MCQ Quiz: Test and Treat

The “Test and Treat” model represents a significant evolution in the scope of pharmacy practice, empowering pharmacists to play a more direct role in managing acute, minor health conditions. As outlined in the Professional Practice Skills Lab and Pharmacy Law curricula, pharmacists operating under specific state protocols or collaborative practice agreements can now perform point-of-care (POC) tests for conditions like influenza and Group A Streptococcus. Based on the results, they can initiate guideline-approved pharmacotherapy, thereby improving patient access to timely care. This quiz will test your knowledge on the clinical and operational aspects of establishing and running a “Test and Treat” service, from patient assessment and CLIA-waived testing to appropriate treatment and referral.

1. A “Test and Treat” service in a pharmacy allows a pharmacist, under a specific protocol, to:

• a) Diagnose any medical condition.
• b) Perform a point-of-care test and initiate therapy for a limited set of minor health conditions.
• c) Prescribe any medication without physician oversight.
• d) Compound sterile IV preparations for outpatients.

Answer: b) Perform a point-of-care test and initiate therapy for a limited set of minor health conditions.

2. The legal authority for pharmacists in states like Florida to “Test and Treat” for conditions like influenza and strep throat is granted through:

• a) A federal mandate.
• b) A hospital-wide protocol.
• a) A state-specific law and collaborative practice agreement with a supervising physician.
• d) The pharmacist’s own discretion.

Answer: a) A state-specific law and collaborative practice agreement with a supervising physician.

3. The point-of-care tests used in these programs (e.g., rapid flu test) must be:

• a) Performed by a certified lab technician.
• b) Sent to an outside lab with a 3-day turnaround time.
• c) CLIA-waived.
• d) Approved for home use by patients.

Answer: c) CLIA-waived.

4. A patient presents with a sore throat, fever, and swollen lymph nodes. Which scoring tool can help a pharmacist determine the likelihood of Group A Streptococcal pharyngitis?

• a) The CHA₂DS₂-VASc score
• b) The HAS-BLED score
• c) The Modified Centor Criteria
• d) The MASCC score

Answer: c) The Modified Centor Criteria

5. A 25-year-old patient has a Centor score of 4. A rapid antigen detection test (RADT) for strep throat is performed and is positive. What is the first-line antibiotic treatment?

• a) Oseltamivir
• b) Azithromycin
• c) Penicillin or Amoxicillin
• d) Doxycycline

Answer: c) Penicillin or Amoxicillin

6. A patient presents with a cough, fever of 101°F, and myalgias that started yesterday. A rapid influenza test is positive. What is the most appropriate treatment?

• a) An inhaled corticosteroid
• b) Oral oseltamivir
• c) Oral amoxicillin
• d) Over-the-counter dextromethorphan

Answer: b) Oral oseltamivir

7. Antiviral treatment for influenza provides the most benefit when initiated within how many hours of symptom onset?

• a) 12 hours
• b) 24 hours
• c) 48 hours
• d) 72 hours

Answer: c) 48 hours

8. A key step before performing any point-of-care test is to:

• a) Obtain informed consent from the patient.
• b) Bill the patient’s insurance.
• c) Pre-authorize the medication.
• d) Call the patient’s primary care physician.

Answer: a) Obtain informed consent from the patient.

9. A “false negative” result on a rapid antigen detection test means:

• a) The patient does not have the infection, and the test is negative.
• b) The patient has the infection, but the test result is negative.
• c) The patient does not have the infection, but the test result is positive.
• d) The test is broken.

Answer: b) The patient has the infection, but the test result is negative.

10. A patient tests positive for influenza A. A critical counseling point the pharmacist should provide with their oseltamivir prescription is:

• a) “This medication will cure you in 24 hours.”
• b) “It is important to complete the full course of therapy to decrease the duration of symptoms and prevent complications.”
• c) “You can share this medication with family members to prevent them from getting sick.”
• d) “Take this medication on an empty stomach.”

Answer: b) “It is important to complete the full course of therapy to decrease the duration of symptoms and prevent complications.”

