Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Today will be somewhat useful. Um It's going to be a little bit interactive because we'll go through some key kind of state um questions and um hopefully, if you'd like, you can also participate as well, feel free to pop something on the chat or um you can engage as much as you like if you want to keep it to yourself as well. That's absolutely fine. Um So let's crack on um if you go to the next slide, please. So just a quick overview of what's going to happen um in this talk, we'll try and keep it in the one hour mark, but basically we'll whisk through kind of what the PSA exam structure is. I'm sure that you guys know this already and then we'll go through the domains of examples and come to things, look, look out for and really just the key things that you need to know for your exams. Um Final few tips are like how to navigate the online B NF and also some exam techniques that you might want to know as well. OK. So next slide please. So the PS psa exam, I'm sure you guys know this already, it's not the hardest exam in the world, but it's something that's just a check, a tick box thing that you need to do. It's an open book exam that you can use for B NF, which, which is going to be your best friend in this exam. We've got E eight sections there with 200 marks and you need to do it in two hours. It's supposed to pass or fail exam. But um, no pressure that you need to completely pass this in your first trial, you can still reset the exam, but obviously it's good to kind of get it out of the way. Um So we'll go for your dissections together in a bit anyway. So next slide, please. So really the most important thing to with this exam is timing, a lot of people will struggle with kind of time keeping in this exam because it's, we've only got 100 and 20 minutes. So it's not a lot of time to do all of these exams. Um One strategic that I was kind of taught in medical school is to have a look at the waiting of the exam. So you can see that I've put down all the eight kind of sections in, in this exam. Um where prescribing a prescription review kind of takes up quite a lot of your marks. So it's really important to spend quite a bit of time on this sort of these two sections of the exam and really just to time keep on everything. So um calculation questions are usually quite kind of fast conversion exams. We try to aim to get those right as well. Um Don't get too bogged down with any sort of um questions and always just make sure to look at the time as well. So in terms of like time allocation, you can kind of have a look at the weight of the exam. So, like I said, because the first two kind of um sections take up the most time. Um If we kind of think about it in terms of the percentage, you can spend maybe like 40 minutes in prescribing 60 minutes in prescri prescription review and eight minutes on all the 8% and six minutes on all the 6% which in total, we'll actually give you like 100 minutes to finish the exam with 20 minutes left to kind of review everything. So just kind of have that at the back of your mind and make sure that you look at the clock when you do the exam cos it's quite stressful and you just need to be on it um for your exam. Ok? Um So without further ado, I think we can just go through kind of the um each section with sort of what's commonly seen some common questions or questions that we got from the question bank. Apologies that you guys already done it already, but I think it's just good to kind of have an example where there's like some, some sort of learning, learning, um, tips and things to look out for. Um, next slide, please. So we'll just go through prescribing. Um, so in prescribing it takes up 40% of your marks. It can range up to acute scenarios, chronic scenarios, things that you can see in GP placements. And there's a lot of questions where sometimes they'll ask about fluids, ask about anti antibiotics prescription. So it's almost like a guarantee that you'll see maybe one fluid and maybe one antibiotic prescription in this section. So obviously make sure that you know about um you're, you're quite like confident in all of these prescribing questions. Um One thing that I got a bit confused when I was a medical student is kind of the scoring of this um part because it takes up 10 marks in each question, which to me is like, oh my God, it's quite a, quite a lot of marks to take up on. But essentially this exam just wants to make sure that you're a safe prescriber. So a lot of the times it just looks at the medication, um if you've got the right medication, then you score um quite a high mark on it anyway. And then so five marks on the medication. Um There are sometimes things that you need to look out for which I'll go through later and that will make certain choices, a more suboptimal kind of um option for the question and that will kind of bring down your marks and then your dose route and frequency would make up the L5 other marks. So if you got the right medication, you'd guarantee to get some sort of marks in, in that certain question if that makes sense. Um So next slide, so um what we're going to do is we can go through this question together. Um So I can give you like maybe a one minute and like a minute and a half to kind of just go through this question if you guys can get your B NF up and just type down what you think it's the right answer in the chat or you can keep it to yourself as well and then we can go for it after a minute. OK. So just remember that with prescribing, it can have multiple correct answers. I'm just gonna start the timer now. OK. That's about a minute and a half. I'm not sure if anyone's popped anything on the track. OK. So I've got on and 4 mg. IV. That's perfect. OK. So should we go out, go on to um the next flight for the answers, please? So, um with the, with this question, so the correct answer for scoring all, all of the 10 points is um Cyclin. Um and I'll just kind of go through the reason why um in the next slide Um So hopefully, um, if you guys don't have kind of sort of, you don't really know where to find kind of, this sort of thing is that you can go on the BNF and search out nausea and vomiting. Usually it will give kind of a treatment summary and then on there you can see all of the drugs. Um So I think one of the answer was an on which is, which is a good, good answer. But let me just go through why um this might not be the best option for this answer. Um So I'm sorry, Anna, would you be able to go back to the questions like two slides for? Thank you. Um So I think um the reason why the roots would be a very important case here is um you were absolutely right to do an IV because the patient is not very tolerating um oral medication. So if you put an oral medication