prian7481

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About prian7481

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    Doctor
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    MRCPsych
  1. When is the last date to submit sub preferences?!
  2. I passed the CASC in my 3rd attempt- Passed 15/16 on the Tuesday, the 9th Sept. Things (I think) I did differently compared to 2 previous attempts: 1. Read around the topic of each past stations and discussed with my consultant in detail as far as possible. 2. Had a general structure in my mind for all the different style of stations for eg: h/o taking, risk assessment etc.. and adapted them to the scenario. 3. Even though I could not cover all the questions, I made sure I managed to cover the tasks asked for by asking at least 2 or 3 questions each. 4. In the last half minute, rounded up the task by saying things like , "I get a better understanding of whats going on with you. This can definitely be treated and we will make sure you we can help you get over this." 5. A digital stopwatch helped me keep track of time in the single stations. I didn't bother timing the paired ones!! I definitely believe good luck plays a part in passing the exam as we all have the knowledge thats required for CASC. We all pass one day with some tweaking of our style of approach. Good luck everyone.
  3. Ok, then I failed the DT MSE!! Passed all other stations!! Thought would fail the TLE but passed
  4. I think 1 is postnatal depression h/o taking, 6 is Delirium tremens h/o. Not sure of PM stations!!
  5. Afternoon stations: 09/09/14 Thyroid examination: 3 tasks- explain blood results, query about hypothyroid symptoms, and do a thyroid examination. I forgot to check eye signs- don’t know if it is a pass or fail point. Capacity assessment for financial management- In a patient with residual schizophrenia. He had capacity and was not at a risk of overspending or financial exploitation. The other task is conveying your findings to him. Displacement reaction: Actor talked about frozen moments at work. He was not forthcoming when asked about any stresses with relationship, asked me why? I explained that sometimes the stressors in other areas of life can impact his functioning at work. Then he talked about his wondering of whether his wife might be having an affair. I linked both the situations and explained the defence mechanism but because I already knew the scenario, it appeared bit mechanical!! Vascular dementia: Assess cognitive deficits in this patient who had a recent stroke and has a loss of vision in one eye and? Do other tests/ questions that relates to vascular dementia ( something like this, got confused after reading this, did not know what exactly to do) I did MMSE ( actor appeared as if he is puzzled that I am doing the MMSE!!) and some frontal lobe tests. Asked a question each on autobiographical and semantic memory. Did not know what else to ask! Temporal lobe epilepsy: GP thinks he is having TLE, take a h/o TLE. The actor was really difficult. Did not come up with any answers with open questioning. I lost structure in this station. I asked Qs here and there and he was answering yes or no for all the aura, ictal and post ictal symptoms. I said in the end, I am not sure what’s going on with him but will refer him for EEG!! It did not go well for me. Neuroleptic malignant syndrome- Nice lady, stressed when I told the diagnosis, got reassured with the management plan. Genetic and Alzheimer’s- Usual questions- Actor was pleasant and was reassured Psychopathology- MSE- Young man presenting with paranoid delusions and 3rd person and running commentary auditory hallucinations. No thought disorders. Asked about risk of self-harm and others, mood, coping and insight but was not able to ask passivity as the bell rang. Felt bad!! Co-operative actor giving you all the symptoms.
  6. Morning stations: 09/09/14 Post natal depression: GP thinks that this patient has postnatal depression in a lady who is 10 weeks pregnant and has 7 month old baby- She was presenting with symptoms of clinical depression (tearful throughout) along with ideas of guilt and some delusional ideas of baby is suffering from a serious illness possibly leukaemia and was sure despite the reassurance from her family and health visitor. She did not pose any risk to self but on probing said that she might want to end the pain of the baby if this continues but did not have any solid plans. Talk to husband- I gave a diagnosis of postnatal depression with psychosis and discussed Mother and Baby unit admission and discussed starting her on with antidepressants and low dose antipsychotics considering her pregnancy. (Not sure whether it is puerperal psychosis or postnatal depression with psychosis as I did not get a chronological order of symptoms, if depression started first or these delusional ideas, could have given me a clue!!!) Paediatric overdose: To assess the risk and etiological factors for overdose. The girl was having a paper in hand with writing- ‘They are coming’. Did ABC of the overdose, asked about the past h/o and future risk and she said that she did not feel safe to go home and feels safer in the hospital. No abuse h/o. Mum in hospital diagnosed with depression following job redundancy. Talk to the paediatric nurse: Not very difficult. Agreed with the management plan. Asked me to talk to the step father as he is waiting to take her home, I said I would do- (Is it a mistake? - Confidentiality issues? ) Conversion disorder: take social h/o. do not do an examination. Lady with weakness in left arm and right leg and was noticed to be moving them during sleep as normally. She was pleasant and was denying any stress when asked an open question. I had to ask each and every area specifically about work, relationship, family issues and she was not easily giving away anything. She had stressors in all these areas. Also asked how the illness impacted her life now. Talk to husband: Usual stuff, nothing new. Delirium tremens: Do a MSE on this Old man admitted following a fall and fracture and take alcohol history. Nurses concerned about his behaviour and he smelt of alcohol. He appeared disoriented to time but said that he is in hospital. He could not remember the fall or fracture and said that he is here for a regular check-up-. He gave a h/o of having seen a cat in the ward and people are talking about him but at the time of assessment he did not respond to any external stimuli. I managed to explore a bit of his delusions and hallucinations. Asked about his alcohol intake and he got irritable and minimised the intake. Then, started asking the orientation, Attention Qs but the bell rang. Talk to the orthopaedic nurse: Actor appeared bored already ( I was the last candidate for that station) I explained my findings and diagnosis, asked him about the phone conversation with daughter who said that he had been drinking heavily for years and I gave the diagnosis of Delirium tremens and discussed the management. He was quiet and when I asked does he have any Qs, he sort of woke up J and asked me whether we can take him to the mental health ward. I gave the usual answer of medical emergency and treatment in acute medical or surgical wards…….. And the bell rang.
