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Pass the PSA, 1e

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Our advanced question bank platform allows you to filter PSA questions based on specialty and PSA question format.

You should also revise the fluid management, opioid pain management, insulin management and pre-operative management topics in the Oxford Handbook of Clinical Medicine. Questions on these topics are common in the PSA and many find them difficult. Fluid management is particularly important. Enzyme inhibitors: AO DEVICES – allopurinol, omeprazole, disulfiram, erythromycin, valproate, isoniazid, ciprofloxacin, ethanol (acute intoxication), sulphonamides. Others: grapefruit juice, amiodarone, and SSRIs (fluoxetine, sertraline). Each question has 10 marks available (5 for the drug choice and 5 for the choice of dose/route/frequency). The treatment summaries can help in this section if you are not sure what drug should be used. However, having a good basic understanding of most conditions allows you to focus on looking up the appropriate drug based on your prior understanding which helps save time. Based on the information provided, you have to decide whether to stop a drug, decrease the dose, increase the dose, prescribe another drug or make no changes.You will be asked to choose an appropriate drug or intravenous fluid with its corresponding dose, route, and frequency. Know how to prescribe gentamicin and how to use the gentamicin chart to determine next prescription timing Search up the medications “monitoring requirements”, “important safety information” or “pre-treatment screening” on the BNF. Questions will cover Medicine, Surgery, General Practice, Psychiatry, Paediatrics, Obstetrics & Gynaecology, and Geriatrics. All final-year medical students and overseas graduates coming to the UK to work as Foundation Year 1 (FY1) doctors are required to take the Prescribing Safety Assessment (PSA).

For final-year medical students, your medical school will arrange the PSA and set the examination date(s) within the agreed national schedule. You’ll be sent details of the exam, including how to activate and use your PSA account, directly from your medical school. This section will task you with selecting the most suitable plan of monitoring for either beneficial or harmful effects of a newly started medication. It is common for this section to have a question about giving advice regarding missed oral contraceptive pills. The full advice is available in the BNF, but it may be difficult to locate. You need not remember the advice, but you must be very sure where to find it in the BNF. Practise finding it beforehand. Medicinal Forms’ is another subsection to be aware of, particularly for the prescribing and calculations sections. It is important to know what form and dose medications are available in. The PSA takes place 3 times per year, in September, March and May. New F1 doctors without PSA sit the exam in September (one month after starting work). If they fail, they re-sit in March and again in May if needed. Doctors who do not pass the exam before the end of their F1 year cannot progress into F2, and will have an extension of F1 training (to a maximum of one year) until they pass PSA.I also used my own pharmacology notes from medical school to revise key drugs from each branch of medicine e.g. respiratory drugs, GI drugs etc, which was perhaps more useful. QUB has its own formulary of drugs which highlights ‘need to know’ information which helped me to fill in any gaps. The book ‘The Top 100 Drugs’ by Hitchings, Lonsdale, Burrage & Baker was also helpful for this. The maximum dose of paracetamol is 1g QDS – common dosing errors will include 1g 4hrly or co-prescription of paracetamol and co-codamol. Starting from 2020, marks are no longer given for the date, time & signature, and you are not required to enter them in each question. This makes it more difficult to score well in this section. PSA question structures and layouts reproduced with permission of the Medical Schools Council and the British Pharmacological Society. These structures and layouts apply to the pilot PSA assessment and may not be precisely replicated in the final version of the PSA.

Most of the questions can be answered with the help of the BNF. However, as there are several drugs listed in each question, having to look up every one of them in the BNF will require a lot of time. To save time, your clinical knowledge is important. Refer to the BNF only if you are unsure. Start by revising all the notes in Pass The PSA and Get Ahead! The Prescribing Safety Assessment. If you have lecture slides or notes from the PSA teaching sessions of your medical school, revise them as well. In this section, each question will list several drugs that have been prescribed, where you have to identify one or more of the drugs that are inappropriate or have a particular problem, such as adverse effects, contraindications, interactions with other drugs, ineffectiveness or dose error.You will be provided with a clinical scenario and some investigation results and tasked with determining the most appropriate course of action forward with regard to prescribing. (e.g withdrawing a medication, reducing its dose, no change, increasing its dose or switching to a new medication). For questions about the monitoring for beneficial effects, you need to use your clinical knowledge and judgement to determine to most appropriate monitoring option. The information about that is not usually available in the BNF. You will be given a clinical scenario where a drug (often new) has been prescribed. You will be asked to select the most appropriate monitoring actions. Get familiar with the BNF (both online and paper versions) and know where to find things as it isn’t always obvious or easy. For example, converting opioid doses is in the palliative care summary, HRT is in the sex hormones summary, and high INR management is in the oral anticoagulants summary.

Delivered jointly by the British Pharmacological Society and the MSC Assessment, the PSA is an online exam designed to assess your knowledge, skills and judgement of prescribing medicines within the context of the NHS. This includes writing, reviewing and amending prescriptions, calculating drug doses, and identifying adverse drug reactions and medication errors. This section can be tight on time and it is not possible to search up every listed medication on the BNF. As such knowledge of common effects, adverse reactions and interactions of common medication is helpful. Know what to do in the event of a missed contraceptive pill (this varies depending on the type of pill being taken). When identifying drugs with dose errors, note that in some cases the error is with the frequency rather than the dose itself. A correct dose with a wrong frequency counts as a dose error as well.Another key way of familiarising yourself with the PSA exam and what will be assessed is to complete practice tests. Once you are registered for an exam date, you’ll be given access to three PSA practice papers to facilitate your preparation for the exam. These are a really useful starting point. To ensure that you are fully prepared, you should utilise these alongside further practice tests, to give you plenty of opportunities to practise answering the types of questions you’ll encounter within the given time. Remember time is a key factor in the PSA which is what makes it such a difficult exam. Therefore, practising completing the exam within the time limit is great preparation! Explore the BNF content The questions in the Planning Management, Providing Information, Adverse Drug Reactions, Drug Monitoring and Data Interpretation sections are in the Single Best Answer (SBA) format. For each question, there are 5 choices of answers where you have to choose the one that is the most appropriate. Get ahead! The Prescribing Safety Assessment’ by Muneeb Choudhry, Nicholas Rubek Fuggle and Amar Iqbal

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