Computer generated transcript

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

Um Hi Iron. I guess we'll make a start now. I'll just quickly share my slides, right? So uh let me know if you can see this. Ok. No. Yep, we can see it so great. Thanks. Um So thank you very much for coming, everyone, especially on such short notice with the time change, Iran and I are both fy ones at the moment. So we did the PSA earlier this year. So we're just gonna quickly go over the exam and maybe some tips, tips and resources we found helpful revising for it. So just like we mentioned, this talk will really just be an overview about what the exam is. Um what each section is about, some sample questions of how we get about answering them and also some tips and resources at the end. So, just a quick introduction to the exam. So the P SA is on this website that you guys are, must be all familiar with when you did the mock exam last year. So it's the exact same ex um structure and appearance as the mock. So it'll be the exact same website and just a bit about the structure. So you have eight sections covering different parts of prescribing. And they also cover these um seven specialties. So medical surgical, elderly patients, pediatrics like OP and GP and they cover it in different numbers of items. So the majority of questions will be in medicine, elderly care and as well as GP. But it's also good to run through things like peds and which are more specific. Um and just a quick overview of the marks allocation for each section. So the majority of marks will actually be in the first part in prescribing. And that's where you score the most marked. It's important to try to not miss any questions if you can just because that's where the majority of the marks are from and then it will move on to prescription review and then the next highest would be planning management and so on. So, Eranga and I will cover all these sections, I will cover the first four and Ranga will cover the last four and just a quick note, um it's stated in the blueprint that these five topics are the most commonly appearing questions in the exam. So it's important to just go over these ones quickly. They're very high yield. So each psa exam will cover at least two of these items in the exam. And I find that infusion fluids can be quite tricky sometimes. So it's good to go over that as well. So, yeah, so in the exam, you'll have access to the B NF or medicines complete and depending on how you feel, which one works better for you, you can just stick to that and just keep practicing on it. So you're familiar with how to access all the different parts of the B NF. They are both the same, um, they have both the same information, but it's just different layouts on how you can use them. So it just depends on what your preference is. Um So yeah, we'll go through the sections now. So the first section is prescribing and like I mentioned, it represents the most marks in the exam and they'll start off with a clinical scenario where they'll ask you to prescribe a drug or IV fluid. And then they will ask you about prescriptions for common conditions, things like acute conditions, chronic conditions, pain management. So they want you to see how you use the um um pain ladder. And also you're expected to give the name of the drug, the dose, the route frequency and duration. So it is about eight questions each with 10 marks making up 80 in total. So they have different marks for different parts of the question that you answer for five, for drug choice, five, for dose and frequency and so on. So just a quick example um of a question. So we can, so II would ask if you guys also open up the B NF as you are going through these questions, just so you guys can also get familiar with the B NF as you're going through the question and trying to find the answers as well. So this case is about a 60 year old woman who's admitted to the hospital with a two day history of left calf pain, recently returned to the UK after a long haul flight from Hong Kong. So her left calf is tender and swollen and there's small pitting edema in the left ankle. Her inr is one and a Doppler ultrasound scan confirms a DVT in the left protal vein. So the prescription request is to write a prescription for one drug that is most appropriate to treat her DVT. So as when we go to the BNF and search up venous thromboembolism and you scroll down a little bit, you find this section of how, what the treatment of um venous thromboembolism is and they will either have um prevention or treatment. So it's important to choose the right one. So you have options of choosing either Apixaban or Rivaroxaban. And when you click on the pix, you come to the treatment options and what's on the BNF, which is initially 10 mg twice a day for seven days and then maintenance, 5 mg. So what you put in in the prescription is just Dixan 10 mg twice daily in oral. And that would be a full 10 marks for that for that question. And just to give you an idea about how they mark the questions which I'm sure some of you are familiar with from the mark. Um So you may get marks even though it's not like the best answer. So it's important, even if you don't know the answer, you just put something in there in case you might be right because you may still get some points for it. So, and, and another thing I like to do is like maybe put small details in the question that might track you out. So things like looking at