in, it wouldn't kind of deduct you to um zero marks, but it might just put you down to the optimum level because you're not giving the perfect kind of the most optimum route for the patient just because patient might not because your patient vomiting. So no medication might not be, he might not keep up with the medication. So A IV would be the best route in terms of why um Onda would not be the most optimum Andy would be one is because I think in here. It's that acute um, interval, it's quite long. So it is a little bit tricky and ii completely see why. But, um, this is why I've kind of put this question on here just because there's a bit of learning point in there. So just be aware of kind of the contraindications because certain kind of medications cause prolonged QT. Um, and I think on that is one of them. So, um, just be aware of the root of it and what sort of kind of medication if there's any kind of contraindications or if the patient's allergic, are they pregnant? That sort of thing? Because that can um affect which medication, which option that you're choosing for if that makes sense? Ok. Um So if we go um to the next slide, I'm just going to go through kind of common scenarios that can show up in this scenario. Uh Next slide please and end of the expi thank you. Um Yeah, so common scenarios that can show up, like I said, antibiotics is a very common one to show up. So just be aware of kind of where you can find the antibiotics. You don't need to know it by heart. But um just navigate on the BN F for a little bit because it comes under infection, but it has like multiple infection um pages that you need to know. Um So um common scenario. So like UTI S kind of ear infections that sort of thing to be aware of the contraindications. So sometimes they might be a bit sneaky and put like penicillin allergic or patients like pregnant. So these are just things that to be aware of so that you can get all of the um marks for this kind of section. Um The other thing was the antiemetics as well. Can the patient eat? If not, then we would using an oral route because an IV route would be the best. Um Other things are like, oh QT prolongation, Parkinson's that sort of thing can be contraindicated. So it is quite a quick decision that you need to make, but just be aware of these little kind of um slip force slip for that they can put um and just trick you into getting the suboptimal kind of option. Other things are like GP scenarios that you can search actually on BNF. So if you search medical emergency in the community that will show up with having quite a few like GP scenarios. So if you get stuck, if you don't know which medication do you give in certain conditions, you can always go and refer it to BNF. Um Palliative care is also quite a common one. Sometimes they'll ask about kind of um opioid conversions or breakthrough medications. Um I think we're going to cover that in the calculation bit later. So I'm going to leave that to you Michelle later. Um The other thing is just contraception patches as well. I, when I was a medical student, I don't really, I find it, I find this part quite difficult to find it on um kind of the exam. But so, um for me, I kind of just memorized the contraceptions for myself. But if you don't want to, if you feel like there's quite a lot to remember, you can also just go on to B and F and search contraceptions, hormonal and that will show certain medications that you can prescribe for contraception patches. Um Next month, please. And then the other one is just fluid prescription. I'm sure that in medical school that's been covered for it, but it's just a quick reminder of kind of um the fluid prescription as well. Um So if you Yeah, thank you. So I'm just going to go through a few scenarios. Um If you like, you can also put what you think on the chat box as well or um have the little thing to yourself. So in adults fluid prescription, if a patient is hemodynamically unstable, what sort of um kind of, what sort of fluids would you give? So hopefully. Oh, perfect. Yeah. 0.9% sodium. Yeah, that's perfect. So um next one. Yeah. Um So the other oh sorry. The other scenario is um hemodynamically unstable but they've got low glucose. Yeah, exactly. So this is 10% glucose, 200 mg. Perfect. Or you can give 10% glucose 200 mg either way. Um You can also check that on the B MF if you get stuck on that. Cool. Next scenario, maintenance, fluids. This is one of them that they can also ask, what would you do? You kind of know what kind of formula do we go with? And how long do we give that for? Yeah, perfect. Uh So 100 twe uh 5020 I think that's uh the pediatrics one. but that's absolutely right. So if it's a pediatric flu prescription, which I'll go through in a bit um and the maintenance that's a 100 5020 ro but in an adult it's just making sure that um for each kg that we give 20 to 30 mg of water, um 1 mg of sodium and make sure that you've got glucose as well. And so usually it's like um one bag of sweet and too salty, but they usually just ask you to prescribe one bag and usually um if you click one more and that um thank you. So um for the fluids, you can put any time between 6 to 12 hours and that will still give you the correct answer. Um So this is basically, I think you, you guys are quite on it with the fluid prescription. Um but just to make sure that these are simple things that you don't miss out in your exam. Um And if you go, if you continue, so it's just the Children prescription as well. So in Children, it's a little bit different. We've kind of covered the maintenance, but, um, the Children hemodynamically unstable ones, I think it is quite mean to ask them, but just in case they do, we've just got formulas for it. So, um, next, please. So it's 10% times weight times 10. And if they don't give you the weight, you can also estimate it with the age as well. So next, and that's kind of how you estimate it four plus eight times two. and we talked about how to prescribe maintenance for Children. Um Just now. So next, yeah, so that's kind of how you prescribe that. Um That's going to be covered again um by Michelle as well. So if you've got any questions, we can try and answer that um in a bit as well. So I think normally that's kind of what you need to know for fluid prescription. It'd be really, really harsh for them if they ask you to prescribe things like replacement fluids. So I wouldn't worry too much because usually the questions are quite straightforward in the exam. Next, please. So the next part that we're going to talk about is prescription review, which is taking up 16% of the exam, which is still quite a lot. Um There's a couple of patterns that you might find when you're practicing for this exam. They usually asked about drug interaction, dosing