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Neeraj_Bajaj

Long Case- Head Injury !! Will I pass

19 posts in this topic

Head Injury Long Case

Did Pmp well had worked hard was feeling confident , wanted to finish the long case and chill out, BUT Destiny God whatever you say didnt want that-Patient really difficullt to control in terms of history , you can ask her something and she will give you an answere which is all over the place didnt make much sense and took me a long tme to make sense of what she was trying to say!! I did tell that to the examiners

My long case was Head Injury frontal lobe syndrome , MMSE 20,

What I did right

MMSE Frontal Lobe testing luria, abstract functioning, cognitive etimates, agnosia ,dysgraphia,Forced utilisation

trsied looking at mood symptoms had some personality change, forced utilisation, poor concentraion.History structure was fine

DD- I said Frontal Lobe Dementia or Frontal Lobe syndrome

Pushed me to say one and i said F L dementia(Disaster) asked did she have deterirating cousre and I said no and said I would consider F Syndorome and said sorry

Then comes obs iv

ask about head injury and change in personality

Disaster again patient difficult to control rambled on

Managemnt went well I said Later I should have considered PTSD as well abut the lady didnt have any symtoms

examiners asked me about Post traumatic amnesia and i ealised I had missed that but inswered all the questions in management like head injury is a risk factor for Alz dem, Shizo, depression, epilepsy, psychotropics reducing siezure threshold, PTSD ICD 10 criteria

Examiners were looking for LOC and PTA mainly which I missed and I am most likely to fail

BUT In my 42 months of training I have not seen a single case of head injury , I dont know how many of us might have seen it , and the patient who was a nightmare and kept saying i will show u pics of my grandchildren (total Moria- Child Like)) and disinhibited

Have got a really bad feelikng and thinking they will fail me for it

What do people think are there any grounds for appeal with this performance if I fail ??

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I know it's difficult, but try to chill out for a while. You did what you had to do and now it's time to wait for the outcome. Hopefully it'll be a good one.

Examiners are well aware of difficult cases and they do take that into account. They don't expect you to come up with all the answers after you've seen a patient for the first time and for one hour only. What they're looking for is somebody who's barking at the right tree and saying the right things (mostly). And we all make mistakes in our daily practice (yes, including the examiners)

You talk about all the things you forgot or 'didn't get right'... We all forget more than what we say (how could you say everything in ten minutes!).

Sometimes history is not the main aspect of the interview, but testing (you seem to have done a fair amount of it) or mental state, etc. A good exam is not one where the patient collaborates fully (particularly in front of the examiners) and everything runs smoothly. It's all about how you handle the situation.

Try not to think so much about the negatives and consider all the positive things you did.

I wish you all the best.

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I think you have done fairly well...

guess it was more of neuropsych rather than just psych...

as long as you picked up the frontal lobe signs...

you must be ok... I guess...

All the best and keep us posted...

cheers

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Funtoosh,

you seem to have done reasonably well as already said above.

Im just curious to ask as you have not mentioned in your post (you might have mentioned in the exam)- did your DD include Hypomania/mania with points for and against? What is LOC?

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hi

i hate it when people like you complain.you seemed to have just smashed the long case and you are complaining.what about people like us that never asked for head injury in neurolgy case.what else do you need to support frontal lobe sign other than what the patient demonstrated?

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Hi

I think you did well if you substantiated your DD well. I had a similar experience, with a patient who thought he had BPAD. To cut a long story short, I mentioned Schizoaffective disorder as my most preferered diagnosis.

The examiner asked me why I thought so and I mentioned that since he: 1. Had a brother with Schizophrenia (treated at the same hospital), 2. Had smoked cannabis more than 50 times (and I mentioned that I was considering Andreasons paper) and 3. that his first episode included manic and first rank symptoms.

I explained this to a consultant where I work and he said that I did the right thing.

As Oreta said, the examiners just want to see if your barking up the wrong tree.

Relax, you did more than just your best and that will see you through!