11. A patient presents with a severe sore throat, difficulty swallowing, and a “hot potato” voice. The pharmacist should:

• a) Perform a rapid strep test immediately.
• b) Dispense empiric amoxicillin.
• c) Immediately refer the patient to a higher level of care due to suspicion of a peritonsillar abscess.
• d) Recommend salt water gargles.

Answer: c) Immediately refer the patient to a higher level of care due to suspicion of a peritonsillar abscess.

12. What does CLIA stand for?

• a) Clinical Laboratory Information Act
• b) Certified Lab Inspection Agency
• c) Clinical Laboratory Improvement Amendments
• d) Collaborative Laboratory and Information Agreement

Answer: c) Clinical Laboratory Improvement Amendments

13. A patient tests positive for Group A Strep and has a history of a non-anaphylactic rash with penicillin. Which of the following is an appropriate alternative antibiotic?

• a) Amoxicillin
• b) Cephalexin
• c) Vancomycin
• d) Gentamicin

Answer: b) Cephalexin

14. An important part of managing a “Test and Treat” service is:

• a) Never cleaning the testing area.
• b) Using expired test kits to save money.
• c) Performing and documenting quality control measures for the testing equipment.
• d) Allowing pharmacy technicians to interpret the results.

Answer: c) Performing and documenting quality control measures for the testing equipment.

15. After providing treatment under a “Test and Treat” protocol, the pharmacist has a professional responsibility to:

• a) Keep the encounter a secret.
• b) Notify the patient’s primary care provider of the encounter and treatment provided.
• c) Enroll the patient in a clinical trial.
• d) Tell the patient never to see their primary care provider again.

Answer: b) Notify the patient’s primary care provider of the encounter and treatment provided.

16. A patient with a Centor score of 1 (e.g., only has a sore throat) presents to the pharmacy. The most appropriate action is to:

• a) Perform a rapid strep test.
• b) Provide empiric antibiotics.
• c) Advise symptomatic care (e.g., lozenges, analgesics) as strep is unlikely.
• d) Refer to the emergency department.

Answer: c) Advise symptomatic care (e.g., lozenges, analgesics) as strep is unlikely.

17. The primary goal of treating Group A Streptococcal pharyngitis with antibiotics is to:

• a) Prevent the patient from ever getting a sore throat again.
• b) Prevent the complication of acute rheumatic fever.
• c) Reduce fever by one degree.
• d) Improve the taste of food.

Answer: b) Prevent the complication of acute rheumatic fever.

18. A patient is outside the 48-hour window for influenza symptoms but is severely ill and has risk factors for complications. The pharmacist should:

• a) Refuse to test them.
• b) Test them and, if positive, recommend they follow up with their physician as oseltamivir may still be considered.
• c) Provide oseltamivir regardless of the test result.
• d) Recommend an over-the-counter cough suppressant only.

Answer: b) Test them and, if positive, recommend they follow up with their physician as oseltamivir may still be considered.

19. Which of the following is a “red flag” symptom in a patient presenting with flu-like illness that requires immediate medical referral?

• a) A mild cough
• b) A temperature of 100.5°F
• c) Shortness of breath or difficulty breathing
• d) A runny nose

Answer: c) Shortness of breath or difficulty breathing

20. A patient’s rapid strep test is negative, but they have a high Centor score (e.g., 4) and strong clinical suspicion for strep throat. The protocol may direct the pharmacist to:

• a) Treat with antibiotics anyway.
• b) Repeat the rapid test immediately.
• c) Refer the patient for a throat culture, which is more sensitive.
• d) Tell the patient they have a viral infection.

Answer: c) Refer the patient for a throat culture, which is more sensitive.

21. Proper specimen collection for a rapid strep test involves swabbing:

• a) The inside of the cheek.
• b) The tongue.
• c) Both tonsils and the posterior pharynx, avoiding the tongue.
• d) The nasal passages.

Answer: c) Both tonsils and the posterior pharynx, avoiding the tongue.

22. Which of the following is a potential revenue source for a “Test and Treat” service?

• a) Billing for the point-of-care test.
• b) Billing for the patient assessment and medication dispensing.
• c) A cash-pay, bundled service fee.
• d) All of the above.

Answer: d) All of the above.

