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Contents
Basics of writing prescription 2
Approach to write step by step 4
Palliative care stations 9
VTE prophylaxis stations 19
DVT and PE stations 27
Non valvar AF 34
CAP and COPD exacerbation stations 41
Urinary tract infection stations 52
Methotrexate and infection stations 59
Pre-operative prophylaxis stations 62
Lithium stations 67
Pediatric stations (QUINSY) 71
PROM 78
MRSA 81
Cellulitis ( diabetic foot) 88
Pain control 91
GP prescription 95
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Basics of writing prescription

 Only use a black pen. Other ink colors for other staff members.
 DRUGS ALWAYS IN CAPITAL LETTERS.
 Prescription must include the patient's surname and given name,
DOB, date of admission. There will be a sticker to fix.
 Fill the patient data and hospital from the handover notes in both
charts, it’s your data gathering marks.
 Both positive and negative allergy histories and drug sensitivities
MUST be
documented.
 Where allergy history is positive, symptoms of the allergy should
be described.
 For antibiotics:
 Always have start and stop date.
 Always have specific indication.
 Don’t forget the gem box to add notes to specify if the drug
will continue for more than 5 days.
 Always write specified times.
 Any IV route mention in the additional information box (switch
IV-PO ASAP)
 For regular drugs:
 Write year and start date at the top of paper only.
 For as required prescriptions:
 the indication should be included.
 the minimum dose interval must be specified (6hours
NOT QDS)
 NO trailing zeroes (5mg NOT 5.0mg)
 Quantities less than 1g should be written in milligrams (500mg not
0.5g)
 Quantities less than 1mg should be written in micrograms
(100micrograms not
0.1mg)
 When decimals are unavoidable the decimal point must be preceded
by another figure (0.5ml not .5ml)
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 Dose units, the words micrograms, Nano grams and units must
not be abbreviated.
 The term milliliter is abbreviated to ml not cc or cm3

 Only the following abbreviations are to be used to describe the route

of administration:
 IV – intravenous // SC – subcutaneous // IM – intramuscular
 NEB – nebulized // PO –oral // TOP – topical // PV – vaginal
 INH – inhalation /// PR – rectal
 All other routes of administration must be written out in full, e.g.
intrathecal, epidural,
sublingual, buccal.
 Prescribers must specify the precise location or area to be covered for
topical drugs. for example: MUPIROCIN OINTMENT (1
application in dose box – apply to each nostril in additional
information box)
 YOUR DATA GATHERING MARKS:
 Patient data and hospital data in each chart provided.
 Allergies if its positive or negative
 YOUR IPS MARKS:
 Enter the station confident maintain eye contact and greet your
examiner.
 Always leave your table tidy and organized by closing BNF or
returning chart and everything to its place and close your pen.
 Thank the examiner before leaving.
 Your handwriting should be clear and easy to read and don’t write
anything in other staff boxes.
 If there was a mistake don’t cross out and try to rewrite just fill
another box.
 YOUR MANAGEMENT MARKS:
 It’s your task to write drugs in the stem and open bnf in almost
every scenario.
 Fill and complete your task drug by drug don’t leave drug without
complete boxes including your name and bleep number provided
in handover notes.
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Approach step by step

1. Read your stem well sometimes there might be a
hidden task,(fever or pain mentioned without direct
indication)

2. Write your name and GMC number at the top of 1st

paper and fluid chart or syringe chart if provided.

3. Start fix the sticker and put data from handover note
in 1st and 3rd paper and top of any extra charts
provided e.g IV fluid or syringe driver charts.

4. State the patient allergies whether they have or not

and write your name and signature and exam date.

5. Tick the boxes of VTE assessment or MRSA boxes if

needed in the scenario.

6. Write the year and date of your exam in the

designated box in regular medication paper if you are
using it.

