1. A 25-year-old woman with a history of recurrent genital herpes asks how aciclovir works. What is the correct explanation?

• Inhibits viral DNA polymerase, preventing replication
• Blocks viral entry into host cells
• Targets reverse transcriptase to inhibit viral replication
• Enhances the immune response to fight the infection

Answer: Inhibits viral DNA polymerase, preventing replication

Aciclovir is a guanosine analogue that selectively inhibits herpesviral DNA polymerase, reducing viral replication.

2. What is the primary indication for prescribing alendronic acid?

• Rheumatoid arthritis
• Osteoporosis
• Paget's disease of bone
• Osteomalacia

Answer: Osteoporosis

Alendronic acid is a bisphosphonate used first-line for osteoporosis to reduce fracture risk, although it can also be used for Paget’s disease.

3. A 55-year-old man with gout is started on allopurinol. He asks about the most serious side effect. What is the correct answer?

• Hypoglycaemia
• Stevens-Johnson syndrome
• Hyperkalaemia
• Hypocalcaemia

Answer: Stevens-Johnson syndrome

Allopurinol can rarely cause severe cutaneous adverse reactions like Stevens-Johnson syndrome or toxic epidermal necrolysis.

4. What is the mechanism of action of aluminium hydroxide in managing hyperacidity?

• Neutralises stomach acid by direct chemical reaction
• Inhibits the proton pump in parietal cells
• Blocks histamine H2 receptors on gastric cells
• Stimulates mucous production in the stomach lining

Answer: Neutralises stomach acid by direct chemical reaction

Aluminium hydroxide is an antacid that neutralises gastric acidity through a simple chemical reaction.

5. A patient taking amiloride for hypertension develops hyperkalaemia. What is the mechanism of this side effect?

• Increased renal excretion of potassium
• Inhibition of potassium excretion in the distal tubule
• Enhanced aldosterone activity
• Decreased potassium absorption in the gut

Answer: Inhibition of potassium excretion in the distal tubule

Amiloride blocks epithelial sodium channels in the distal nephron, decreasing potassium excretion and thereby risking hyperkalaemia.

6. What is the most serious long-term complication of amiodarone use?

• Pulmonary fibrosis
• Hypothyroidism
• Liver dysfunction
• Skin pigmentation changes

Answer: Pulmonary fibrosis

Amiodarone can affect multiple organs, but pulmonary fibrosis is among the most severe long-term risks.

7. A 40-year-old woman with chronic pain is prescribed amitriptyline. She asks about the most common side effect. What is the correct response?

• Drowsiness
• Hypertension
• Dry mouth
• Constipation

Answer: Dry mouth

Amitriptyline’s anticholinergic properties often cause dry mouth as the most prevalent side effect.

8. What is the most common side effect of amlodipine?

• Peripheral oedema
• Bradycardia
• Hyperkalemia
• Dry cough

Answer: Peripheral oedema

Amlodipine commonly causes vasodilatory peripheral oedema, especially around the ankles.

9. A 50-year-old man with a history of penicillin allergy is prescribed amoxicillin. What is the most appropriate next step?

• Switch to a macrolide antibiotic
• Administer a test dose of amoxicillin
• Proceed with amoxicillin if the allergy was mild
• Discuss risks and benefits with the patient

Answer: Discuss risks and benefits with the patient

In penicillin-allergic patients, clarifying the nature of the allergy and obtaining informed consent is crucial before prescribing amoxicillin.

10. In which of the following patients is aspirin contraindicated?

• A 65-year-old man with a history of myocardial infarction
• A 70-year-old woman with a history of peptic ulcer disease
• A 50-year-old man with stable angina
• A 5-year-old child with a viral illness

Answer: A 5-year-old child with a viral illness

Aspirin is contraindicated in children under 16 with viral infections due to the risk of Reye’s syndrome.