23. The standard adult dose of oseltamivir for the treatment of influenza is:

• a) 75 mg once daily for 5 days.
• b) 75 mg twice daily for 5 days.
• c) 75 mg once daily for 10 days.
• d) 75 mg twice daily for 10 days.

Answer: b) 75 mg twice daily for 5 days.

24. The implementation of “Test and Treat” services in pharmacies is an example of:

• a) A decrease in the pharmacist’s scope of practice.
• b) An expansion of the pharmacist’s role in providing accessible patient care.
• c) A service that is only available in hospitals.
• d) A model that increases healthcare costs without improving outcomes.

Answer: b) An expansion of the pharmacist’s role in providing accessible patient care.

25. A pharmacist counsels a patient who tested negative for both flu and strep. Appropriate counseling includes:

• a) Information on symptomatic relief for a likely viral infection.
• b) When to follow up with a physician if symptoms do not improve or worsen.
• c) Reassurance that antibiotics are not needed.
• d) All of the above.

Answer: d) All of the above.

26. The sensitivity of a test refers to its ability to:

• a) Correctly identify those without the disease (true negative rate).
• b) Correctly identify those with the disease (true positive rate).
• c) Provide results quickly.
• d) Withstand changes in temperature.

Answer: b) Correctly identify those with the disease (true positive rate).

27. Rapid antigen tests for influenza and strep generally have high specificity but lower sensitivity. This means:

• a) A positive result is likely a true positive, but a negative result does not completely rule out infection.
• b) A negative result is always a true negative.
• c) A positive result is likely a false positive.
• d) The tests are not useful in clinical practice.

Answer: a) A positive result is likely a true positive, but a negative result does not completely rule out infection.

28. An important component of any “Test and Treat” protocol is clear criteria for:

• a) Patient inclusion and exclusion.
• b) When to treat.
• c) When to refer to a higher level of care.
• d) All of the above.

Answer: d) All of the above.

29. What is a key benefit of pharmacy-based “Test and Treat” services for the public?

• a) It is more expensive than visiting a physician.
• b) It provides increased access to care and more convenient, timely treatment.
• c) It eliminates the need for primary care physicians.
• d) It increases the wait time at the pharmacy.

Answer: b) It provides increased access to care and more convenient, timely treatment.

30. The standard duration of amoxicillin therapy for streptococcal pharyngitis is:

• a) 3 days
• b) 5 days
• c) 7 days
• d) 10 days

Answer: d) 10 days

31. A patient asks for a “Z-Pak” (azithromycin) for their sore throat. After testing positive for strep, the pharmacist should explain that:

• a) Azithromycin is the drug of choice for strep throat.
• b) Amoxicillin is preferred due to high rates of streptococcal resistance to azithromycin.
• c) A Z-pak is not an antibiotic.
• d) They can have a Z-pak if they pay cash.

Answer: b) Amoxicillin is preferred due to high rates of streptococcal resistance to azithromycin.

32. The skills lab module on “Test and Treat” is designed to ensure students are competent in:

• a) Patient assessment.
• b) Performing the POC test correctly.
• c) Counseling on results and treatment.
• d) All of the above.

Answer: d) All of the above.

33. An important infection control measure when performing nasal or throat swabs is:

• a) Reusing the same swab for multiple patients.
• b) Wearing appropriate personal protective equipment (PPE) like gloves.
• c) Performing the test in the main pharmacy waiting area.
• d) Not washing hands between patients.

Answer: b) Wearing appropriate personal protective equipment (PPE) like gloves.

34. Which of the following patients should be excluded from a pharmacy-based strep throat “Test and Treat” service and be referred?

• a) A healthy 20-year-old with a sore throat and fever.
• b) A 4-year-old child presenting with symptoms.
• c) A patient with a history of rheumatic fever.
• d) A patient asking for a work note.

Answer: c) A patient with a history of rheumatic fever.

35. A common adverse effect of oseltamivir is:

• a) Hypertension
• b) Nausea and vomiting
• c) Constipation
• d) Drowsiness

Answer: b) Nausea and vomiting

36. A patient is eligible for a “Test and Treat” service but refuses the POC test. The pharmacist should:

• a) Perform the test anyway.
• b) Respect the patient’s refusal and provide counseling on symptomatic care and when to see a physician.
• c) Dispense an antibiotic empirically.
• d) Refuse any further service to the patient.

