Pregnancy, lactation, paediatrics and geriatrics

30 Gulf Prometric Pharmacist (DHA, DOH, MOH, SCFHS, QCHP) practice questions on Pregnancy, lactation, paediatrics and geriatrics, part of Clinical Pharmacy and Therapeutics. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

1. Question 1 · Medium

   A woman who is planning a pregnancy has taken sodium valproate for epilepsy for years and is seizure-free. What is the best advice?

   1. ASwitch to phenytoin, which has the lowest malformation risk of all antiepileptics
   2. BStop valproate immediately and leave the epilepsy untreated until delivery
   3. CContinue valproate at the lowest dose and add folic acid 400 micrograms
   4. DRefer for specialist review to switch to lamotrigine, with high-dose folic acid

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   Answer: D · Refer for specialist review to switch to lamotrigine, with high-dose folic acid

   Valproate carries the highest risk of major malformations and neurodevelopmental disorders among antiepileptics, so it should be avoided in women who may become pregnant. A neurologist should switch her to an agent such as lamotrigine or levetiracetam in an orderly way before conception. High-dose folic acid is given, and seizure control must not be lost.

   • A: Phenytoin is itself teratogenic (fetal hydantoin syndrome).
   • B: Stopping without a replacement risks dangerous seizures.
   • C: Staying on valproate keeps the highest fetal risk.

   Remember this

   Valproate is avoided in women who may become pregnant; switch under specialist review.

2. Question 2 · Medium

   Why is ceftriaxone generally avoided in a 5-day-old jaundiced neonate?

   1. AIt is poorly absorbed after injection in neonates
   2. BIt irreversibly inhibits the hepatic glucuronyl transferase enzyme
   3. CIt displaces bilirubin from albumin, risking encephalopathy
   4. DIt causes grey baby syndrome through accumulation

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   Answer: C · It displaces bilirubin from albumin, risking encephalopathy

   Ceftriaxone binds strongly to albumin and displaces bilirubin, raising free bilirubin that can cross the blood-brain barrier and cause bilirubin encephalopathy. It also precipitates with calcium-containing infusions in neonates, with fatal lung and kidney deposits reported. An alternative cephalosporin such as cefotaxime is used.

   • A: Ceftriaxone is well absorbed after injection.
   • B: It does not inhibit glucuronyl transferase.
   • D: Grey baby syndrome belongs to chloramphenicol.

   Remember this

   Avoid ceftriaxone in jaundiced neonates and with calcium infusions; use cefotaxime instead.

3. Question 3 · Medium

   A newborn given chloramphenicol develops an ashen-grey colour, hypotension and vomiting. What is the underlying mechanism?

   1. ADirect toxicity to the cochlea and vestibule
   2. BImmature glucuronidation causes accumulation
   3. CDisplacement of bilirubin from albumin binding
   4. DChelation of calcium in developing bone and teeth

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   Answer: B · Immature glucuronidation causes accumulation

   Neonates have poor hepatic glucuronidation and immature renal excretion, so chloramphenicol builds up and impairs mitochondrial function, causing grey baby syndrome with circulatory collapse. The drug is avoided in neonates or given with level monitoring. Bilirubin displacement describes sulfonamides and ceftriaxone.

   • A: Cochlear toxicity is an aminoglycoside effect.
   • C: Bilirubin displacement is the sulfonamide and ceftriaxone problem.
   • D: Calcium chelation is the tetracycline problem.

   Remember this

   Grey baby syndrome follows chloramphenicol accumulation from immature neonatal glucuronidation.

4. Question 4 · Medium

   A paediatrician in Doha prescribes paracetamol 15 mg/kg per dose for a child weighing 18 kg. What is the single dose?

   1. A1,350 mg
   2. B180 mg
   3. C90 mg
   4. D270 mg

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   Answer: D · 270 mg

   The dose is 15 mg/kg x 18 kg = 270 mg per dose, given every 4-6 hours with no more than 4 doses a day. The total must stay below 75 mg/kg/day, which here is 1,350 mg. Other values come from a wrong multiplier or arithmetic slip.

   • A: 1,350 mg is the maximum daily dose, not a single dose.
   • B: 180 mg is 10 mg/kg, a low dose.
   • C: 90 mg is 5 mg/kg and too low to be effective.

