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About Alexis

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    Revising CASC
  1. Dear THC, I'm like a year late but is the Whatsapp group still active? If so, may I have the link please? Thank you very much in advance!
  2. Dear all, I'm just starting to prepare for CASC. So far majority of the posts here are compilations of past stations, specific topic discussions or people looking for training partners. Would like to ask - apart from watching the videos, are there any helpful reference books for me to go through before going into videos and practice? Any advice will be highly appreciated. Thanks!
  3. @ramarkrs: I scored the lowest in forensic & psychotherapy so I can't give much helpful advice. :S But I personally think the tables of summary after each question in PsychMentor is helpful, although I didn't subscribe for Paper B. Any other suggestions?
  4. Hi Spectacular, If I may ask, which component did you score the least? This is a general sharing of what I did for the exam and got lucky, not tips per se For Critical Review, I used: - "Doctor's Guide to Critical Appraisal" by Dr Narinder & Gurpal Gosall - "Medical Statistics Made Easy" by Harris & Taylor Disclaimer: I'm not advertising any books or websites/ques banks I genuinely felt that these 2 books were very easy to understand and helped me a lot in grasping the concepts in statistics. Some may deem these books not too in-depth, but being a dummy in stats, I'm happy enough with the books The rest.. I personally tried loads of questions on SPMM & Birmingham. I think the practice effect helps remembering certain % for epidemiology (e.g. % of DSH, % of delirium going into dementia, etc). I found it impossible to memorise those stats while studying, but practice effect did help a bit. I still did loads of guessing for epidemiology ques in exam though. I went through the previous exam posts in here as well to see the past year questions. Days before exam I randomly found out PsychMentor offers free Mock paper. I'm not sure if it's always there or it's only available near exam season, but do check this out: It was helpful to assess your standard. In the end of the day I personally think it's practice effect & understanding, regardless which ques bank you try or learn from. Do things at your own pace. Hope these help. All the best!
  5. I'll try to summarize the ques posted before & add in some that I remember: MCQ 1. Drug contraindicated in alcohol: Metronidazole 2. Percentage of antisocial personality disorder in prisoners 3. Which is not part of testamentary capacity? 4. Psychological amnesia: for crimes of passion 5. A man complaining of left hand weakness. Tests come back negative. How to test if someone is suffering from functional cause? Hoover's test 6. Annual conversion rate of MCI to other forms of dementia: 5-10% / 15-20% / 30-40% 7. Man with schizoaffective disorder previously adequately treated with Clozapine, but he recently had epileptic seizure. His Clozapine level is at the upper end of therapeutic range. What's the next step? Options: Stop Clozapine / Reduce Clozapine dose / Add Valproate 8. A 40+ year old man currently in depressive phase, but has history of mania ~ years ago. What's the best tx? Lithium / Valproate / Quetiapine / Lamotrigine 9. Clozapine not indicated as outpatient initiation for patient with? Options: DM / Hypertension / H/o paralytic ileus 10. Memantine contraindicated in? Options: eGFR 51ml/min/1.73m2 / Epilepsy / H/o myocardial infarction / HR 55bpm 11. 5 year old boy with severe learning disability, microcephaly, noisy & hypertelorism. Options: Cri-du-chat / Williams / Angelman 12. Which of the following is true about Williams syndrome? Options: Most causes are sporadic mutations / It's caused by mutation in chromosome 22 / It causes severe learning disability 13. REM behavioral disorder: More common in Lewy Body Dementia 14. Antipsychotic with best evidence base for initial use in Parkinson disease: Clozapine? (Quetiapine was one of the options too. The word "initial use" got me in dilemma actually) 15. 35-year-old man diagnosed as ADHD with moderate functional impairment. What's the best treatment? Options: Methylphenidate / Atomoxetine / Clonidine 16. Which of the following has the best ROC for alcohol screening? Options: AUDIT / CDT / GGT / MCV 17. Which of the following is true about non-epileptic convulsion? Options: 1/10 patients in specialist service have non-epileptic convulsion / 90% are women / Usually no urinary incontinence / May have preceding epileptic seizure in the past 18-20. Referring to the Fagan nomogram given, prevalence of an illness is 10%. Positive LR was 2 while negative LR was 0.5. - If a person was screened negative, what's the probability he has the illness? - Same ques as above, but prevalence changed to 30% instead of 10%. - What contributed to the difference of probability in the example above? Options: PPV & NPV has changed / PPV is heavily dependent on prevalence / Sensitivity & specificity have changed. 21-24. Excerpt about wanting to find out about old people in nursing home's sleep. Interview was done & electronic questionnaires were distributed to the carers. - What was the aim of the study? - What was the sampling method? (Options: Convenience / Purposive / etc) - What was the strength of the study? - What can be inferred from the result? 