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Planning Management · PSA section guide

Planning Management in the PSA: what it tests, how it is marked, and a real question

Choose the safest and most appropriate next step in treatment, in the right order, for this specific patient.

Practise Planning Management →20 questions free across all sections, no card
8items in the exam
2marks each
16 / 200of the paper
93questions in the bank

At a glance

Items in the exam8
Marks per item2
Share of the paper16 of 200
Question styleSingle best answer from five
Primary skillChoosing the correct next treatment step
BNF useTreatment summaries, then the relevant monograph
PassthePSA bank93 questions, rated easy to hard
On PassthePSASingle best answer in the exam's layout, explanation cites the BNF pathway
Time at exam pace1 min 12 s

What this section is really testing

  • Identifying the immediate clinical problem and whether it is urgent, because urgency changes which step comes first.
  • Knowing first-line rather than merely acceptable treatment, as set out in the BNF treatment summary for the condition.
  • Applying patient-specific modifiers: age, ethnicity, renal function, pregnancy, comorbidity and current medicines.
  • Sequencing: recognising that a correct treatment can still be the wrong answer if something must happen before it.

A repeatable approach

  1. Identify the problemDiagnosis or clinical state in one phrase: severe hypercalcaemia, new atrial fibrillation, stage 2 hypertension.
  2. Decide the urgencyIs the patient unstable? Stabilisation and reversal come before definitive treatment.
  3. Find the first-line pathwaySearch the condition. The treatment summary lists steps in order.
  4. Apply the modifiersAge under or over 55, family origin, eGFR, pregnancy, asthma: each moves the answer within the pathway.
  5. Check it is the next stepNot a later correct step. Not a second-line agent. The one thing that should happen now.

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BNF strategy for this section

The exam is open book, and the time is short. Know which heading answers which question before you open the monograph.

Condition→Treatment summary→First-line step→Patient modifier→Next step
What is first-line for this condition?
Treatment summaries
Does this patient change the choice?
The summary's own subheadings, then the monograph's cautions
Is the option contraindicated here?
Contra-indications
Is it safe with what they take?
Interactions

The general technique, with drills, is in the BNF speed guide.

Next step, not any step

Most options in a planning item are real treatments for the condition. The discrimination is sequence. Ask three questions of the option you like.

  1. BeforeIs there something that must happen first: fluids, oxygen, stopping a drug, correcting a result?
  2. NowIs this the treatment summary's first-line step for a patient with these modifiers?
  3. LaterOr is it a second-line or add-on step that only follows if the first fails?

Common traps

Second-line too earlyThe treatment may be right eventually but is not the initial step.
Ignoring the modifierRenal function, age, pregnancy or family origin changes the standard pathway.
Treating the numberAn abnormal result does not always need a drug. Sometimes the next step is to stop one.
Right treatment, wrong orderFluids before the bisphosphonate. Oxygen before the antibiotic. Stabilise, then treat.
Choosing the familiar drugThe option you have seen most often on the wards is not always the summary's first line.

Areas worth being comfortable with

Not predictions. These are the broad clinical areas this section draws on, taken from the shape of the exam and the BNF; being fluent in them makes the lookup fast.

  • Hypertension: first line by age and family origin, then the add-on sequence
  • Type 2 diabetes: escalation after metformin
  • Atrial fibrillation: rate versus rhythm, and anticoagulation
  • Heart failure with reduced ejection fraction
  • Asthma and COPD stepwise treatment
  • Acute coronary syndromes and secondary prevention
  • Common infections and the antibiotic of first choice
  • Hypercalcaemia, hyperkalaemia and other emergencies
  • Epilepsy in adults, including women of childbearing potential
  • Pain, depression and other symptom-led pathways

A real planning management question from the bank

This is one of the 20 items every visitor can try free, in the interface the exam uses. Work it before you open the answer.

ID : MAN-20Planning Management2 marksmedium
Case presentation

A 72-year-old woman develops profuse watery diarrhoea 1 week after a course of co-amoxiclav.

PMH: recurrent urinary tract infections.

DH: recent co-amoxiclav (completed), omeprazole 20 mg PO once daily.

On examination: mild abdominal tenderness; afebrile, not shocked.

Investigations: stool toxin testing confirms a first episode of Clostridioides difficile infection; WCC 14 ×10⁹/L (4.0–11.0), creatinine 92 µmol/L (60–110).

QuestionSelect the most appropriate first-line treatment.
(mark it with a tick)
MANAGEMENT OPTIONS
  • intravenous ceftriaxone
  • loperamide
  • oral amoxicillin
  • oral metronidazole
  • oral vancomycin
Answer and marking
Correct answer

oral vancomycin

Marks

2

Explanation

Oral vancomycin is now first-line for a first episode of C. difficile infection; metronidazole is an alternative if vancomycin is unavailable. Antimotility drugs such as loperamide should be avoided.

Try another planning management question →

More free planning management questions, each with its full explanation

MAN-88 · HardAntithrombotic treatment four weeks after a stented NSTEMI2 marks →MAN-01 · EasyFirst-line treatment for stage 2 hypertension in a 48-year-old2 marks →

Before you submit

  • Have I named the problem and its urgency?
  • Is this the treatment summary's first-line step, not a later one?
  • Have I applied every modifier the case gives me?
  • Is anything needed before this step?
  • Is the option contraindicated for this patient?

Practice questions

93 Planning Management questions, easy to hard, marked like the exam

Every answer comes with the explanation and the BNF reference behind it. Twenty questions across all eight sections are free. Pass guarantee: fail after 400+ questions and your access is extended free for 3 months.

Practise this section →Try the free 20-question sample

Continue revising

Communicating InformationPrioritising the safety-critical advice2 marks per item →Data InterpretationActing on results: continue, adjust, hold or stop2 marks per item →PrescribingChoosing the right drug, then writing it safely10 marks per item →

View all 8 sections and the exam overview →

Section weightings follow the published PSA blueprint. The BNF headings named here are the current online BNF's. Check any dose or threshold against the BNF before you rely on it; this page teaches the method, the BNF holds the numbers.

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