  7. I failed the 2nd time, passed one less station than the last attempt!! One good thing is that the feedback forms have 3-4 expected tasks to be completed by the candidates for each station. Shall we start posting those tasks for each day's stations? I appeared on the 22nd Jan, I will post them soon with the topics. This way we can at least figure out the examiner's expectations from the candidates and can have discussions of what maximum we can cover within the timeframe.
  8. I passed this station with a B. I just went in and said to him that I am here to address his concerns and went with his flow. He was asking about diagnosis which I explained. Then he asked about treatment, when I told him the Bio psych social approach. I talked about behavioural therapy at first and then went on to talk about Methyl phenidate and mentioned the side effects and the need for regular monitoring. Then social approach like family therapy and educating the teacher and inviting his teacher for the meetings. Others as mentioned by afterlife like websites and leaflets
  9. Yes the actor did not say anything openly so I ended up asking all closed Qs Asked her all the core criteria: Inattention Impulsivity and Hyperactivity. Interestingly I was asking with examples as she did not give me any examples when I asked for it! For example, I asked her will he be able to sit and eat at the table without any problems? Then, asked her about the symptoms in other situation like school and supermarket. I also mentioned at this time that I have read through the GP letter and about his behaiour in the GP surgery. Then went on to rule out, conduct disorder, autism, LD and any tics! Then, family history, when she opened up saying her brother's child was diagnosed with ADHD and that he is taking Methyl phenidate and asked me whether his son also has ADHD, then I told her that we will send out questionnaire to her and his teachers and will make an appointment to see his son. Then I carried on by asking his developmental and medical history. And asked about current family situations, when she mentioned taht she is pregnant and worried about her growing baby, its just empathising with her and being honest with her that teh other child might also be affected and acknowledging her stress at this point!! Finally, told her that it sounds that her son might be suffering form ADHD with the given symptoms and a positive family history but as mentioned before will see him and send out questionnaires. I passed this station with a B
  10. Passed with a B The lady was guarded to me as well initially and had to probe her a lot. When asked about has she noticed any changes in her Husband recently, she said yes, how long, for past 9months, anything particularly happened at that time, head on collision. Asked details of the accident, time of LOC, recovery, any investigations and any abnormal findings, she said he was discharged the same day. Did she notice any change sin his speech, mobility - NO Then asked in specific about the 4 core symptoms: Behavioural Personality Psychiatric- mood changes, apathy, tearfulness Dementia Rule out depression and suicidal ideas Risk to others- any irritability ended up in physical aggression Neglect- wel will cover this ADLs when asking about memory Any medical, past psychiatric, medication premorbid personality - This I ask at the beginning as the actor was not very forthcoming. I thanked her, briefly summarised about the positive findings and left
  11. I did pretty much the same and found myself repeating again and again to him. And he repeatedly told me that hi is in a hotel!! Ok, to start with, I explained to him that I am psychiatrist and here to talk about the care package proposed by his doctors. I also said that I am sorry that he had a difficult time by having a heart attack. He did not remember anything and said that he is in a hotel . I asked, did anyone talk to him about the care package, he said NO. I explained to him what it involved, benefits and risks, and checked his understanding, as expected he asked what did you say? who you are? - This make clear that he cannot understand and retain. Then I persisted that the care package helps to support him; what does he think, he said he can manage on his own. Then asked about what are the benefits and disadvantages of not having them, he did not remember what I explained earlier. At this point, I started doing registration, repetition and recall and orientation to TPP, which he failed. Then after one more attempt of briefly explaining him the care package and saying who I am, I asked what is his decision on care package, he said I don't want any support. I ended up by saying Mr. X, it appears that you have trouble remembering things and that is affecting your decision. I am concerned about your decision at the moment. I will come back later to talk to you about this, is that ok? He said Ok and the bell rang I have to mention here, although I passed this station, in the areas of concerns, it was marked, poor structure and communication, so we have to improve the structure further!!
  12. Same here Crapped A and cracked B I passed this station with a B and the next one with an A. will post the details of the 1st station later.
  13. Thanks Toby, looking forward to your valuable input here.
  14. I did everything as above and the bell rang when I was checking peripheral pulses. The actor was grumpy from the start and I had to apologise to him for my cold hands. I did it systematically as far as I know, but failed the station. I don't know why???
  15. I failed this station. I convinced the actor to give sample for UDS and also addressed her social difficulties and felt good after the station but the feedback said, in the areas of concern as communication and range and depth.