GPhC Exam Questions: 25 Sample SBAs/EMQs with Tips
GPhC exam questions aren’t about memorising facts — they’re about making safe decisions at pace. Below are 25 realistic SBA/EMQ-style practice questions plus drills to build speed and accuracy.
What you’ll learn (and how to use this page)
- What the assessment looks like
- How to use these 25 practice questions
- Section A: 20 Single Best Answers (SBAs)
- Section B: EMQs (Q21–Q25)
- Speed & accuracy drill: what to practise now
- Final encouragement + next steps
What the assessment looks like
You’ll sit two parts on the same day.
Part 2: 120 multiple-choice questions in 150 minutes — 90 SBAs (A–E) and 30 EMQs (A–H).
There’s a break between parts. But here’s the catch: you must pass both parts in the same sitting. No carrying marks forward.
About 25% of questions include onscreen resources (BNF extracts, SPC snippets, images). You can use an approved calculator in Part 1 only.
The content follows GPhC style conventions (rINN use, specific wording patterns). Clinical focus hits cardiovascular, nervous system, endocrine, and infection hard. You’ll see ~20% paediatrics and regular coverage of high-risk drugs: anticoagulants, insulin, methotrexate, opioids, valproate.
• ~3 minutes per calculation in Part 1
• Just over 1 minute per question in Part 2
That’s why you need to practise fast, safe decisions now — not later.
How to use these 25 GPhC exam practice questions
These mirror real SBA/EMQ style and tone (they’re not actual GPhC items, but they’re close).
You’ll get a mix of high-yield therapy areas, high-risk medicines, and ~20% paediatrics — just like exam day.
Want the full exam blueprint?
For format, eligibility, dates, and pass marks, read the pillar guide: GPhC Exam 2025–2026.
Section A — Single Best Answer (SBAs)
1) AF stroke prevention (CV / anticoagulants)
A 76-year-old with non-valvular AF (CHA₂DS₂-VASc = 5, eGFR 58 mL/min/1.73 m²) is admitted after a fall (no head injury; CT normal). Which single best option is most appropriate for long-term stroke prevention?
A. Warfarin (target INR 2.5)
B. Aspirin 75 mg daily
C. Apixaban standard dose
D. Clopidogrel 75 mg daily
E. No antithrombotic therapy
Answer: C
For non-valvular AF with high CHA₂DS₂-VASc, a DOAC is preferred unless contraindicated. The eGFR is acceptable for standard apixaban dosing. Aspirin and clopidogrel aren’t appropriate for AF stroke prevention. Withholding therapy is unsafe given the stroke risk.
2) Type 2 diabetes with CKD (endocrine / dosing)
A 64-year-old on metformin 1 g BD, dapagliflozin 10 mg OD. eGFR 32 mL/min/1.73 m², HbA1c rising. Best next step?
A. Continue both unchanged
B. Stop metformin
C. Stop dapagliflozin
D. Add gliclazide
E. Switch metformin to sitagliptin, continue dapagliflozin
Answer: B
Metformin requires dose reduction or cessation as renal function falls. At eGFR ~30–44, many regimens demand reduction; lower ranges require discontinuation to reduce lactic acidosis risk. SGLT2 inhibitors may still offer renal and cardiac benefit depending on local guidance — but the priority here is metformin safety.
3) NSTEMI secondary prevention (CV / interactions)
A 58-year-old post-NSTEMI on aspirin, ticagrelor, atorvastatin 80 mg, ramipril, bisoprolol, omeprazole. Complains of myalgia. Which change is best?
A. Switch atorvastatin to simvastatin 80 mg
B. Add clarithromycin for suspected chest infection
C. Reduce atorvastatin to 20 mg immediately
D. Check CK and consider switch to an equipotent non-CYP3A4 statin
E. Stop all statins permanently
Answer: D
You evaluate statin-associated myopathy (check CK first). Then consider switching to a statin with fewer CYP3A4 issues — like rosuvastatin — rather than knee-jerk dose reduction or cessation. And never add interacting macrolides like clarithromycin to this mix.
