Guild Intern Training Program

Oral Exam Practice – Mock Exam FOUR – ANSWER Guide

Preamble
This resource has been developed to be delivered as a preceptor/mentor-led exercise, in a ‘mock’ Oral
Examination style. Please review the materials below prior to conducting the ‘mock exam’ with your
intern. Do not share this answer guide with your intern as it will negate the point of this resource.
For more information regarding the Pharmacy Board of Australia (PBA) Oral Exam, please refer to the
candidate guide available here

Instructions
• Set aside with your intern a suitable length of time for this exercise (approximately 35 minutes)
• This ‘mock exam’ will be separated into three (3) sections, as per the PBA Oral Exam:
1. Part A: Primary Healthcare (10 mins)
2. Part B: Legal and Ethical Practice (5 mins)
3. Part C: Problem Solving and Communication (20 minutes)
• The preceptor/mentor will be required to role-play as the assessor/patient/doctor throughout the
exercise and only provide information to interns if/when correct patient history taking is
conducted
• The preceptor resource will have the complete set of details, including the answers for each case:
o Note that this resource is a guide and is not intended to supply all possible
answers/interpretations for the cases.
o Additionally, unless otherwise stated, the intern would not necessarily need to provide
ALL of the possible counselling points/answers for each case to be deemed competent.
o The preceptor is welcome to add their own professional/clinical or anecdotal advice to the
intern throughout the role-play to add to the intern’s experience.
• The intern resource will only include the case description, with limited details. It will be up to them
to provide the correct answers and elicit the required medical histories from you when required.

Disclaimer
The Guild Intern Training Program has made every effort to ensure that, at the date of publication, this
document is free from errors or omissions. Note that the Guild Intern Training Program and/or any person
associated with the preparation of this document accepts no liability for loss which a user of this document
may suffer as a result of reliance on this document for:
• Using this document not for its intended purpose
• Any interpretations or opinions stated in, or which may be inferred from, this document
• Errors, omissions or inaccuracy of information in this document

Q.NITP.F118.V2– Oral Exam Practice – Mock Exam FOUR – ANSWER Guide – January 2022

Part A: Primary Healthcare
Closed Book, 10 minutes
Part A: Primary Healthcare – Head Lice
Scenario A young man presents to the pharmacy requesting something for head lice.
Information Who is the patient?
Gathering
What are symptoms?
Duration of symptoms?
Action taken so far?
Other medication?
OTC/ complimentary
medications?
Medical conditions?
Allergies?
Pregnancy/Breastfeeding
Other notes (if asked):
Patient Identify condition and
Counselling explain nature of the
condition
Suitable product(s), how
they work and directions
Q.NITP.F118.V2– Oral Exam Practice – Mock Exam FOUR – ANSWER Guide – January 2022
Guild Intern Training Program
His 2 children, his wife and himself
Everyone in household has itchy scalp. Multiple live louse were seen
by wife while combing children’s hair
A few days
Nothing
No
Everyone in the family takes a multivitamin daily
Nil
Nil
Wife is pregnant
First time they have had head lice. Problem at school at the moment.
Children ages 4 and 7 years old.
Head lice – infestation with most common symptom being itching on
scalp, back of neck and behind ears. This is due to an allergic reaction
to the saliva of the louse.
• Permetherin 1% Lotion (Quellada Head Lice Treatment®) - Wash
with usual shampoo then apply 1% lotion to damp hair. Leave on
for 10 mins, rinse with warm water. Dry hair with towel. Use fine-
tooth comb to remove eggs/dead lice. Repeat after 7-10 days.
• Another possible option - Dimeticone (Hedrin®) considered safe
(although Permethrin preferred). Directions: Apply to dry hair,
ensuring it is completely covered from scalp to tip. Allow hair to
dry naturally. Wash out with shampoo after the specified time
(see package insert for full details). Use a fine-tooth comb to
remove eggs and dead lice. Repeat treatment after 7 days.
• Protect the patient’s eyes with a towel or face cloth. Wear gloves
when applying the product and wash hands after
• Potential adverse effects: irritation/swelling/redness
• After treatment, do not rewash hair for one to two days.
• In between chemical treatments, the wet-combing method
should be used twice to remove eggs. It should also be repeated
weekly for several weeks after cure.
• Wash pillow cases/bed sheets on hot cycle or place in a clothes
dryer for 15 minutes. Soak combs/brushes in hot water (over 60
°C) for at least 30 seconds. Place items that can’t be washed in a
sealed plastic bag for at least 2 weeks.
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• Preventative measures: tie hair back, avoid sharing hair brushes

/combs /hats /pillows, notify school etc
Malathion (KP24 ®) – not recommended in pregnancy
Post Scenario Unsuitable product(s)
Questions (if not Diagnosis is unclear, Signs of secondary infection, topical lice
Referral to GP if/when
already asked) treatments and physical methods have failed
required
References APF 25, AMH 2021, eMIMs

Q.NITP.F118.V2– Oral Exam Practice – Mock Exam FOUR – ANSWER Guide – January 2022
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Part B: Legal and Ethical Practice

Closed Book, 5 minutes

Guild Intern Training Program – Oral Mock Exam– Part B: Legal and Ethical Practice

Scenario A pharmacist constantly dispenses while on the phone, comes in late, dresses sloppily,
has bad breath and is a slow dispenser. You are not aware of any dispensing errors the
pharmacist has created at this stage. You are the Pharmacist-in-charge of the pharmacy,
how do you proceed?