the past medical history, um age weight, creatinine clearance or drug history, look for any interactions. So for example, for um Apixaban, there is uh dose adjustments needed to be done for renal impairment, um patients. So they reduce it to 2.5 if for example, someone's creatinine is high or if they are over 80 or body weight is 60 or less, or you have to reduce it if their creatinine clearance is like 15 to 29 but they will put it in the question for you to make sure you pay attention to it. And also it's important to look at any contraindications to the, to the drug as well. So things like recent bleeding, anything like that. All right. So the next section is prescription review, which is the next biggest chunk of the exam. So you're usually given the list of currently prescribed drugs about 6 to 10 and you'll be asked to identify things like any drug interactions, any prescription errors in terms of like dosing or intervals, intervals, or any dangerous prescriptions based on the clinical context. So you usually get about eight questions, four marks each. And then this is one of the questions we can go through. So a 78 year old man collapsed um and he was suspected to have a sustained hip trauma during the incident. So he has hypertension, biventricular heart failure, C KD and osteoarthritis of both hips. His uh B biochem shows that his potassium is 100 and 30 which is a bit low, potassium is 6.2 which is really high. Um Urea is 8.5 which is high, creatinine is also high and his current medications are on this list on the right. So this is a question ii love when they ask about elevated potassium because it's usually like, OK, Ati can identify things that cause Ati and high potassium. And the next question would be what's most likely to be the cause of serious complications following head trauma. So we'll go through the list of prescriptions. So he's on omeprazole which may lower your potas uh your sodium. But that's not a question. Fosamine, spironolactone, bisoprolol, simvastatin, Ramipril, paracetamol, and diclofenac. So for the first question, um I'm sure you guys are already thinking about this in the hi in your heads. But um the like you three prescriptions to cause this elevated potassium is spironolactone, diclofenac and Ramipril And if you're having any doubts about whether you're correct, um, something that I found very late on in my revision was this appendix one interactions. So if you guys go to BNF right now and search up Appendix one, it's a very helpful page. It just tells you all the drug that causes with high potassium or low potassium or causes increased risk of bleeding, prolonged QT, which is a common question as well. Um And you just call one f every time you use it, that's like the fastest way to answer these kind of questions. And the second question, what is one prescription that is most likely to be a cause of serious complications. So the answer to that is diclofenac because it increases the risk of bleeding and considering the fact that he's collapsed, it's likely he has an injury. Um So if you don't suspend the diclofenac, there's an increased chance of that just getting worse, right? And section three. So is an M CQ, which is where they ask you the most appropriate management option from a list of five. So they usually ask you about treatment from all sorts of um conditions, preventive curative symptomatic or palliative. And they may even ask things about where you don't use any drug therapy. So that's like physio or a tens machine for pain. Um Yeah, and then we'll just go through a question quickly. So this is one of the examples on the website as Well, so a 70 year old is admitted for worsening breathlessness and a cough. Um She's on amLODIPine salbutamol um as required amoxicillin and she's a longstanding smoker. So her temperature is normal pulse is 96 rhythm, regular BP is 100 and 70 respirate is a bit high at 22 and saturating 90% 96% on air and respiratory exam reveals a widespread wheeze and chest actually shows hyper expansion of the lung fields with some old scarring at the left apex. So select the most appropriate management option at this stage. So you have options are atenolol, furosemide, hydrocortisone, ox oxygen or salbutamol. So at this point, you're probably thinking this could be maybe CO PD. Um And because she, OK, she probably doesn't need the oxygen and what she needs acutely is probably the C So yeah, so there are some questions where you don't really need the B NF to answer like this one. And you can just kind of just use your, your own like clinical knowledge and your exam room vision to answer it. So, yeah, this was the answer to that question. Um And for the last section is providing information which I found a bit more tricky. So this section kind of assesses how you can gather like which is the most important information to share with patients carers or other health health professionals. So it is a tricky question because it can be quite subjective. So I will give you an example of this. So this is quite straightforward question. But basically a 36 year old man is assessed on the medical admissions unit for a suspected DVT in his left calf following a recent orthopedic surgery. He was on enoxaparin um daily. But a Doppler ultrasound scan confirms the presence of a DVT in the left lower leg and he is advised to take warfarin three times daily for three months. So um which would be the most important information to share