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2006 PMP\'s

10 posts in this topic

Hi all,

Is it possible to get past pmp's of 2006 on superego cafe site.

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ATM 2006

• a woman attends A&E with a 3 month old baby worried about her thoughts of dropping the baby. she has no past psychiatric history and has her husband at home looking after the 4 yr old son.

• a woman in her 70s with history of dementia, unable to look after her house chores. she is covered in bruises and lives with her husband.

• Young patient with a long alcohol history, presents to the A&E with visual hallucinations, agitated, pyrexial, respiratory crepitations. Assessment & management?

• Patient with mild LD, with well controlled epilepy, on valproate and carbamazepine having episodic behavioural problems. Current episode since 2 weeks. Started with being irritable, talking more and now presents with being withdrawn, not eating, lack of interest in all activities. How will you assess and manage?

• Pt. diagnosed with schizophrenia on an adult ward, using Cannabis, and selling it to other patients, nursing staff are asking you to discharge him immediately. How will you assess and manage

• woman is in hospital with depression for 9 months not responding to antidepressants and two courses of ECT.

how do you manage her.

• Child 10-12 yrs old with TS is in special needs school. And as he was inattentive teachers planned to transfer him to severly disabled special school.His mother was worried.How would you allay her anxiety.

Questions were what are the causes and neurological complication of TS.

• Young man presented to you with depression with suicidal ideation.He was a care taker. He is feeling since he found that his wife was having an affair.

How will you assess and manage.

• midlle age man ... some depressive symptoms...suicidal as he thinks his wife is having an affair

2) 11 yr boy with tuberous sclerosis , in mild ld school not coping....school want him in a sever ld school..parents disagree

3) 59 yr old man ..inpatient..1 antidepressant and 2 ect..not responded

• schizophrenic on the ward dealing cannabis, nursing staff wanting him discharged

2) women with epilepsy on 2 antiepileptics valproate and carbam having 2 weeklk episodes of manic behaviour and followed by depressed mood assess

3) alcoholic with DTS

• 40 or so y old man depressed and suicidal, found out wife had an affair, no past psych hx himself but fam hx of suicide, said all the obvious but also challenged info re affair and added possibility of morbid jealousy, examiner said it wasn't on his list but agreed it had to be excluded and asked me a bit about it

• 11 y old boy tuberous sclerosis, mild to moderate LD, poor concentration and withdrawn at school for past year. School feels he should move to a place for severe LD kids. Parents anxious. Started off, thought it was quite tough but again they were listening and wanted to hear especially that I would relieve anxieties of parents, felt this was one of these PMPs where they want to see how you deal with the unexepected

• 59 y old man, had antidepressant and 2 courses of ECT, remains depressed and suicidal

• 20 yr old male, ref by gp, attempted suicide as he is getting isolated and paranoid. he does rituals and repeated checking, assess and manage.

70 yr lady, husband died 6mn ago, she lost wt, neglects herself, children live far away, do a domiciliary assessment. d/d

22 girl, panic attacks plus anxiety symptoms, now mostly at house, aetiology, d/d , Mx

• 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.

• 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....

• 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

• 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.

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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.

• 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

• 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?

• 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?

• 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

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

• 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.

• 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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o 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.

o 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.

o 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 .

• . 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.

• 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

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

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SPG 2006

1. Male/16, obsessed with food and cleanliness, assess and manage. &nbsp:lol:dx: OCD, ED, Anakastic PD, Tourette, autistic spectrum disorder. Risk to this young gentleman.

2. Social phobia (same as superego 2005 autumn q. 58; Management and psychological therapies for social phobia. Differentials.

3. Antisocial PD with depression got a gun in black market and came to see me in follow up clinic. Discussions about detailed risk assessment and confidentiality issues. (Same as superego 2004 spring q. 29); (Who will be involving in managing this case. Duty of care to warn his care co-coordinator, ASW, GP, assertive outreach CPN, police, ward staff and others who are all involved in his care. Make sure that it is properly documented for future reference, in case CPN and ASW would want to see him again after discharge from hospital. Forensic referral would be a must.)