Discuss legal Is the pharmacist in breach of the law? Would this constitute Mandatory Reporting?
considerations
Is the pharmacist posing a risk to the health of the public?
Is the pharmacist falling short of the Guidelines for Dispensing Medications if behaviours
continue regarding to ‘dispensing whilst on the phone’

Discuss ethical Could there be a personal reason impacting the pharmacist at this time?
considerations

Possible options for Inappropriate

action (appropriate • Do nothing – he hasn’t made any mistakes yet
and inappropriate) • Mandatory reporting of pharmacist without any further investigation or
reasonable belief that the pharmacist is behaving in a manner which would be
considered notifiable conduct

Appropriate
• Approach the pharmacist privately to discuss the issues –is a reason for his
behaviour? Is his slow dispensing is due to inefficiencies in the pharmacy etc
• Provide with a copy of the PBA prescribing guidelines and highlight areas of
concern
• Ask the pharmacist to review workplace policies around dress standards etc
• Schedule a meeting for review/discussion of these issues
• If behaviour does not change in a reasonable period of time, consider a formal
written warning

What is the action you There is no evidence to suggest the pharmacist is behaving in such a way that would be
would take to produce considered as notifiable conduct. The issue must be addressed in a discrete manner.
a satisfactory outcome
Approach the pharmacist privately to discuss the issues in a professional manner so that
and why?
they don’t feel embarrassed or under attack and are more willingly to openly discuss the
issues at hand.
Provide them with a copy of the PBA prescribing guidelines and highlight areas of
concern to review along with workplace policies around dress standards and personal
presentation. Schedule a meeting for follow up in a few weeks’ time to provide feedback.
Describe If an error is made this could lead to potential harm to public, which would also
consequences all negatively impact the business.
involved parties e.g.
Extra stress on other staff to compensate for his lateness
patient, doctor,
colleague If approached inappropriately – potential harm to mental health of pharmacist in
question
Poor presentation of staff member could negatively reflect on the business

Q.NITP.F118.V2– Oral Exam Practice – Mock Exam FOUR – ANSWER Guide – January 2022
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How could this Hold a staff meeting for all pharmacy staff to remind all staff of the dress code/personal
situation be prevented grooming expectations and importance of promptness
in the future
Educate all dispensary staff on the expectations and requirements outlined in the PBA
prescribing guidelines
Consider conducting regular performance reviews for all staff members
References
1. PBA Guidelines for mandatory notifications
• Not liking the way somebody does something or feeling they can do the job
better does NOT constitute reasonable belief of a mandatory notification
Notifiable conduct by registered health practitioners is defined as:

• practising while intoxicated by alcohol or drugs

• sexual misconduct in the practice of the profession
• placing the public at risk of substantial harm because of an impairment (health
issue), or
• placing the public at risk because of a significant departure from accepted
professional standards.

2. PBA Guideline for dispensing of Medications

Q.NITP.F118.V2– Oral Exam Practice – Mock Exam FOUR – ANSWER Guide – January 2022
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Part C: Problem Solving and Communication

Open book (intern may use their resources), 20 minutes

Case Presentation (Intern has the same copy)

Case Presentation RX
Mrs Chen presents to your pharmacy with the attached prescription. Patient: Mrs Ling Chen
Address: 101 Hypercholesteria
Rd, Brisbane

Rx: Rosuvastatin 40mg

Sig: 1 d
Rpt: 1

Dr M Li (RACP)
1256987
101 Heart Lane, Brisbane

Dispense History Medication Last dispense date Prescriber

6 days ago Dr P Zhang
Atorvastatin 80mg
1n
6 days ago Dr P Zhang
Perindopril 10mg
1d
6 days ago Dr P Zhang
Pantoprazole 20mg
1m
30 days ago Dr P Zhang
Atorvastatin 80mg
1n
30 days ago Dr P Zhang
Perindopril 10mg
1d
30 days ago Dr P Zhang
Pantoprazole 20mg
1m

Additional Information Mrs Chen has recently moved into the area to live with her daughter’s family.
She is in the pharmacy today with her daughter; they have just returned from a cardiology appointment.
Previously you have noticed Mrs Chen’s English is limited (her first language is Mandarin).