Answer: b) Respect the patient’s refusal and provide counseling on symptomatic care and when to see a physician.

37. Proper documentation of a “Test and Treat” encounter should include:

• a) Patient demographics and consent.
• b) Test results and the lot number of the test kit.
• c) The treatment provided or referral made.
• d) All of the above.

Answer: d) All of the above.

38. The “specificity” of a test refers to its ability to:

• a) Correctly identify those with the disease (true positive rate).
• b) Correctly identify those without the disease (true negative rate).
• c) Be performed on specific patient populations only.
• d) Detect a specific brand of virus.

Answer: b) Correctly identify those without the disease (true negative rate).

39. A patient with influenza should be counseled to stay home and avoid contact with others to:

• a) Get more rest.
• b) Prevent the spread of the virus.
• c) Save money on transportation.
• d) Watch more television.

Answer: b) Prevent the spread of the virus.

40. Why is treating strep throat important even if it is a self-limiting illness?

• a) To prevent the serious, non-suppurative complication of acute rheumatic fever.
• b) To shorten the duration of symptoms by about one day.
• c) To prevent abscess formation.
• d) All of the above.

Answer: d) All of the above.

41. Which of the following is a point in the Modified Centor Criteria?

• a) Presence of a cough.
• b) Absence of a cough.
• c) Age over 50.
• d) Normal-appearing tonsils.

Answer: b) Absence of a cough.

42. A patient asks for an antibiotic for their flu-like symptoms to “feel better faster.” The pharmacist explains that antibiotics are not effective against viruses. This is an example of:

• a) A “Test and Treat” service.
• b) Antimicrobial stewardship.
• c) A medication error.
• d) A collaborative practice agreement.

Answer: b) Antimicrobial stewardship.

43. A key operational requirement for a pharmacy offering POC testing is:

• a) A separate, private area for patient assessment and testing.
• b) A comfortable waiting room.
• c) A large sign outside the pharmacy.
• d) A drive-thru window.

Answer: a) A separate, private area for patient assessment and testing.

44. Which of the following is NOT a typical condition covered under most “Test and Treat” protocols?

• a) Influenza
• b) Group A Streptococcus
• c) Uncomplicated Urinary Tract Infection (in some states)
• d) Hypertension

Answer: d) Hypertension

45. A patient tests positive for strep throat. They should be counseled that they are generally no longer contagious after:

• a) 1 hour of starting antibiotics.
• b) 12-24 hours of starting antibiotics.
• c) 5 days of starting antibiotics.
• d) The full 10-day course is complete.

Answer: b) 12-24 hours of starting antibiotics.

46. The pharmacist’s role in “Test and Treat” is grounded in their accessibility and expertise in:

• a) Surgery.
• b) Patient assessment and pharmacotherapy.
• c) Radiology.
• d) Psychiatry.

Answer: b) Patient assessment and pharmacotherapy.

47. A patient wants a flu test because they were exposed to a sick family member yesterday, but they have no symptoms. The pharmacist should explain that:

• a) They should be tested immediately.
• b) Testing is not indicated at this time, as the test is most accurate when a person has symptoms.
• c) They should take oseltamivir prophylactically.
• d) They are immune to the flu.

Answer: b) Testing is not indicated at this time, as the test is most accurate when a person has symptoms.

48. A major liability concern for a pharmacist performing “Test and Treat” services is:

• a) Failure to follow the established protocol.
• b) Missing a “red flag” symptom and failing to refer.
• c) Improper documentation.
• d) All of the above.

Answer: d) All of the above.

49. For a patient with a confirmed case of influenza, a pharmacist can also recommend:

• a) Symptomatic care with analgesics/antipyretics.
• b) Over-the-counter remedies for cough and congestion.
• c) The importance of hydration and rest.
• d) All of the above.

Answer: d) All of the above.

50. The successful implementation of “Test and Treat” services ultimately relies on:

• a) Adequate training and competency of the pharmacist.
• b) A well-defined protocol or collaborative practice agreement.
• c) A clear understanding of the service’s scope and limitations.
• d) All of the above.

Answer: d) All of the above.