The Prescribing Safety Assessment (PSA) is a mandatory UK exam sat by final-year medical students and foundation-year doctors to demonstrate core prescribing competency. Set by the British Pharmacological Society and Medical Schools Council, it covers safe prescribing principles, drug interactions, monitoring requirements, and prescribing for vulnerable patient groups — all tested through realistic clinical scenarios.
Our free PSA practice test PDF gives you a representative set of exam-style questions across every domain of the assessment. Whether you are preparing for your first sitting or working to strengthen weak areas, this PDF lets you study offline, annotate freely, and track your progress at your own pace. Download it now and use it alongside your BNF revision for best results.
A large portion of PSA marks come from applying the fundamental rules of safe prescribing. You must be able to identify the correct indication for a drug, verify there are no absolute contraindications in the clinical history presented, and calculate doses accurately for adult patients. Common calculation tasks include weight-based dosing (mg/kg), infusion rate calculations, and converting between oral and IV formulations. Errors in any of these steps are directly linked to patient harm, so the exam tests them rigorously. Practise writing complete, legally correct prescriptions on drug charts: legible generic drug names, correct route, dose, frequency, and signature.
The PSA frequently presents patients on multiple medicines and asks you to identify a dangerous interaction or an adverse effect that explains new symptoms. High-yield interaction pairs include warfarin with NSAIDs or antibiotics, methotrexate with trimethoprim (folate antagonism), lithium with diuretics and NSAIDs, and serotonin syndrome combinations such as SSRIs with tramadol. Adverse effect recognition questions give you a clinical vignette — a rash, a blood result, or a symptom cluster — and ask you to name the culprit drug or the most appropriate immediate action. Knowing the classic toxidrome for each drug class (e.g., digoxin toxicity: nausea, visual disturbance, bradyarrhythmia) is essential.
Three drugs dominate the monitoring domain: warfarin, lithium, and methotrexate. For warfarin, you must know when to check INR, how to adjust doses based on INR results, and when to withhold or reverse anticoagulation. Lithium requires understanding of the narrow therapeutic index (target 0.4–1.0 mmol/L for maintenance), the signs of toxicity (coarse tremor, confusion, diarrhoea), and that renal function must be checked before starting and regularly thereafter. Methotrexate monitoring questions test full blood count and liver function test timing, plus the critical interaction with folic acid supplementation and the folate-depleting danger of co-prescribing trimethoprim. Other monitored drugs that appear include amiodarone (TFTs, LFTs, CXR), ACE inhibitors (U&E at initiation and dose change), and clozapine (mandatory neutrophil monitoring).
PSA items routinely test dose adjustment for renal impairment (using eGFR to classify CKD stages and match them to BNF guidance), hepatic impairment (Child-Pugh scoring, avoiding hepatotoxic drugs), and pregnancy (trimester-specific teratogenicity, drugs safe vs. contraindicated). Paediatric dosing by weight or age band also appears. The exam provides access to the BNF and BNF for Children, so your preparation should include practising fast BNF navigation: appendix interactions, specific drug monographs, and cautions/contraindications sections. Candidates who struggle under time pressure are usually those unfamiliar with BNF layout — deliberate practice with the digital BNF before exam day is strongly recommended.
The PDF is a great offline companion, but reinforcing your knowledge with interactive questions builds the recall speed you need under exam conditions. Our PSA practice tests cover all eight prescribing task types with instant feedback on every answer, so you can identify gaps and focus your remaining revision time precisely where it counts.