4) Paediatrics: acute asthma plan (respiratory)
A 7-year-old with frequent wheeze uses salbutamol >3 times/week; night symptoms 2×/week. Best next step?
A. Add LAMA
B. Start regular low-dose inhaled corticosteroid
C. Start theophylline
D. Switch to salbutamol nebules PRN only
E. Oral prednisolone maintenance
Answer: B
Persistent symptoms despite SABA indicate the need for an ICS controller in children. This is straightforward guideline application — and hits your ~20% paediatrics quota.
5) Epilepsy + pregnancy planning (neuro / valproate)
25-year-old on sodium valproate is planning pregnancy. Best action?
A. Advise continue; no change
B. Switch urgently without neurology input
C. Discuss PPP (pregnancy prevention programme) and urgent specialist review to change therapy
D. Start folic acid 200 mcg daily and continue valproate
E. Stop all ASMs immediately
Answer: C
Valproate is high-risk in pregnancy — it requires the pregnancy prevention programme and specialist review for an alternative ASM. You don’t switch solo. You don’t continue. You escalate.
6) AKI + ACE inhibitor (renal / CV)
72-year-old on ramipril develops AKI stage 2 (pre-renal). Best immediate medicines optimisation step?
A. Increase ramipril dose
B. Hold ramipril and NSAIDs, review volume status
C. Start furosemide 80 mg immediately
D. Add spironolactone
E. Continue all meds; re-check eGFR in 3 months
Answer: B
With AKI, you temporarily stop ACE inhibitors, ARBs, and NSAIDs. Then you address volume status and review nephrotoxic risks. Don’t delay.
7) Warfarin bridging (anticoagulation)
A patient with DVT switches to warfarin. When can LMWH be stopped?
A. Immediately after first warfarin dose
B. When INR ≥2.0 for at least 24 hours (per local protocol)
C. After 48 hours regardless of INR
D. When INR ≥1.5 once
E. After 7 days regardless of INR
Answer: B
Standard approach: maintain LMWH until INR is therapeutic and stable. Anticoagulants are high-risk drugs — no shortcuts.
8) Community OTC: otitis externa (ENT)
A 30-year-old with itchy painful ear canal after swimming; no fever, intact tympanic membrane, NKDA. Best OTC?
A. Oral amoxicillin
B. Olive oil drops only
C. Acetic acid 2% ear drops
D. Oral flucloxacillin
E. Topical gentamicin + steroid without diagnosis
Answer: C
Mild otitis externa responds to acidifying drops. Oral antibiotics are usually unnecessary without systemic involvement. Keep it simple.
9) Insulin regimen error (endocrine / safety)
A patient on insulin glargine OD and insulin aspart with meals mistakenly takes aspart instead of glargine at bedtime. Best immediate advice (no hypoglycaemia yet)?
A. Take the missed glargine immediately and usual morning dose
B. Omit glargine tonight and monitor; take usual glargine next day; monitor for nocturnal hypoglycaemia
C. Take extra carbs then usual glargine
D. Take metformin to "offset"
E. Skip insulin for 24 hours
Answer: B
Rapid-acting insulin instead of basal at night increases hypoglycaemia risk overnight. Omit further insulin tonight, monitor closely, and reset the next day (with local guidance). Insulins are high-risk. Treat errors seriously.
10) Antidepressant + methadone (interactions / QT)
A 37-year-old on methadone 90 mg OD starts citalopram 20 mg OD. Most likely interaction risk?
A. Bleeding
B. Bradycardia
C. Diarrhoea
D. Hypertensive crisis
E. QT prolongation
Answer: E
Citalopram with methadone increases QT risk. This is classic interaction testing.