4. F/23-4 yr lady came to A&E took drug overdose of paracetamol due to break in the relationship with boyfriend, known a history of sexual abuse, had 3 previous ODs, has scars from DSH, two termination of pregnancy, substance misuse. How will you manage? (Probes: treatment for PD; how would you assess suicide risk, short term management, long term management, psychological management, would you admit and why, what you would like to achieve in this admission.)

5. M/59 with LD, epilepsy, cardiac problems and unstable diabetes the surgeon wants to operate on his gangrene but he is refusing how will you manage. (Probe: capacity.)

6. The lady with BPAD who are stable on lithium for three years and want to start a family how will you manage? (What would you tell her concerning her lithium, what are the risks when you stop, percentage of women who get psychotic in pregnancy if lithium stopped, what if she continues, side effects and effects on the baby, what if she wants to stop lithium- would you stop 'just like that' or do something else, over what period of time you would reduce lithium, what if she is well afterwards, would you restart lithium , how soon, what settings in, what if she remains well in this pregnancy and wants to have another baby- what would you advise re. risk of relapse- still high? What would you tell the patient re risk. What is the risk of relapse following birth?)

7. 76 yr old, aggressive, threats to neighbours, banging walls.

8. Treatment-resistant depression on paroxetine 50mg, poor compliance

9. 52 yr old in A&E wants to leave after an OD

10. 62/F w/ hx of recurrent depressive episode with suicidal intent admitted and got 6 ECT. Not effective. Assess and Mx (Probes: Initial acute Mx; Ddx and background info; If treatment resistant, causes; If chose to go on ECT, Mx)

11. 59 male working doctor drunkard, admit med for haemetemesis, 48 hrs got confusion and sexually harassed female nurses (Probes: acute mx , Ddx (put acute confusional disorder top), Ddx for delirium (put DT top!), Mx for DT, fitness to work as doctor)

12. 21 year old anorexic w/ heavy laxative use, not coming out of house not talking to anybody, group concerned, emaciated at last interview what you will do. (Warrant required, acute Mx in ward (must include bed-rest!), in-psychiatric ward Mx, Prognosis (include age)

13. 24 years old schizophrenic man on the ward. Still disturbed by delusions and hallucinations despite of treatment with oral antipsychotics and a depot. &nbsp:lol:iscuss Mx. (Rx-resistant schizophrenia: Gather background info, liaise with RMO, r/v previous notes and letters, physical conditions, which antipsychotic was it? Looking for reason for non effectiveness: dose? Length? Non-compliance? Psychosocial stressors? Substance abuse. NICE guidelines: try switching to atypical, try augmenting, and consider clozapine; psychosocial Rx: adherence therapy, family therapy for high EE, CBT; Prompts: what would guide choice? EPSE, previous partial response, current psychosocial circumstances)

14. 80 years old woman brought into hospital by police being found wandering in the streets. How would you manage? (Urgency of situation, very concerned for poor frail lady; Need to gather info: liaise with medical team to make sure she's fit and looking for a mobile phone/chain, etc pointing to identity in order to contact NOK/carer; Physical examination: neurology + signs of abuse/neglect; MSE A&B very important: smell? clothes? etc. Consciousness? Is she responding? Abnormal thoughts, responding to psychotic Sx? Cognitive Ax. &nbsp:lol:dx: Obvious delirium vs. dementia, psychotic, affective and exclude physical disorder. I stressed importance of liaising with physicians. Only at the end remembered alcohol and side effects of Rx. &nbsp:lol:idn't mention dissociation or grief reaction, feeling uneasy about it.