7. Start with your task as most of the management marks

on our task i.e. the the new drug you're prescribing for
the patient, using the BNF and any required
modifications of old drugs the patient has been using
for any chronic medical condition, then write their old
drugs. One drug at fully at a time to secure most of
the management marks
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LETS PRACTICE:
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PATIENT HANDOVER NOTES

Hospital name: Manchester Royal hospital

Hospital number: 112233

Ward: Palliative department

Date of admission: 31/12/2023

Consultant: Dr Adam Jones

Patient name: Mrs. Victoria Yates

Date of birth: 15/06/1944

Address: 12 priory ST, M23 3CH, Manchester

NHS number: 123456

Weight: 60 kg

Height: 165 cm

Bleep number: 1111

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PALLIATIVE CARE (1)

Who are you:

You are FY2 in palliative department

Who the patient is:

Mrs. Victoria Yates, aged 80, is diagnosed with metastatic
pancreatic cancer.

Other information you have about the patient:

Patient is terminal. Palliative care has been prescribed. She has
been referred from hospital to hospice for the continuation of
palliative care. She cannot eat or drink very well.

What you must do:

Write down the prescription of her palliative care medications
Plan: she will be discharged to hospice for palliative care with the
following medications:
Morphine 5mg SC every 4 hours (max 6 doses) for pain
Cyclizine 50mg TDS SC for nausea and vomiting
Midazolam 2.5mg SC 4 hourly (max 6 doses) for agitation
Hyoscine bromide 400 micrograms SC 4 hourly (max 2.4mg) for
secretion
Paracetamol 1g PO every 4 to 6 hours (max 4g/day) for pain
Atorvastatin 10mg PO OD
Kindly note, patient is allergic to penicillin when she took it she developed
breathlessness
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01/01 1111

01/01 1111
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PALLIATIVE CARE (2)

Who are you:

You are FY2 in palliative department
Who the patient is:
Mrs. Victoria Yates, aged 80, is diagnosed with metastatic
pancreatic cancer.
Other information you have about the patient:
Patient is terminal. Palliative care has been prescribed. She has
been referred from hospital to hospice for the continuation of
palliative care. She cannot eat or drink very well.
What you must do:
Write down the prescription of her palliative care medications
Plan: she will be discharged to hospice for palliative care with the
following medications:
 Morphine for pain via syringe driver 30 mg per 24 hours SC.
 Morphine for breakthrough pain
 Cyclizine 50mg TDS SC for nausea and vomiting
 Midazolam 2.5mg SC 4 hourly (max 6 doses) for agitation
 Hyoscine butylbromide 20 milligram SC 4 hourly for
secretion
 Paracetamol 1g PO every 4 to 6 hours (max 4g/day) for pain
 Atorvastatin 10mg PO OD
Hospital Handover Notes:
Patient name: Victoria Yates Date of Birth: 25/03/1942
NHS Number: 123456 Consultant: Dr. Jake Smith
Hospital: Manchester hospital Bleep number: 1111
Allergy: Penicillin Reaction: Breathlessness
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refer to syringe driver chart

01/01 1111

01/01 1111
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PALLIATIVE CARE (3)

Who are you:
You are FY2 in palliative department
Who the patient is:
Mrs Victoria Yates, aged 80, is diagnosed with metastatic
pancreatic cancer.
Other information you have about the patient:
Patient is terminal. Palliative care has been prescribed. She has
been referred from hospital to hospice for the continuation of
palliative care. She cannot eat or drink very well.
What you must do:
Write down the prescription of her palliative care medications
Plan: she will be discharged to hospice for palliative care with the
following medications:
• Diamorphine hydrochloride 5 SC every 4 hours (max 6 doses)
for pain
• Cyclizine 50mg TDS SC for nausea and vomiting
• Midazolam 2.5mg SC 4 hourly (max 6 doses) for agitation
• Hyoscine hydrobromide 400 micrograms SC 4 hourly (max
2.4mg) for secretion
• Paracetamol 1g PO every 4 to 6 hours (max 4g/day) for pain
• Atorvastatin 10mg PO OD
Hospital Handover Notes:
Patient name: Victoria Yates Date of Birth: 25/03/1942
NHS Number: 123456 Consultant: Dr. Jake Smith
Hospital: Manchester hospital Bleep number: 1234
Allergy: Penicillin Reaction: Breathlessness
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1234

1234

01/01

01/01
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Palliative care (4)

Who are you:

Fy2 in the palliative department.

