Gurpal

Feedback: MRCPsych CASC January 2016

116 posts in this topic

GBH guy  from yesterday was Polish. Does anyone have an idea why they picked Polish person? Was it relevant to the task?? 

About cognitive in Korsakoff the instruction said that he was fired from work 6 months ago but he kept saying he painted the school hall as a part of his job 2 days ago and also in instruction it said that hospital checked his address but he was not registered there and again he didn't seem to be aware of it (confabulation?) 

Good luck to all remaining candidates :)

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Dear Sheet

Many thanks for your help. 

Kindest regards 

Udas 

Sorry, I meant Sheesa, apology again. 

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1 hour ago, shydros said:

To all those who are taking this exam...keep faith in yourself...as someone who worked hard to get this out of the way i can only advice that be yourself and do not let one station effect you. just do it and forget about that fully. Stations that you think you wont pass, you might just pass by a mile...and stations you think you have passed wont be that easy. So there is little to go by instinct in the exam. Its subjective and it depends on your mental state and that of the actor and the examiner.

So all you can do is ...give it your best without any trace of axiety. Confidence is KEY as this would make you stand out from the rest of the crowd. SMILE and be courteous and respectful to patients just as you would normally. DO NOT FORGET to greet and do not forget to THANK appropraitely. Be NATURAL. Remember ...even if you started on the wrong foot you can simply apologise , admit and retreive a station depending on your skill to come out of a bad situation. I did it myself and was surprised. So there is no hard and fast rule in this exam. Its all a reflection of your confidence and communication. So all you need to be is yourself. BEST OF LUCK and heres hoping everyone who worked hard gets through.

Many thanks Shydros

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20/1/16 

Simple 

MSE Mania - alpha omega 

cog exam on alcoholic 

Asperger and psychosis with change in behaviour - ? assess behaviour and cause 

Talk to mother who wants to know about depot injection choices for son

Take history of elicit drug use and harmful effect

woman setting bonfire in the garden assess delusion whether primary or secondary and assess risk 

risk assessment on patient with known history of schizophrenia admitted for waving knife at wife due to her putting sexual thoughts ( threesomes) into his head to make her admit what she did 

inperpersonal therapy suitability and motivation 

Paired 

1. Alzheimer with challenging behaviours talk to the carer 

then speak to the angry son about father being pr scribed with olanzapine explain him other non medical treatments 

2. Assess postnatal depression with psychosis 

talk to the husband 

3. Assess 21 yrs old woman presenting with symptoms of panic attacks 

talk to her mother 

4. Man wanting to stop 20 mg of fluoxetine CPN thinks he has sexual side effects talk to find out what the problem is 

next talk to wife 

 

 

 

 

 

 

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re: depot injection, any particular one? what oral tablet is he on?

 

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He was on olanzapine. Mum wanted to know about depots in general, but also asked about risperidone depot specifically

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Feedback from a friend 

 

delirium tremens and management with a nurse

conversion disorder speak to mother

sexual side effect- fluoxetine speak to wife and address ice

Frontal lobe syndrome and examination 

 

BW

 

 

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Wednesday Simple

young girl with religious back ground was in a ? religious concert 3/7 ago; was brought to hospital by father following strange behaviour? denied taking any drugs there. she was sqautting on the chair and moving to the other chair at times,  looking around seeing fire around her. said God was talking to her and chosen by god;  repeating I'm alpha omega. felt she didn't need to eat or sleep for 3 days. Task: MSE

Autism with Schizophrenia OPD review: on Risperidone 4 mg daily, his outpatient review was broufght forward by family, talking about CIA and him being an undercover, went in tangent about James Bond and his interest in his movies. 2 days ago heard a woman in the street called him bad names?? said he had verbal altercation with the woman. denied any intention to do anything the her later. denied taking drugs. ?? I think said people knew about his mission as an undercover.