   Remember this

   Paediatric paracetamol is 15 mg/kg per dose, with at most 75 mg/kg in 24 hours.

5. Question 5 · Easy

   A woman with no risk factors is planning a pregnancy. Which folic acid dose is advised daily from before conception until the 12th week?

   1. A400 micrograms
   2. B40 micrograms
   3. C40 milligrams
   4. D4 milligrams

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   Answer: A · 400 micrograms

   Folic acid 400 micrograms daily lowers the risk of neural tube defects when started at least a month before conception and continued to 12 weeks. A higher dose of 4-5 mg is kept for women at raised risk, such as those with a previous affected pregnancy, diabetes or antiepileptic use.

   • B: 40 micrograms is far below an effective preventive dose.
   • C: 40 mg is a toxic overdose with no extra benefit.
   • D: 4 mg is the high-risk dose, not the standard one.

   Remember this

   Standard periconceptional folic acid is 400 micrograms daily; high-risk women need 4-5 mg.

6. Question 6 · Hard

   An 82-year-old woman (52 kg) has a serum creatinine of 108 micromol/L and a urinary tract infection. Nitrofurantoin is prescribed. Using Cockcroft-Gault, which statement is correct?

   1. ACrCl about 29 mL/min; switch to ciprofloxacin at the full usual dose
   2. BCrCl about 34 mL/min; give nitrofurantoin at the usual dose
   3. CCrCl about 29 mL/min; avoid nitrofurantoin and choose fosfomycin
   4. DCrCl about 29 mL/min; give nitrofurantoin at half the usual dose

   Answer and explanation in LearnFree account

7. Question 7 · Easy

   Which antibiotic can be used safely to treat a respiratory tract infection in a pregnant woman?

   1. AAmoxicillin
   2. BDoxycycline
   3. CCiprofloxacin
   4. DStreptomycin

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8. Question 8 · Medium

   The mother of an 8-year-old with chickenpox asks for something to bring down his fever and itching. Which advice is correct?

   1. AGive paracetamol and avoid aspirin and ibuprofen
   2. BGive aspirin, which is the best antipyretic for children
   3. CGive diclofenac gel for the whole body
   4. DGive ibuprofen, which also treats the rash

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9. Question 9 · Medium

   A 12-week-pregnant woman has chronic hypertension and so is at high risk of pre-eclampsia. Which preventive measure is recommended?

   1. AAspirin 300 mg daily from 28 weeks until delivery
   2. BAspirin 75-150 mg daily from 12 weeks until delivery
   3. CClopidogrel 75 mg once daily from 12 weeks until delivery
   4. DEnoxaparin 40 mg daily from 12 weeks until delivery

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10. Question 10 · Hard

    A pregnant woman is stable on lithium at 800 mg daily with a level of 0.7 mmol/L. By the second trimester her level has fallen to 0.4 mmol/L. What explains this and what is the safest plan?

    1. ARaised GFR increases lithium clearance; monitor levels often and watch for a rise after delivery
    2. BFetal metabolism of lithium; double the dose and check levels yearly
    3. CReduced absorption in pregnancy; stop lithium for the rest of the pregnancy and restart after
    4. DIncreased protein binding of lithium; no change in monitoring is needed

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11. Question 11 · Easy

    Which anticoagulant is preferred for treating venous thromboembolism throughout pregnancy?

    1. AApixaban
    2. BWarfarin
    3. CRivaroxaban
    4. DEnoxaparin

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12. Question 12 · Medium

    A woman stable on levothyroxine 100 micrograms daily for hypothyroidism has a positive pregnancy test. What is the correct advice?

    1. AKeep the dose unchanged until delivery
    2. BStop levothyroxine in the first trimester because the fetus makes its own thyroxine
    3. CReduce the dose to avoid fetal thyrotoxicosis
    4. DIncrease the dose by about 25-30% and check TSH every 4-6 weeks

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13. Question 13 · Medium

    First-trimester exposure to which drug is linked with Ebstein anomaly of the fetal heart?

    1. ALithium
    2. BWarfarin
    3. CPhenytoin
    4. DValproate

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14. Question 14 · Medium

    A mother who is breastfeeding her 2-month-old infant needs treatment for postnatal depression. Which antidepressant is generally preferred?