with the patient. So the options are Warfarin tablets are blue. Warfarin is better tolerated if taken in the evening. Warfarin therapy reduces the risk of a second DVT. Warfarin increases your likelihood of bleeding or weekly blood tests will be required throughout treatment. So I guessing you guys will already guess this. But the answer would probably be that Warfarin is the more like increases your risk of bleeding. So it's important for people to know in case they are doing something very risky or you know, getting injured. So increase your risk of bleeding. But um this is one of the most straightforward questions but but just to go through other questions they may ask. So things they want you to explain is how for example, amitriptyline um is encouraged to, you're discouraged from drinking and driving when you're on amitriptyline just because it can increase your drowsiness and things like diabetes. They want patients to know about sick pay rules and also about the, some of the risks of medications that they are on. For example, like SGR T two inhibitors, sometimes you may need to be stopped if you're acutely unwell or things in diabetes where for example, you are preparing for surgery and they may need to stop taking some of the medications before surgery. Um, so, yeah, those are the, some of the questions they may ask. Um, and I'll let Iran take over the, the last four sections. Yeah, so I'm just gonna take on the next, um, four sections and we'll go through those, um, just give a better introduction to those. Um, uh, next slide please. Yep. So, um section five is the calculation skills section. Um Honestly, this is one of the trickiest sections of PSA and I think Mathan will agree as well that in our PSA exam was one of the trickier sections and the questions are quite, um, quite complex. Um So, uh it is worth about, um, 8% of the total mark. Um, our university allowed us to take a calculator. It's one of those um non scientific basic calculators, but um, check with your university, most universities still allow it. Um, but do check with the university first. Um usually, um the scenarios uh ask you to calculate things like doses or rates of administration. Um And there are various formulas you can use. For example, scenarios are scenarios are uh drug dilutions um making those adjustments a week and um identifying sort of like correct um medicines to give, to achieve the dose as needed. Uh Next, this is an example question you can go through it as well. Um This is maybe uh one of the slightly um more average to the easier side of things. Um So this is a two month old boy in the p kids emergency department needs midazolam to be administered for ticus. Uh The dose of uh Bucco midazolam is 300 mcg per kilogram repeated once if necessary. After 10 minutes weight is 5 kg. And the Midazolam solution is available as 5 mg per milliliter solution. So they want you to know what volume of the midazolam should be given to the patient for the first dose. Give you a few seconds to think about this. So um basically, they need 300 mcg per kilogram. The boy weighs 5 kg and they want to know the volume of um that you give, you can calculate in your head as well. Um You can go to the next slide if anyone's thought about it just yet. Um So the answer to this and it's, it's requires a bit of calculation um is uh 0.3 mL how we got to this answer. Um It's basically um the what they want is um you can first calculate the dose of midazolam as needed. So if it's 300 mcg per kilogram and the weigh 5 kg, uh you can multiply 300 or well, 300 mcg times five to get 1005 100 mcg and 1005 100 mcg is 1.5 mg. Um So then you can uh crosscheck with the cat patient. If there's 5 mg in a milliliter um to get 1.5 mg, you'll have to by 1.5 by five to get 0.3. So just sort of things like this. One of the most important um formulas you use for this is concentration equals dose of volume. And you can just use this to sort of put everything in and move them around. Um Just go to the next question, please. Yeah, this is another example. Um this is maybe a slightly trickier one. So uh it's a 60 year old woman um with a particular condition um which needs a certain drug um to be given at 5 mcg per kilogram. She weighs 80 kg. Um And the drug is available in this particular concentration. Um One part of the drug is dilated with nine parts of glucose. And this is a really, there's, there's a lot of steps to this. Um but they want to know basically what volume of the drug should be given intravenously. So to sort of simplify um this type of question, um you can go to the next uh side, please. So um to simplify this um sort of question, I think again, using the volume equals dose sort of concentration of dose of volume, moving things around. Um and using that, you can find out exactly what dose is needed for their weight and then need to calculate the initial concentration. But then because they want what is um the diluted volume. Um And because the dilated with nine parts of glucose, um so you have to multiply the initial um concentration with the dilated um with the initial volume with the by 10 to get the dilated volume um to get the 10 mL that is called here and goes in your own time. These are the sort of um sort of challenging questions that they can ask. Um And in the calculation section, uh next slide, some tips are um to use um the concentration of dose of volume um ratio uh formula um knowing basics of units and ratios. Um