Guild Intern Training Program

Oral Exam Practice - Mock Exam NINE – 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.F174.V1 – Oral Exam Practice – Mock Exam NINE – Answer Guide – January 2022
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Part A: Primary Healthcare

Closed Book, 10 minutes

Part A: Primary Healthcare – Cold sore

Scenario A 21-year old male presents to the pharmacy wanting something for his lip.
Information Who is the patient? Himself (male- 21 years old)
Gathering What are symptoms? On right hand side of upper lip there is burning, tingling, pain and itching.
He mentions this happened 3 months ago and 2 years ago in the same spot
and both times it turned into a blister. He wants to see if he can prevent
the blister from occurring as he has to go to an important meeting
tomorrow that he is very stressed about.
Duration of symptoms? Since this morning.
Action taken so far? Put some ice on it, but that didn’t help.
Other medication? Sertraline 50mg
OTC/ complimentary Nil
medications?
Medical conditions? Depression.
Allergies? Nil.
Pregnancy/Breastfeeding No.

Other notes (if asked): No fever, no discharge, no pain inside the mouth, no swollen lymph nodes,
no symptoms anywhere else, patient is not immunocompromised, patient
has normal renal function.
Patient Counselling Identify condition and explain • This appears to be a cold sore, it is a common recurring viral infection
nature of the condition usually brought upon by a trigger e.g. illness, sunburn, stress etc.
• Avoid unnecessary touching of the area and wash hands if you touch
your lips.
• Avoid:
➢ sharing toothbrushes
➢ sharing drinking glasses or bottles
➢ sharing cutlery
➢ sharing towels or other personal items
➢ close contact (such as kissing and hugging) with newborn
and young babies
➢ kissing others
➢ close contact with children with burns or eczema
➢ close contact with people with suppressed immune
systems.

Suitable product(s), how they A cold sore should self-resolve within 14 days however if patient prefers to
work and directions treat there are a number of options available over the counter
(unscheduled, S2, S3) as below.

ANTI-VIRAL ORAL OPTION

• famciclovir 500mg X 3 tablets at once (Schedule 3)

ANTI-VIRAL TOPICAL OPTIONS

- Ensure to wash hand before and after application

• aciclovir 5% topical cream- applied 5 times a day for 4-5 days

OR
• penciclovir 1% topical cream- applied every 2 hours while awake for 4
days (at least 6 times a day)
OR
• idoxuridine 0.5%, lidocaine 2%- apply every hour for the first day and
then every 4 hours until lesion disappears.
• OR

Q.NITP.F174.V1 – Oral Exam Practice – Mock Exam NINE – Answer Guide – January 2022
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• aciclovir 5%, hydrocortisone 1% cream- apply 5 times a day for 5 days

Analgesics may be utilised if needed.

Cold sore hydrocolloid patches may be useful for healing and scab
prevention.
Post Scenario Unsuitable product(s) • Anti-fungal cream
Questions (if not
• Topical capsaicin
already asked)
Referral to GP if/when • Symptoms last longer than 14 days
required • Symptoms present on other areas of the body
• Any symptoms of a secondary bacterial infection- e.g. redness around
the blister, pus in the blister, fever.
• Painful mouth ulceration and poor oral intake
• Systemic symptoms
• >3 outbreaks a year
• Immunocompromised patient
References 1. APF 25, Non-prescription medicine guides, Guidance for provision of a Pharmacist Only medicine
Famciclovir
2. Better Health Channel, Cold Sores. Accessed: January 2022.
3. Australian Medicines Handbook, 2021.
4. MIMS, Accessed: December 2021.

Q.NITP.F174.V1 – Oral Exam Practice – Mock Exam NINE – 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 You have made a dispense error and supplied olanzapine 20mg instead of omeprazole 20mg. The
patient has come to the pharmacy feeling sedated and has symptoms of reflux after taking the
tablet for 4 days before realising. How do you proceed?
Discuss legal • Incorrect item has been supplied to the patient and patient has adverse effects.
considerations • Patient has not taken any legal action, though it would be important to inform your
professional indemnity insurance and appropriately handle this situation.
Discuss ethical • “A pharmacist makes the health and wellbeing of the patient their first priority” Care Principle
considerations 1, PSA Code of Ethics. (1)
• Patient is experiencing some adverse effects most likely from the medication error. Is the
patient OK?
• Patient may lose trust in the pharmacy/ pharmacist who dispensed the medicine.
• Were there contributing factors that contributed to the error that need to be addressed?
Possible options for Appropriate
action (appropriate and • Pharmacist to handle the incident, apologise to the patient, gather all contact details of the
inappropriate) patient, empathise and invite open discussion, do not offer compensation, do not mention
your insurance cover, call professional indemnity insurance, adequately document the
incident (including on patients dispense history), inform owner and manager of the
pharmacy, contact prescriber for advice and as a professional courtesy. – For further
information see PDL Guide to Incident Management. (2)
• In this case it would be appropriate to supply the patient with the correct medicine and
discard the incorrect medicine in the RUM bin as well as above steps.
• If needed after the incident contact Pharmacist Support Services or a psychologist if feeling
stressed/ worried/ anxious.

Inappropriate
• Offer compensation.
• Tell the patient you have insurance cover.
• Avoid contacting the prescriber.
• Blame the patient for not noticing earlier.
What is the action you • As above in appropriate action
would take to produce a • This approach would minimise harm to the patient and ensure all relevant parties are
satisfactory outcome and informed in a professional and timely manner. This approach also helps ensure that adequate
why?
documentation has been recorded in case needed for future reference.