Poly drug abuser: on heroin, spending £40 a day for it, shoplifting, was caught twice and was locked up for a while, IVDU: HepC positive, girl friend was working, and not into drugs also negative for HepC? he had to leave his job in kitchen 6 month ago ??drug related, but said I didn't like the job, on benefit now. no children, . started drugs since 19, mainly cannabis and heroin but now only heroin ( narrowing of repertoire), had withdrawal Sx, relief by reinstating heroin use then increasing heroin again to previos level and priority of drug over other activities. ???probably waiting to be seen in drug services, said he wanted to stop it otherwise girlfriend  would leave him. ??poor motivation. task was history of drug abuse and ?? review for referral to drug services ( not sure for the second part)

Nihilistic delusion: middle aged woman, found by friend 3/7 ago when she lit a bonfire to cremate her dead body,said if she goes home wil do it again, not eating or drinking for 3 days, asked her how a dead person can talk, said body is dead and it was the spirit talking through her body and ??? spirit will join the body later  , ?? probalby after the cremation. said she first saw an angel and it was a sign that she was dead. Hx of depression for 6-7 yrs, had ECT in the past. husband ?? left her 7-8 months ago and I think was alone. task: if delusion is primary or secondary also ?? assess the risk.

the Korsakoff man was found unconsious  3 wks ago and was in medical ward for 3 weeks, SW couldn't verify the address he had given as he said he was working in school but was sacked from there 6 mo ago. He had confabulation. In MMSE he missed all the points for time orientaion , I forgot to check the recall otherwise he did well. MSE wasn't remarkable .

In IPT session the instruction said she was depressed and wanted to know about IPT. but initially she said she wanted to have talking therapy not mentioning IPT. said her mother died 6/12 ago. her son left  home 6 yrs ago and daughter also left 6-7 months ago ( empty nest) she also was working but hasn't been to work for 4 wks, husband a psychiatrist ?? not so supportive telling her to go to gym to feel better.

the violent guy pulled aknife to ward his girlfriend after felt that she wanted him to have sex with men and other girls. had a history of schizophrenia with no insight and erratic complince, Hx of threatening behavior to previous girlfriend ?? feeling that she put thoughts in his head. also another violent behaviour that I can't remember the details. had palns for future but not realistic. task was asses risk of future viol;ence.

Depot station: Mother had read about depot asked about Olanzapine and Risperidone depot injection.  her son John on olanzapine  for the last 4-5 years with erratic compliance. she knew Risperidone was given on a fixed interval ( didn't mention 2 wks) wanted to know if there was any time flexibility with Olanzapine depot. then said what side effect they had. task was discussing depot with her.

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1 hour ago, SARAH7 said:

Feedback from a friend 

 

delirium tremens and management with a nurse

conversion disorder speak to mother

sexual side effect- fluoxetine speak to wife and address ice

Frontal lobe syndrome and examination 

 

BW

 

 

21st Jan 2016 paired stations

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Hi all, anyone posting the afternoon stations please? 

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Mania/ multiple drug use/angry mum schizophrenia son on Clozapine / overdose risk assessment PD/ dementia with LD/ wandering/ treatment resistant depression  do bloods explain mx/agoraphobia

 

According to my friends

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Was it treatment resistant depression or depression with psychosis , on todays single? What was the management ? Lithium or Antipsychotic? 

Edited by Dr18

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Paired questions

1 delirium tremens : MSE & take alcohol history

2 management to the nurse

3 conversion: hx focusing on visual loss and examination

4 talk to mum: few collateral history, diagnosis, answer concerns, no management discussion

5 on fluoxetine, wants to come off Fluoxetine

6 talk to wife, address concerns 

7 head injury history

8 cognitive assessment related to the history from mom

singles

mania: mse

multiple drug use: take hx to assess harmful cause

schizophrenia : angry mom wants to take son home

LD with Downs: hx to assess dementia

wandering: assess risk of wandering, tell daughter if mom can be taken home

depression on venlafaxine: discuss investigation, management 

agoraphobia: tell about agoraphobia, desensitisation 

girl stabbed herself, at a & e: assess suicidal risk

 

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Thanks. I am really confused as the story was really long and the guy was hearing voices according to the history. 

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I think the question was, few episodes of Depression in the past, he was started on Fluoxetine on 20mg then increased to 40mg, didn't work and started on Venlafaxine 150 mg by GP.

I don't think he had psychosis, he said  Venlafaxine has slightly improved the symptoms but not much, he was ready to do anything to get better. Had few episodes of Depression in the past, not tried any other melds except fluoxetine and venlafaxine, no talking therapies in the past. 

