throat

Source: Science Photo Library

Earache is a common problem that can be the result of a variety of different pathologies. A patient presents with a mildly painful red and tender ear canal that has occurred rapidly (see image). A thin discharge has also been present. Which of the following conditions would you diagnose this patient with?

A: Acute otitis media
B: Otitis media with effusion
C: A perforated eardrum
D: Otitis externa

From: How to diagnose and manage primary and secondary earache and ear infections

8. Diabetes

Unless well managed, pregnant women with diabetes face an increased risk of adverse outcomes including miscarriage and pre-eclampsia. Babies born to mothers with diabetes face an increased risk of pre-term delivery, birth trauma, being large for gestational age, higher rates of admission to neonatal units, stillbirth and neonatal death. Which of the following statements is true?

A: All women with pre-existing diabetes should take high-dose (prescription only) folic acid 5mg once a day for at least three months before conception and up until 12 weeks’ gestation
B: All women with pre-existing diabetes should take folic acid 1200µg daily for at least three months before conception and up until 12 weeks’ gestation
C: All women with pre-existing diabetes should take high-dose (prescription only) folic acid 5mg once a day for at least three months before conception and up until six weeks’ gestation
D: All women with pre-existing diabetes should take folic acid 800µg daily for at least three months before conception and up until 16 weeks’ gestation

From: Managing diabetes in women during preconception and pregnancy

9. Medicines

The solvent propylene glycol (PG) is used in a variety of oral liquid, topical and injectable medicines. Accumulation of PG can occur in neonates and young children as they cannot adequately metabolise and eliminate the excipient. What is the European Medicines Agency proposed safety limit for PG for a child aged five?

A: 50mg/kg
B: 150mg/kg
C: 300mg/kg
D: 500mg/kg

From: How to identify and manage ‘problem’ excipients in medicines for children

10. Infectious diseases

In late 2016, the national guidelines for the public health management of pertussis in England were updated to reflect how the ‘vulnerable groups’ have changed following evidence of the high effectiveness of the maternal vaccination programme. Which of these statements does not reflect vulnerable groups at increased risk of severe or complicated pertussis outlined in this guidance?

A: Any child (born <32 weeks) aged less than two months, regardless of maternal vaccination status
B: Any child aged under one year who has not completed their primary vaccination programme
C: Any child (born >32 weeks) aged less than two months whose mother was unvaccinated
D: Any child aged over two months who is unvaccinated or partially vaccinated (regardless of maternal vaccination status)

From: Whooping cough: public health management and guidance

11. Foot care

The number of people with diabetes who, in any given week, have an active foot ulceration is estimated to be around 60,000–75,000 in England, and around 5–7% of people with diabetes will experience a foot ulcer at some point in their life.

A patient with diabetes presents with a callous and nerve damage (neuropathy) in their right foot. Which of the following correctly outlines their risk status and recommended review period?

A: Low risk — annual foot review
B: Low–moderate risk — review by foot protection service every six months
C: Moderate risk — review three–six months with foot protection service
D: High risk — one–two months or every one–two weeks if patient concerned

From: The diabetic foot

12. Skin cancer

In the UK, sunscreens have both Sun Protection Factor (SPF) and UVA star systems. SPF relates to the ability of the sunscreen to protect the wearer from sunburn, therefore, primarily offering protection from UVB. The UVA star system is rated from 0 to 5 stars and indicates the protection against UVA relative to protection against UVB. Which of the following does the National Institute for Health and Care Excellence (NICE) recommend sunscreens must have?

A: Provide at least SPF 30 to protect against UVB and three-star UVA protection
B: Provide at least SPF 15 to protect against UVB and four-star UVA protection
C: Provide at least SPF 15 to protect against UVB and three-star UVA protection
D: Provide at least SPF 30 to protect against UVB and four-star UVA protection

From: Melanoma: risk factors and advice on sunscreen use

13. Emergency medicine

Emergency medicine

Source: Science Photo Library

Sepsis is characterised by life-threatening organ dysfunction caused by dysregulated host response to infection. Outside of the intensive care unit, the National Institute for Health and Care Excellence (NICE) recommends which of the following as first-line therapy for the management of sepsis?

A: Inotropes
B: Broad spectrum antibiotics
C: Levosimendan
D: Fluid resuscitation

From: Sepsis: an update on identification and management

14. Dementia

Long-term use of medicines with anticholinergic side effects by older people can impair cognition and increase falls risk, morbidity and, possibly, mortality. Patients living with mild dementias appear to be more susceptible to the cognitive side effects. According to the Anticholinergic Burden Scale, which of the following medicines is not given an ACB score of 2 (equivalent to a mild or moderate effect)?

A: Pethidine
B: Carbamazepine
C: Morphine
D: Methotrimeprazine

From: How pharmacy can provide patient-centred care for dementia patients

15. Immunology

The characteristic symptoms associated with coeliac disease include bloating, diarrhoea, constipation, abdominal pain and cramping, wind, nausea, unexpected weight loss (but not in all), unexplained anaemia, extreme fatigue, and severe or persistent mouth ulcers. Which of the following statements accurately reflects information from a patient that should be referred to their GP for testing for coeliac disease?

A: Unexplained weight loss; fatigue; light, fatty and foul-smelling stools experienced recurrently over a prolonged period of time
B: Abdominal pain and cramping; unexplained weight loss; fatigue; dark, tarry stools
C: Unexplained weight loss; fatigue; light, fatty and foul-smelling stools experienced recurrently over a short period of time
D: Abdominal pain and cramping only

From: How to identify symptoms of coeliac disease in community pharmacy and primary care


1. C 6. B 11. C
2. B7. D12. B
3. D8. A13. D
4. D9. D14. C
5. A10. B 15. A

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2017.20204094

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