Preview content might not be up to date. For full access to the live content, checkout our Pricing page.
Section 1 - Prescribing
Introduction
Section 1 of the PSA examination evaluates your ability to write safe and appropriate medication prescriptions, a fundamental skill for any FY1 doctor.
You will be presented with a clinical scenario and are expected to identify and prescribe the most appropriate treatment. This can include medications or fluids. Be aware, questions do not only focus on adults, and may also include paediatric patients.
Section 1 carries 40% of the total marks for the Prescribing Safety Assessment. It is a very heavily-weighted section, and thus the most important section. Maximising your score in section 1 will give you a strong footing for the rest of the exam.
| Question Style | Fill in the blanks (Drug name, dose, route, frequency) |
|---|---|
| Total Questions | 8 |
| Marks per Question | 10 (Total of 80 marks) |
| Advised Time per Question | 5 minutes |
Example Question
Case presentation
A 72-year-old man presents to the medical assessment unit with shortness of breath and oedema for 1 week. PMH: Ischaemic heart disease, type 2 diabetes, chronic kidney disease leg ulcers, gout. DH. BP 5 years ago: baseline 150/90 mmHg. He is on furosemide 40 mg PO daily, hydrochlorothiazide 500 micrograms PO daily, allopurinol 100 mg PO daily, amlodipine 5 mg PO daily, enalapril maleate 20 mg PO daily, losartan potassium 75 mg PO daily, and metformin 500 mg PO twice daily.
On examination
Temperature 37.2°C, HR 72 bpm and rhythm regular, BP 148/90 mmHg, JVP Raised, RR 22/min, O₂ sat 98% breathing 40% oxygen. Bilateral pitting leg oedema to thighs.
Investigations
Na⁺ 138 mmol/L (137-144), K⁺ 5.4 mmol/L (3.5-5.3), Urea 15.1 mmol/L (2.5-7.0), Cr 187 μmol/L (60-110)
CXR shows cardiomegaly and pulmonary oedema.
Prescribing request
Write a prescription for ONE drug that is most appropriate to alleviate his breathlessness and oedema.
(Use the "once-only medicines" prescription form provided.)
PRESCRIPTION FORM
Source: PSA
How to Approach This Section
Questions will present a clinical scenario where a patient needs to be prescribed a new drug. Your job is to diagnose the patient and correctly prescribe the corresponding drug. If you already know which drug needs to be prescribed you can look directly at the drug nomogram on the BNF. However, in the PSA exam, the correct answer will be based on whatever is stated in the BNF.
For example, imagine in a question a patient requires an anticoagulant and you choose dabigatran as your drug of choice, but the BNF states that apixaban is the first line drug. Even though dabigatran may be a suitable option for the patient in clinical practice, you will not be awarded full marks as the BNF states that apixaban is used initially.
In order to avoid this mistake we suggest you take the following approach when tackling questions in Section 1:
-
Understand the Clinical Scenario
Read the question carefully and understand the clinical scenario. What is the patient’s diagnosis? Section 1 is not testing your ability to diagnose a patient, therefore the clinical presentation will usually be very typical of a condition with overt symptoms which should make the top differential diagnosis very clear.
-
Find the Corresponding Treatment Summary
Once you know the patient’s diagnosis, you need to use the BNF to open the corresponding treatment summary. Treatment summaries are very similar to NICE guidelines where they break down the pharmacological management of many conditions. The full list can be accessed from the home page by clicking ‘View treatment summaries A to Z’.
The number of treatment summaries will initially appear extensive, but once you start practising questions, you will quickly identify which treatment summaries are useful. You do not have access to NICE guidelines in the PSA exam, so the BNF treatment summaries are your best friend!
-
Identify the Appropriate Drug
Treatment summaries will contain lots of information regarding the management of a condition or group of conditions. Whenever a drug is mentioned in the treatment summary there will also be a hyperlink to the drug nomogram page. This means that once you have identified the correct drug from the treatment summary, you can click on the drug name to open the drug’s individual page on the BNF.
-
Find the Correct Dose, Frequency, and Route
Almost there, this is the final step! Now that we have identified the correct drug, we need to find the appropriate dose, frequency, and route for our patient. When you are using the BNF you will see that any particular drug can have many different indications. And for each of these indications the dose, frequency, and route will differ. Therefore the patient’s diagnosis will be used to guide us to find the correct information.
And that’s it! When you first start practising questions for Section 1 it can seem very daunting and complicated. Once you have completed Section 1 on PSA Complete and practised enough questions you will be very comfortable conquering the prescribing questions!
Content Overview
The guide for this section is subdivided into: