PSA MOCKS AND CHECKS

CORRECT
WRONG

PSA website 2nd mock first half – 30%

1 CORRECT – procyclidine used 4drug induced parkinsonism
2 WRONG – stupidly did not read the question about what was already being prescribed – give what
hasn’t bn given, pt was already on ipratropium oops
– COPD exacerbation meds to give = same as asthma exacerbation meds to give = o2 (non rebreathe
100% for asthma but more cautious for COPD) + inhaled nebulised salbutamol n ipratropium +
moderate exacerbation = oral prednisolone VS severe = iv hydrocortisone VS life threatening = iv
aminophylline
3 WRONG – BNF fluids summary page has how much mmol of Na, Cl, K is in each percent of infusion
fluid – ur menna use that info as well as the fact that in 24h, person needs 30ml/kg/h of fluid AND
1mmol/kg/day of Na, K, Cl AND 50g of glucose (THUS in 48h they need DOUBLE that, and if they’ve
already had fluid bags, make up what they need in the next hours to be on track by the end of that bag);
on the prescription, state the concentration of each fluid in the mix, with / in between different solutions –
in 0.9% NaCl (by mass of NaCl compound) theres 150 mmol of NaCl (learn by heart) and the Q told u
that 0.15%KCL has 20mmol of K+
Will the patient in this question (receiving 150*2+20 mmol of KCL in 36 hours have received way too much
chloride? (ideally, would have 225mmol of Cl in 36 hours, instead he’s had 320))? Did we have to add
potassium chloride to the dextrose? Could we have added a different anion instead (e.g. potassium lactate)?
Does it matter to have that much chloride (due to risk of hyperchloremic acidosis) or will the cells take up some
of the excess chloride?
4 WRONG – Q wanted continuous combined HRT prescription written as amount of oestrogen and
progesterone in the patch – I am SO CONFUSED
PRESCRIPTION REVIEW
5 WRONG – fentanyl opiate not atenolol causes confusion (so does trazodone antidepressant (sari similar
to ssri) and benzo midazolam) CORRECT – atenolol contraindicated due to ischaemic leg ulcers
6 CORRECT – prednisoone and diltiazem (cacb acting on myocardium and pacemaker cells and abit on
perhipheral smooth muscle too, like a middle ground between verapamil and amlodipine) exacerbate
heart failure, while perindopril and spironolactone make hyperkalaemia
7 WRONG – rtq – antibiotics predispose to vaginal candida because they kill vagina bacteria so the fungi
get all the nutrients (?) – I missed amoxicillin (and put Bendroflumethiazide oops – thiazides are
contraindicated in gout… I knew there was something haha) then CORRECT that prednisolone should
be continued throughout other illnesses

MANAGEMENT
8 WRONG – instead of reducing food intake which is ‘unsustainable’, increase the insulin dose
9 CORRECT – nitrofurantoin for UTI
10 WRONG – SCARLET FEVER was treatment summary that I should have looked up – strawberry
tongue and macular rash (its not Kawasaki disease that’s POST VIRAL IN FIVE YEAR OLDS)
11
12
13
14
15