Your patient:
Mrs Victoria Yates, aged 80, is diagnosed with metastatic
pancreatic cancer. She is on palliative care and can’t eat and drink
well.

Other notes:
Patient is on diamorphine SC syringe driver of 5 gm per day.
Yesterday, she received a total of 6 mg of diamorphine to control
her pain and she vomited once due to the pain.
She is allergic to penicillin when she took it developed
breathlessness.

Your task:
Review her medication and make adjustment if required.
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Cases discussion
 Try to memorize doses, drug names, and indication of each drug
sometimes it won’t be provided in the stem.
 Open the BNF on palliative care pages pick any drug and open on it.
Rules for breakthrough pain:
 any patient on syringe driver for pain killer need to be prescribed
breakthrough pain whether it’s mentioned directly on the stem or not.
 To calculate it, divide the 24hours dose by 6 or by 10.
 Example: MORPHINE over 24 hour of 30 mg dose  30/6= 5 so
dose in breakthrough pain is 5 mg 4 hourly in as required chart and
indication will be breakthrough
pain.
 Any patient received 2 or more
doses of the breakthrough pain,
then his pain is not controlled and
dose of the syringe need to be
adjusted and increased
accordingly.
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VTE Risk Assessment

Where are you:

You are FY2 in obstetrics & gynecology

Who the patient is:

Miss Daniella Halifax, aged 42, had her 4th delivery
yesterday, she lost 1.5 L blood yesterday.

Other information you have about the patient:

No known allergy
She has not been diagnosed with any past medical history
Her weight is 93 kg.
She had multiple perineal stitches and she is in pain.

Special Note:
None

What you must do:

Do DVT risk assessment and prescribe VTE prophylaxis if
needed.
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VTE prophylaxis in admitted patient

Who are you:

Fy2 in AMU

Your patient:
Danny smith 65 years old admitted after having a fall. He is
having hypertension and osteoporosis.

Other notes:
He is on amlodipine 10mg OD, alendronic acid 70 mg one
tablet weekly on Tuesday, co-codamol 8/500 2 tablet prn
max QDS, atorvastatin 20 mg once daily, calcihew2-d3 1
tab in the afternoon, levothyroxine 75 mcg.
No know allergies.

Your task:
Prescribe VTE prophylaxis and his other medication.
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75 micrograms
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1234

Case discussion
Postnatal VTE risk assessment:
 Chart will be provided pick risk factor from the
question(could be mentioned C section or had
prolonged delivery ..etc) and apply it to the chart to get
whether the patient is moderate or high risk to
determine the duration of the drug.
 Patient weight will determine the dose.
 Don’t forget to tick the VTE risk assessment boxes.
 Don’t forget patient in pain so prescribe pain killer
even the task does not mention it. (open the BNF on it)
 If patient is breast feeding chose enoxaparin from the
chart. It’s the safest option in breast feeding.
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VTE prophylaxis in medical patient:

 Open the BNF on dalteparin.
 Tick the boxes.
 Don’t forget that alendronic acid is on empty somach.
 Duration might be determined by consultant.
 Co-codamol 8/500 is the drug name and write in the
gem box its combination (paracetamol/codeine
phosphate).
 If the patient has low egfr switch to unfractionated
heparin.
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Pulmonary embolism

Where are you:

You are FY2 in Medicine

Who the patient is:

Miss Hannah Knowles, aged 60, has been admitted to the hospital
because of breathlessness.
She was diagnosed with pulmonary embolism and was managed
in the hospital

Other information you have about the patient:

She is a diagnosed case of hypercholesterolemia. She had a long-
haul flight 10 days ago. She was prescribed the following
medications:
○ Apixaban for 6 months
○ Atorvastatin 20mg OD
○ Aspirin 75mg OD
eGFR is 87, D-dimer is increased

Special Note
Patient is allergic to codeine. She gets itching after taking
codeine

What you must do:

Write down the prescription for the above medications
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DVT

Where you are:

You are an FY2 in A&E.

