Pass the PSA Mocks

Question 1

anticoag and metform pre surgery

Answer 1

Stop all anticoagulants pre surgery, stop metformin day of surgery

Question 2

max daily alendronate

Answer 2

10mg

Question 3

paracetamol and cocodamol combo OD - how to change?

Answer 3

stop paracetamol if combo OD and leave co-codamol as stronger.

Question 4

crucial step in checking for prescribing errors

Answer 4

Be alarmed if you see any ‘grams’ in units – uncommon and usually massive OD. Check all dose units.

Question 5

another ACEx side effect

Answer 5

can be dizziness

Question 6

watch aspirin dosing

Answer 6

Watch for aspirin dosing – only 300mg for short periods in stroke / MI, then should be moved down to 75mg.

Question 7

co codamol dosign

Answer 7

Max co codamol paracetamol dose is 2 tabs QDS (as 500mg in each co-codamol tab)

Question 8

aspirin doesn’t cause this unlike other NSAIDs

Answer 8

Aspirin doesn’t cause renal failure

Question 9

drowsy pt stop some drugs

Answer 9

obviously stop any benzos but also If drowsy, stop any opioids including codeine!

Question 10

warfarin induced OD

Answer 10

Don’t stop warfarin on induced OD, stop the interactant (commonly erythromicin)

Question 11

pre op alteratioins on bb, ccb, aspirin

Answer 11

Avoid altering beta blockers or calcium blockers pre-op. stop antiplatelets like aspirin.

Question 12

common trick in Qs about prescribing erros

Answer 12

Watch out for mg/g units being wrong either way! Common trick!

Question 13

lithium toxicity possible trigger

Answer 13

Lithium excretion much reduced by ACEx, thiazides, and NSAIDs i.e. kidney toxics – can lead to toxic!

Question 14

changing thyroxine doses

Answer 14

Only change levothyroxine in 25mcg increments eitherway

Question 15

if unfamiliar with normal dosing for a drug, check what?

Answer 15

Check MAX doses if unfamiliar with it

Question 16

fluid balance Qs

Answer 16

With FLUID balance questions, match input to output! Look at U/O and oral intake and match.

Question 17

increasing dosing how

Answer 17

Always increase dosing by smallest possible increment, esp with narrow range e.g. phenytoin

Question 18

sodium already low, what drugs to avoid?

Answer 18

Do not start SIADH risky drugs i.e. carbamazepine in patients with already low sodium

Question 19

normal pt no electro probs what bag of fluid when NBM

Answer 19

If given a ‘normal’ patient NBM and no electrolyte info, give standard 8hr 1 L normal saline +20KCl

Question 20

pen allergic - carbapanems?

Answer 20

There is 10% cross reactivity with carbapanems with penicillin allergic patients.

Question 21

first step acute Qs

Answer 21

When asked what to do first acutely, always follow ABCDE order as usual

Question 22

kidney disease T2DM and tried lifestyle

Answer 22

. SU drugs 1st line if kidney disease and type 2 diabetes + tried lifestyle change.

Question 23

COPD stable obs

Answer 23

Start on 24% venturi COPD if stable obs

Question 24

fluid deplete

Answer 24

Fluid – check over what time, picture real life – STAT needed in acutely deplete pts

Question 25

ACEx angio oedema

Answer 25

Angio-oedema withACEx occurs slowly, months later

Question 26

ACEx test renal function

Answer 26

Test renal 2 wks post starting ACEx.

Question 27

statins info warnings

Answer 27

Statins are taken at night. stop statins alongside clarythromicin. Don’t drink grapefruit juice ‘dietary restriction’.

Question 28

antipsychotics starting thing

Answer 28

Antipsychotics – need starting ECG and baseline bloods+lipids. Recheck lipids 3monthly, gluc 6mo.

Question 29

unwell but on ISupp

Answer 29

Immunosuppresants are stopped during illness e.g. UTI and methotrexate

Question 30

steroid sick day rules

Answer 30

Sick day rules steroids – double the normal daily dose for duration of illness! if long term steroids

Question 31

1% solution is what you foolish papaladoop?

Answer 31

A 1% solution contains 1 g in 100 mL. | Thus there are 10 mg in 1 mL. !!! YOU KEEP FORGETTING THIS. JUST USE YOUR MATHS BRAIN FFS LOL.

Question 32

deciding on codeine vs tramadol

Answer 32

Tramadol can cause agitation / hallucination in the elderly, codeine produces constipation – weigh these risks up based on pt profile i.e. bowels.