errors. Um if there's any kind of contraindications, basically, it is just trying to make sure that um as a prescriber, you're not prescribing something unsafe or inappropriate for the patients. So something to be aware of. It's like drug sensitivities and uh allergies for for this section. So we can go through another kind of practice question again. I'll give you like a minute to go through this ques this practice question together and then we can go through the answers to next slide, please. I'm just going to start my timer. So feel free to have a look at the question and think about what um you think is the right answer? OK, one minute is up. So hopefully you guys kind of had a chance to have a look at the questions. So I'll just um we'll kind of just crack on with what the answers are. So, um next, please. So for part A, I was looking for kind of what are the causes of hyperkalemia. And um the correct answer would be um the ticks on here and next, please. So B is looking for the cause of tremor and um that's the correct answer for this question. So hopefully you guys get something similar. So I'm just going to it, it's quite a kind of a straightforward question. But um I always find this part the most hardest because it takes quite a lot of time to kind of find the drug interactions or find certain side effects. So hopefully the next slide will give you a bit of kind of tips to how we can navigate this question a bit faster. So I'm sure that you guys probably know this already is that you need to um kind of look for certain side effects. So there's, there's two ways to actually approach this question. Um So control F is your best, best friend. Um So you can kind of search for the medication and then control effort and find kind of certain side effects. But the other way that you can do it is that if you've got a list of medications that you see in the previous question, you can put like hyperkalemia as a side effect. And if you put and, and then the medications, it will kind of just show you the medications that finds hyperkalemia. So it's almost like a search box thing. But, um, sometimes, uh, the, the only thing about BNF is that they have certain, they use certain wordings, which is a bit annoying because, um, if they say, for example, ankle swelling, you can't really just search swelling on BNF. You need to search something like edema or peripheral edema to have a kind of, to find, to find what you want to find. So it's, it's a little bit just like on your free time, just search certain words and find out what they like to use. So they like to use like hyperkalemia, hyponatremia instead of like electrolytes, imbalances, they use dehydration. So it's like very specific wording that you just need to know. Um So hopefully these would be kind of useful tips for you to speed up your process um in this kind of section of the exam. So next, please. So what I thought would be quite useful as well is just to have a look at the common errors that they like to put in the exams. So, um, some of them, you don't really need to search each each question because you can just have a look at the questions. And, um, if you can, if, if you know certain like side effects, you can already take out certain certain medications or already find the answer and that will save you a lot of time. But the other thing is that, um, I find quite tricky as also the prescription errors of trying to find the errors bit. So, next, next, please. So what we're going to do is just to have a quick look, um, at this bit as well. A lot of the times they just like to ask things that are common pre prescription errors. It's not things that it's like very niche and tricky. So it's important to use people look at the time because for example, statins they like to, um, it ideally given night. So certain things that are pretty much common sense, you probably see it a lot in the hospitals, but it's just things to be aware of. So statins, you give it at night, steroids, you give it in the morning and sleeping tetanus at night as well. The other thing they like to trick you on is frequency. So um stuff like electronic acid, sometimes they prescribe as OD, but the dose would be like a once weekly thing instead of OD. And the other thing is psychiatric drugs, drugs as well as every 1 to 2 weeks. If they put every day, it's clearly a wrong answer. Um And also just to make sure to look at the dosing. So most of the medications are mg but certain medications are micrograms. So stuff like levothyroxine, tamsulosin, these are micrograms. So if you see that it's an MG, you can almost quickly just find out what the wrong answer is and just double check it on the BNF and that will save you a lot of time. Um Next, please. So the other thing is just common pitfalls um in this, in this exam is just looking at the allergies, considered the contraindications of drugs. So stuff like what we go through prolonged QT pregnancy and that sort of thing, consider the route of the drug as well. And um the other thing is just IV potassium, sometimes they can trick you more than 10 mg. So, um this, this section is I think is the hardest indeed. But if you want the same time or if you're keen to kind of your time on here. The other thing to know is the basic side effect of this medication. So, like ace inhibitors, these are common, you know, common side effects of it are like hyperkalemia that you should already know. And if that comes up, you can almost just take that, take that already and move on to the next questions and know which medications to hold for renal impairments because they quite like to ask that as well. Um So next, so thank you, Eunice. So I'll quickly talk about me. Um Planning management. So I would say planning management is similar to what questions that you have done so far on past met, probably on other past uh practicing me, uh practicing papers as well. So it's basically just to, it could be prescribing something, it could be just a step or like it doesn't involve any medication, but it's just what's the most appropriate treatment or next step based on individual patients circumstances. So for this sort of question, I normally do look at the symptoms, the science investigation um that was given to you, they could have given you a known diagnosis or you probably have to get it out yourself. So I would just get it a as a hint from in the like different hints and sort of picture them together. So for this uh these sort of questions, treatment, summaries of BNF, it's a, it's your best friend to go if you are struck if you are stuck or you're struggling to find out what the next step you should be. So, I would say, know, sort of try to know about a bit about the common emergencies, like, um, a CS, like AK diabetic emergencies, pulmonary