Who the patient is:

Mr Harry Warrington, aged 47, has been diagnosed with
DVT.

Other information you have about the patient:

Regular medication:
Amlodipine 10mg OD PO
Aspirin 75 OD PO
Paracetamol 1g QID

What you must do

Prescribe: Rivaroxaban
Special note:
None
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Case discussion
PE and apixaban:
 Ignore aspirin as you can’t prescribe 2 blood thinners
at the same time.
 Apixaban has a loading and maintenance dose.
 Open the BNF on apixaban

DVT and Rivaroxaban:

 Same as PE
 Rivaroxaban has loading and maintenance dose.
 To be taken with food in the additional information
box.
 Change the dose in the additional information box by
stating dose and date of changing. (NOT IN NEW
BOX)
 Open the BNF on it.
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Non valvular atrial fibrillation

Where Are you:

You are FY2 in Medicine
Who the patient is:
Mrs. Andrea Brighton, aged 81, was diagnosed with non-
valvular atrial fibrillations
Other information you have about the
patient:
Patient had CABG 10 years ago
Sr. creatinine is 152 µmol/L
Patient was prescribed apixaban and atenolol
Special Note:
patient has been admitted to the hospital 3 days ago with
acute exacerbation of COPD.
He is on doxycycline salbutamol prn, prednisolone and
Dalteparin.
Has allergy to penicillin and clarithromycin.

What you must do:

Write down the prescription for the above medications
Handover notes:
Your bleep number: 1234
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write your exam date in

that box
04/
01

STOP 04/01/24
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Case discussion
 Admitted patient so there was a Dr already prescribed
him medication following their initial presentaion.
 Your role is to add medication .
 Open the BNF on apixaban and atenolol(if dose not
provided)
 STOP DALTEPARIN as patient can’t be on 2 blood
thinners.
 Be aware of the patient age, eGFR and serum
creatinine.
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Community acquired pneumonia (1)

Where Are you:

You are FY2 in A&E

Who the patient is:

Mr. Jamie Strauss, aged 55, was admitted with breathlessness and
cough. He was diagnosed with community acquired pneumonia in
the hospital. Consultant has reviewed the patient and planned to
start him on clarithromycin 500mg PO BD for 5 days

Other information you have about the patient:

Other regular medications:
○ Salbutamol 200 microgram (1-2 puff PRN) up to 4 times a day
○ Seretide 250 evohaler 1 puff BD
○ Ipratropium bromide 40 microgram (1-2 puffs BD)
○ Prednisolone 30mg PO OD 7 days
○ Aspirin 75mg PO OD
○ Ramipril 2.5mg PO OD
○ Levothyroxine 50 microgram PO OD
○ Atorvastatin 20mg PO OD
Special Note: None

What you must do:

Write down the prescription for the above medications
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75 mg
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1-2 puffs

Case discussion
 Interaction between clarithromycin and statins, so open the
bnf on macrolides or statins interaction section .
 Start with your task (CLARITHROMYCIN) then
ATORVASTATIN then PREDNISOLONE then the rest of
drugs.

 If question mentioned to prescribe Doxycycline then follow

the task and prescribe Doxycycline, however dont stop
atorvastatin her.
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Community acquired pneumonia (2)

Where Are you:

- You are FY2 in A&E

Who the patient is:

- Mr. Jamie Strauss, aged 55, was admitted with breathlessness
and cough. He was diagnosed with community acquired
pneumonia in the hospital. Consultant has reviewed the patient
and planned to start him on IV Co-Amoxiclav 1000mg BD for 7
days. With low flow oxygen
(Venturi Mask).

