PSA practice paper content

Question 1

COPD acute exacerbation - bronchospasm

Answer 1

SABA - salbutamol 1 mg/mL nebuliser liquid
dose is 2.5-5mg via nebuliser
Found in asthma - airway obstructions

Question 2

First line DVT

Answer 2

APIXABAN 10 mg PO twice daily for 7 days then 5 mg PO twice daily

Question 3

When to offer statin as primary prevention

Answer 3

In pts. w/ 10 year-CV-risk of 10% or more

Question 4

Drugs causing urinary retention

Answer 4

Anti-cholinergics
a-adrenoceptor agonists (metaraminol, phenylephrine)
Benzodiazepines
NSAIDs
CCBs
Anti-histamines
Alcohol

Question 5

Drugs causing confusion

Answer 5

Anti-cholinergics
Anti-psychotics
Anti-depressants
Anti-convulsants

LESS COMMON: H2 receptor antagonists, Digoxin, Beta blockers, Corticosteroids, NSAIDS, antibiotics

Question 6

DKA insulin administration

Answer 6

FIXED RATE short acting 0.1 Units/kg/hour

Question 7

What should be monitored for effect in fluid replacement and why

Answer 7

Blood pressure -> dehydration usually associated with reduced urinary output but monitoring the production of urine is less reliable measure of success in the early stages of fluid replacement than blood pressure

Question 8

HRT -> what to monitor and why

Answer 8

Blood pressure
HRT can cause sodium and fluid retention = rise in blood pressure. HRT should be stopped if BP rises above systolic 160 or diastolic 95

Question 9

LIVER enzyme increase to warrant a reduction of dose or discontinuation of statin:

Answer 9

3 TIMES UPPER LIMIT OF RANGE VALUE

Question 10

IF both peak and trough gentamicin levels are high, what should be done to gentamicin dose

Answer 10

DECREASE dose and INCREASE INTERVAL

Question 11

First line IV tx. Hypoglycaemia

Answer 11

GLUCOSE 20% (50-100 ml) in up to 20 minutes

Question 12

Electrolyte disturbance with Tacrolimus

Answer 12

May cause hyperkalaemia -> due to reduced potassium excretion

Question 13

Which drug should be stopped at least 7 days prior to surgery

Answer 13

Aspirin

Question 13

Which drug should be stopped at least 7 days prior to surgery

Answer 13

Aspirin

Question 14

Electrolyte disturbance with SSRIs?

Answer 14

HYPONATRAEMIA

Question 15

IF INR > 1.5 on the day of surgery, what should be given

Answer 15

Vit K

Question 16

Antibiotics which can cause cholestatic jaundice

Answer 16

Flucloxacillin

Question 17

What rise in creatinine is tolerated in pts. taking ACEis

Answer 17

<20%

Question 18

Indication of effective treatment with furosemide

Answer 18

Reduction of weight

Question 19

ACEi therapy in heart failure - how do you monitor for beneficial effect of treatment

Answer 19

Exercise tolerance

Question 20

Palliative care prescribing: pain -> how much morphine

Answer 20

20-30 mg/day w/ 5 mg for breakthrough pain

Question 21

Drugs causing:
a) ATAXIA
b) Parkinsonism

Answer 21

a) Phenytoin, carbamazepine, valproate
b) Antipsychotics, metoclopramide

Question 22

Loop and thiazide diuretic effect on calcium

Answer 22

Loops: HYPOCALCAEMIA
Thiazides: HYPERCALCAMIA

Question 23

Loop and thiazide diuretic effect on calcium

Answer 23

Loops: HYPOCALCAEMIA
Thiazides: HYPERCALCAMIA

Question 24

Drugs causing impaired glucose tolerance

Answer 24

Thiazides Loops diuretics Corticosteroids Ciclosporin

Question 25

4 drugs causing constipation

Answer 25

Verapamil Opioids Antipsychotics Tricyclic antidepressants

Question 26

Monitoring parameters for LITHIUM

Answer 26

Drug level, TFT, UE

Question 27

Common side effects of Levodopa

Answer 27

Dry mouth Postural hypotension Psychosis Palpitations Anorexia

Question 28

Palpitations

Answer 28

anorexia

Question 29

Maintenance fluids for children

Answer 29

100 ml/ kg/ day for first 10 KG 50 ml/ kg/ day for next 10 kg (to 20kg) 20ml/ kg/ day for the remaining weight over 20kg