So converting from nano nanograms, for example, to micrograms to milligrams. Um and also just remembering um sort of the numbers involved in things like ratios. So 1% would mean um in a cream, for example, would be 1 g and 100 ml. So these are some useful things to know. Um again, time pressure is really um is really one of the keys in the P SA. So write things down to calculate if it helps. Um And again, at the end, just quickly check your arm to see if it makes sense. Because for example, if you end up with um in like the first question, if you end up with something like 100 ml, you know, that's probably not um gonna be the right answer if you have to give a kid 100 ml of uh Midazolam Stat. Um So, um, just check your answer afterwards, see if it makes sense. Uh Next side, please. Um So the next section is on adverse drug reactions. Um Again, with 8% of the total marks. Um and this is an insecure section. So, um unlike the previous section, this is um this in Wilson Choice. Um And basically they want to test a few different things. Um So one of them is just to identify the most likely list effects of the drug, um identifying what drug could have caused a particular presentation. So they may give you a presentation that resembles N api or hypokalemia. So it might um involve you recognizing that and then identifying which drug could have caused that um identifying medicines that can interact with each other. Um But also, um just how to managing uh manage um an adverse drug reaction. Um Next please. This is an example question um that can come up from this section. So here we have um a 35 year old man who attended their GP um for migraines. Uh they are advised to commence treatment with uh propranolol uh 40 mg daily. Um And they want to uh want to know what the most likely adverse effect is that can be caused by this. So you have five options of alopecia, erectile dysfunction, hyperkalemia, sedation, and weight gain. So, um as useful as it is to look through the B NF, um which is uh what I would recommend to do, um uh it would uh uh I think it would also um be very, very helpful um to know things like this off the top of your head, um or at least try to make sense of that answer like this. And then you can double check with the B NF um which is probably one of the better ways of going about it and which will save you a lot of time as well. Um So just go the next side, please. So the answer to this um is erectile dysfunction. Um You can obviously get this by um going through B NF um and trying to look for each of these um using control F but if you know the answer and you want to save time, um it would help to know it off the top of your head. So for the section as with a few other sections of P SA, it's helpful to know some uh medicine theory and use some common sense to um answer questions to help you save some time. And again, if um if that doesn't help, um if it's a particularly tricky question or if you just want to um confirm your answer, um control F is your best friend? Um Next section, please. The next session is um the therapeutic drug monitoring section. So this is also worth eight percent of your marks. Um There are eight questions and it's an M CQ with five options. Um So usually it's um where patients starts a particular drug and then they have to identify how to monitor its beneficial adverse effects. Next. So this is an example question. Um So here you can see that um 7071 year old woman admitted with um community acquired pneumonia um on examination, they've mentioned a few things um and uh confirmed by chest X ray and they started um treatment with co amoxiclav. Um So select the most appropriate option to monitor for a beneficial effect of this prescription in the first three days of treatment. So you have chest auscultation, chest X ray, heart rate, respiratory rate and reduced fusion color. So this kind of question um can be a bit tricky sometimes because um as you can see, um many of these answers can be corrected to some degree. Um But obviously, these sort of questions are testing usually the the most um sort of correct answer or the best um the best fit answer. Um As you can see here, a lot of the answers seem quite subjective. Um but um if you look carefully at them, uh there's a few that are objective. Um I suppose um one of them is respiratory rate, you can say it's quite an objective measurement also involving the curb 65 score. Um Another one is heart rate. So, again, something you can measure um chest augmentation while it may um it may be an indicator of if things have settled, it may be dependent from person to person. Um And was fusion color. Um Again, depends on if the um um ii it may, it may not be the most correct answer as well. So, uh if you just move on to the next uh yeah. So in this case, uh it, it has um um be given as the most uh correct answer here. Um just because it will um the treatment of the pneumonia will reduce the oxygen requirement um and uh help improve this patient's condition. So the respiratory it will uh is is the most correct answer here. Um Moving on to the next slide. Yeah, this is just another question on sort of different um uh different ways in which they can ask um questions in this. So there's a 40 year old woman who goes to a GP with a sore throat and a cough um with a past medical history of hyperthyroidism. Um they mentioned um that they take carbimazol and propranolol probably for the hyperthyroidism. Um and on