11) CAP in pregnancy (infection / safety)
28-year-old, 20 weeks pregnant, community-acquired pneumonia, penicillin allergic (immediate). Best first-line oral?
A. Doxycycline
B. Clarithromycin
C. Ciprofloxacin
D. Trimethoprim
E. Linezolid
Answer: B
A macrolide is generally preferred in pregnancy when tetracyclines are contraindicated and penicillins can’t be used. Local guidelines vary, but the exam tests safe class choices.
12) Migraine prophylaxis (neuro)
A 24-year-old woman with migraines 6/month wants prevention; BMI 21; uses COCP; NKDA. Best first choice?
A. Sumatriptan OD
B. Topiramate
C. Propranolol
D. Riboflavin only
E. Amitriptyline + sumatriptan
Answer: C
Propranolol is a common first-line preventive. Topiramate carries teratogenic risk and affects COCP efficacy. Triptans are for acute use, not prevention.
13) COPD inhaler escalation (respiratory)
Ex-smoker still breathless on LABA alone, 2 exacerbations last year, eosinophils 400 cells/µL. Best step?
A. Add LAMA only
B. Switch to high-dose ICS alone
C. LABA/ICS combination
D. Oral prednisolone maintenance
E. Montelukast
Answer: C
Exacerbations plus raised eosinophils signal the need for ICS/LABA combination therapy.
14) Heart failure with reduced EF (CV / hyperkalaemia)
HFrEF patient on ramipril + bisoprolol; K⁺ 5.6 mmol/L after starting spironolactone 25 mg. Best action?
A. Increase spironolactone
B. Stop spironolactone; re-check K⁺/renal; consider lower dose or alternative
C. Add potassium supplements
D. Ignore; continue
E. Stop ACE inhibitor first
Answer: B
Hyperkalaemia with an MRA requires review, cessation, and monitoring. Don’t add potassium supplements. Don’t ignore it.
15) UTI in men (infection)
A 50-year-old male with dysuria, frequency, afebrile. Best empirical oral?
A. Nitrofurantoin MR (if eGFR adequate)
B. Trimethoprim first in all
C. Ciprofloxacin first in all
D. Amoxicillin
E. No antibiotics ever
Answer: A
Nitrofurantoin is often first-line in uncomplicated cystitis where renal function allows. Trimethoprim is guided by resistance and folate status. Fluoroquinolones aren’t first-line for uncomplicated infections.
16) Paediatrics: scarlet fever contact (infection / PHE-style)
A 6-year-old sibling of confirmed scarlet fever, mild sore throat, no penicillin allergy. Best advice?
A. Immediate prophylactic antibiotics
B. No antibiotics unless symptomatic with Centor features; safety-net and school exclusion guidance
C. Start clarithromycin
D. Start amoxicillin for 3 days only
E. Refer to A&E urgently
Answer: B
Antibiotics for confirmed or suspected strep with clinical features. Otherwise, advise symptom care, exclusion if diagnosed, and safety-netting. Don’t over-prescribe.
17) Methotrexate weekly dosing error (high-risk)
Patient thinks methotrexate 10 mg is daily, not weekly. Best immediate steps?
A. Reassure it's fine
B. Dispense 28 tablets now
C. Withhold supply, urgent clinical review, explicit weekly counselling and folic acid regimen
D. Switch to azathioprine without review
E. No record required
Answer: C
Weekly dosing errors with methotrexate are serious. You stop supply, counsel explicitly, confirm the dose day, ensure folate is prescribed, and check recent FBC and LFTs. This is on the high-risk list for a reason.
18) Statin + macrolide (interaction)
Community query: patient on simvastatin 40 mg needs macrolide. Safest advice?
A. Clarithromycin + continue simvastatin
B. Erythromycin + continue statin
C. Temporarily stop simvastatin during macrolide course and 3–7 days after; consider non-CYP3A4 statin if recurrent need
D. Ignore
E. Double simvastatin dose
Answer: C
Macrolides inhibit CYP3A4, which raises simvastatin exposure and myopathy risk. Stop the statin during treatment and for a few days after.