Other information you have about the patient:

- Other regular medications :
- Salbutamol 200 microgram (1-2 puff PRN) up to 4 times a day.
- Seretide 250 evohaler 1 puff BD.
- Ipratropium bromide 40 microgram (1-2 puffs BD).
- Prednisolone 30mg PO OD for 5 days.
- Aspirin 75mg PO OD.

Special Note:
- The patient is allergic to penicillin and codeine. Develops rash
for both.
- Has HTN, CHL, and COPD.

What you must do

- Write down the prescription for the above medications
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01/
01

your name and sign 1234

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1-2 puffs
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Case discussion

 When change antibiotic change to the same route asked

for in your task ( IVIV)
 Search for alternatives in infection chapter or
memorize the drug and open on it directly.
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Acute exacerbation of COPD

Where Are you:

You are FY2 in Medicine

Who the patient is:

Mr. Holmes Knowles, aged 60, has been admitted to the
hospital because of breathlessness and cough.

Other information you have about the patient:

Pt admitted to the ward for acute exacerbation of COPD.
Prescribe Clarithromycin and regular medications.

OTHER MEDICATION:
Seretide 250 EVOHALER one puff BD
SALBUTAMOL 100 mcg, 1-2 puff, 6 hourly, PRN
TERBUTALINE 2 puffs, 6 hourly, PRN.
TADALAFIL 2.5 mg, PO, PRN for erectile dysfunction,
max dose 2.5 mg.

Special Note:
Patient is allergic to PENICILLIN AND
CLARITHROMYCIN/AZITHROMYCIN. He gets itching.

What you must do:

Write down the prescription for the above medications.
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SOB

Case discussion
 Open the BNF on infection chapter to get the alternative or just
memorize its doxycycline and open the BNF on it directly.
 Doxycycline has a loading and maintenance dose
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Urinary tract infection (1)

Where are you:

You are FY2 in medicine

Who the patient is:

Miss Rachel Trunk, aged 30, has come to you with burning
micturition

Other information you have about the patient:

She was prescribed nitrofurantoin for suspected UTI. A urine
sample was collected and sent for culture and sensitivity.

Other medications:
○ Amlodipine 10mg OD
○ Paracetamol PRN max 4 grams

Special Note:
Patient is allergic to penicillin. After taking penicillin patient
developed rash.

What you must do :

Write down the prescription for the above medications, check dose
and write down the antibiotic.
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pain / fever
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Urinary tract infection (2)

Where are you:

You are FY2 in medicine

Who the patient is:

Mr Tommy Trunk, aged 65, has come to you with burning
micturition

Other information you have about the patient:

He was prescribed nitrofurantoin for suspected UTI .He has a past
history of hypertension.
eGFR: 35 ml/min
K level : 5.35

Other medications:
Amlodipine 10mg OD
Ramipril 5 mg OD
Paracetamol PRN max 4 grams

Special Note:
Patient is allergic to penicillin. After taking penicillin patient
developed rash.

What you must do :

Write down the prescription for the above medications, check dose
and write down the antibiotic.
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stop ramipril
monitor BP/ K levels / eGFR- order ECG
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pain / fever

Case discussion

UTI

Male / preganancy
/Catheter associated --> 7 Female --> 3 days
days

 Any UTI station you have to look at kidney function if

provided.
 Nitrofurantoin can’t be given if eGFR < 45ml/min, change to
trimethoprim.
 Open the BNF on NITROFURANTOIN or
TRIMETHOPRIM.
 TRIMETHOPRIM interact with RAMIPRIL as both increase
K level so if k level > 5 mmol/L, you need to stop
RAMIPRIL AND MONITOR K level.
 Sometimes they mention that patient experience postural
hypotension.
 NITROFURANTOIN C/I near term, change it to
TRIMETHOPRIM.
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Methotrexate and infection

Where are you:

You are FY2 in Medicine

Who the patient is:

Miss Sally Rude, aged 80, has been diagnosed with acute
Pyelonephritis. She has a history of Rheumatoid Arthritis. She has
Hypertension. Weight of the patient is 65 kg.