examination, so be red and swollen, uh ex left tonsil, it seems like um basically a sore throat. Um But they just want to ask in this question what the most appropriate option is to monitor the adverse effects of carbimazol at this stage. So, if you know off the top of your head, again, the answer to this um carbimazol um is known to um cause agranulocytosis. Um And uh a full blood count would be the most um correct option here. So if you go on to the next slide, um So yeah, uh you can look at this B NF as well if you um don't really know the answer to a question like this. Um In this particular question, if you search for um carbimazole, you could find on the B NF uh almost just under the first section. It came up under the important safety information for neutropenia agranulosis as being um a common um sort of adverse effect. And it's really important to look for that um uh especially uh in times of infection. Um So, yeah, some tips for this section again um includes to know the theory. Well, the answer may not always be clearly shown the B NF. So if the important safety information section is in there, sometimes it may just be in one of the other sections. Um Often the answers are measurable um things instead of subjective as um I mentioned in question one uh next slide and the final section um of the whole PSA is the data interpretation section. Uh So this one is worth um six percent of the total marks. Um And here, you have to make a decision um of uh make a decision on a drug based on certain data to, to be interpreted. So you have things like drug charts, um your blood results BMS, other observations, things like that. For example, you can get things like gentamicin paracetamol charts. Um And you have to interpret what's needed to be done for this drug um in the clinical scenario. Uh Next slide, it's an example question um If this you can see here. So man presents to A and D with um one episode of pr bleeding with the background of diverticular disease and he reports that he has passed some fresh red blood, he takes Warfarin um and the systemically, well, they mention some observations, they were quite unconcerning. Um And uh the blood results show an inr of 5.2 which is above the target for this patient. So they want to know the most appropriate position with regards to clinical presentation data. Um So, one option is to continue the current dose of warfarin and trans transfuse a red uh unit of red cells. One is to stop Warfarin and give um 5 mg of uh Vitamin D and or Vitamin K Um Another option is to stop Warfarin, give 1 to 3 mg and the other options are um various other. Um Yeah, the next one is 1 to 3 mg orally. The last one is um if you should be told the Warfarin for two days and we start uh next slide. So for a question like this again, uh B NF will have all the answers. Um You should realize um that this is a minor bleed because the patient is stable and um in a mild bleed in this case, um Vitamin K is given as a slow injection and it also gives um the advice on stopping the warfarin. So if you just search Vitamin D on um on B NF for this um this answer just um and it's fairly straightforward next, please. Yeah, so I think um that's about it in terms of the sections. Um I can share some tips that were used um And some resources that we've used um for the B NF to, to pass and to um score. Well, so if you just go on to the next slide um for myself, um I found one of the most helpful things um for the B NF was to actually prepare for finals. Um So I just too such was not just gonna help the B NF but also was gonna help me for finals itself um where I felt like um that would help both and uh this would especially be useful for um the conditions that are more high yield. So medicine, uh elderly care, which is geriatrics and general practice. I think uh those sort of things I put an increased focus in. Um And I also tried not just to look at conditions but also to be more focused on to the drugs. Um So I try to know um the drug off the top of my head. So instead of having to search for which drug it might be first, I might know which drug so I can just look at the dose and save myself some time there. Um Which time is one of the most critical things in the in the P SA. Um Another resource I found very, very helpful. I think this is one of the most valuable resource for myself was to prepare for the P SA course. There was a Facebook group um that I joined and they had um uh a course and some um some videos and some learning material. Um e they're especially helpful for things like fluids, um things like Warfarin um uh and things like the contraceptive pills and various other sort of little things that um I didn't really pay attention to our medical school, didn't really pay um much attention to um when teaching us things. Um But they were quite important for the P SA. Um I think the course is paid just now, but I'm not sure if the slides are still free. Um I just use the slides and I found them really useful. Um So that was one of the main things I used um quest and pass questions. I found them uh fairly useful to get a hang of what kind of questions might be asked. Um, so I just sort of did them, um, uh, here and there, um, in sort of a few, like 23 weeks leading up to the P SA just to keep my head on couple of things, um, for the P SA itself and, uh, the mock P SA papers, I think those are really good as well. So if you do those, um, before the exam, it will give you an