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Gurpal

Autumn 2006 Part 2  PMPs Feedback

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Please feedback your experience of the PMPs exam. It would be very helpful if you could list the PMPs you were asked. The more detail the better. Cheers!

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12.10 pm 15/11/2006

Three PMPS were:

1)31 year old female admitted on a section to hospital , 5 year history of schizophrenia.

Non compliant with medication. has a domineering mother who does not accept her diagnosis.Started on a typical depot , now refusing because of side effects.

Assess and manage

2)False Memory Syndrome

Long statement about this woman who has had 2 year long psychotherapy and since then seen a hypnotist .Now complaining of sexual abuse by father and also remembers being touched by a neighbour!!!!

Assess and manage

3)31 year old man 3 months ago marriage broke up , since then drinking 60 units per weeek , feeling low and now mentions to friend that hea wants to end it all!!

You are seeing him in the OPC

Assess and manage

The false memory syndrome was a disaster!!!

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The three PMPs I had were:

1.- 63 yr old man who had a miocardial infarction six months previously. He says he feels too tired to go back to work. All tests (including exercise tests) are OK. His wife also says he's not engaging in so many activities at home. Assess and manage.

2.- 9 yr old boy who is underperforming at school. His attention is poor and he shows a disruptive behaviour. He has no friends. His behaviour is consistent at home, at school and in the playground (?). He engages in high risk behaviour. He also has a six year old sister who has also started displaying some disruptive behaviour. Assess and manage.

3.- A woman is concerned about her husband, who appears to be very jealous of her. He accusses her of seeing other men and looks through her underwear for any signs of infidelity. He also asks her where she's going every time she wants to leave the house and often won't allow her out. He has hit her on several occasions. The GP asks you to see the wife before you see him. Assess and manage.

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my PMPs were-

1. 26 year old woman referred by GP with all symptoms of panic disorder and stops going to work as school teacher. Discuss assessment and management.

questions were about complications of Panic disorder and details of CBT and pharmacotherapy.

2. 40 yr. old woman referred by GP 9 months after a car crash. has developed symptoms of hyperarousal, flashbacks and avoidance. insurace case is pending. assess and manage.

questions were about CBT, pharmacotherapy and differentiating between genuine and fake PTSD.

3. Homeless man with alcohol dependence referred by GP for alcohol detox. some symptoms of confusion assess and manage.

questions about biological and social management of alcohol dependence.

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My PMP's were

1) 47 yr old( not sure of the age) with schizophrenia on clozapine treatment( total of 350mg or 450 mg daily) who had relapsed after being stable for about 2 or 3 yrs. How will you manage? They asked for possible causes of his relapse etc. 8-)

2) 75 yr old man living alone and hoarding rubbish.GP referred after neighbours expressed that they are concerned about him being a fire risk. Asked for differentials and how I will manage . They also asked for any legal implications of the case, the risk he poses, use of MHA etc. 8-)

3) 35 yr old married man who was referred by GP because he belives he is a woman ( has had the belief for yrs).How will I assess and manage. Asked about risks . :(

I found the last PMP quite difficult, couldn't recollect any of the terminologoies. Described vouyerism and transvestism to examiner's but could not coime up with the terms. Only emntioned Gender Identity disorder towards the end when it suddenly sprung to my mind.It was obvious that I wasn't ready for any question on sexual disorders

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Could anyone who did the 5 pm pmp on the 15 remember them.One was about the woman who could not bond with child.The other was about alcohol use.The last was about the meat and milk woman.I am terrible when it comes to remembering exam questions

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1. Post appendicectomy patient 2 days after, geting aggressive in the post op ward. assess and manage.

2. Learning disabled 40 year old male living with his elderly parents, getting irritable aggressive and behavioural changes . The day centre he was attending closed down recently.

3. Antisocial PD, male, with h/o alcohol and substance misuse has come to your OPC , referred by GP for depression has revealed that he has recently bought a firearm. Assess and manage this case.

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I had the same PMP's as rastafarian. I haven't done an LD job, and I am sure the examiners were laughing at me, when I was answering it! :-/ Don't have a good feeling at all

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i did mine on 16th at 1530

1. 2 schizophernia patients want to get marry! They aslo want to start a family! They saw u at opd and ask for advices?!

Question discussed: any problems of them getting marry? antipsychotic medication in preg (they wanted to know the side effects of using antipsychotic during preg but i can't remember as there isn't any obvious effect to baby, is there?!), risk of relapse of being preg and risk of postnatal psychosis

2. single mum just make redunctant, 8 and 10 years old daughter at home, 5-6 depressive symptoms and ... 'she doesn't want to take medication as she heard it would affect concentration! Assess and manage.

usual stuff and details on CBT

3. 30+ male over last 3 years forcing his wife to live with him otherwise he threaten to harm her and abducted the children, patient parents also mentioned about past history of threatening behaviours. Assess and manage

As soon as i mention the term morbid jealous, the examiner just kept grilling me on that and i honesty dunno what does he wants, afterwards talking about risk, where do u want to treat him, MHA

I dunno how other people feel but I don't feel good about my exams. I always been taught by lots of people including SpR and guildford course examiners should let u keep talking unless you are in the wrong tract. In my exams, it's completely different as they never let me to speak more than 2 mins without interruption! they just keep disturbing my train of thoughts!