embolism, stroke, like these sort of common stuff. They might pop up and sort of say, what's your next best management or next step? What would you like to do? So, um, if you know these sort of common emergencies, well, then you probably don't have to spend time looking through the treatment, summaries, which actually you, you probably spend a bit of time trying to find out what's the next appropriate action obviously, as mentioned by unit, you can sort of control f and find the keywords and sort of see what you can do, but it doesn't take some time. So, um it's similar to like my question but uh make sure you know a bit about the how to manage to come in emergencies. So we can start with. Um, so with these questions, it's about um eight sort of eight questions in total and each worth about two marks. So um we can start with some examples. So this probably you might have seen this question before as well. So again, we can spend ano uh another one minute sort of have a look and look at the, look at the sample, look at the um results, sorry answers and then pop it in the chat and then we can go through them. I OK, thank you. So I think we've got an answer there so we can just quickly go through the ans like the how we are approaching this sort of question as well. So, um, thank you for the answer. I think your answer is the perfect spot on. And so basically in this scenario, if they haven't give you a diagnosis, and I hope everyone has sort of thought of what's actually happening at the moment. So given that the hint, they have said presenting hi co presenting symptoms are like lethargy, let lethargy, tightness and anorexia with the background of type one diabetes and on insulin as well. So it's kind of giving you a picture that's something probably going on with related to diabetes. And also the next hint would be like urinalysis showing ketone glucose and sort of these sort of diabetic ketoacidosis picture and then further to a further to act on it. So you can actually see with um have a look. Um So normally in a situation, you would do a VBG just to see if there's an any acidosis or anything. But um and here as well, it shows like the white cells count and um white cells count is higher and also urea creatinine high glucose uh with a PBG showing like low bicarbonate acid do as well. So it could hint that this patient is actually having a metabolic acidosis. So it's involving a bit of data interpretation as well. So that's like basically the pa patient had two problems going on, could be possibly an infection and could, could possibly be a DKA. So then you have to think which is actually more appropriate as a next step, which is more emergency for. Well, as far as we know, DK is definitely one of the most important emergency that we can't really not treat it. So for personally, in a clinical setting, we would treat the DK A DK A first and once we have managed that we'll go on to infection. So the next step would be the most appropriate one would be like using an insulin as a at a fixed rate to treat the DKA and then current and then after that to treat the infections. So this is pretty much how planning um planning or management would be. So given as re to repeat, like it's just given with no no unknown diagnosis. And what's the next appropriate? You could have quite a lot of answers coming up. As you mentioned, it could be action, it could be medication, but it's just how you are reacting to that situation at that moment. And what's the most appropriate action? Oh, you would prioritize. So the next page. So um next session would be providing information. So for this, it's more like if you have to let the patient go home, 11 most important information, what do they need to bring home with? So it could have popped up with multiple answers. So again, it's the most important one that you can't miss, you can't miss out. So normally it's either the direction or side effects of the medication. So, um for example, I think there are some common side effects that you should be aware of. For some, for example, for insulin warfarin methotrexate or like oral hypoglycemic medication, these are the one that they would have a specific side effects or um direction of medication use that you need to be aware of. For example, like methotrexate is once weekly mentioned earlier by uh units as well like alendronic acid as also one weekly as well. For Warfarin. It's important like for example, make sure they are not bruising, they have to do the inr clinic from time to time insulin wise, make sure you don't um you've got sick day rule. So it's quite a lot of common one that you need to be bear in mind with. And also kind of quickly remember because it's taking quite a lot of time if you have to search all of these on E NF when you when during your exam time. The other thing that I would be probably spending more time on is the contraception and the breastfeeding information. Um because to be honest on the BNF section, contraception is actually quite long. Um as mentioned before by Eunice, you probably try to learn it, give yourself a bit of picture before going in because by the time you're quite stressed and with the in with the how tense the me uh the exam is, you probably struggle to find all the information you need. So do familiarize yourself with the contraception and the breast breastfeeding information as well. Um On the BNF, there should be uh columns about like some with the big columns, there would be something about like patient counseling column or like specific administration methods or even there sometimes got a big bulky section about like RM HRA or any advice on the B NF. So for some medications that are known to have a lot of side effects, I will have a quick read about that or if you don't have time for during exam, focus on those section, you might find the most in most informative information on those sections. Um So with these sessions, um I think it's about six questions in total. So um to proportion, like to the extent proportionate, I would say spend about seven minutes in total. So about one minutes and 15 seconds on each questions. So um at the end of the day, think about what's the most relevant to the patient as well. So again, that's another example, we can spend about a minute on it and then think what's the most? This is again, the contraceptive question. So uh spend a minute or so and then we can come to the and discuss the answer together, pop in the chat as well. Ok, maybe we should crack on. So this is quite a lengthy question, to be honest, that's quite a lot of work. So, um, so we can just sort of crack like again in ex in the PSA exam, there might be quite lengthy questions like this. So it does take up your time to sort of read through them, sort of understand them and