idea of where you stand um for things. Uh And it's good to time yourself um because it is um as I said, very time critical. Um my family, I think over to you for the next next section. All right. Um I'll just quickly go over what I found helpful as well. So like Iran mentioned, speed really is your friend and how we got by with this exam is just splitting screen and F or control F for the whole exam just keeping A B NF next to you and trying to search things very quickly. And appendix one again was really helpful to looking for things really quickly uh in terms of all the electrolytes. Um And personally, I found that the mind the beep has a really good course. So they have um almost a whole page or teaching session on each section of the exam and they have an hour section on uh hour session on each which is recorded. Um And they go through all the tricky questions, they go through how to look up the B NF to find out the answers. Um And personally, I found things like contraception, quite hard to uh look for in the B NF or things like insulin before and after surgery. Um uh or even some of the, the antibiotics need to prescribe for infection. So, infection, so I found this course quite helpful in teaching you how to navigate things quickly and also deciding where, which platform you like using, whether it's the B NF or medicines complete. Because um a lot of people say that medicines complete has the actual feature of checking for drug interactions. And honestly, I use BNF for everything else except for the drug interactions. So I found that medicines complete can be a bit confusing. So I only use that for drug interactions. But um yeah, it's really up to your preference and how you find works for you during your practice sections. Um And like Ranga mentioned, um the PSA website has a few mo mo I think two mock exams for you to try before the exam. And honestly, they were quite demotivating because some of them are quite tricky, but it's good to keep practicing them even if you don't do it. Um If you do it just more than once you still get to learn from it. So I thought that was quite helpful. Um So yeah, I think that is us, we're happy to take any questions if you guys have any. Um I think we have one question here. Um Do you recommend just doing the sections in order or doing some specific sections first? Um II personally, um went through the whole thing um in order. Um I ended the exam with about a minute to spare. Um I think that might be quite on average for most people. I think a lot of people find it quite stuck for time. Um Definitely the first, um, prescribing section I would recommend doing that. Um, first because that's the most not lie. Um If you are quite stuck for time, I feel like the calculation section might take quite a lot of the time, especially if you find maths a bit tricky. Um So if, um I could recommend you something, I think if you don't find maths tricky, I would probably just go through the whole thing in order. If, um, if you are, um, if you do find maths a bit tricky, then uh you could probably just maybe, um, leave that at the end if you find the question really, really difficult. Um And if you have anything to add to that, my family. Uh yeah, I would agree that I personally did it all in order just because I was worried I would um somehow now I have time to come back to something and forget about it. So I did it that way. But I remember that Iran brought his calculator to the exam and he was just stressing everybody out, like, when he was doing calculating because we were like, oh my God, you are the calculation section. But no, so you can definitely jump to different sections to do it. So, yeah, it's up to what you find works for you. Uh I think Amina's asking how long the exam is. Uh, I think it was an hour if I'm not mistaken. Um, Or was that? No, I was, 0, um 100 and 20 minutes. Yeah. Two hours, 22 hours. Yeah, two hours in bed. Yeah. Uh I think there's a question. When did you guys start prepping for the exam? Um Do you want to answer this first or? Um uh you can go? Yeah. Um Well, I personally found um that II tried to prepare as much as I could for finals while also trying to make my preparation relevant for P SA. Um So I, II can't say if my preparation is particularly accurate in terms of preparation just for the P SA, but I would say solely focusing on P SA material. I would say it was probably about a week before. Um but I, before that in like the three weeks leading after it, I did um sort of regular questions every sort of 34 days on the different sections of P SA to keep myself um in the game um as it were on the different sections. Um And then in the last week I just did only P SA material. Um, if that helps with fungi. Yeah, II would agree with that. I think the, you can definitely incorporate it to your normal revision and how you study. Um, I think uh it was tricky for some people because like a lot of the specialty boards we, we haven't done yet, like psychiatry and again, which are a bit more specialized. So those things you need to like, revise a bit more about like, for example, fluids for kids or for obstetrics, like all like counseling for contraception. Um and like miscarriage, what do you do post um hysterectomy things like that? Um So I think those questions need you to be to study a bit more in those areas and they can corporate the interior revision. But I think PSA itself probably took me about the same time, like two weeks