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Thanks to all of you

Now my observed interview was personalty change and Explore head injury

patient was rambling on and in the personality change my ploy was establish her personality before the head injury and then after and As I was asking her about her premorbid personality things like hobbies what sort of a person do u think u are, relegion and that where he stoppedv me saying

we all know when people start asking about relegion

and that left me just numb 1st this case from hell and then the examiner doesnt have the patience to at least give me some time to finish the job when the patient went out I was mumbling under my breath I was just gonna ask how her personality was after the injury.

so thats the observed interview

Management went well

They wanted to know about PT amnesia as I had completely missed it in my history and LOC

I also in my Idiocy said I should Have considered PTSD and they asked me about PTSD and i told them full ICD 10

Next tell us about PT amnesia as soon as i mentioned effect on prognosis they moved on to LOC

then should a psychiatrist be involved in head injury case

Yes, raised risk of SCHIZO, Dementia, Depression, behavioural problems,TLE

then what are the problems in traetment

I said most Psychotropics decrease siezure threshold also increased side effects and refractory to treatment at times.Then i got a bit tongue tied when talking about organic depression

also mentioned suliride as it is least likely to cause problems with siezures at this examiner appeared surprised as if i said something wrong

but I came and checked It si given in maudsley and is right

But I am having nightmares

My DD were Frontal Lobe syndrome and Fronto temporal dementia and he asked me name one( for god sake is he mad)

I said Frontotemporal Dementia s MMSE was 20 and then he said there is a deterirating coures and this point i reatracted and siad no I will consider Frontal Lobe syndrome and she did not have deteriorating course

When i mentioned Forced Utilisation he appeared impressed

Frontal lobe signs

WAS disinhibited and had inappropriate affect, personality change

liked sweat things

some behavioural problems

Did

Test for agnosia

Abstract reasoning

Luria motor

cognitive estimates

Graphasthesia

Fingers crossed I hope this doesnt happen to anyone else

I ws just hoping I will get any psychiatric case and will o home feeling ok but insted got this nightmare

anyway thanks to all u guys keep it coming (ur Views)

and Yes I did mention Mania in the DD

My DDD were

Alz Dem

Vas DEM

Functional

Mania

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Well I think it sounds like you did really well with a very difficult case. I'm sure I wouldn't have known as much as you. I also had quite a complicated case (although doesn't sound as bad as yours) with alcohol and multiple medical/social/legal issues and am having intrusive thoughts about it still. I am hoping that they give allowances for more difficult cases so fingers crossed. Anyway, there is absolutely nothing we can do about it now so just try to put it behind you and enjoy your free time until the result.

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the fact that he was all over during your observed interview

the examiners would have realised how difficult the patient was ti get info

i am surprised that there wasnt an informant with the patient

i think you did well

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Yes I know People reading this tread would like to know if I actually passed and the answer is

YES I Paaaaaaaaaasssssssssssssssssseeeeeeeeeeeeeedddddddd Huuuuuuuurrrrrraaaaahhh!

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finally i can have a good night sleep iiiiiiiiiiiiiiiiiiiiiii passed, but looking back now, luck plays a lot in passing, considering i didn't finish my presentation before time went up.. and it really comes done to confidence in the midst of chaos, i am relieved

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Well done Funtoosh.

Now we can say: 'we all knew you would pass'

Hehehe

Congratulations!

;)

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Thanks all !! But it was a nightmare waiting for the outcome and in my frustration I wrote a long letter to Anthony,

Yep

I mean Dr Anthony Bateman Chief examiner ventilating my feelings and making it quite clear in a diplomatic way how crap the exams are and how big a role Luck Plays.

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Well, it seems that you won in all accounts.

- You vented your frustration

- You let the chief examiner know what exams look like from the front line

- You actually passed the exam

Well done!

;)

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Well to be honest it was a great feeling when i wrote this letter to the college, I wanted to pass but was at leat partly relieved by the fact that I have made my feelings known to the college rather then just feeling unlucky.

So Guys If God forbid you are ever in the unfortunate situation like I was do write to the college , at least they should know how we feel like.

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