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15. 32 years old woman on orthopaedic ward having jumped off the window and fractured her hip following cessation of her paroxetine tablets. Her boyfriend is blaming the antidepressants. How would you deal with that? (Usual info gathering, need for urgency, liaison with orthopedic team and tactful approach, need to understand what they think and why discuss with boyfriend with permission. Withdrawal is a possibility but plenty more are, therefore Ax: what happened, what other factors associated/ fight? Alcohol? Drugs? Need to take full MSE and act on findings/ risk Ax. Didn't seem to want to hear my risk Ax asked what the most likely cause is. I said a combination of factors, most likely partly the altered mental state from paroxetine, inter-relational difficulties, alcohol intoxication or withdraw, impulsively jumping off. Suicidal attempt. Discontinuation syndrome. Would you restart her on paroxetine? Change it to prozac)

16. A 53/54 year old man has recently been diagnosed with Dementia. He cares for his wife who is totally dependent on him and she has a diagnosis of mild depression. Social service has raised concerns that they have made a suicide act. How would you assess and manage?

17. The single mother of a 14-yr-old boy is concerned about him. He has been playing truant from school, fire setting, aggressive and has recently been expelled from school. He has had similar problems several years ago. His father left the home several years ago.

How would you assess and manage?

18. Staff on a medical ward is concern about a 64/65 year old woman who is having chemotherapy for carcinoma of the thyroid. She is said to have recently become sexually abusive towards both female and male members of staff. They also report that this is out of character for her. How would you assess and manage?

19. 24-year-old paranoid schizophrenic on medium secure ward on high dose antipsychotic depot complains that staff interferes with him by scratching his face at night. He also complains of penile discharge. (Wanted me to say that high dose depot is related to sudden death; Ensure it's not really happening by staff or patients, is it hallucination (psychotic or hypnagogic, tactile), is it that he sees them do it, feels it or wakes up and believes it to have happened (delusional). Penile discharge again same as above, is it real, have samples been collected, urinalysis and if not then is it hallucinatory or delusional and has it happened since before during admission. Risk: is he going to attack the staff because he thinks they are scratching him. 'Are there any guidelines you are aware of regarding the high dose depot'. The College has guidelines. I answered that I would like to know has been on this high depot for years or has it been upped since admission, but that I would basically check to see if he had a proper trial of a typical, atypical and if that then has been trialed on clozapine.

20. 30/35-year-old woman referred by GP seeing you in your outpatient's clinic with her friend. Recently getting anxious. She has panic attacks every time she went out. She is terrified of leaving home. How would you asses and manage?

21. A 45-year-old civil servant is referred to you by GP. He has been drinking 3-4 bottles of vodka per week and few bottles of wine some days. How would you assess and manage?

22. A 55-year-old man with 6 year history of Parkinson’s referred by neurologist. Since last few weeks he is having visual hallucinations, small humans & animals in his room. He accused his wife of stealing his benefits money from his bank account. How would you assess and manage?

23. A GP has telephoned you regarding a 47-9-year-old lady divorced with 18 yr hx paranoid schizophrenia, not engaging with treatment for the last 3 years. Really barking (that was the gist), part of her delusions. Now concerns from local school authority regarding her threatening behaviour towards school kids whom she believes are laughing at her. Also believes she's being controlled by aliens. Thoughts of harming children, voices etc. Assess and manage (What sources of collateral information? What anticipated management difficulties? What section will you use? How long can treatment be enforced with Section 3? What will you do if after 3 months refuses treatment on section 3?)

24. 26-yr-old heroin addict turns up at casualty at 2am, saying he's suicidal. Last fix was 12 hours ago. Says he will kill himself, if he doesn't get what he wants. Assess and

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24. 26-yr-old heroin addict turns up at casualty at 2am, saying he's suicidal. Last fix was 12 hours ago. Says he will kill himself, if he doesn't get what he wants. Assess and manage. (What other investigations & what emphasis on physical exam? Will you admit? What options available for treatment of opiate withdrawal? Will you section him? What will you do if he insists he is suicidal you offer admission and he declines?)

25. 30 yr borderline P.D. Had exploratory psychotherapy for 3 yrs, but still self harming. Assess and manage.