Other information you have about the patient:

eGFR is 40.
Regular medications are
○ Amlodipine 10mg OD
○ Methotrexate 7.5mg once weekly every Tuesday
○ Folic acid 5mg once weekly/ daily except Tuesday

Special Note:
Patient is allergic to Clarithromycin. Patient had itching.

What you must do:

Consultant had requested you to start her on Cefalexin
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7.5 mg
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Case discussion
 Open the BNF on cefalexin to pick the dose and look at renal
impairment modifications.
 Stop methotrexate during active infection as its
immunosuppressant.
 Don’t give folic acid in same day as methotrexate.
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Acute pancreatitis

Where Are you:

You are FY2 in Medicine

Who the patient is:

Miss Hannah Knowles, aged 60, has been diagnosed with acute
pancreatitis, patient is having cholecystectomy after 2 days.
She has a past medical history of DVT and asthma.

Other information you have about the patient:

Prescribe MEROPENAM 500 mg TDS.
Hartman fluid.

OTHER MEDICATION:
Seretide 250 EVOHALER one puff BD
Salbutamol 100 microgram 1-2 puffs 6 hourly prn
AMLODIPINE 10 mg
Apixaban 10 mg OD for DVT

Special Note:
Patient is allergic to PENICILLIN. She gets RASH.
Patient weight is 65 kg

What you must do:

Write down the prescription for the above medications
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OR IF THE STEM DID NOT MENTION FLUID TYPE

1234

1234
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Case discussion
Be on the safe side and avoid meropenem and cefurxime and
prescribe (GENTAMYCIN AND METRONIDZAOLE) as there is
allergy.

You can write them in once only chart.

Since the surgery is after 2 days, write the dates 2 days after your
exam date.
Antibiotics can be taken up to 30 minutes before operation.

If the state the fluid type Hartmann’s, then prescribe it. If the stem
doesn’t mention the type then you can give (4%
DEXTROSE/0.18% SALINE), but don’t forget to add KCL.
(20mmol/L for each bag)

If the patient is on APIXABAN then you have to stop 48

hours before surgery.
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Lithium and pain killer

Where are you:

You are FY2 in psychiatry ward

Who the patient is:

Mr. Robert Washington, aged 50, has hurt his ankle and is in
severe pain

Other information you have about the patient:

He has been diagnosed with COPD and bipolar disorder.
Regular medications:
○ Ipratropium bromide 20 microgram (1-2 puffs BD)
○ Atorvastatin 20mg PO OD
○ Lithium 300 mg PO OD

Special Note:
Patient is allergic to penicillin. After taking penicillin patient
developed rash.

What you must do:

Write down the prescription for Ibuprofen
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OR
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Case discussion
Lithium has narrow therapeutic/toxic ratio so you should be
careful with its level.

You can write NSAIDS but you need to monitor levels of lithuim
and adjust dose accordingly .

It's better to change it to PARACETAMOL.

Open the BNF at the appendix 1 to reach interaction between
lithium and NSAIDs.
If there is a patient with renal impariment avoid NSAIDs.(if
necessary; use with caution).
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Peritonsillar abscess (Quinsy)

Where are you:
You are FY2 in Medicine

Who the patient is:

Tracy Yates, aged 6 years, has been diagnosed with peritonsillar
abscess (quinsy). She was managed in the ER. There are no signs
of dehydration. Patient has difficulty swallowing, Weight of the
child is 23 kg.