PSA WEBSITE THIRD MOCK – 67%

PRESCRIBING
1 WRONG – ondansetron (serotonin 5HT3 antagonist) has low risk of prolonging QT interval – so don’t
give to pt whose already on quietapine which also prolongs QT hang on – this pt has slightly low K+ - is
this a saving factor for making the QT shorter!? – right ans was cyclizine (antihistamine w
anticholinergic properties; not for heart failure or epilepsy; no evidence of teratogenicity but careful of
final trimester) – im still so confused about correct types of antiemetics where can I find good notes?
2 CORRECT – acyclovir for shingles rash on face
3 CORRECT – tachycardiac and hypotensive pt needs fluid resus (500ml 0.9%NaCl)
4 CORRECT – metformin is first line for t2dm (start w low dose OD PO) once lifestyle measures failed
(read about oral hypoglycaemics on passmed and psa book please)
5 WRONG – ciclosporin (immunosuppressant for psoriasis or cancer) causes hyperkalaemia (AND OR –
unwanted (e.g. -interactions gets u more monographs) control f in monograph (if a page comes up in a
result with the AND in the search, the page contains both terms, even if there aren’t yellow highlights))
also, part B, citalopram (SSRI) dose was wrong (20mg not 60mg – for elderly people, the dose needed
reducing – generally in old ppl be careful of narrow therapeutic index and neuro drugs and liver or
kidney metabolized drugs); other drugs in Q that I didn’t know = hydralazine (relax SMC for
vasodilation as antihypertensive) + isosorbide mononitrate = oral nitrate dilates coronary arteries for
angina preventaion, rabeprazole = PPI like omeprazole (why was this Q out of 4?)
6 CORRECT – dexamethasone dose for croup is 1.5mg not 15mg
7 CORRECT – alenronic acid (bisphosphonate) and prednisolone (causes stomach ulcers) = dyspepsia;
lansoprazole (PPI) and alendronic acid = cause of loose stools (sometimes if u search too many OR drugs
u will not see some results – best to search AND pairs, but change one of the pair for each suspicious
option – remember, if u get a result without an educational highlight, click and use cmdF – also use
–“unwanted phrase”) (other drugs in Q that I didn’t know = tiotropium = LAMA long acting muscarinic
antagonist inhaled for COPD, whereas Ipratropium is short acting)
8 WRONG – ankle swelling caused by amlodipine and NSAD naproxen, NOT lisinopril (WTF – my BNF
said lisinopril not naproxen caused ankle oedema, when I searched oedema AND lisinopril OR naproxen)
ALSO stupidly missed out part B – bradycardia cos of bisoprolol and digoxin (AND I am so confused
about bracketing when doing A and B or C – is it A and B or A and C, or is it A and B OR only C!?) –
where can I find out
9 WRONG – cotrimazole pessary for 7 days instead of vaginal cream as single dose for pregnant person
w candida (I guess pregnant ppl generally get longer doses of abx etc cos theyre immunosuppressed by
presence of fetus) – looking at all of the options, the DIFFERENCES (equating to decisions that u need to
make) are which drug (cotrimazole or fluconazole), duration, route (pessary is like the thing u stick up
your vagina for prolapse, its left in there for 7 days and releases cotrimazole I guess…)
10 CORRECT vancomycin oral as first line for C diff; metronidazole second line
11 WRONG – emergency DKA treatment = FIXED rate insulin infusion (because emergencies = same
treatement for everyone generally – or perhaps it makes sense because theres a UNIDERICATIONAL
aim for glucose and ketones, compared to surgery when we give variable rate insulin infusion because we
do not know what will happen) AND CONTINUE any normal long acting insulin prescriptions (this is on
BNF in diabetic emergency treatment summaries), but stop short acting insulin ofc cos ur not eating at
meal times (glargine = gLARGOine = long acting and Humulin = hu(meal)in is short acting)
12 WRONG – amitriptyline 10mg night 1st line for post herpetic neuralgia BUT all neuromodulators (eg
that n gabapentin) take a while for effect to happen – paracetamol relieves acute pain AND FEVER (37.3
= mild fever) (also be careful of anticholinergic side effects in amitriptyline 4 older ppl)
13 CORRECT – loperamide (anti diarrhoea acts on opoid receptors in the gut to decrease motility and
increase absorbtion) = taken after each loose stool
14 CORRECT – antidepressants take 6wks to show effects
15 CORRECT – ciclosporin immunosuppressant (calcineurin inhibitor stops Tcell activation and does
not cause agranulocytosis) requires monitoring of kidney function (and risk of hyperkalaemia)
CALCULATIONS
16 [weight 35kg, dose 5mg/kg/day = 35*5mg/day, vials of drug = 100mg/20ml = 5mg/ml, Q=how much do we
need in ml from the vial? – ans = 35ml] WRONG – I was being dumb and overlooked the fact that the
dilution information was superfluous oops, I said 175ml
17 [weight 88kg, dose=50mg/kg =50*88, acetylcysteine concentrate = 200mg/ml, ml needed for dose =
50*88/200 = 88/4 = 22ml of acetylcysteine concentrate; that’s added to 500ml of glucose and infused over 4h –
so that’s 522ml/4h, Q=rate of infusion in ml/h – ans is 130.5ml/h] WRONG – fucked up dividing 522 by 4 –
its 130.5 but I said 147 wtaf – I remember doung the working right (IGNORE the info about 10ml
ampoules because we can give half ampoules)
18 CORRECT
19 CORRECT

