PSA Level 2 — Questions and Answers

Question 1: In what unit is the effective dosage measured?

Becquerel (bq)
Sievert (Sv) (Correct answer)
Gray (gy)
Roentgen (r)

Correct answer: Sievert (Sv)

The Sievert (Sv) is the unit used to measure the effective dose of radiation, which accounts for the biological effects of different types of radiation on human tissue. It quantifies the health risk from exposure to ionizing radiation. This differs from Gray (Gy), which measures absorbed dose, and Becquerel (Bq), which measures radioactivity.

Question 2: What would you typically recommend for an Adult with Edentulous?

Individualized exam based on clinical signs/symptoms (Correct answer)
Per unit mass of matter
Gray (gy) = j/kg
Air

Correct answer: Individualized exam based on clinical signs/symptoms

For an edentulous adult (lacking teeth), the recommendation is an individualized examination based on clinical signs and symptoms. This approach ensures that any oral health issues, such as ill-fitting dentures, mucosal lesions, or underlying systemic conditions affecting oral tissues, are properly identified and addressed. A tailored assessment is essential for maintaining oral health and function in these patients.

Question 3: What are the sick day regulations for prednisolone?

Prescribe a bolus
Renal dysfunction
Oxycodone and fentanyl
Double the dose (Correct answer)

Correct answer: Double the dose

For patients on long-term prednisolone, 'sick day rules' often involve doubling the dose during periods of acute illness or stress. This is because the body's natural cortisol production is suppressed by exogenous steroids, and during illness, the body requires higher corticosteroid levels to cope with stress. Failing to increase the dose can lead to adrenal crisis.

Question 4: Which common medicine is contraindicated in PVD?

Oxycodone and fentanyl
Renal dysfunction
Acei
Beta blockers (Correct answer)

Correct answer: Beta blockers

Beta-blockers are generally contraindicated or used with extreme caution in patients with severe peripheral vascular disease (PVD). They can worsen symptoms by causing vasoconstriction in already compromised limbs, reducing blood flow and potentially exacerbating claudication or critical limb ischemia. Non-selective beta-blockers are particularly problematic.

Question 5: What is a good medicine for sleep?

Zopiclone 15.75mg On Prn
Zopiclone 4.75mg On Prn
Zopiclone 3.75mg On PRN (Correct answer)
Zopiclone 97.75mg On Prn

Correct answer: Zopiclone 3.75mg On PRN

Zopiclone 3.75mg is a common starting dose for insomnia, particularly in elderly patients or those sensitive to sedatives, and is often prescribed 'as needed' (PRN). This lower dose helps minimize side effects such as excessive sedation, dizziness, and dependence. It is typically used as a short-term treatment for insomnia.

Question 6: What should be prescribed for hypoglycemia?

20% glucose 50ml 5 min (Correct answer)
15% glucose 50ml 5 min
nacl over 4 hours with no potassium
24 hours

Correct answer: 20% glucose 50ml 5 min

For severe hypoglycemia in an unconscious patient or one unable to take oral glucose, intravenous 20% glucose (dextrose) is the recommended treatment. Administering 50ml over 5 minutes provides a rapid increase in blood glucose levels. This concentrated solution quickly reverses the acute effects of low blood sugar.

Question 7: What are the most typical mirtazepine side effects?

Asthma
Abnormal dreams (Correct answer)
Renal dysfunction
Oxycodone and fentanyl

Correct answer: Abnormal dreams

Mirtazapine is an antidepressant known for several side effects, including sedation, increased appetite, and weight gain. Abnormal dreams, including vivid dreams or nightmares, are also a commonly reported side effect, particularly during the initial stages of treatment. Patients should be counselled about these potential sleep disturbances.

Question 8: What fluids should be prescribed for high calcium levels?

Nacl over 1 hours with no potassium
NaCl over 4 hours with no potassium (Correct answer)
Nacl over 20 hours with no potassium
Nacl over 96 hours with no potassium

Correct answer: NaCl over 4 hours with no potassium

For hypercalcemia, intravenous normal saline (0.9% NaCl) is the initial treatment of choice to promote renal calcium excretion and correct dehydration. Administering it over 4 hours helps rehydrate the patient and dilute serum calcium. Potassium is typically omitted unless there is a known deficiency, as hypercalcemia itself can sometimes be associated with hypokalemia.

Question 9: What is the typical therapy for acute dystonia?

abnormal dreams
procyclidine hydrochloride (Correct answer)
beta blockers
asthma

Correct answer: procyclidine hydrochloride

Acute dystonia, a severe side effect of certain medications (especially antipsychotics), involves involuntary muscle contractions causing abnormal postures. Procyclidine hydrochloride, an anticholinergic agent, is the first-line treatment for acute dystonia. It rapidly relieves symptoms by restoring the balance of neurotransmitters in the brain.

Question 10: Which medicine reacts with another to create myopathy?

statins and macrolides (erthromycin) (Correct answer)
hypotension/postural hypotension
clozapine and carbimazole
more than 10mmol/hr

Correct answer: statins and macrolides (erthromycin)

The co-administration of statins (e.g., simvastatin) and macrolide antibiotics (e.g., erythromycin, clarithromycin) is a well-known drug interaction that can lead to myopathy, including rhabdomyolysis. Macrolides inhibit the CYP3A4 enzyme, which is responsible for metabolizing many statins, leading to increased statin levels and a higher risk of muscle toxicity.

Question 11: Which medications cause increased lactate?

hepatotoxic, fractures, bladder cancer
citalopram
ceftriaxone + amoxicillin
metformin - lactic acidosis (Correct answer)

Correct answer: metformin - lactic acidosis

Metformin, a common medication for type 2 diabetes, can cause lactic acidosis, a rare but serious side effect characterized by increased lactate levels in the blood. This risk is heightened in patients with renal impairment, heart failure, or conditions causing tissue hypoxia. Therefore, metformin is contraindicated in severe renal dysfunction.

PSA Level 2

In what unit is the effective dosage measured?