 

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Linked stations

1.Talk to the mother of 23 y.o. man. He had a brain injury 2 years ago. Seems he had a frontal lobe injury and she tells you that his personality has changed since the injury.

Assess cognitive function with 23 y.o. man.

2.To interview a man with a morbid jalousie. His partner brought him to A&E after he was punching a pillow.Previously stubbed his ex - partner due to his delusions and admitted under MHA. Currently he is on Risperidone and wants to increase the dose.

To speak to his partner who is not aware of her partner's delusions and wants to take him home. She believes he is angry because of the issues at work. 

3. To speak to 8 y.o. boy's mother with ADHD. GP made a referral of this boy as he has features of Adhd and disruptive at school. Talk about this boy's current problems and further assessment to come to the right diagnosis.

To speak to boy's father and explain dx and treatment. 

4. A man exposed himself in his garden in front of his neighbour. Find out etiology.

To speak to his wife. She wants things to be confidential. Then she tells that he was sexual inappropriate with his grandaughter. Kept asking if things could be kept confidential.

 

Edited by Alex21
more information
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Friday 
Qtc big tric, didn't pick up low heart rate

 transference,

mania,

assess psychosis or cultural believes ?world wide conspiracy (papers of Bible with him)

angry mother clozapine

,depression with psychosis management,

overdose borderline 

Paired 

Frontal lobe syndrome 

Morbid jealousy 

Adhd child mother father

Indecent exposure 

 

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1.ECG-

Pt on Quetiapine 700mg X4 years, on Gliclazide, Furosemide & Loratidine. No shortness of breath, no chest pain / Family h/o her problems.

V cooperative patient. ECG- Ventricular rate -33, QT-465,QTC-665. Lots of T waves.

Pt as usual wants to know what are "these squigly lines". Why is the ECG not right? What are going to do now? Ans - Due to low HR & poor transmission of electrical impulses, I will stop Q & send u to A&E for Cardiolgist opinion / treatment. Will start u on different AP like Aripiprazole. 

2.TRD with mood congruent AH. 

Pt has been on Fluoxetine in the past. Not helped. Currently on Venlafaxine 150. Talk to him re further Invtns & treatment.

Bit irritable pt. "You tell me" to the initial open qns. Confirm any stress, any physical problems -reported that recently GP has confirmed 'Impairment of glucose'. Not on any meds. No other blood tests done eg- TFT.

Treatment - Increase Venlafaxine , add AP / Lithium / Mirtazapine ( be mindful of DM) / CBT / ECT as last resort.

3. Fred O connor had been to his GP. During blood test, Fred made comments on the 'bar codes' & was talking about world wide conspiracies . Task - GP wants to know if he is suffering from psychosis.

Fred wouldnt stop talking. Spoke about few persons controlling the governments of countries who in turn control people. Bar codes- he saw 666 on the vial & went off talking about 'the beast' as per Bible. Has made little impact on his life / on his mood. Appeared to be just over religious rather than Psychotic. Thats my conclusion at the end of 7 mins. I may be totally wrong.......

 

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Thursday singles / angry mother clozapine 

Does anyone have any details of the above station from Thursday singles? I had real difficulty in reading the full scenario before going inside the cubicle. Is it fair to give such a long scenario which you can not finish reading within the time provided ? Some one should complain or raise this issue with college! The same happened with treatment resistant depression station !!

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Hi, I could only remember that the patient used to live with his brother in a ? Flat,

Exploited by his brother, not eating and drinking but drinking alcohol, admitted under ? Section, raised LFT at admission, started on Clozapine for last 3 months. Since then slightly pleasant but still needs help while eating, drinking and personal care. Mom lives 30 miles away, full time worker, father alcoholic doesn't work and stays at home.

mother wants to take the patient home, decision made by the team that the patient can't go home, inform the mother.

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Can anyone comment on the length of 10 minute  stations. Are they appropriate...?  do they seem long ? What should you do if you think you have finished early......... is it a good sign?  

 

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I have noticed that if your 10 minute station finishes early- you are missing something as they are done in such a way that it will take you time to cover all that is needed for the task

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