Common Registration Assessment · Part 2 practice
GPhC clinical practice questions: SBA and EMQ with answers
Four single best answer questions and one extended matching set. Pick an answer first, then open the reasoning and the BNF wording behind it.
Updated 3 October 2026
Revision use only. These are original questions, not GPhC questions. The patients are invented. The medicines are real and each answer is checked against the BNF entry named under it. Do not use any answer here for patient care. For the official examples see the GPhC example questions guide.
Single best answer questions
Question 1 · Statin dose and interacting drug
Mr Okafor, 62, takes simvastatin 40 mg at night. His GP starts amlodipine 5 mg daily for hypertension. Which action is most appropriate?
- A. Continue both at the current doses
- B. Reduce simvastatin to a maximum of 20 mg daily
- C. Increase simvastatin to 80 mg at night
- D. Stop amlodipine and choose a different statin
- E. Move simvastatin to the morning
Show the answer and reasoning
Answer: B
The BNF simvastatin entry gives the manufacturer advice of a maximum of 20 mg daily with concurrent use of amiodarone, amlodipine or ranolazine.
Question 2 · Metformin and renal function
Mrs Hughes, 71, has type 2 diabetes and takes metformin 1 g twice daily. A repeat blood test confirms an eGFR of 26 mL/minute/1.73 m2. Which action is most appropriate?
- A. Continue metformin at the same dose
- B. Halve the dose and recheck in 12 months
- C. Stop metformin and arrange a review of her diabetes treatment
- D. Change to modified-release metformin at the same daily dose
- E. Advise her to take metformin on an empty stomach
Show the answer and reasoning
Answer: C
The BNF metformin entry says the manufacturer advises avoiding it if eGFR is less than 30 mL/minute/1.73 m2, and lists it as contra-indicated in severe renal impairment because of the risk of lactic acidosis. A dose reduction does not meet that advice, so she needs a treatment review.
Question 3 · Lithium monitoring
Mr Bell, 58, is stable on lithium carbonate taken once daily at night. A routine serum-lithium level is due. When should the blood sample be taken?
- A. Two hours after his dose
- B. Six hours after his dose
- C. Twelve hours after his dose
- D. Twenty-four hours after his dose
- E. At any time, as timing makes no difference
Show the answer and reasoning
Answer: C
The BNF lithium entry says samples should be taken 12 hours post dose. For a once-daily night dose that is the following morning, before the next dose.
Question 4 · Warfarin and a new analgesic
Mrs Das, 77, has had a stable INR on warfarin for two years. Her prescriber wants to start tramadol for pain. What is the most appropriate pharmacy action?
- A. Supply the tramadol with no further action, as her INR is stable
- B. Stop her warfarin while she takes tramadol
- C. Tell the prescriber about the interaction and ask for additional INR monitoring or a warfarin dose review when tramadol starts
- D. Tell her to take the two medicines at different times of day
- E. Tell her to mention any bruising or bleeding only at her next routine review
Show the answer and reasoning
Answer: C
MHRA advice in the BNF warfarin entry (June 2024) says there is a risk of increased INR when warfarin and tramadol are taken together, and that dose adjustment or additional INR monitoring should be considered when tramadol is started. Patients should be told to report signs of major bleeding.
Extended matching set
Choose the best action from the list for each patient. Each option can be used once, more than once, or not at all.
- A. Limit simvastatin to 20 mg daily
- B. Avoid the drug
- C. Check INR early and monitor more closely
- D. Check serum-lithium concentration and review lithium treatment
- E. Increase the dose
- F. No change needed
Item 1
Mr Park takes simvastatin 40 mg at night. His cardiologist adds diltiazem.
Show the answer and reasoning
Answer: A
BNF simvastatin: maximum 20 mg daily with verapamil and diltiazem.
Item 2
Ms Reid has an eGFR of 28 mL/minute/1.73 m2 and is taking metformin.
Show the answer and reasoning
Answer: B
BNF metformin: manufacturer advises avoid if eGFR is less than 30.
Item 3
Mr Lowe takes warfarin and a prescriber starts tramadol.
Show the answer and reasoning
Answer: C
MHRA advice in the BNF warfarin entry: consider additional INR monitoring or a warfarin dose adjustment when starting tramadol.
Item 4
Mrs Patel takes lithium and has just been started on a diuretic by her GP.
Show the answer and reasoning
Answer: D
BNF lithium lists diuretic treatment as a caution (risk of toxicity) and advises serum-lithium monitoring every 3 months for patients taking drugs that interact with lithium.
Next steps
- Eight calculation questions with worked answers
- Mistake log template for the ones you miss
- Exam format and question types
- How to use mock exams
Frequently asked questions
Are these real GPhC questions?
No. They are original revision questions written for this page. The GPhC publishes its own example questions, covered in our guide to what the GPhC publishes.
Are the patients real?
No. Every patient, name and result is invented. The medicines are real and each answer is checked against the BNF wording quoted under it.
Can I use these answers in practice?
No. They are for revision only. In practice, check the current BNF, the product information and local guidance for the actual patient.