then sort of make the next step management as well. So again, if you know the material yourself, if you know the guidelines yourself quite well, so it would be a good chance that you don't have to go through reading all of them uh as well. So with this patient, so basically, it's about the missed pill. So she has missed her first pill yesterday, which and her second pill was due five hours ago. So she had sexual intercourse for on each of the last past three days. So she is on Micro Guinan, which is a con combined contraceptive pills. So first of all, you have to know that combi like the time interval for a combined contraceptive pills and a a progesterone only pill. So um the 2nd 2nd of all, so um what do you count as a missed pill? So a missed pill is normally like if you miss it more for more than 24 hours, which is different from a poop Um So for at this s at this situation, so technically, the patient has only missed one pills because the second pill is just due five hours ago. So she's technically not missing the second pills yet. And she is, I think from, she's missing the first pill of the cycle. So she's starting a new pack, the first pill of her cycle. So when it comes to an emergency, hormonal contraception advice, it's only recommended if you're missing two or more pills um from the first seven tablets in the pack. So technically, in this situation, she's only missing one pill and I understand that she had unprotected intercourse, but because she's only having one missed pill, so she's still protected. So the answer would be she should just take her missed pills, today's pills, even though it's taking two pills and she doesn't need an emergency contraception. So this is one of the reason I put these questions is because I it's important to know some of the and how can I say some of the medication? Well enough because when it comes to time, obviously, there is area that you can search on B NF. So if you go on to direction of administration and patient and carer advice, you'll be able to find missed pills. So how do you count as an, what do you count as an missed pill? And what can you do with missing pills? But then obviously reading all of those with your lengthy questions, it would take you a lot of time. So do be prepared about question like this and make sure that you know, some of your some of the Administra administration method quite well yourself. So I think Michelle we'll talk about the calculation part. So yeah, I'm gonna start by talking about uh the next section which is calculations. So in this section, um you'll have eight questions. Um each question is worth two marks, so 16 marks in total. Um I would say that in general the calculations uh section is quite straightforward um compared to maybe some of the previous um sections. Um So I'll just go through this really quickly. Um So it's usually um you, you're required to calculate the dose based on weight or body surface area um or it's about diluting a drug. Um As long as you're able to convert um different units of drug doses and concentrations, um You'll be OK, basically. Um So let's go on to the first um question. Um So again, I'll give about a minute. Um So just pop the answer in the chat um and then we can go through it together. OK. So it's been about a minute. Um Does anyone want to maybe put in the chat? OK. So someone's put 100 and 50 that's really close but not quite um anyone else have any other suggestions? OK. So, um I guess the tricky thing here is um knowing the concentration um of 20% glucose as and what, what that actually means. And I remember before I sat the PSA this was something that I um that really confused me as well um when it comes to percentages. So firstly, let's go through the answer. So um Anna, do you mind clicking the slide? Thank you. Yeah. So um the answer for this um is 100 and 25 mils. Um So that was really close. Um So how you would calculate this? Firstly is to um calculate how much um glucose in terms of grams um is in a given volume. So here, as we can see, 1% of something means 1 g in 100 mils. So in this scenario, if you were to give 20% glucose, um that means that there is 20 g um of glucose in 100 mils. Um And here you basically want 25 g. So you would do 25 divided by 20 which gives you the ratio. So 1.25 and then times it back by the 100 mils which gives you 100 and 25 mils. Um The reason why I put the slide there is because firstly, this can be a little bit tricky. Um And secondly, um it i in terms of it's not just for glucose, but also this is important for things like um creams or anesthetic agents. So um other things that you might come across are things like 1% lidocaine, for example. So 1% lidocaine would be, um, saying there's 1 g of lidocaine in 100 mils. Um, usually with lidocaine, you give it as a local anesthetic. Um So you won't use such a big volume. So another way would be saying there's in 1% of lidocaine, there is 10 mg in every meal. So that's just something to remember. Um Another thing that you might come across is adrenaline. Um So Anna mentioned some um emergencies that you should keep on top of your head in terms of doses of things. So adrenaline is um an important one. So just remember when people say one in 1000 of adrenaline, it means 1 g of adrenaline in 1000 mL or 1 L next slide, please. Ok. So um this is a second question again. Um I'll give you about a minute just to go through this and calculate um both the 24 hour dose and also what the hourly infusion rates might be. Ok? So it's been about a minute. Um Any suggestions in the chat um for how much maintenance fluids we're going to prescribe for this child. OK. So I go oh sorry, I just saw in the chart that someone else for the last question. Put 100 and 25. So well done. You were right. Um OK. So for this question, um Yes, you are clicking, sorry, not, yes, Anna. Um Thank you. So um this is the answer. So let's look at the blue box first. So this is something that um Eunice was talking about just now about the 150 20 rule when prescribing maintenance fluids for Children. So essentially this means um 100 mils um per kilogram per day for the 1st 10 kg, then 50 for the next 10 kg. So basically for a child that weighs over 20 kg automatically um according to this formula, you'd be prescribing um 1500 based on the 1st 2 20 kg. And then for the next um after the 1st 20 kg, in this case, the child weighed 40 kg. So for the remaining 20 kg, you're doing 20 mils per kilos per day per day. So that's 400 mils. Um So if you add that all up, if we go to the right hand side um of the slide, if you add that all up over 24 hours, the main uh the maintenance fluids required is 1900 mils. And then when you divide that over 24 hours, you get 79 MS per hour. So the reason why I asked for both in this um