19) Depression + bleeding risk (sertraline + warfarin)
Patient on warfarin needs antidepressant. Which has lower interaction-bleeding signal vs alternatives?
A. Fluoxetine
B. Paroxetine
C. Sertraline
D. Fluvoxamine
E. Citalopram
Answer: C
Sertraline is often preferred due to lower CYP interactions compared to fluoxetine and fluvoxamine. But you still counsel on bleeding risk and INR monitoring.
20) Paediatrics: ibuprofen vs varicella
A 5-year-old with likely chickenpox and fever. Best OTC advice?
A. Ibuprofen
B. Aspirin
C. Paracetamol
D. Codeine
E. Dihydrocodeine
Answer: C
Avoid ibuprofen and aspirin in varicella. Paracetamol is preferred. Simple safety rule, frequently tested.
Section B — EMQs (themes with the same option list)
Theme for Q21–Q22: Consequences of drug interactions
A. Bleeding risk increased
B. Bradycardia
C. Diarrhoea
D. Hypertensive crisis
E. Myopathy
F. QT interval prolongation
G. Reduced eGFR
H. Thrombosis
21) SSRI + rivaroxaban
64-year-old on escitalopram 20 mg OD; new rivaroxaban 20 mg OD for AF. Most likely consequence?
Answer: A (Bleeding risk increased)
SSRIs and SNRIs can increase bleeding tendency via platelet effects when combined with anticoagulants. Counsel and monitor.
22) Amiodarone + azithromycin
68-year-old on amiodarone now prescribed azithromycin for LRTI. Most likely consequence?
Answer: F (QT interval prolongation)
Additive QT effects. Consider non-QT-prolonging alternatives and check ECG and interactions before prescribing.
Theme for Q23–Q25: Choosing the most appropriate antibiotic
A. Nitrofurantoin MR (if eGFR adequate)
B. Amoxicillin
C. Doxycycline
D. Phenoxymethylpenicillin
E. Clindamycin
F. Co-amoxiclav
G. Ciprofloxacin
H. Trimethoprim
23) Uncomplicated cystitis
22-year-old non-pregnant female with uncomplicated cystitis; eGFR 80; no allergies.
Answer: A (Nitrofurantoin MR)
First-line when renal function is adequate.
24) Streptococcal tonsillitis in a child
8-year-old with confirmed streptococcal tonsillitis; NKDA.
Answer: D (Phenoxymethylpenicillin)
First-line for strep throat in children without penicillin allergy.
25) Pneumonia with penicillin anaphylaxis
Adult pneumonia, true penicillin anaphylaxis, not pregnant.
Answer: C (Doxycycline)
Tetracycline (doxycycline) or macrolide are common alternatives in penicillin allergy. Avoid tetracyclines in pregnancy.
Speed & accuracy drill: what to practise now
Rehearse 3-minute calculation loops (read → set up → compute → quick verify).
Practise ~70–75 second SBA loops (predict → scan options → justify).
Anticoagulants, insulin, methotrexate, opioids, valproate — make these automatic. Know dose checks, interactions, and counselling points cold.
Weight-based dosing, formulations, red flags. Don’t skip this.
Work to GPhC style: SBAs have 5 options, one best answer. EMQs use shared 8-option lists. Keep language precise. Use rINNs. Avoid negatives unless clearly formatted.
Know the rules of exam day: Two parts, same day. Calculators in Part 1 only (approved models). Some questions include onscreen resources. You must pass both parts in the same sitting.
Final encouragement
You’re training to make safe, effective decisions at pace — that’s exactly what the assessment measures.
Practise with realism: time pressure, precise wording, and your “why” for each answer.
If you want the “big picture” as well…
Read the pillar guide next: GPhC Exam 2025–2026.