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Free PEBC Practice Questions
Ten PEBC-style multiple-choice questions taken from our free demo, each with the answer and an explanation of every option. Try each one before opening the answer.
These are practice questions written in the style of the PEBC Qualifying Exam (Part I, MCQ). They are not real exam questions. For the full experience under exam timing, take the free 40-question demo with a free account.
- Question 1Anticoagulation
A 79-year-old man with nonvalvular atrial fibrillation is prescribed apixaban for stroke prevention.
Current medications: bisoprolol, atorvastatin.
Clinical findings: weighs 74 kg, serum creatinine 145 micromol/L, calculated CrCl approximately 38 mL/min. No active bleeding, mechanical valve or severe liver disease.
Which apixaban dose is MOST appropriate based on the available information?
- A. 2.5 mg twice daily, because his serum creatinine is 133 µmol/L or higher.
- B. 2.5 mg twice daily, because any CrCl below 50 mL/min requires dose reduction.
- C. 5 mg twice daily, because he meets only one dose-reduction criterion.
- D. 10 mg twice daily for 7 days, then 5 mg twice daily.
Show answer and explanation
Correct answer: C. 5 mg twice daily, because he meets only one dose-reduction criterion.
For stroke prevention in atrial fibrillation, apixaban is 5 mg twice daily. The dose is reduced to 2.5 mg twice daily only when at least two of these are present: age 80 years or older, weight 60 kg or less, serum creatinine 133 µmol/L or higher.
He is 79, weighs 74 kg and has a creatinine of 145 µmol/L, so he meets only one criterion. His CrCl of 38 mL/min does not by itself change the AF dose.
Reference: Thrombosis Canada, Apixaban clinical guide; Eliquis Canadian product monograph.
Why each option is right or wrong
- A: One criterion (creatinine) alone does not justify the reduced dose.
- B: CrCl below 50 mL/min is not one of the apixaban AF dose-reduction criteria (that threshold applies to other DOACs).
- C: Correct. He meets only one of the three criteria, so 5 mg twice daily is appropriate.
- D: 10 mg twice daily for 7 days is the initial regimen for acute VTE treatment, not AF.
- Question 2Calculations
Giovanna receives Drug A 100 mg IV every 6 hours while hospitalized.
Clinical plan: at discharge, the prescriber wants to maintain approximately the same total systemic exposure using an oral solution given twice daily. Drug A has linear pharmacokinetics, the oral solution contains 100 mg/5 mL, and absolute oral bioavailability is 50%. Renal and hepatic function are stable and no other dose adjustment is required.
What volume of oral solution should be given per dose?
- A. 10 mL
- B. 15 mL
- C. 20 mL
- D. 25 mL
Show answer and explanation
Correct answer: C. 20 mL
Step 1: IV daily dose = 100 mg × 4 = 400 mg/day.
Step 2: With oral bioavailability of 50%, the oral daily dose for the same exposure = 400 ÷ 0.50 = 800 mg/day.
Step 3: Twice daily = 400 mg per dose.
Step 4: The solution is 100 mg/5 mL = 20 mg/mL, so volume = 400 ÷ 20 = 20 mL per dose.
Why each option is right or wrong
- A: 10 mL (200 mg) ignores the bioavailability correction.
- B: 15 mL (300 mg) does not follow from either correct step.
- C: Correct. 800 mg/day ÷ 2 = 400 mg = 20 mL.
- D: 25 mL (500 mg) overestimates the required dose.
- Question 3Infectious disease
A 74-year-old man with COPD presents with fever, pleuritic chest pain and productive cough.
Medical history: COPD, no history of MRSA or Pseudomonas.
Clinical findings: chest imaging shows a right lower-lobe infiltrate. Blood cultures grow gram-positive, lancet-shaped diplococci that are alpha-hemolytic and optochin susceptible. Renal function is stable. He is clinically improving on empiric ceftriaxone plus azithromycin.
Which organism is MOST consistent with the microbiology findings?