or one week and a half. So, yeah. Um for the mock PSA papers, is it the five questions on the PSA website? Uh No, there are more questions. Um The mock papers to get access to them, you have to sign in using your medical school account. So it should be the one the same account that you use to sign in for your mock PSA. Um And then uh once you sign into that, you can see there, I think three or four not papers on there that you can try. Um And they have pass marks for each as well. Um I think some of those uh, papers were quite challenging. Um, the real exam, I'm not gonna, um sort of, it's, it's not to demotivate you guys, but it was definitely challenging, although I think people did generally fare quite well. Um So it might seem worrisome right afterwards. But, um, I think most people did pass so it is quite reassuring when the results do come out as well. Um, um, pass marks, I think ours was about 61% if I'm not mistaken. I just saw uh on the website today. Do you remember? Ma? Thank you. Yeah, I think it was 61%. Uh but it varies depending on paper. Uh some papers are a bit harder so the pass mark was a bit lower. Um But um, yeah, it also varies paper and even on the more exams on the website, they will give you a good idea of what the past marks are because they do grade you on it. So it ranges from about 60 to 65 if I remember correctly. Yeah. Yeah. Yeah, I think so. Yeah. Um Why is Appendix one on the B NF MA if you have it open? Thank you, Brian to send a link. Thank you Brian. And um, I think that you are, um, Shannon, you're able to search it specifically during the exam so you can put in all your drugs and you can actually search up appendix one as well. You're allowed to do that. So that's pretty good. Uh I think there's another option where if you want to look at interactions of for drug, uh even on the BNF nice website, uh you can click on the drug and then there's a section called interactions and you can type the t maybe the other drugs in your list to see if there are any interactions with that. Um That's another option um that you can use, can you bring your own calculator? So Glasgow allowed us to bring a calculator. Um We could use um sort of basic uh non scientific calculators. Um I think most universities do allow calculators although I do remember seeing some reports of maybe one or universities not allowing it. So if you aren't from Glasgow, uh or even if you are just follow what your medical school says. Um But do keep a calculator handy in case you're allowed to bring it. I think the next question is um can you use any of the nice sections or just the BNF? From what I understand you can use only the B NF. Um you can use the treatment summaries part of it but you can't access things like C KS or anything like that. So it's just the treatment summaries or the drug specific summaries on B NF. Yeah. Yeah. Yeah. So just, oh go ahead, go ahead. Oh no, I was just gonna say Um Yeah, if anyone doesn't have any other questions, um I think uh there might be a feedback. All right. Um So if someone just has another question, uh I was wondering about B NFC P Yeah, if there's a PS question, uh you're very welcome to uh press the um I think it's the top right corner and change to B NFC. Um You're very welcome to do that. Yeah. So like uh where you see the BNF, there's like a green line at the top, right? So if you just click on it, you can immediately change it to the BN FC on the B NF. I think what I found interesting um starting work in Peds was that um the P SA um type questions? Actually, I come across on a daily basis um because a lot of the calculations in Peds are based on the weight. So it's actually quite interesting because um a lot of the calculations stuff actually II do on a daily basis um in my job. Yeah. And as well as the Appendix one, like um a lot of the F ones use it for looking for things like prolonged QT because there are a lot of drugs that cause it, that you might not, might not know specifically. Um Someone asked any advantage of using a hard copy of the B NF. Now, one of the CT S recommended it when they did it in the PSA a few years ago. Um I do remember somebody mentioning that the hard cuff the venous was useful back then for appendix one. I think now that there's appendix one on the website, it may not be as helpful. Um But again, perhaps personal preference, um if you feel like it might help to have that as well, um by all means, um um although I didn't know if every university will allow the hard copy just because people may have things written there. So again, check with what your university says and follow those guidelines. Yeah. Yeah. Yeah. So I suppose, yeah, not everyone else still has it. Yeah. And I think a lot of my friends are also saying we don't know how it survive the exam without. Come on f Yeah, it's very fast exam. There's a lot to cover. So that was very helpful. Yeah. So yeah. Um just to reiterate again, like some of the main topics are these five things on the list like opioids, anticoagulants, insulins, antibiotics, infusion fluids. Um And then, yeah, prioritize the 1st 1st section uh because that's the most marks. Um But yeah, um if no one else has any questions, we could probably end the session. Yup. I hope you guys found it useful. Thanks. Um A everyone for joining. I think there's a feedback form uh in the chat. If you guys could fill that in. Uh We'd really appreciate that as well. Yeah. Thank you very much guys.