Other information you have about the patient:

Consultant has advised the following medications:
○ Phenoxymethylpenicillin
○ Metronidazole
○ IV fluids maintenance

Special Note:
Patient is allergic to clarithromycin. Patient had itching

What you must do:

Write down the prescription for the above medications. Check
doses with BNF. Calculate the fluid dose
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switch IV-PO ASAP

switch IV-PO ASAP

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your sign e.g

KCL 10 mmol J.Smith
your sign e.g
KCL 10 mmol J.Smith
your sign e.g
KCL 10 mmol J.Smith

Case discussion
 Quinsy is complication of throat infection so its serious
disease and needs initially IV antibiotics while
phenoxymethyl penicillin not present in IV formula you need
to change it to BENZYLPENICILLIN SODIUM.
 Sometimes they don’t comment of ability to swallow, either
ways we prescribe IV anbtibiotics.
 Whether patient is dehydrated or not we are always asked
to prescribe maintenance fluids.
 Open the BNF on BENZYLPENICLLIN SODUIM and
METRONIDAZOLE to pick the dose.
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 If the duration is not in the stem, guidelines state that

treatment should be from 5 to 10 days, start with 5 days.
 Try to memorize doses and write your task first then open the BNF
on the drugs (25mg/kg/dose 6hourly for BENZYLPENICLLIN
SODIUM and 7.5 mg/kg/dose 8hourly for METRONIDAZOLE)
 If the question mentioning HARTMAN'S then prescribe
HARTMAN'S

 FLUID CHART: (type of fluid / amount / rate)

 Type: always in children maintenance fluid is (0.9%
NaCl/5% GLUCOSE) + 10 mmol/l KCL in the additives
 Amount: 1st 10 kg  multiply by 100
2nd 10 kg  multiply by 50
More than 20  multiply by 20
 Rate: divide the whole amount by 24 hours
 This station: 23 kg patient  (10*100 = 1000) +
(10*50=500) +(3*20=60) = 1560 ml per day .
Divide over 24 hours 1560/24=65ml/hr
Or you can do it through the chart itself
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Lower respiratory tract infection

Who are you:

Fy2 in the pediatric department.

Your patient:
Lucy smith 1-year-old patient diagnosed with lower respiratory
tract infection.
Weight is 9kg

Other notes :
None

Your task:
Consultant prescribed cefuroxime and cholrpheniramine 2.5 mg
IM max 4 times a day as required.
Patient no eating well so prescribe maintenance fluids.
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36

your sign e.g

KCL 10 mmol J.Smith
your sign e.g
KCL 10 mmol J.Smith

Case discussion
Open the BNFc on CEFUROXIME to pick the dose
(20mg/kg/dose 8 hourly
Fluids chart like previous station.  (9*100=900) – (900/24=36
ml/hr)
Chlorpheniramine is for allergy.
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PROM

Where are you:

You are FY2 in Obstetric & gynecology

Who the patient is:

Miss Maria Adam 34 week pregnant presented with premature
rupture of membranes.

Other information you have about the patient:

No past medical history
Regular medications
Calcichew-D3 orally once daily
Metformin 500mg TDS

Special Note:
Patient allergic to Penicillin. Reaction – Rash

What you must do:

Prescribe Dexamethasone
Erythromycin.
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2
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Case discussion
Sometimes ERYTHROMYCIN and DEXAMETHASONE doses
will not be in the stem as new BNF contain this specific indication
with doses and duration.
ERYTHROMYCIN

DEXAMETHASONE

Antibiotic administration:
In the UK, both the National Institute for Health and Care Excellence (NICE) and the
Royal College of Obstetricians and Gynecologists (RCOG) recommend the use of
ERYTHROMYCIN 250 mg qds for 10 days (or until labour is established if this is
sooner)
- Corticosteroid prophylaxis:
Between 24+0 and 33+6 weeks of gestation women should be offered a single course of
antenatal corticosteroids i.e. Dexamethasone 12mg intramuscular. Two bolus doses 24
hours apart.
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MRSA
Where are you:
You are FY2 in MRSA Ward

Who the patient is:

Mr. David Halifax, Aged 82, has been diagnosed with MRSA skin
infection

Other information you have about the patient:

Patient was on the following medications:-
● Amlodipine 10mg OD
● Paracetamol PRN (max 4 gram)
● Mupirocin ointment BD 5 Days
● Vancomycin
Weight is 80 kg
eGFR - normal

Special Note:
Patient is allergic to penicillin. After taking penicillin patient
developed a rash.

