PSA Level 1 — Questions and Answers

Question 1: What is the term for a high platelet count?

confusion
thrombocytosis (Correct answer)
agranulocytosis
dehydration

Correct answer: thrombocytosis

The term for a high platelet count is thrombocytosis. Platelets are tiny blood cells that help your body form clots to stop bleeding. An abnormally high number of platelets can increase the risk of blood clots or, paradoxically, bleeding in some cases.

Question 2: Which dopamine antagonists can pass the blood-brain barrier?

Loop Diuretics
Furosemide Thiazides
Beta Blockers
Metaclopramide (Correct answer)

Correct answer: Metaclopramide

Metoclopramide is a dopamine antagonist that can pass the blood-brain barrier. This ability to cross into the central nervous system is responsible for its antiemetic effects (reducing nausea and vomiting) by blocking dopamine receptors in the chemoreceptor trigger zone. However, it also explains its potential for central nervous system side effects, such as extrapyramidal symptoms.

Question 3: What are the most usual side effects of lamotrigine?

Rash, rarely Stevens-Johnson syndrome (Correct answer)
Confusion
Fatigue, mood disorders and agitation
Diabetic nephropathy Cardiovascular disease

Correct answer: Rash, rarely Stevens-Johnson syndrome

The most usual and serious side effect of lamotrigine is a rash, which can rarely progress to severe cutaneous adverse reactions like Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN). Due to this risk, lamotrigine is typically initiated at a low dose and slowly titrated upwards to minimize the likelihood of developing a rash.

Question 4: What is an alternative analgesic to amitriptyline for neuropathic pain?

Cyclizine 50mg 8hrs Iv
Duloxetine 60mg Po Od
Pregabalin 75mg PO BD (Correct answer)
Pregabalin 150mg Po Bd

Correct answer: Pregabalin 75mg PO BD

Pregabalin 75mg PO BD is an effective alternative analgesic to amitriptyline for neuropathic pain. Both medications are commonly used for this condition, but pregabalin offers a different mechanism of action and may be preferred if amitriptyline is not tolerated or contraindicated. The 75mg twice daily dose is a standard starting point for pregabalin in neuropathic pain management.

Question 5: What are the most usual side effects of Sodium Valproate?

Tremor, teratogenicity, weight gain (Correct answer)
Rash, rarely stevens-johnson syndrome
Fatigue, mood disorders and agitation
Rash, dysarthria, ataxia, nystagmus, ⇓na

Correct answer: Tremor, teratogenicity, weight gain

The most usual side effects of Sodium Valproate include tremor, teratogenicity (a significant risk of birth defects if taken during pregnancy), and weight gain. These are well-documented and important considerations when prescribing this medication, particularly for women of childbearing potential. Other side effects can occur, but these are among the most common and clinically significant.

Question 6: Which anti-hypertensive medications cause renal damage?

Thiazides
Metaclopramide
Loop diuretics
All of them (Correct answer)

Correct answer: All of them

All anti-hypertensive medications can potentially cause or exacerbate renal damage, especially in vulnerable patients or with inappropriate use. While some, like ACE inhibitors and ARBs, are renoprotective in certain conditions, they can also cause acute kidney injury. Diuretics (thiazides, loop diuretics) can lead to dehydration and reduced renal perfusion, impacting kidney function. Therefore, careful monitoring of renal function is essential with any anti-hypertensive therapy.

Question 7: What are the most usual side effects of Phenytoin?

Rash, dysarthria, ataxia, nystagmus, ⇓na
Ataxia, peripheral neuropathy, gum hyperplasia, hepatotoxicity (Correct answer)
Rash, rarely stevens-johnson syndrome
Fatigue, mood disorders and agitation

Correct answer: Ataxia, peripheral neuropathy, gum hyperplasia, hepatotoxicity

The most usual side effects of Phenytoin include ataxia (impaired coordination), peripheral neuropathy (nerve damage), gum hyperplasia (overgrowth of gum tissue), and hepatotoxicity (liver damage). These are classic and well-recognized adverse effects associated with long-term phenytoin use, requiring careful monitoring and patient education.

Question 8: What exactly is neutrophilia?

a seizure lasting >30 minutes
high neutrophil count (Correct answer)
bendroflumethiazide
low platelet count

Correct answer: high neutrophil count

Neutrophilia is a medical term indicating an abnormally high concentration of neutrophils in the blood. Neutrophils are a type of white blood cell crucial for fighting bacterial and fungal infections. An elevated count often suggests an active infection, inflammation, or other stress response in the body.

Question 9: What is the maximum Paracetamol dosage for people weighing <50kg?

duloxetine 60mg po od
495mg Qds Po
co-codamol 30/500 2 tablets qds po
500mg QDS PO (Correct answer)

Correct answer: 500mg QDS PO

For adults weighing less than 50kg, the maximum recommended paracetamol dosage is typically 500mg four times a day (QDS), totaling 2g per day. This lower dose is crucial to prevent hepatotoxicity, as paracetamol metabolism can be less efficient in individuals with lower body weight, increasing the risk of liver damage. Always consider individual patient factors and local guidelines.

Question 10: Which two drugs would be harmful to discontinue before surgery?

Bleeding Tissue Damage Myeloproliferative Disorders
Loop Diuretics
Calcium Channel Blockers Beta Blockers (Correct answer)
Men - Valproate Women - Lamotrigine

Correct answer: Calcium Channel Blockers Beta Blockers

Abruptly discontinuing beta-blockers before surgery can lead to a 'beta-blocker withdrawal syndrome,' characterized by rebound hypertension and tachycardia. Similarly, calcium channel blockers are often continued to manage hypertension or angina, and their sudden cessation can also result in rebound effects or exacerbation of underlying conditions. Maintaining these medications perioperatively helps prevent cardiovascular instability and adverse events.

Question 11: Identify three causes of euvolemic hyponatraemia.

SIADH Psychogenic polydipsia Hypothyroidism (Correct answer)
Iron deficiency anaemia Thalassaemia Sideroblastic Anaemia
Viral infection lymphomas chronic lymphocytic leukemia
Fluid loss addison's disease diuretics

Correct answer: SIADH Psychogenic polydipsia Hypothyroidism

Euvolemic hyponatraemia occurs when the body has a normal total body water content but a low sodium concentration. SIADH causes excessive water retention, diluting sodium. Psychogenic polydipsia involves excessive water intake, leading to dilutional hyponatraemia, while severe hypothyroidism can impair free water excretion, contributing to this electrolyte imbalance.

PSA Level 1

What is the term for a high platelet count?