- A. Enterococcus faecalis
- B. Staphylococcus aureus
- C. Streptococcus pneumoniae
- D. Viridans group streptococci
Show answer and explanation
Correct answer: C. Streptococcus pneumoniae
Streptococcus pneumoniae is the classic gram-positive, lancet-shaped diplococcus. It is alpha-hemolytic and optochin susceptible, which separates it from viridans streptococci (also alpha-hemolytic but optochin resistant).
Once cultures and susceptibilities are known, therapy for pneumococcal pneumonia should be narrowed in line with antimicrobial stewardship principles.
Why each option is right or wrong
- A: Enterococcus faecalis is a gram-positive coccus in pairs or short chains, usually non-hemolytic, and not optochin susceptible.
- B: Staphylococcus aureus forms gram-positive clusters and is catalase positive and coagulase positive.
- C: Correct. Lancet-shaped diplococci, alpha-hemolysis and optochin susceptibility identify S. pneumoniae.
- D: Viridans streptococci are also alpha-hemolytic but are optochin resistant.
- Question 4Immunization
A healthy 29-year-old receives MMR vaccine today before international travel.
Clinical context: she also requires varicella vaccine but declines a second injection today because she feels anxious after the first vaccine. She has no immunocompromising condition, is not pregnant and has not received blood products. She asks whether she can return in one week for varicella vaccine.
What is the BEST recommendation?
- A. Give varicella vaccine any time after 24 hours, because the two vaccines contain different viruses.
- B. Give varicella in one week, because the interval rule applies only to inactivated vaccines.
- C. Give varicella in one week and check varicella serology 6 weeks later to confirm response.
- D. If not given on the same day, separate the two live parenteral vaccines by at least 4 weeks.
Show answer and explanation
Correct answer: D. If not given on the same day, separate the two live parenteral vaccines by at least 4 weeks.
Live parenteral vaccines such as MMR and varicella can be given on the same day. If they are not given at the same visit, they should be separated by at least 4 weeks, because the first live vaccine can blunt the immune response to a second one given too soon.
Reference: Canadian Immunization Guide, Timing of vaccine administration.
Why each option is right or wrong
- A: Different viruses do not remove the interference concern; 24 hours is far too short.
- B: The 4-week interval applies to live parenteral vaccines, not inactivated ones.
- C: Giving it too soon risks a reduced response; serology is not the right fix.
- D: Correct. Live parenteral vaccines not given the same day should be at least 4 weeks apart.
- Question 5Evidence-based medicine
A 5-year randomized trial evaluates a preventive therapy.
Study details: the primary event occurs in 12% of participants receiving placebo; the intervention produces a 25% relative risk reduction. Baseline characteristics are balanced, follow-up is complete, and the effect estimate is assumed to be valid.
A pharmacist is asked to translate the relative effect into an absolute measure that can be discussed with patients.
Approximately how many patients must be treated for 5 years to prevent one event?
- A. 4
- B. 25
- C. 34
- D. 48
Show answer and explanation
Correct answer: C. 34
Step 1: Absolute risk reduction (ARR) = control event rate × relative risk reduction = 0.12 × 0.25 = 0.03 (3%).
Step 2: NNT = 1 ÷ ARR = 1 ÷ 0.03 = 33.3, rounded up to 34 over 5 years.
NNTs are rounded up because a partial patient cannot be treated, and rounding down would overstate the benefit.
Why each option is right or wrong
- A: 4 is 1 ÷ RRR (1 ÷ 0.25), which treats a relative measure as absolute.
- B: 25 would require an ARR of 4%.
- C: Correct. 1 ÷ (0.12 × 0.25) = 33.3, rounded up to 34.
- D: 48 would require an ARR of about 2.1%.
- Question 6Oncology supportive care
LC is a 48-year-old woman starting a highly emetogenic IV chemotherapy regimen for breast cancer.
Medical history: motion sickness, significant nausea during pregnancy.
Clinical findings: renal and hepatic function and electrolytes are normal. She is particularly worried about nausea and asks whether a single dose of ondansetron before chemotherapy should be sufficient.
Which prophylactic strategy is MOST appropriate for highly emetogenic chemotherapy?