25-27. Funnel plot (assymetrical with missing dots near the broader end). - What was missing in the above data? (Options: Big studies with negative result / Big studies with positive result / Small studies with negative result / Small studies with positive result) - By filling up the missing area with new plots, what happened to the result? (Options: It is more representative of true finding / It underestimates the effect size / It overestimates the effect size) - What was the bias causing the asymmetry: Publication bias. 28-29. Forest plot with unpublished result & published result and a total effect regarding comparison of Agomelatine vs placebo. - What can be inferred from the data? - What was the strength of the study: Including unpublished results. 30. A trainee has been asked to do an audit on their clinical practice. So he collected the data, presented his finding in the meeting. 8 weeks later, he re-audit again. What's missing from his audit? Options: Lack of intervention / Lack of new treatment option to improve the problem 31. What is the pathology in ADHD? 32. A new drug is found to have equal efficacy and safety with an old drug. How to evaluate the benefit of this one? I think it was cost minimisation analysis. 33. You're interviewing a child with PTSD secondary to child abuse. What's the approach for his other siblings? Options: Not to ask about trauma directly unless disclosed by child / Have session with the siblings without the abuser (forgot other options) 34. A patient was previously on Paroxetine but stopped taking it abruptly for few days. He's now back with anxiety & agitation. What's the likely step? Options: Start another antidepressant (forgot the drug given) / Restart Paroxetine and taper off slowly 35. "Empty chair" is associated with which psychotherapy? Answer: Gestalt therapy 36. A lady who was always neglecting her responsibilities at work and not cooperative with her colleagues was recently made redundant from work. She said it's because of her colleagues badmouthing about her rather than admitting her mistake. Options: Rationalization / Denial / Reaction formation / Displacement / etc 37. Risk of suicide after deliberate self-harm: 1 in 100 38. Narcolepsy is associated with which of the following? Options: Extracampine hallucinations / Myoclonic jerks / etc 39. Which is the most effective primary prevention of alcoholism? Options: Promote sensible drinking / Increasing the price of alcohol / etc 40. Treatment option for pathological gambling: Naltrexone? (unsure of answer) 41. Patient just recovered from manic episode. How long should he wait before he can drive again? Options: 1 month / 3 months / 6 months / 1 year / etc 42. The ability of a questionnaire to measure what it sets out to measure. What type of validity is this? 43. Something on test-retest reliability 44. Calculating specificity 45-46. Kaplan-Meier curve showing probability of not developing depression with time among smokers & non-smokers. - What does the y-axis in the graph represent? (Answer: Probability of not developing depression) - What conclusion can be drawn from the graph? (One of the options was, by 10 years, 95% of the non-smokers develop depression. Don't fall for the trick! Remember that the y-axis is actually the probability of NOT developing depression) 47. Common psychiatric disorder in SLE: Mania? (unsure) 48. Question on bulimia & anorexia 49. High heritability in: Schizophrenia? (unsure) EMI 1. Abstinence after successful heroin detox with a supportive partner: Naltrexone 2. Completed alcohol detox 2 weeks ago & currently having craving. Pt wants to prevent relapse: Acamprosate 3. A lady chronic alcohol user currently presenting with confusion, ophthalmoplegia. Tx: Thiamine 4. Learning from imitation: Social learning 5. Encouragement by giving reinforcement unrelated to the desired behaviour: ?non contingent reinforcement 6. Assessment for mx of difficult behaviours: Functional analysis 7. Mother complains child having haematuria. Upon urinalysis, found red food colouring instead of blood in urine: Munchausen by proxy 8. Man been investigated for colon cancer but negative findings. He still insists having colon cancer, and now claims that he can't work anymore because of it. ? Factitious ?malingering? 9. Lady been investigated for illness many times but all negative findings. She insists doctors are missing something. Hypochondriasis 10. A young man just underwent rhinoplasty but now claims he's nose is even more malformed. Body dysmorphic disorder 11. A 6-year-old girl referred for repetitive hand movements starts losing ability to speak. ?Rett's 12. An 8-year-old boy is unable to interact well with his peers in school as he couldn't understand the conversations especially if the classroom is noisy. Once he understands instructions and knows what's expected from him, he's able to perform well. ?Normal development 13. An adopted girl's foster mother is concerned that she doesn't attach to her, but would start crying when she's put in the crib. ?Reactive attachment disorder 14. "Experimental event rate - (minus) control event rate": Absolute benefit increase 15. 1 / ABI = NNT 16. Questions on learning disability - Rett's syndrome, Landau-Kleffner's syndrome, etc. 17. A lady currently in 1st trimester of pregnancy having 1st episode mania. What's suitable tx? (Options: Fluoxetine / all types of anticonvulsants / the only choice of antipsychotic in the list was Haloperidol) 18. There were questions on the different types of dementia - including Alzheimer's, Binswanger's, Lewy Body Dementia, etc. 19-21. 3 questions on PCL-R: What is the History / Clinical / Affective component? (Options: Psychopathy / impulsivity / Needing activity to kill boredom / etc) 22-23. Key term for solution focused therapy & DBT 24-26. Types of family therapy 27. Fredreich ataxia, biswanger Thanks to all the sharing here, we managed to get up to 76 recall questions LOL! That's like half of the exam Hope we all passed the exam, fingers crossed! Good luck everyone!