Q.NITP.F118.V2– Oral Exam Practice – Mock Exam FOUR – ANSWER Guide – January 2022
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Case Details (for Assessor use only)

- Rosuvastatin 40mg is a new medication for herself (from specialist this morning)
Information New Medication(s)
- Medical condition is high cholesterol (Hypercholesterolaemia)
Gathering and (incl. multiple)
Processing
Medication History Atorvastatin 80mg 1 daily: 6 months
(incl. duration of
Perindopril 10mg 1 daily: 1 year
therapy)
Pantoprazole 20mg 1 daily; 7 months
- Liquorice 300mg midday – to treat reflux (gastritis)1 – friend recommended it – past 3
OTC / Complimentary
months (NO, doctor is not aware)
Medications
- High cholesterol – not controlled optimally
Medical Conditions
- Blood pressure – controlled – still a little bit high according to the GP – especially in
the last 3 months
- Heartburn/GORD – most nights, especially if she eats too late
- English is not patient’s first language
Patient Issues
- Patient is of Asian descent (see medication issues)
- Codeine
Allergies
- No
Pregnancy/
Breastfeeding
- Patient may have a limited understanding of English – has daughter is present so the
Product Counselling Issues
intern can discuss with her rather than the patient.
Knowledge /
Counselling / Medication issues Rosuvastatin
Decision
making - Rosuvastatin is replacing Atorvastatin
- Rosuvastatin dose - Asian ancestry—use lowest starting dose as pharmacokinetic
studies indicate that people of Asian ancestry may need lower doses (40 mg daily
dose is contraindicated by manufacturer)2

Pantoprazole
- Patient is not getting optimal benefit from Pantoprazole 20mg – needs to use
liquorice, could consider increasing pantoprazole dose if needed:
o Pantoprazole monograph AMH5: Initially, oral/IV 40 mg once daily for 4–
8 weeks; If response inadequate, increase oral dose to 40 mg twice daily
for a further 4 weeks. Maintenance oral: reduce to minimum required.2
Liquorice
- Patient is taking Liquorice 300mg d to treat reflux symptoms
o Therapeutic doses of liquorice have been used to treat a variety of conditions,
including bronchitis, chronic gastritis, peptic ulcer, constipation, colic, dermatitis
and primary adrenocorticoid insufficiency1
o Anti-hypertensives: glycyrrhizin can cause sodium and water retention, which
may reduce effect of anti-hypertensives.1
o Avoid use in cardiovascular disorders (can cause fluid retention, hypernatraemia
and hypokalaemia).1
Referral to Tutor to play DR
GP/contact GP - Dr (Cardiologist) should be contacted with recommendation to start rosuvastatin
at 5mg 2 NOTE to tutor: if intern’s ask why Dr wanted to swap from atorvastatin to
rosuvastatin in the first place – it’s because the Dr recently had a visit from a drug rep
who suggested that ‘according to recent trials’ rosuvastatin has ‘more evidence’ for
reducing cholesterol in treatment resistant patients. Dr would therefore still like
patient to cease atorvastatin and start rosuvastatin at the lower dose of 5mg – he
will monitor and up-titrate according to response.

Q.NITP.F118.V2– Oral Exam Practice – Mock Exam FOUR – ANSWER Guide – January 2022
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- Dr (GP) should be contacted with regards to patient’s heartburn complaints

o Patient has been using liquorice to help with heartburn (may be the reason
for her recent uncontrolled hypertension) - recommend to the GP to
optimise current pantoprazole therapy to negate the need for Liquorice
o Dr can advise Intern to ask patient to see him tomorrow for review – no
change at this time is needed
o Alternatively → Intern can advise patient to speak to Dr about the
possibility of a dose increase etc.
- Dose of rosuvastatin adjusted to 5mg d2
Medication Change(s)
- Atorvastatin ceased
- Advise patient on possibility of increasing pantoprazole, as liquorice is to be ceased
(referral to GP to revise heartburn therapy)
- Effectively gather information on current medications including CAMs.
Summary
- Intern should identify patient is from Asian ancestry
- Intern to identify that rosuvastatin 40mg dose is not an appropriate starting dose for this patient2
- Intern should refer patient to the Dr for assessment of pantoprazole dose (cease Liquorice)
- Intern should counsel appropriately and effectively on how to use rosuvastatin including lifestyle factors on
how to reduce cholesterol
1. Sansom LN, ed. Australian pharmaceutical formulary and handbook. 25th edn. Complementary medicines
References
monographs: Liquorice. Canberra: Pharmaceutical Society of Australia, 2019.
2. Rossi S editor. Australian medicines handbook. Adelaide: Australian Medicines Handbook Pty Ltd; 2021

Q.NITP.F118.V2– Oral Exam Practice – Mock Exam FOUR – ANSWER Guide – January 2022