Question 33

pen allergic and on methotrexate

Answer 33

Nitrofurantoin for UTI in pen allergic patients on methotrexate.

Question 34

pneumonia HAP

Answer 34

Pneumnia guidelinles – HAP – tazocin first.

Question 35

laxative broad contraindications

Answer 35

No lactulose if bloated! No stimulants if cramping or colitis.

Question 36

codeine starting dose

Answer 36

Codeine start at 30mg 6 hourly. (don’t leap straight to morphine!!!)

Question 37

indigestion

Answer 37

Indigetion – magnesium carbonate 10ml.

Question 38

kidney impaired ACEx may show as what?

Answer 38

kidney impairment and ACEx may present as malaise!

Question 39

facial flushing anti HTN

Answer 39

Amlodipine can cause facial flushing

Question 40

enox needs these pre starting

Answer 40

Enoxaparin need minimum eGFR of 30 and minimum weight 50kg

Question 41

rv paracetamol dose with

Answer 41

adult <50kg

Question 42

AKI approach

Answer 42

With deviated electrolytes and acute kidney injury, focus on removing the nephrotoxics rather than on the electrolytes too much (unless massive deviation)

Question 43

if unsure what's gone wrong

Answer 43

If unsure, always double check dosese – esp old people, e.g. citalopram dose is lower in over 65s

Question 44

Hb levels for transfusion

Answer 44

Low Hb -> only transfuse if severely sympto and Hb <70. If IHD be more careful even if Hb higher. Better option is ferrous sulphate which increases by 10 a week the Hb

Question 45

ferrous sulphate

Answer 45

Better option is ferrous sulphate which increases by 10 a week the Hb

Question 46

acute anxiolytic

Answer 46

If asked for acute anxiolytic, given diazepam or beta blocker.

Question 47

sodium valproate starting

Answer 47

Sodium valproate – need LFTs to start, don’t routinely check vit D baseline.

Question 48

on steroids, wcc high

Answer 48

Remember steroids can cause leucocytosis (high WCC – check other markers to exclude infection)

Question 49

adjusting dosing with patient in mind

Answer 49

Always adjust dosing vs your own patient not the normal range – i.e. with phenytoin if getting gum changes and dysrarthira then reduce dose if in range and no seizures. #

Question 50

hypotensive bleeding patient

Answer 50

In a bleeding Q asking about ‘first step’ and pt is hypotensive – stat saline first, then transfuse! Remember ABCDE approach

Question 51

FFP given when

Answer 51

FFP given only if PT 1.5 x normal limits

Question 52

v low glucose and cannula in

Answer 52

100ml 20% glucose IV if severe hypoglyc and IV access

Question 53

severe UC flare

Answer 53

Severe UC flar >6 motions a day and systemic upset – thus IV hydrocort/fluids

Question 54

milder UC flare

Answer 54

If milder flare, give 30mg pred OD PO.

Question 55

approach with cal gluconate and hyperkal

Answer 55

Repeat calcium gluconate 10% every 15 mins up to 50ml total until ECG stable in hyperkal.

Question 56

AF there longer than 48 hrs, check the Q details!!

Answer 56

If AF there for 48 hrs+, then resort to other drugs not cardioverting agents.

Question 57

asthmatic with AF

Answer 57

Use digoxin in ashmatics with AF

Question 58

warfarin bleeding first step always

Answer 58

If haemo stable, reversing warfarin most important step in bleeding pt, not transfusing.

Question 59

rotate insulin injection site

Answer 59

Rotate insulin site or get lipodystrophy and variable insulin absorption.

Question 60

excess alcohol young type 1 DM

Answer 60

Excess alcohol is high risk for HYPOlycaemia in young diabetic adults.

Question 61

monitor this when giving phenytoin

Answer 61

IV phenytoin needs ECG monitor as assoc with arrythmias.

Question 62

monitoring aminophylline

Answer 62

Even for aminophylline, you take a theophylline level to monitor.

Question 63

best markerk for abx clearing chest inf

Answer 63

Best marker abx for CAP working – oxygen sats/ABG then resp rate

Question 64

on fluoxetine and new rash

Answer 64

If new rash with fluoxetine, discontinue as may be first sign of systemic reaction

Question 65

adverse effects of COCP

Answer 65

Adverse COCP affects- weight gain, irritability, new headaches +/- HTN

Question 66

m gravis with incontinence CAUTION

Answer 66

M gravis can’t have anticholinergics – esp relevant in bladder incontinence – give duloxetine.