Describe consequences • Appropriately handling the situation minimises future harm to the patient and ensures
all involved parties e.g. problem is resolved in a timely manner with respect given to the patient and prescriber.
patient, doctor, • Inappropriately handling the situation may cause harm to the patient, lack of trust in
colleague pharmacy/ pharmacist from the prescriber and patient (if honest prompt communication is
not taken), pharmacist may become stressed/ anxious if they have taken inappropriate action
to resolve the situation.
How could this situation “Minimising risk to patients or clients is an important component of practice” (3)
be prevented in the
future ➢ Identify system issues and create an action plan to help reduce risk of errors.
➢ Use barcode scanners. (4)
➢ It is necessary that medicines are checked throughout the process of dispensing (including
at the time of supply). (4)
➢ Workload should be reasonable and manageable. (4)
➢ Workflow- distractions minimised during process of dispensing. (4)
➢ Review PDL Guide to Good Dispensing, PBA Guidelines for Dispensing of Medicines, PBA
Code of Conduct (2, 3, 4)
➢ Identification of look alike, sound alike drugs.

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➢ Identification of factors that may have predisposed the pharmacist to making the error
(review and reflect).
(NB: The above is list is not exhaustive)

References 1. PSA Code of Ethics for Pharmacists. Available: https://www.psa.org.au/practice-support-

industry/ethics/
2. PDL Guide to Incident Management. Available: www.pdl.org.au
3. Pharmacy Board of Australia: Code of Conduct (March 2014). Available:
https://www.pharmacyboard.gov.au/Codes-Guidelines.aspx
4. Pharmacy Board of Australia: Guidelines for Dispensing of Medicines (December 2015)..
Available: https://www.pharmacyboard.gov.au/Codes-Guidelines.aspx

Q.NITP.F174.V1 – Oral Exam Practice – Mock Exam NINE – 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
Complex Case Scenario
Case Presentation RX:
Mr. Farmer presents to your pharmacy with a prescription for
Endep® which he would like to have filled. Dr. Smith
Mr. Farmer

Endep® 25mg Qty 50

1 at night
1 rpt

Dispense History Medication Last dispense date Prescriber

Paracetamol 500mg 1 day ago Dr. Smith

2 tablets four times a day if
needed
QTY: 100 tabs

Valaciclovir 500mg 1 day ago Dr. Smith

1 daily for 1 week
QTY: 60 tabs

Rizatriptan 10mg wafters 4 weeks ago Dr. Smith

1 as needed (Max 3 in 24 hours)
QTY: 4 tabs

Additional Information Mr Farmer is a 35-year-old male.

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Case Details (for Assessor use only)

Information New Medication(s) Endep® is a new medication for this patient to be taken one at night. If intern asks what it is for
Gathering and (incl. multiple) please advise it is for ‘shingles pain’. The Endep® has not been prescribed for depression. The
Processing patient had symptoms of shingles yesterday and was immediately prescribed antiviral therapy by
GP. Shingles blisters on the right-hand side of the back.

Medication History - Paracetamol 500mg 2 four times a day was prescribed yesterday for pain associated with
(incl. duration of shingles and the patient is taking 2 tablets three times a day for pain associated with
therapy) shingles- finding it not effective.
- Valaciclovir 500mg 1 daily was prescribed yesterday for shingles.
- The pain that the patient has from the shingles is very severe.

OTC / Ibuprofen 2 three times a day for acute shingles pain

Complimentary
Medications
Medical Conditions Shingles- diagnosed yesterday, on right hand side of back.
Migraines- gets occasionally, uses rizatriptan once every few months.
Patient Details Mr. Farmer is 35 years old.

BMI= 24
Smoking status = nil
Alcohol = 1 drink per week
Exercise= 5 times a week at the gym
Nutrition = eats very healthy
Vaccinations = up to date
Renal function = normal for age
Immunocompromised= no

Allergies Nil known.

Pregnancy/ No
Breastfeeding
Product Medication issues Intern to identify:
Knowledge / - PRIMARY ISSUE: The dose of valaciclovir prescribed yesterday was an underdose and needs
Counselling / to be increased.
Decision making - If intern advises that Endep® dose is too high of a starting dose – advise you as the
prescriber are happy with a 25mg starting dose.

Medication Intern should contact Dr. Smith:

change/contact GP 1. Recommend change of dose of valaciclovir from 500mg once daily for 7 days to 1g three
times a day for 7 days.

GP Response - Thank intern pharmacist for identifying issue with the valaciclovir dose. Request that the patient be counselled on
the new dose. 1g three times a day = 2 tablets three times a day.

Intern - Inform patient on new dose of anti-viral, reassure patient an effective dose is still being commenced within the 72
Counselling hours of rash’s first appearance.

Exam Result - Top marks: Valaciclovir dose increased to 2 tablets three times a day with appropriate counselling.
- Not successful: if intern fails to recognise the incorrect dose, if intern recommends Herpes Zoster vaccination.

References 1. Rossi S editor. Australian medicines handbook. Adelaide: Australian Medicines Handbook Pty Ltd; 2021
2. eTG, 2021

Q.NITP.F174.V1 – Oral Exam Practice – Mock Exam NINE – Answer Guide – January 2022