ADVERSE DRUG REACTIONS

20 CORRECT – liraglutide (GLP1 analogue) can cause vomiting
21 WRONG – tramadol and citalopram both increase likelihood of serotonin syndrome – tramadol
makes your trauma more (practically and emotionally) dolce – its SNRI and weak opoid (whereas
codeine, fentanyl and morphine are not) – zopiclone is a GABA agonist ‘non-benzo sedative’ to help w
sleep, though benzos also potentiate GABA (whats the quickest way to search bnf for this info? Either
checking interactions w citalopram SSRI, or looking in individual drug monographs – maybe best to go
straight to citalopram interactions and command f all those drugs – it WILL say if the combo exert a
similar pharmacological action aka exacerbate each other s side effects)
22 CORRECT – rifampicin and isoniazid affect liver enzymes to alter contraceptive pill effectiveness
23 CORRECT – procyclidine is antidote for parkinsonism induced by drugs e.g. haloperidol (on BNF,
parkinsonism is a SE for ‘all antipsychotic drugs’ because of antagonism of Dopamine which is
upregulated in psychosis, but not in the basal ganglia!)
24 WRONG – COCP monitor BP not weight – that’s strange I swear I found the opposite on the BNF… -
and I did – WTF – looked up Katya, then onto the drug monograph, then command F for weight and
blood pressure and weight increase was a SE of all oral contraceptives, and although HTN was a caution
‘don’t prescribe for this’, its not a SE that BP could increase!
25 CORRECT - azathioprine – check TMPT thiopurinemethyltransferase before starting
26 CORRECT – measure diuretic effectiveness using weight
27 CORRECT - DOACS like apixaban do not require official monitoring so rely on pt reports of
bruises4adverse effects
28 WRONG – idk wtf to do about pain management swapping opoids boohoooooooo – fentanyl patches
take too long to work 4use in acute pain; the problem here was ‘oliguria’ (aka) and drowsiness (morphine
sulfate accumulates due to renal failure because its usually renally excreted following hepatic
metabolism) (oxycodone better than morphine sulfate because hepatic metabolism of oxycodone
inactivates it, whereas hepatic metabolism of morphine sulfate makes it more active b4 renal excretion)
wheres the best place to find this on BNF and HOWs the quickest way to find it…?
29 CORRECT – prothrombin complex for major bleeding on warfarin
30 CORRECT – amiodarone wreaking havoc (hyperthyroidism) means pls stop amiodarone

PSA ebook mock #1 answers – 20 & 21 Jan

CORRECT
WRONG

PRESCRIPTION REVIEW

1 A = microgynon enoxaparin aspirin B = metformin WRONG – add novomix for B because novomix
insulin should be converted into sliding scale
2 = alendronic acid + cocodamol + paracetamol + amoxicillin WRONG – statin and tamoxifen is incorrect
dose but cocodamol and amoxicillin is correct dose – pt in Q was male; tamoxifen only used for men w
prostate/breast cancer; Q had typo (statins are in milligrams not grams); also idk how this patient is
taking too much paracetamol (500mg up to 6hourly => in 24 hours that’s 2g, not 4g => BUT ONE tablet
of cocodamol has 500mg of paracetamol; you stop the paracetamol instead of the cocodamol)
3 lisinopril WRONG – and aspirin (the DOSE was too high – 300mg is for treatment, 75mg is for
prevention)
4 = propranolol (too low) + cocodamol (don’t understand the 5/500 thing) WRONG – swap propranolol for
Q-laira (it’s a contraceptive that a MALE patient should not be taking) (cocodamol 5/500 means 5mg
codeine and 500mg paracetamol; thus here is a paracetamol overdose) – if the Q says SERIOUS drug
errors then the errors wil risk patient harm
5 lisinopril cocodamol diazepam ipruprofen CORRECT
6 A = indigestion = klaricid (clarithromycin) + naproxen WRONG swap clarithromycin for prednisolone,
which causes gastric ulcers by prohibiting gastric epithelial renewal; macrolides = indigestion not
ulceration… B = hyperglycaemia prednisolone CORRECT C = coagulation is warfarin WRONG –
erythromycin (klaricid) is blamed for p450 inhibiton, leading to increased warfarin concentration – they
both get the blame hmmph – BUT the one that was started MORE RECENTLY gets the blame‼
7 lithium + aspirin + prednisolone + Bisoprolol WRONG – swap bisoprolol for Bendroflumethiazide
(because it causes gout, not otherwise dangerous pre-surgery) – beta blockers and CaCb should be
CONTINUED during surgery to avoid tachycardia
8 Yasmin + ibuprofen + cyclizine + enoxaparin WRONG – swap cyclizine for paracetamol (which is wrong
cos dose was 1 mg not g – remember 4g per day is max adult paracetamol concentration)