- A. A 5-HT3 antagonist alone before chemotherapy, adding other agents only after vomiting occurs.
- B. Dexamethasone plus dimenhydrinate, reserving a 5-HT3 antagonist for breakthrough symptoms.
- C. Combination prophylaxis with a 5-HT3 antagonist, dexamethasone, an NK1 antagonist and olanzapine.
- D. Metoclopramide alone for 3 days because delayed nausea is primarily dopamine mediated.
Show answer and explanation
Correct answer: C. Combination prophylaxis with a 5-HT3 antagonist, dexamethasone, an NK1 antagonist and olanzapine.
Highly emetogenic chemotherapy needs proactive prophylaxis that blocks several pathways. Current regimens combine a 5-HT3 antagonist, dexamethasone and an NK1 antagonist, with olanzapine commonly added. Her history of motion sickness and pregnancy-related nausea further increases her risk.
Reference: Ontario Health (Cancer Care Ontario), Antiemetic recommendations for chemotherapy-induced nausea and vomiting.
Why each option is right or wrong
- A: A 5-HT3 antagonist alone is inadequate for highly emetogenic chemotherapy, and rescue-only treatment is not recommended.
- B: Dimenhydrinate is not a core prophylactic agent; omitting the 5-HT3 antagonist leaves a major pathway unblocked.
- C: Correct. Multi-agent prophylaxis (5-HT3 antagonist, dexamethasone, NK1 antagonist, with olanzapine) is the standard.
- D: Metoclopramide alone is not adequate prophylaxis for highly emetogenic chemotherapy.
- Question 7Compounding
A pharmacist is checking several products during a dispensary quality audit.
Products reviewed: an unopened manufacturer vial with an expiry date 2028-04, a reconstituted antibiotic suspension, a preserved multidose injectable vial first punctured 10 days ago, and a compounded oral liquid prepared by the pharmacy. All products have been stored according to their labels and there is no visible contamination.
Which statement BEST distinguishes expiry dating from beyond-use dating?
- A. The manufacturer's printed expiry date continues to govern all products after opening or reconstitution if storage is correct.
- B. Beyond-use date and manufacturer expiry date are interchangeable terms for the same stability endpoint.
- C. A multidose vial can always be used until its printed expiry date unless visible contamination occurs.
- D. A beyond-use date is assigned after preparation, opening, reconstitution or compounding and may be earlier than the expiry date.
Show answer and explanation
Correct answer: D. A beyond-use date is assigned after preparation, opening, reconstitution or compounding and may be earlier than the expiry date.
A manufacturer's expiry date applies to the unopened product stored as labelled. Once a product is reconstituted, compounded, repackaged or opened, a beyond-use date (BUD) applies, and it is often earlier than the expiry date.
The exact BUD depends on the product and preparation (manufacturer instructions, stability data and compounding standards).
Reference: NAPRA Model Standards for Pharmacy Compounding; Health Canada product monographs.
Why each option is right or wrong
- A: The printed expiry date does not govern a product after it is opened, reconstituted or compounded.
- B: The two terms are not interchangeable; they describe different stability endpoints.
- C: A punctured multidose vial has an in-use limit set by the manufacturer, regardless of the printed expiry.
- D: Correct. A BUD is assigned after preparation, opening or reconstitution and may be earlier than the expiry date.
- Question 8Diabetes and kidney
A 66-year-old with type 2 diabetes and hypertension develops 2 days of vomiting and diarrhea and is unable to maintain fluids.
Current medications: metformin, empagliflozin, ramipril, hydrochlorothiazide, atorvastatin, basal insulin.
Clinical findings: BP 96/60 mmHg, creatinine risen from 92 to 151 micromol/L. He asks which chronic medications should be temporarily held while dehydrated and acutely unwell.
Which medications should be temporarily withheld during sick-day management?
- A. Metformin, empagliflozin, ramipril, and hydrochlorothiazide.
- B. Metformin, empagliflozin, ramipril, and basal insulin.
- C. Empagliflozin, hydrochlorothiazide, atorvastatin, and basal insulin
- D. Ramipril, hydrochlorothiazide, atorvastatin, and basal insulin.