    1. AFluoxetine
    2. BDoxepin
    3. CSertraline
    4. DLithium carbonate

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15. Question 15 · Hard

    An 80-year-old man with a creatinine clearance of 30 mL/min takes digoxin 250 micrograms daily and was started on amiodarone last week. He now has nausea, yellow-green vision and a heart rate of 44/min. What is the most likely cause and best action?

    1. AAmiodarone-induced hyperthyroidism; stop amiodarone and continue digoxin
    2. BHypokalaemia alone; give oral potassium and continue digoxin unchanged
    3. CViral gastroenteritis; give metoclopramide and reassure
    4. DDigoxin toxicity; withhold digoxin and check level and potassium

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16. Question 16 · Easy

    According to the Beers Criteria, which medicine is potentially inappropriate for a 78-year-old patient because of its strong anticholinergic effects?

    1. ADiphenhydramine
    2. BAtorvastatin
    3. CParacetamol
    4. DAmlodipine

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17. Question 17 · Medium

    A woman with hypertension taking ramipril 5 mg daily finds she is 8 weeks pregnant. Her blood pressure was 150/95 mmHg at the last visit. What is the best action?

    1. ASwitch to losartan, which is safe in pregnancy
    2. BContinue ramipril until the end of the first trimester
    3. CHalve the ramipril dose and monitor monthly
    4. DStop ramipril and switch to labetalol or nifedipine

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18. Question 18 · Hard

    A 10 kg child is prescribed ibuprofen 10 mg/kg per dose, with a limit of 40 mg/kg in 24 hours. The suspension is 100 mg per 5 mL. Which statement is correct?

    1. AEach dose is 10 mL, and at most 2 doses may be given in 24 hours
    2. BEach dose is 2.5 mL, and at most 8 doses may be given in 24 hours
    3. CEach dose is 5 mL, and at most 4 doses may be given in 24 hours
    4. DEach dose is 5 mL, and at most 8 doses may be given in 24 hours

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19. Question 19 · Hard

    A premature infant weighing 1.5 kg needs a caffeine citrate loading dose of 20 mg/kg for apnoea of prematurity. The injection contains 20 mg/mL. What volume is given?

    1. A3 mL
    2. B30 mL
    3. C1.5 mL
    4. D0.75 mL

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20. Question 20 · Easy

    Which analgesic is considered the safest first choice for a breastfeeding mother with a headache?

    1. AParacetamol
    2. BTramadol
    3. CHigh-dose aspirin
    4. DCodeine

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21. Question 21 · Medium

    A 78-year-old woman has taken omeprazole 20 mg daily for 2 years for mild dyspepsia. She has no history of ulcer, bleeding or Barrett oesophagus. What is the best step?

    1. ATry stopping or stepping down, with on-demand use if needed
    2. BContinue unchanged indefinitely without any further review or follow-up
    3. CDouble the dose to improve long-term symptom control
    4. DAdd ranitidine at night to prevent breakthrough symptoms

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22. Question 22 · Medium

    A woman at 38 weeks of pregnancy has an uncomplicated urinary tract infection. Which antibiotic should be avoided because of the risk to the newborn?

    1. AAmoxicillin
    2. BNitrofurantoin
    3. CFosfomycin trometamol
    4. DCefalexin

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23. Question 23 · Medium

    An elderly man with type 2 diabetes and an eGFR of 40 mL/min/1.73 m2 has repeated hypoglycaemia on glibenclamide. Which change is most appropriate?

    1. AIncrease the glibenclamide dose
    2. BStart a sliding-scale insulin regimen
    3. CAdd pioglitazone
    4. DSwitch to linagliptin

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24. Question 24 · Medium

    A healthy 74-year-old woman with no history of cardiovascular disease asks to start aspirin 75 mg daily to prevent a heart attack. What should the pharmacist advise?

    1. AStart 300 mg daily for a faster and much stronger preventive effect
    2. BDo not start it: bleeding risk outweighs benefit at this age
    3. CUse enteric-coated aspirin, which removes the bleeding risk
    4. DStart it, because every adult over 70 benefits from aspirin

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25. Question 25 · Medium

    A man of 80 with Alzheimer disease takes donepezil and now has urge incontinence. Which treatment is the best choice?

    1. ATolterodine
    2. BOxybutynin
    3. CMirabegron
    4. DHyoscine

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