DATA INTERP

9 e CORRECT
10 d CORRECT
11 a WRONG – d – give 4h of IV fluids instead of oral fluids BECAUSE urine output is BIG
(200ml/h=2.4L/12h) – aka ‘polyuric’ phase of recovery from AKI – means u can’t drink enough oral
fluids to maintain ur electrolytes, so IV is better (hence pt was dehydrated). Of the IV options, the acute
ones are needed, cos he’s dehydrated, and e has allowed potassium infusion rate (10mM per hour)
12 e WRONG – more important to increase phenytoin dose as slow as possible than to tighten fluid
restriction (this might not help w SIADH anyway; carbamazepine increases risk of SIADH btw)
13 b CORRECT – is there a good way of working out / calculating why 40-60mmol per day of kcl
(alongside 2L of fluid) is approx. human daily req? – does it depend on normal losses – K concentration
in plasma is 4.5mmol/L and we are giving potassium daily maintenance as 40mmol/2litres =
20mmol/Litre – that’s around 4x plasma concentration – is that so that some stuff goes into the cells? –
PLEASE EMAIL PMG – nooo basicalyy if ur nil by mouth u need extra potassium that u don’t need if ur
not nil by mouth so hartmanns is for non nil by mouth unless u add potassium that u would otherwise eat
14 e - salbutamol makes plasma potassium lower (BECAUSE it activates NaKATPase) ooooh I wonder why
BUT I THINK ITS E CORRECT

PLANNING MANAGEMENT

15 b CORRECT
16 e WRONG – c – sulfonylureas are used in t2dm BEFORE insulin (despite risk of weight gain and
hypos, smh that’s nicer than injecting and food monitoring aha)
17 D WRONG – e – NSAID dose too high in the option (1g per day of naproxen) AND history of
indigestion – TENS is legit – also Amitriptyline 100mg is depression and 10mg is neuropathic pain
18 d CORRECT
19 d WRONG – a – exacerbation of COPD – d was too much o2 (wd give 24 not 60 % because COPD goal
is lower sats) – oral or IV steroids help w COPD exacerbations BUT take longer to work than
ipratropium (nebulized = fastest to get to airway) (also, bi means two and bipap is used for t2 resp
failure, whereas CPAP is for type 1)
20 d CORRECT
21 d CORRECT
22 a CORRECT

COMMUNICATING INFORMATION

23 b CORRECT
24 b CORRECT
25 a CORRECT
26 e CORRECT
27 a CORRECT – clarithromycin is like erythromycin aka liver enzyme inhibition
28 d (careful when parameter is right but timeframe is wrong) WRONG – c – ‘cardiovascular RF’ incl
smoking; olanzapine causes long QTc in those w ‘cardio RF’ so do ECG

CALCULATIONS – please analyse why the wrong ones were wrong using the exam Qs

29 187.5 MICROGRAMS of digoxin for AF - one tablet of 125mg and one of 62.5 mg once daily
CORRECT
30 volume = ; dose = 8mmol; 20mmol per 10ml ampoule; - need 10*20/8 = 200/8 = 25ml WRONG 4ml
31 initial ampoule concentration= 5g/10ml = 5,000mg/10ml - we need 200mg/ml concentration - that’s
5,000mg in 25ml - so we dilute with 15ml WRONG 10ml
32 rate is 150mg per minute; concentration is 5g for 20mmol; dose to find time for is 8mmol - that’s 5*8/20
grams = 40/20 = 2 grams - infusion rate is 150mg per minute; that’s 1500mg (1.5g) in 10 minutes and 2mg in
(10*2/1.5 = 10*4/3 = 40/3 = 13.3 minutes) - nearest minute is 13 minutes for infusion time CORRECT
33 15mg oral prednisolone into IM alternative - initially 100 mg, then (by continuous intravenous infusion)
200 mg every 24 hours, diluted in Glucose 5%, alternatively (by intramuscular injection or by
intravenous injection) 50 mg every 6 hours, dose increased to 100 mg every 6 hours in patients who are
severely obese. WRONG – look in ‘glucocorticoid therapy’ treatment summaries on BNF to find
conversion between oral prednisolone and IM hydrocortisone – and remember to double oral dose
because pt is unwell
34 250ml in one hour is 250/60 in one minute = 42ml/min WRONG 4.2ml/min
35 1 g every 8 hours CORRECT
36 dose = 10mg; concentration = 1:100 = 1kg in 100litres = 1gram : 100ml - desired thing = volume - that’s 1
ml CORRECT