Question 30

4C antibiotics and what might they cause

Answer 30

C.difficile Ciprofloxacin Co-amoxiclav Clindamycin Cephalosporins

Question 31

Medications to stop preoperatively

Answer 31

ACEi/ARBs Diuretics Anticoagulants Antiplatelets HRT and COCP (STOP 4 weeks before) Lithium NSAIDs ILACKOP Insulin (consider starting pt. on sliding scale Lithium Anticoagulants/antiplatelets COCP K sparing diuretic (spironolactone) Oral hypoglycaemic Phytonidione (Vit K) Perindopril (or any acei)

Question 32

Diabetic drugs: which drug should be omitted on day of surgery

Answer 32

SGLT-2 inhibitors - Dapagliflozin

Question 33

Diabetic drugs: which should be omitted the morning of surgery

Answer 33

Sulphonylureas

Question 34

When should metformin be changed on the day of surgery

Answer 34

If taken TDS, omit LUNCHTIME dose if OD or BD continue as normal

Question 35

If pt. NBM - how must medication be given

Answer 35

Intravenously

Question 36

Oral hypoglycaemics advice: Metformin

Answer 36

Look out for signs and symptoms of lactic acidosis such as dyspnoea, muscle cramps, abdominal pain, hypothermia or asthenia

Question 37

Oral hypoglycaemics advice: Sulphonylureas

Answer 37

Look out for signs and symptoms of hypoglycaemia. Higher risk elderly patients or those with renal impairment

Question 38

Oral hypoglycaemics advice: SGLT2 inhibitors

Answer 38

Look out for signs and symptoms of DKA even if BM is normal (As glucose being removed through urine)

Question 39

Diabetic management: T1DM how often should HbA1c be checked -

Answer 39

3 monthly

Question 40

How often should diabetics visit the podiatrist

Answer 40

Once per year

Question 41

Important information RE: all anti-psychotics

Answer 41

As photosensitisation may occur with higher doses, patients should avoid direct sun-light Drowsiness may affect performance of skilled tasks, effects of alcohol are enhanced.

Question 42

Which commonly prescribed anti-platelets should be avoided with lithium

Answer 42

NSAIDs -> can increase lithium levels in the blood resulting in an increased risk of lithium side effects

Question 43

Who all should receive 5mg FOLIC ACID (increased dose) for the duration of pregnancy

Answer 43

Hx. of neural tube defects Diabetes Sickle cell disease Anti-epileptics

Question 44

Pain medications which can accumulate in renal failure

Answer 44

Morphine and Codeine Oxycodone should be given instead

Question 45

Which cardio drug should be stopped in SEVERE PVD

Answer 45

B-blockers - cause peripheral vasoconstriction and worsen ischaemia (ACEis are also cautioned in severe PVD)

Question 46

Which CCB may exacerbate heart failure

Answer 46

VERAPAMIL DILTIAZEM

Question 47

Is routine monitoring required with use of SSRIs

Answer 47

NO

Question 48

Best marker of beneficial effects of antibiotic in UTI

Answer 48

Resolution of SYMPTOMS - over next 72 hours

Question 49

What should be done when a statin is suspected to be th cause of myopathy and CK concentration is markedly elevated

Answer 49

Treatment should be discontinued, if symptoms resolve and CK levels return to normal, statin should be introduced at LOWER DOSE