question is, is, is just to remind um everyone to, to be careful of the units. So once you've e especially when it comes to prescribing fluids, so once you've worked out what their 24 hour requirement is both for Children and for adults. Remember to, um, just pay attention to the question, see if it's asking you for the sort of total dose over 24 hours or the hourly infusion rate. In which case, you just have to divide it by 24 before you arrive at your final answer. Um, next side please. And then this is just something. Um, again, I think you just touched on earlier. It's not a question, it's just um a reminder that um at least for the PSA um I'm not sure about your medical school finals. Um I remember having to kind of learn this off by heart anyway, but at least for your PSA because you have access to the BNF. Um This is the, the opioid conversions in terms of Oramorph oxyCODONE. Um IV morphine, subcutaneous, morphine, traMADol, etcetera. Um You can find in one nice little neat table. Um If you go, if you basically just type in the search bar and BNF uh prescribing in palliative care or um from what you can see here, you can go to medicines guidance and then scroll down and find prescribing inal care. And basically, um again, if you control F morphine or like doses or equivalent dose or something like that, it will bring you to this section of the page um which will give you this nice table. Um so that you don't have to memorize this off by heart. Um for the PSA if it asks you for any of these um conversions. Um And one more thing that I'm gonna say here is um as you can see, um for morphine and oxyCODONE, for example, um the doses the doses between po so oral and IV and uh subcutaneous are a little bit different. So again, in your questions, be careful and look at what route they're asking you for um when you're calculating the doses and um remember to do a conversion if it's a different route. Um for example, from subcutaneous to um po for example of morphine. Um Right, I think that was all for calculations. So, next slide, please. Thank you. So, um now we're gonna move on to talk about um the sixth section um of the PSA which is adverse drug reactions. Again, you get eight questions um in this section. Um and it's again worth two marks each um making it a total of 16 marks. So with this section, um you will have to know the potentially dangerous drug interactions and identify the most likely um adverse effect of a specific drug. Um Obviously, the sort of commonly prescribed drugs that they will ask you about in terms of side effect profile. Um and drug interactions are um nsaids, antibiotics, beta blockers, calcium channel blockers, um ace inhibitors, that sort of thing. Um And the common side effects that um they're gonna ask you about um are renal impairment, hepatic impairment, uh hypokalemia, hyperkalemia, basically, any electrolyte disturbance um and also urinary retention um which is quite an important one as well. Um So if we move on to our first question of the section, thank you. Um Sorry, this one's a bit blurry. Um Again, this was taken from the mock paper. Um So have a go um I'll give you guys one minute again. Um and then go through. Yes. Mhm. Ok. So it's been about a minute. Anyone um want to have a go at which adverse effect they're asking for here? Yeah, perfect. Well done. So, leukopenia is the correct answer in this scenario. Um So the drug hearing question is methotrexate. Now, um you might already just from reading that list know that leukopenia um is a side effect. Um And that's why when it comes to drug monitoring. Um um we need to do routine FBC S on people taking methotrexate. Um But anyway, let's say you weren't sure you just wanted to double check whether that's the um most common side effect um in the list of five, you can again look for the drug on B NF and then scroll down to side effects. So, next slide, please. Yeah, great. Thank you. So, yeah. So, um I've screen shotted the um side effects bit of the BNF of methotrexate here. Um Just to show you that um again, pay attention to the question, it says the adverse effect that is most likely to be caused by this treatment. So, in other terms, it's asking you for the most common side effect. Um This is, this was quite a nice question in a sense that all the other four are basically not even side effects, but however, they might be a little bit more mean and actually all five of them, um will be side effects um, of a certain drug. And you're basically asked to choose the most likely one. So in that case, what you want to do is look in the common or very common session. So um always look in there first and see if there's anything there. Um It's particularly important when you're doing controlled uh control F for example, because let's say you did control f blindness as, as your first option and you see it come up as a side effect in the uncommon section. Um That may still be the right answer, but they, that might be the wrong answer because there might be another side effect that's more common and it will be under the common slash very common bit of the B NF. So this was just to illustrate this point. Um OK, next slide, please. So um another question, um last question for me again, um I'll give you guys one minute just to have a read and have a think great well done. Someone said traMADol and that's the correct answer. Um So next slide, please. Um So again, SSRI S and traMADol, um it's pretty well known sort of drug interaction. Um But if you were to search up again, I've just put a screenshot there of what you might do. Um BNF is your best friend here. So what you can do is it's essentially asking you which drug, let's say you, you, you didn't know, it's essentially asking you which drug interacts with citalopram. So what I would do is type citalopram into B NF and then um in navigate to section click interactions. So when you click interactions, it basically brings you onto another page and it's a list of all the possible medications that interact with citalopram. Um And what that interaction is. So what happens um when you get to that page, obviously, it's a huge list. Um and you're not gonna scroll through all of them. So, um again, another tip is control f so you can basically control f all the five options. Um And then see which one is the one that, that interacts again, more than one of the options might be um on uh might, might have a drug interaction. Um with Citalopram, let's say in this uh scenario. Um in that case, obviously, look for the one there, it said in the question just now, um it specifically said Serotonin syndrome. So you're looking for the one that has the interaction that literally says Serotonin Syndrome, um which, which is what we have here. Um Great. So, next slide, please, right. So