What you must do:

Write down the prescription for the above medications, Check
dose and write down vancomycin.
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N.B:
Vancomycin drug chart should be provided in the exam, if it’s not
then use the BNF
Directions of usage according to the relevant indication.
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Case discussion
 You will have the chart in the exam so you will need to
check the notes for patient weight to get the loading dose and
the volume of dilution and duration.
 Check egfr for the dose and intervals and volume of dilution.
 Check the chart for monitoring the dose.
 Mupirocin is a drug with different preparation and different
concentrations so you need to write the full name
(MUPIROCIN 2% OINTMENT). You need to state the
location of application.
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Cellulitis (diabetic foot)

Where Are you:

You are FY2 in Surgery

Who the patient is:

Mr. Rio Fernandes, aged 50, has been admitted due to cellulitis
(Diabetic Foot)

Other information you have about the patient:

Patient was diagnosed with Diabetes 5 years ago. He is on
Metformin 500mg TDS PO. He is also using paracetamol 1 g PRN
maximum 4 doses a day.

Special Note:
Patient is allergic to Penicillin. Patient had itching.

What you must do:

Consultant had requested you to start him on Co-trimoxazole with
Gentamicin or metronidazole.
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01/01/24
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Case discussion
It better not to choose gentamycin as its nephrotoxic and patient is
diabetic.
Open the BNF on both drugs, but try to memorize doses to save
your time.
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Pain control

Who are you:

Fy2 in orthopedic department.

Your patient:
Nancy Ali 70 years old had a hip fracture and scheduled for hip
replacement surgery, prescribe morphine to control her pain as
required and anti-sickness medication.

Other information:
She has RA and hypertension for which she is on amlodipine 10 mg
once daily, methotrexate 70 mg every Tuesday, folic acid 5 mg
daily, and aspirin
75 mg once daily
Your task:
Prescribe the above drugs.
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Case discussion
 CYCLIZINE is the safest antiemetic, open BNF for
it.
 Don’t forget folic acid can’t be given on the same
day as methotrexate.
 Follow the task and open BNF on morphine.
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GP prescription
 State the name and address of the patient
 Have an appropriate date (usually the date of signing)
 Each medication item should be separated by a solid or
hashed horizontal line or similar separator.
 Details of the medicine to include:
 Name of medicine (generic name unless a specific brand
must be given)
 Form (e.g. tablets, oral s uspension)
 Strength (e.g. 5mg for tablets or 125mg/5ml for an oral
suspension): units and acceptable abbreviations are shown in
Table 6.
 Directions: should include quantity and frequency and for
liquid preparations, it is best practice to write directions using
the mass of active ingredient rather than volume so the
pharmacist is clear on the dosage (especially for oral
suspensions i.e. 125mg rather than 5ml).
 Quantity to be supplied (e.g. 56 tablets)
 For each controlled drug item in schedule 2 or 3, the
text „CD‟ shall be printed after the dm+d product name
e.g. Tramadol 50mg capsules CD.
 Dosage/Frequency should be expressed in words without
numerical figures e.g. One capsule to be taken three times
a day
 For controlled drugs only the quantity must be printed in
both figures and words in that order ; e.g. 56 (Fifty-six)
capsule
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Miss Laura Brown 04/06/1995 of Flat D 22 University

Road, Woodland
Town WD12 1MN presents with an itchy left eye with
yellow discharge that stuck her eye closed this morning.
She denies pain and does not use contact lenses.
What does this patient likely have?

write a prescription for an appropriate eye drop to treat this

problem using a blank FP10 prescription form.
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Mr Alex Johnson 12/09/2011 of Home Farm, Woodland

Town WD10 1FA has been seen by the Child and
Adolescent Psychiatry Team who have diagnosed
him with ADHD. You are to issue a prescription for his
Concerta XL under shared care arrangements. He is
currently taking 18mg in the morning.

Please write a prescription using a blank FP10 prescription

form
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