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Hello Folks! I better feedback now before I go out drinking ::)

14.40 Thursday

Orthopedic team calls me at night as pt got verbally aggressive and tried to leave the ward - 8 hours post op & 3/7 post admission.

? Mx

My answer

-Urgency of situation

-need to give advise on common law/safety of pts and staff

-clarify reasons for admission with team + review history, clinical notes etc

DD acute confusional state - DT - mental illnesses

Mx she prompted 'let's assume it's DT'

Standard DT Mx

Nursing intervention: side room , 1-1, blah blah

Give Chlordiazepoxide reducing regimes, parbolex IM etc

Seemed overall quite happy

H 14.50

18y LD girl referred as not going out of her room and low, not eating/sleeping well also appearing to talk to self and saying not to like that 'old man who comes at night'

-sensitive issue

-need for appropriate adult

-assess at home with member of team + family

-consent/competency

-take full history from her+collateral

- Exclude physical cause

- DD Stress reaction to abuse - psychotic disorder(schiz) - affective with psychot sx + a few less likely ones including social phobia, panick, etc

-Mx Issue of Social Service disclosure (if suspicion high)

-Biol Treat Sx appropriately

-Psychosoc reduce stressors, educate family

Needed only a couple of minor prompts, hope OK, that one was actually quite tough.

15.00

52y M with Parkinson, accusing wife of stealing his things and aggressive, no past history.

started off with safety issues and sensitive approach, din't want to hear asked me about differentials

I mentioned LBD first and Psychosis in Parkinson or Delusional Disorder, she asked me Mx of LBD and pharmacological issues - I hope it went reasonably well although I didn;t mention lots of things that I could have, I take it it's because she prompted me to Mx very early in, I'll keep my fingers crossed

Best of luck everyone

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I did the 5 pm PMPs on Wednesday

1. Post natal depression

2. 38 year old business man who is drinking 50 units a week and doesnt want to reduce his intake. QUestions about how to engage him and controlled drinking

3. OCD- woman with 2 year old and 8 month old kid. Has thoughts about removing beef from the house and it being contaminated. Not allowing milk either.....Q's about psychological Rx and pharmacology

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16th at 12.00 pm:

1)35yr old male, been on 2 antidepressants, still not responding. management.

Straight forward treatment resistant depression.

2)11yr old boy, just been transfered to a new school, refusing to attend school, had similar problems in the past, now is distressed, cant sleep at night.

Diagnosis, most likely.

probe:

a)wat bakground info will u get?

b)his parents asked about emotioanl problms in the future, wat will u tell them.

c)Wat could sleepin problems implicate.

Answers:Wasnt sure exactly of wat the diagnosis would be but i said

a)the usual bkground info(gp, SS, school, child psychiatric team, parent's & their consent, they were waiting for school report.

Dx depression, separation anxiety, adhd, Being bullied,anxiety disorder

b)difficult to tell about emotioanl outcome need more clarification( examiner was nodding!!)good sign

c)nightmares,side effects of Ritalin.

3) single mother, no support, had a baby 6 weeks ago, now agitated, putting baby in & out of the cot.

diagnosis & managemt.

Answered: Post natal depression, possibly post puerpural psychosis...& the rest bla bla bla.

Probe:Asked me what r the risks to baby, wat type of delusion the mother can have with regrds to baby, preferred anitdepressants.

answered: neglect, physical illnesss, violent & homicidal thouhgts.

mentioned delussions of baby being possessed or being evil, attrubting negative events to baby.

nice guidelines: SSRI, preferably short acting sertaline, possible to give older TCA, but i prefer SSRI due to side effects, risk of overdose.

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my first PMP was a 40 y old man admitted on medical ward for tummy pain. 2 days later he was agitated and disorientated. Assess and manage

Questions:

how you treat DT?

what is the long term treatment for alcohol dependence?

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the second PMP was about a 32 y old refugee at police station for pocket picking. strange behaviour(or some thing like this)had history of admission a year ago in hospital> Assess and manage

Questions:

what organic causes...?

would you consider any culture bound syndrom?

if he needs amission what legal powers would you use?

if the police does not press charges and he refuses admission how you admitt him?

How you treat him on the ward

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3rd PMP:

a 44 year old with abdominal pain. a consultant gastroenterologist refers her to you saying he could not find any cause for her pains> Asssess and manage

Questions:

what is the difference between somatisation and hypochondriasis

and between malingering and factitious

How you treat somatisation?