PRESCRIBING

37 - REGMED = omeprazole once daily 10mg oral; PRN = cyclizine 50mg 3* per day oral WRONG – codeine
- good in elderly – reduces pain and causes constipation (whereas tramadol, the other opioid to consider,
causes more hallucinations and delusions) – where was this in the bnf? What was the Q? – I’m confused –
Q was to relive dyspepsia immeadiately in 32yo w cholecystitis recovery – also if its PRN, put ‘8hourly
max’ to mean max3*per day
38 - UFH SC 5000 units every 12h WRONG – Q asks for thromboprophylaxis NOT treatment dose –
LMWH is for prophylaxis (I guess in case pt is discharged) – can use enoxaparin or dalteparin – question
= 1mg is 100units said on BNF but Q does not say pt weight – dose was 5k units for dalteparin and 4k for
enoxaparin – ALSO why not UFH – that’s also indicated on BNF – maybe because prescription will be
KEPT ONCE DISCHARGED PT? (indicated by need for long term thrombophrophylaxis) – LMWH is
more commonly used, UFH is more easily reversible and shorter acting
39 - nitrofurantoin 50mg PO four times per day for 5 days WRONG – for 3 days not 5 (that’s in the BNF) –
also say 6hourly
40 - PRN - sumatriptan - 50mg - oral - how do I summarise bnf as ‘frequency’ on the drug chart? “Initially 50–
100 mg for 1 dose, followed by 50–100 mg after at least 2 hours if required, to be taken only if migraine recurs
(patient not responding to initial dose should not take second dose for same attack); maximum 300 mg per day.”
WRONG – shes not on any pain meds so climb up the WHO ladder (paracetamol NSADIS weak→strong
opoids) – and its NOT migraine so triptan is not needed – search paracetamol AND headache
41 - IV vancomycin 2g 12hourly IV WRONG - it said it said 20 mg per kg per dose and max dose is 2g
BECAUSE some ppl weigh more than 100kg – cant find where bnf says 1g in elderly (the markscheme
indicated that) – also, didn’t put a duration, which is essential for antibiotic prescribing
42 - isphagula husk - one sachet (that’s 10ml) twice daily WRONG – bulk forming laxatives like isphagula
take 3days to work- stimulant laxative eg senna is better
43 - codeine phosphate 30 mg 4 hourly (up to) (max 240mg per day) - oral – regular CORRECT
44 - PRN oxycodone hydrochloride - 5 mg 6hourly - max 400mg daily WRONG – Q indicated that relief was
for indigestion not pain - there’s three types of indigestion medications (antacids) = PPIs (omeprazole,
lansoprazole – take days-weeks for effect to start), H2receptor antagonists (ranitidine, peak effect 3h post
dose), alginates (Gaviscon, peptic, pt=allergic2alginate dressings – effect seen in minutes), salts
(immediate action ie effect seen in minutes, MgC03 or Al(OH)2)

DRUG MONITORING

45 – d WRONG – c – stupid idiot – RTQ – said measure response to treatment (02 sats), not monitoring
required for the drug (theophylline level)
46 – b CORRECT
47 – d CORRECT
48 – b CORRECT (suicidal thoughts at beginning of antidepressant treatment)
49 – d CORRECT
50 – d CORRECT
51 – b CORRECT (measure renal fn b4 starting ramipril cos it helps to determine the starting dose)
52 – a CORRECT
53 – a CORRECT

ADVERSE DRUG REACTIONS

54 – amlodipine CORRECT
55 - co-amoxiclav WRONG – diclofenac NSAID causes AKI – co-amox is just penicillin
56 - codyramol CORRECT
57 – carvedilol WRONG – cyclizine (causes antimuscarinic SE, not for pt w heart failure like this one) –
beta blockers aren’t antimuscarinic!
58 - c (minor bleeding and INR over 1.5) CORRECT
59 – d WRONG – ans was oral chlorphenamine (for allergy) – pt did NOT have anaphylaxis (breathing
issues / stridor) – IV hydrocortisone and IM 5ml of 1:1000 adrenaline are for anaphylaxis
60 – d WRONG – a – just because you do not like orange juice does not make the answer wrong – Q said
pt was conscious