this is just a final slide for me in terms of adverse drug reactions. Um I would advise just basically screens shotting this page. I don't think you need to ever learn this specifically for the PSA you might find it useful for your finals. Um This is basically the two acronyms that I used um when I learned the kind of p 450 drugs. Um So classic interaction is warfarin with any of these to be fair. If you do the whole drug interaction and control F thing, you'll probably find them. Um But I've just put it there as a reminder. Um If you want to learn them, um if you think that's useful and then just to remember that um the P 450 induces decrease your inr, but it usually takes a more prolonged exposure um to a drug um before it decreases your inr. So before it makes you more likely to clot. Um So if you see here, alcohol, for example, chronic alcohol use lowers your I NR makes you more likely to clot whereas on the other side, on the right side, um acute alcohol, so like an alcohol binge would increase your I nr. Um So make you more likely to bleed. Um It also P 450 inhibitors also reduces the effect of clopidogrel. So that's something to keep in mind as well. Um And yeah, that, I mean, as with all of these acronyms, there are always some that don't quite fit uh into the acronym. So there are three, well, two drugs and also grapefruit down there um as well for P 450 inhibitors um that you guys might want to be aware of. Um Great. So, thank you, I'll pass you back over to Anna. Thank you. So we're just going on to about drug monitoring. So basically, this is a session about um this is a question about how do you moni particularly about like neurotherapeutic drugs. So there's quite a few, for example, like digoxin Opalin, um and theophylline. So I would suggest to make sure, you know, a bit know what sort of um you don't have to know in details but sort of know what therapeutic medica uh like narrow therapeutic medications including. So these are some of the very common one. So, um basically, with this sort of question, they just wanna ask you about how is your monitoring options? Whether for um sometimes they could ask you about adverse side effects if it's over the therapeutic window or if it's just a benefit of how do you, how can you tell a drug is working well on the patient? So, um for these sort of questions, make sure that you know, the exact like be aware of either they asking you either for adverse reaction or like for side effects, monitoring side effects or make sure that you know about the time length of monitoring as well. Sometimes with the baseline monitoring or it, it'd be like an interval, for example, like three months, 12 months that they are looking for as well. Um So we can just whiz through these questions quickly if that's the. Um So it's just because I know the time is quite tight as well. So basically, the patients are having a facial flush and night sweats with hypercholesterolemia and also patients on atorvastatin 40. So, um so let's have a look. So um a diagnosis of uh menopause and also on estradiol um as a hormonal replacement therapy. So they're asking what's the monitoring options for the treatment? So the monitoring, there is a lot of monitoring for um before you start uh uh hormonal contraceptive management. But then normally, if it's for a monitoring for like after you start the medication weight is one of the things that we need to look out for. So I wouldn't go through, why is it weight or what's the reason why? But we can sort of go, I think more importantly, you know, where to look for the answer. So basically, it would be under monitoring requirements. So it's one of the side effects of um estradiol. So as a monitoring requirement, so make sure you know where to look for on your exam. So they would say even though there's not popping up, it's the side effects of estradiol. So I would suggest if you can't find anything on the monitoring requirements, if it's not fitting what you look, trying to look for none of the um not matching one of the answers, then go for the side effects because they are asking for adverse effects. So what side effects under that list that would be possibly popping up? And so weight changes is one of the side effects that you need to be aware of estradiol as well. So I think for these sort of questions pretty straightforward, but it's just not knowing where you need to find the answer as well. And so the next set of question would be data interpretation. So for data interpretation, it's more for um knowing the invest knowing the results, interpreting the results um and also manage accordingly. So it could be asking you to change the dosage or changing the treatment completely. So it involves you to interpret the blood and scans results. So most commonly, they will ask you for example, blood results, ECG x-ray. So it could be anything. So um so I think it's about um six questions in total. So about um six questions each worth about two marks. So um we can just move on to the question. So basically, they could give you a question like this. Um patients with going to emergency department with shortness of breath after post chemotherapy. Um basically, patients had pneumonia and neutropenic sepsis. Therefore, they're starting her on tsos and also gentamicin as well. So apart from asking you to interpret blood results or ECG or any scans, they could also give you a graph like this. So basically, to do interpret, when's the next dosing interval or what um once you have to repeat blood or is it like paracetamol at what sort of level that you need to prescribe um medic uh treatment for paracetamol overdose. So for this question, it's a bit, it's quite straightforward, but at the same time, it doesn't involve a lot of clinical reasoning. Um So the question itself is asking uh what's the most appr uh appropriate decision with these with the dosing? Either you can, when are you dosing it again or when are you repeating or are you stopping the medication? So, by interpreting this graph, so the patient had the first dose of gentamicin at five and now they've taken the sample at nine, which is at the level of 8 mcg per milliliter. So I understanding, but from 5 to 9, it's about four hours past which according to the graph, it's, you can't actually see anywhere with a four hour sampling time. So what's the best situation at this moment? So, are you going to dose another gentle like deter like determining the dosing interval now? But then, or are you repeating the bloods tomorrow to have a look or is it stopping gentamicin? But then it's the most important is to actually take the blood samples again in two hours time, which is about at nine in the evening. So you can actually put the graph. So it sometimes doesn't need a lot of clinical reasoning, but