  6. Hi LocumSHO, do you know what was the answer for this question? Was it the lack of intervention or the lack of new experimental treatment before re-audit? I was in a dilemma
  7. Hi, I don't have the 2019 Mock but I can try to explain generally if it helps: Prevalence = Pre-test probability Pre-test odds = The odds of the pre-test event happening vs not happening = Pre-test probability / (1 - pre-test probability) Post-test odds = Pre-test odds x Positive likelihood ratio Side note: Positive LR = Sensitivity / (1 - Specificity) In case the question asks for negative LR, then formula will be (1 - Sensitivity) / Specificity So finally, Post-test probability = Post-test odds / (1 + Post-test odds) In summary, the steps are: Pre-test probability --> Pre-test odds --> Post-test odds --> Post-test probability Hope it helps.
  8. Tests of survival curves: (a) Mantel-Haenszel test (b) Log-rank test (c) Cox proportional hazards test - Mantel-Haenszel test is almost the same as the log-rank test. However, the Mantel-Haenszel test is restricted to 2 curves, whereas the log-rank test may use > 2 curves. - The Cox proportional hazards test allows the risk for death to vary within the model, whereas the log-rank test assumes it to be the same throughout. Types of Fixed Effects Methods: (if there's homogeneity in meta-analysis) (a) Fixed-effect inverse variance (b) Mantel-Haenszel (c) Fixed-effect Peto - When data are sparse (either low event rates / small study size), Mantel-Haenszel method has been shown to have better statistical properties when there are few events. - It uses a different weighting scheme that depends upon which effect measure (e.g. risk ratio, odds ratio, risk difference) is being used.
  9. Cox's proportional hazards model - Commonest approach to model survival or time to event data. - It's analogous to a multiple regression model, and tests the difference between survival times of particular group, while allowing for other factors. - In this model, the dependent variable is the 'hazard', which is the probability of dying (or experiencing the event in question), given that patients have survived up to a given point in time, or the risk for death at that moment. - No assumption is made about the probability distribution of the hazard. - However, it is assumed that if the risk for dying at a particular point in time in one group is, say, twice that in the other group, then at any other time it will still be twice that in the other group. In other words, the hazard ratio does not depend on time. The hazard of failure in one group is a constant ratio (over time) of the hazard of failure in the other group. Log rank test does not assume proportional hazards per se. - Used to compare 2 survival curves, and tests whether there's a difference between the survival times of different groups. However, it does not allow other explanatory variables to be taken into account. - It's used to test the null hypothesis that "there is no difference between the population survival curves" (i.e. the probability of an event occurring at any time point is the same for each population). - It's the most powerful for detecting alternative hypotheses in which the hazards are proportional. Quick Reference:
  10. My shortcut to remember subtypes of criterion/construct validity: CONstruct validity: CONvergent & divergent Criterion validity: Concurrent & predictive
  11. I remember them this way and I think it's easier to understand. Sensitivity (e.g. of a screening test) Among those with the disease, how many will be correctly screened as positive? Specificity Among those without the disease, how many will be correctly screened as negative? Positive Predictive Value Among those who were screened positive, how many actually have the disease? Negative Predictive Value Among those who were screened negative, how many actually don't have the disease? Hope this helps
  12. Performance bias - Happens when one group of subjects in an experiment (e.g., a control group or a treatment group) gets more attention from investigators than another group. - Can also refer to the fact that participants can change their responses if they know which group they are allocated in. (A set of Hawthorne effect) Observer bias (also called experimenter bias or research bias) - Tendency to see what we expect to see, or what we want to see. When a researcher studies a certain group, they usually come to an experiment with prior knowledge and subjective feelings about the group being studied.
  13. Hi hi I know I'm 6 years late but just wanna try answering the question Chi-square is really just a special case of logistic regression, and this is analogous to the relationship between ANOVA & regression. (Ref: Chi-square contingency analysis: - Independent variable is dichotomous - Dependent variable is dichotomous - Purpose: Used to determine whether there's significant difference between expected vs observed frequencies in one or more categories. Logistic regression is a more general analysis, because: - Independent variable is not necessarily dichotomous, and can have >1 independent variable. - Dependent variable (outcome) is dichotomous - Purpose: Predicts value of a dichotomous dependent variable (outcome) by using 1 independent variable & a constant. - E.g. How does the probability of getting lung cancer (yes vs. no) change for every additional pound a person is overweight and for every pack of cigarettes smoked per day? Here, outcome is dichotomous (gets lung cancer vs not getting lung cancer); there're >1 independent variables (weight & packs of cigarettes smoked per day). References:
  14. General rule: Positive Predictive Value (PPV) increases with increasing prevalence. Negative Predictive Value (NPV) reduces with increasing prevalence. In this case, urban had higher prevalence. Thus, urban should have higher PPV, lower NPV. Rural should have lower PPV (option A is correct), higher NPV. Explanation: PPV = Out of those who were tested positive, how many actually had the disease? Thus, prevalence affects the PPV calculation. Sensitivity = Among those with disease, how many will be tested positive? So it doesn't actually matter how many ppl have the disease (prevalence is not important). The important point is, how many ppl will be tested positive.