Show answer and explanation
Correct answer: A. Metformin, empagliflozin, ramipril, and hydrochlorothiazide.
During dehydration or acute illness with poor fluid intake, sick-day medications should be held temporarily: metformin (lactic acidosis), SGLT2 inhibitors (ketoacidosis), ACE inhibitors and diuretics (hypotension and kidney injury). His falling blood pressure and rising creatinine make this urgent.
Basal insulin is usually continued, with more frequent glucose checks and dose adjustment as needed. Held drugs are restarted once he is eating and drinking normally.
Why each option is right or wrong
- A: Correct. Metformin, empagliflozin, ramipril and hydrochlorothiazide are all sick-day medications.
- B: Basal insulin should not simply be stopped; stopping it risks hyperglycemia and ketoacidosis.
- C: Atorvastatin and basal insulin are not routine sick-day holds, and this option leaves metformin and ramipril running.
- D: Atorvastatin and basal insulin are not routine sick-day holds, and this option leaves metformin and empagliflozin running.
- Question 9Biostatistics
A case-control study investigates an uncommon adverse outcome.
Study details: among 500 cases, 45 had prior exposure to the drug of interest; among 500 matched controls, 20 had prior exposure. Selection and exposure ascertainment are considered acceptable for this calculation, and the question asks only for the crude association measure.
What is the approximate odds ratio and its correct interpretation?
- A. 0.44; prior exposure is less common among cases and therefore appears protective.
- B. 2.4; the odds of prior exposure are about 2.4 times higher among cases than controls.
- C. 2.4; approximately 2.4% of exposed patients will develop the adverse outcome.
- D. 25; the drug produces an absolute 25% increase in risk.
Show answer and explanation
Correct answer: B. 2.4; the odds of prior exposure are about 2.4 times higher among cases than controls.
Build the 2 × 2 table: cases exposed 45, unexposed 455; controls exposed 20, unexposed 480.
OR = (45 × 480) ÷ (20 × 455) = 21,600 ÷ 9,100 ≈ 2.4.
In a case-control study the OR compares the odds of exposure among cases with the odds among controls. The design does not give incidence or absolute risk.
Why each option is right or wrong
- A: 0.44 is the inverted ratio; exposure was more common among cases, not less.
- B: Correct. OR ≈ 2.4: the odds of prior exposure are about 2.4 times higher among cases.
- C: An OR is a ratio of odds, not a percentage of exposed patients who develop the outcome.
- D: A case-control study cannot give an absolute risk increase, and 25 is not the calculated value.
- Question 10Medication safety
During a busy evening shift, a pharmacist receives four otherwise plausible prescriptions.
Context: the pharmacy has access to the patient's medication history, but the prescriber cannot be reached immediately. One prescription contains information that is too ambiguous to permit safe dispensing without clarification.
Which situation presents the clearest immediate medication-safety concern?
- A. Digoxin 0.125 mg once daily, with no recent serum digoxin concentration available.
- B. Atorvastatin 20 mg daily, when the latest LDL-C result is unavailable.
- C. Methotrexate 15 mg "take as directed", with no dosing frequency documented.
- D. Warfarin 5 mg "as directed", with no target INR or dosing schedule documented.
Show answer and explanation
Correct answer: C. Methotrexate 15 mg "take as directed", with no dosing frequency documented.
Oral methotrexate for most indications is taken once weekly. A prescription with no frequency risks accidental daily dosing, which can cause fatal toxicity. ISMP Canada lists oral methotrexate as a high-alert medication, and the prescription must be clarified before dispensing.
Why each option is right or wrong
- A: A recent digoxin level is useful for monitoring, but its absence does not make a clear prescription unsafe to dispense.
- B: A current LDL-C helps assess response but is not needed to dispense an established atorvastatin dose.
- C: Correct. Methotrexate with no frequency risks daily instead of weekly dosing.
- D: Warfarin doses vary with the INR, and the pharmacy's records may confirm the current schedule; if they cannot, it also needs clarification, but the daily-vs-weekly methotrexate risk is greater.
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