What medication would you give for pain?

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I had a straight forward resistant depression, postnatal depression and school refusal.

The only question I missed was the name of rating scale in postnatal depression.

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Khuram, i had the same ones as you, for the second one- i mentioned school refusal as a sypmtom but did they ask you for the most likely diagnosis?

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They asked me what is the name of the condition and tell us the causes-----my answer revolved around emotional probs,depression,family issues and bullying in school.

Sleeping with parents on their bed---why?----I said nightmares/terrors

They were keen about physical sensory deficits.

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1.PMP WAS ANOREXIA NERVOSA-BMI 13, DOING A LEVELS,ASSESS @MANAGE

2.72,YR OLD WIDOWER, SEEING DEAD PEOPLE,DEPRESSED ? MANAGE

3 17 YR OLD 1ST EPISODE PSYCHOSIS ,PARENTS WANT TO KNOW ABOUT THE ILLNESS?

LONG CASE WAS VERY CONFUSING AND I AM STILL UNSURE ABOUT DIAGNOSIS

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Khuram, i had the same ones as you, for the second one- i mentioned school refusal as a sypmtom but did they ask you for the most likely diagnosis?

I had the same ones - treatment resistant depression, school refusal, puerperal depression/psychosis. Asked me specifically about whether puerperal psychosis/ depression, i could not give a definitive answer as the descripiton was the lady being agitated, house untidy, and putting the baby in and out of cot. Asked me what type of psychotic symptoms are there in puerperal psychosis and which antipsychotic when breast feeding.

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FRIDAY 10AM

1. 25 yr female... 8 weeks pregnant... h/o depression... currently on paroxetine... worried about the effects on child....wants to stop meds..

2. court has referred to you... in ur outpatient clinic....35 yr old artist.. threw bricks at the glass window of local book store... no previous psychiatric history...

3. 20 yr old girl... brought to A&E after paracetamol OD... refusing treatment... multiple scars on forearms....

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had at 2.30 PM

1. a lady, previous child died after birth. Currently pregnant 33 weeks, obstetricians concerned . assess and manage

2. 19 yr old severe LD exposing himself in public

3. A man brought into A&E after a fight with his wife. Has sustained injuries, police have picked him. no pevious convictions or mental illness. How will you assess and manage.

How was others exprience with these PMPs.?

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had at 2.30 PM

1. a lady, previous child died after birth. Currently pregnant 33 weeks, obstetricians concerned . assess and manage

2. 19 yr old severe LD exposing himself in public

3. A man brought into A&E after a fight with his wife. Has sustained injuries, police have picked him. no pevious convictions or mental illness. How will you assess and manage.

How was others exprience with these PMPs.?

hello i did my pmp at 12noon on 16/11/06

following pmp ---

1.t/t resistant depression

2. school refusal

3.post natal psy. illness--d/d --as usual.

all 3 are mentioned in detail earlier.

what i want to know is-- do we have to pass all 3 pmps. what will be the total pass mark for pmps. can anybody or webmaster help.

thanks.

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No one know even the examiners, I heard

I have my exam in bedford

very well organised

Examiners were friendly

My PMP same like Carlo

One of the examiner was professor

Stange style , as if I was in a teaching session , the course was more serious

The examiners did not let me say any thing on my own , started by questions straitaway

and very interactive , hints and helped me to answer if i stuck in a very unusual way , and this is from first minute

I did not feel i was in exam , to extent . when I finished I felt ok but today I have a feeling that i frgot few basic things , and getting worried

any one has the same experience

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Friday- 10.45 am

1. Bipolar patient stable on Li developed renal failure- renal Physicians want to stop Li. Gp asked for advice. Last episode 15 years ago when he made serious attempt to kill himself. How would you proceed?

Probes- Will you stop Li.,  How can Li cause renal failure?, Can the patient sue for negligence?

2. Women in her 30's- admitted to surgical ward after postop- fracture of wrist- now getting aggressive after started seeing small creatures. No previous psychiatric history. Assess & manage?

Probes: How would you differntiate between DT & psychotic illness? when I gave dd's- Delirium, DT, Drug induced, Mania/hypomania, relapse of psychotic illness.

What are the physical signs you look for DT?

Management of DT?

Dose of Pabrinex and detox? Signs of wernickes?

Causes of mortality in DT- i was stuck at that point.

Other differentials- Wernickes, subdural heamatoma,

Finally they asked me, Could her experiences be based on reality- like a cockroach infested ward :(

3. young lady with a h/o AN. h/o several previous admissions. Wt gain during admission. Soon after discharge back to square one. Now presenting in your opc with a BMI of 11.6. Speech incoherent. How would you proceed?

When I started saying 'this seems to be a medical emergency'. They asked me what are the physical signs you would look for in AN. esp CVS signs.

What metabolic abnormalities?

Examiners were not interested in things like info gathering or structure. too keen to interrupt and disrupt rhythm.

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