actually, like using a bit of, you can just sort of quickly look at the questions, understanding what's actually happening and then determining what you're interpreting and determining the next step. So, um before we moving on to unit again, about navigating on E NF just a quick, um just a quick um a reminder about the feedback, I'll just pop the feedback form on the chat. So if anyone had any, if you want to, if you're by any chance leaving the teaching today, can you please help us to fill out one of the feedback forms so we can have knowing what to improve from next time and then, um we can let you to carry on with the navigating online. Yeah, amazing. Thank you. So thanks for sticking up with us. Um So that's basically a whistle stop of all the eight sections in the next 22 free slides. We've just got a couple of things just like, um just tips for how to navigate on the BNF and final tips for your exams. And um you guys can enjoy the rest of your evening because I know we've taken up quite a bit of your time. Um So in terms of um kind of navigating on the, and we've kind of covered that already um in the other sections, but just kind of to summarize, make sure you familiarize yourself with common scenarios, common drugs that usually come up a lot of these stuff, you already know it in the medical exam. So it's just to make sure that you already know it. So in an exam kind of stressful situation, you already have that in the back of your mind that can speed up a lot of things. If you do get stuck though, you can always refer it to the treatment, summaries. Um, And sure that if you need to find certain um, prescription or adverse drug effects, you can always do the control f or the end or that I showed you just now and also just to play around the interactions um of different drugs in the B NF. So um on the right, that's just kind of a screenshot of how you can search for interactions for each drug. Um Next, please. So final tips on how to prepare for the exams. It's only 15 more days I think before your exams. So just to um just to make sure that time planning is everything. So just to kind of time yourself and mark exams if you haven't done that already, um If you do get bogged down by one question, it's not the end of the world, just flag it up. And if you get stuck, you can always go back and review it sometimes with a pressure, you might, you might be able to answer it anyway. Um Just also remember to navigate know how to navigate around your BNF, what sort of common wordings that they use in BN F as well and have a play of the system as well. Because in the prescribing thing, I think it's like a total. So you can like um search certain words and to, for example, like syrup and 9% sodium chloride instead of saline. So just to know that which sort of things are available, have a play with that as well. And um I think the other things that's really useful is to have a physical calculator because um on the on the software itself, it's not very, it's a very like simple kind of calculator, but it takes a lot of time for you to like do all the clicks. So if your uni allows, just make sure that you ask your uni as well. If you, if you're allowed to get a physical basic calculator, I would recommend just using that instead of the software, um other useful resources to go over just before the exam is just go over the mock assessments on your PSA website. Um just have a look and make sure to go over your past mistakes. The other thing is the GKI Metics. If you haven't done that already, it does kind of just categorize all of the questions. So if you have a specific section that you're not as good as you can always just go through all these questions before the exam So it makes you feel a bit more prepared and more confident. But when you go into the exam and the final tip is that, um, a lot of these questions are very simple. It's more because it's just a stressful time problem. Um If you can try and think about what you already know because you know, a lot more than you think. You know. So if there's like drug, um if it's like the prescription refill, which they give you a pile of drugs, you probably can already eliminate two or free with just your knowledge in medical school. And then after that, just go on the BN F, just remember to stay calm and it will work out eventually. Ok? Um So that's everything and the next slide is just kind of um a screenshot of what can come up in the exam. So I'm sure you can find it on the PSA website as well, but that's everything that I have. And if anyone has any questions, feel free to pop it in the chat as well. But I will really appreciate if you can fill in the feedback form for us. Yes, please and make sure you can also get your certificate as well if you need anything for portfolio and if anything, so if you fill out the feedback form, you can get a certificate as well. And as mentioned by, you know, if you've got any questions like you can pop in the chair and we can try our best to answer them. We'll hang around for a bit and then if anyone got any questions, if not, then thank you so much for spending your evening with us. Hope you've got a good evening and we'll see you soon. Um, I think there is a question about any suggestion where I can find information about presurgery medication changes. Um, I'm not, that's a good question though. Um, Let me have a quick, it's fine. Let me have a quick look. If it's definitely on, then we can sort of advise further. Mm medication changes. Um There is actually a section on B NF on the treatment, summaries for premedication and perioperative drugs. So that might give you a bit of hint. I'm not quite sure if that helps, but then there is a se should be that would be able to guide you further if, if any of these questions pop up in um in the exam, but it would be quite mean if they actually asked you about medication changes for preoperative, I would say. So let's have a look. Ok, fair enough then in that case, um but by all means, um there is actually a premedication and preoperative drugs page on the BNF itself under the treatment summaries. So I understand probably quite tight during your um exam time as well as again, if you control, try to use control f and try to find the medication that you're looking for that. All the, basically it was, um, categorized into different types, like drug that affect gastric acid, antimuscarinic drugs. So that s it like sedative drugs. So it kind of classified into different ones. So maybe try to search for the, the, um, drug class rather than drug name and then see if it pops up. Um, that would help. I think we can sort of call it a day if no one else got any other questions and ok, thank you guys. I'll see you soon. I'll just stop recording and that's it. That's fine.