PSA: question practice and revision.

Choose a topic for focused revision and check your plan against the official specification.

• Prescribing — writing prescriptions for new conditions safely
• Calculation skills — drug doses, infusion rates, paediatric weight-based
• Prescription review — identifying and correcting errors on existing scripts
• Adverse drug reactions — recognition, attribution, reporting
• Drug monitoring — TDM (vancomycin, gentamicin, lithium, warfarin)
• Planning management — choosing the right drug for the clinical scenario
• Providing information — counselling on medication use and side effects
• Data interpretation — adjusting prescriptions based on results (eGFR, INR, U&E)

Mapped to the eight published PSA domains and prioritised using item-density signals across the iatroX bank.

• High-risk drug interactions — warfarin (food, antibiotics, NSAIDs, antiplatelets), lithium (NSAIDs, ACEi, thiazides, dehydration), methotrexate (NSAIDs, trimethoprim), MAOIs (tyramine, opioids), DOACs (P-gp/CYP3A4 inducers)
• Renal dose adjustment — using eGFR thresholds to adjust dose for vancomycin, gentamicin, allopurinol, metformin (stop <30), DOACs (CrCl thresholds), NSAIDs
• Calculations — paediatric weight-based dosing (mg/kg → ml of suspension), insulin infusion rate from prescription, methadone equivalents, parenteral conversion (oral to IV opioids), continuous infusion mcg/kg/min to ml/hr
• Adverse drug reactions — Type A vs Type B vs Type C (chronic) vs Type D (delayed) vs Type E (end-of-treatment). Reporting via Yellow Card. Recognising common causative drugs (NSAIDs, antibiotics, anticonvulsants, antipsychotics)
• Drug monitoring — vancomycin trough levels (target 15-20 for severe infection), gentamicin once-daily nomogram, lithium 12-hour level (target 0.6-1.0), warfarin INR targets per indication, digoxin levels (toxicity 1.5-3 mcg/L)
• Prescription writing — controlled drug requirements (full name, address, age, total dose in words and figures, formulation, strength), pregnancy and breastfeeding categorisation, generic vs brand prescribing rules
• Adverse drug reactions specific to FY1 prescribing — anaphylaxis recognition vs Type 1 hypersensitivity, drug-induced AKI, drug-induced QT prolongation, IV fluid prescribing errors
• Discharge prescribing — TTAs (To Take Away), recognising omissions, dose adjustments at discharge (e.g. statin re-titration), counselling about new medications

Observations from UK medical students and FY1 doctors. Verify against the current BNF and NICE BNF.

Candidate-reported observations — not official guidance.

1. Over-reliance on BNF lookup under time pressure — 2 hours for 60 items = 2 minutes per item. Skill in rapid BNF navigation is itself a competency tested. Practise looking up answers fast, not slowly.
2. Calculation errors — paediatric weight-based dosing under time pressure, mcg vs mg vs ml confusion, decimal-point errors. Always double-check units before writing the answer.
3. Prescription writing errors — controlled drug requirements (often missed: total quantity in words and figures, formulation, strength). PRN dosing intervals. Patient identifiers.
4. Wiseflow platform unfamiliarity — practise on the platform before exam day. The PSA team publishes a practice exam — use it.
5. ADR vs allergy distinction — true Type 1 hypersensitivity (IgE, anaphylaxis) vs intolerance vs Type C (chronic) ADR. Different prescribing implications.
6. Generic vs brand — bioequivalence rules. Most drugs are generic-substitutable; key exceptions are anti-epileptics (especially carbamazepine, phenytoin), modified-release theophylline, lithium, ciclosporin.
7. Renal vs hepatic dosing — different drugs need adjustment in renal vs hepatic impairment. Beware the BNF's renal vs hepatic impairment columns.
8. Drug interactions outside the BNF interaction checker — herbal medicines (e.g. St John's Wort), grapefruit juice, foods (tyramine with MAOIs). These are tested but not in the interaction checker.

A pragmatic phased approach used by recent UK medical students passing the PSA first time.

1. Weeks 1–2

   Foundation pass across all 8 PSA sections. 20-30 items/day with the iatroX adaptive engine, alternating sections. Develop a personal BNF lookup workflow (which sections to scan first for each section type).

2. Weeks 3–4

   Targeted weak-area drilling. Daily calculation practice without a calculator. Drug monitoring section drilling. Practise prescription-writing items repeatedly — they reward repetition.

3. Weeks 5–6

   Full 60-item timed mock PSAs once or twice per week. Use the official PSA practice exam(s). Review every incorrect answer with BNF source verification. Sleep, hydrate before the real day.

Dedicated PSA question practice with answer explanations, guided Tutor review and study planning.

• Focused question practice — Choose the relevant bank and use your answers to identify what to study next.
• Guided reasoning — Explore a difficult answer with Tutor, then apply the distinction independently.
• Review and timed practice — Return to important mistakes and choose a timed practice set where available.

Choose the relevant bank and use the official exam guidance to plan your preparation.

The full PSA question bank is free. The daily sample allowance for paid banks does not limit this free bank. A verified free account includes one guided Tutor session; continued Tutor use is included in all-access.

Final-year UK medical students sit the PSA before graduation as part of medical school finals. A pass is required for full GMC registration. FY1 doctors who failed the medical school sitting can resit through their deanery. International medical graduates with appropriate eligibility may also sit.

60 items across 8 sections, sat over 2 hours (120 minutes) online via the Wiseflow platform. Open-book — you have full access to BNF, BNFc and the NICE BNF interaction checker throughout. The Prescribing section carries the most weight (items worth more).

Criterion-referenced — set per cohort by panel review of item difficulty. Pass marks typically settle around 70% but vary by sitting. The aim is to identify the standard expected of a new FY1 prescriber.

Yes. Full BNF, BNFc and NICE BNF interaction checker access is built into the Wiseflow platform. However, you have only ~2 minutes per item — skill in rapid BNF lookup is itself a competency the PSA tests. Practise lookups under time pressure.

The PSA is a separate prescribing-specific assessment that is required for GMC registration. The UKMLA AKT is the broader knowledge test that is also required (or already integrated into medical school finals for UK students). Both must be passed.

The full PSA question bank is free. The daily sample allowance for paid banks does not limit this free bank. A verified free account includes one guided Tutor session; continued Tutor use is included in all-access.