26. Patient after first session psychodynamic therapy nearly strangled her child. Assess and manage. (Defense mechanisms involved, transference counter-transference, how as a supervisor in would mange and help a trainee who had counter-transference issues.)

27. Patient on antipsychotic has fever. Went into dd and then rapidly into NMS. &nbsp:lol:iagnosing, management etc. Pathophysiology of NMS.

28. Assess and manage a young chap puffing away on cannabis and getting psychotic.

29. 35 year-old lady arrested by police and charged with embezzling 1000 pounds in her post office job. Blew the loot on lotto tickets. She says she has irresistible urge to steal and gamble away the loot. Assess and manage. What are your differentials? Assume it's pathological gambling. How would u proceed? What is the prognosis? If she also has alcohol dependence. How would it affect your prognosis?

30. 15 year-old girl referred by GP with 1-yr hx of inducing vomiting and weight loss. Accompanied by both parents. Assess and manage. What are your differentials?

If it is anorexia, what are indications for admission? Is it your decision? What do you expect to find on physical examination / investigations? You mentioned family therapy. How will you involve the family?

31. 26 year-old doctor whose husband is also a doctor referred by GP. Had baby 3-wks ago. Now husband reports sadness and irritability. Assess and manage. What r the differentials?

Which is most likely? Why would u inform social services? IPT in long term Mx, &nbsp:lol:escribe IPT

32. 29 yr old school teacher referred by GP. History of increasing anxiety, palpitations, sweating and fear of dying. How will you assess and manage. &nbsp:lol:ifferential diagnosis - panic disorder. Management. What will your management as waiting list is high for psychotherapy? What psychological treatment would you give for this client? Risks later if does not respond?

33. 24 yr schizophrenic under your care is charged with arson. Court has requested you to prepare a report on this man. How would you go about it? What are sources of information you are looking for? What are the disposal options?

34. 23 yr has just delivered a baby. She is aloof, not feeding the baby and locking herself in a room. Found by husband with a bottle of paracetamol. How will you assess this lady? (Differential diagnosis - post partum psychosis, risks - management – admission; close observation, monitor MSE, physical treatments; what will do advise regard future? In the Inform the social workers before you assess.)

35. 35 yr old lady had recurrent depressions in the past, now feels some days good and some bad; son is having trouble with police; poor relationship with husband; GP referred; assess and manage?

36. Parents worried about son who is 10-year-old with poor academic performance; has repeated stereotyped behaviour; getting aggressive and irritable; never seen a psych before; assess and manage.

37. Surgeon refers lady 33y; appendicectomy 2 weeks ago; in ward; aggressive and irritable since yesterday. Assess and manage.

38. 40 yr old mother referred by GP, single parent of 8 and 10yr old children. She is facing redundancy. Mood low, loss of interest poor sleep. Not interested in antidepressants. How would you assess and manage the patient?

39. 12 weeks pregnant addict attending your clinic. Heroin, tamezepam and cocaine. Father of the child is a substance misuser. How would you manage?

40. 40 yr old man living with his mother. Now mother admitted to hospital with hip fracture. He is not engaging with services. He is a hoarder, collecting unusual items, paper cuttings etc. How would you asses and manage this patient?

41. 52 year old lady no physical problems became anxious in supermarket dropped stuff and ran. Does not go out anymore. Husband concerned. Assess and manage.

42. 19 year old mild/moderate LD attending college sexually inappropriate to LD females at class. Assess and manage.

43. 40 yr male after dosulepin overdose now an inpatient. Injunction against partner. History of assault. History of heavy alcohol misuse. On constant observation and threatening to staff. Assess and manage.

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44. A mother of 27 yr old patient with schizophrenia wants to talk to you about her son. She and her husband are finding it very difficult to cope with their son who spends most of his time in bed, doing nothing. How will you proceed? (Why do you think mother is approaching you at this stage? What interventions will be helpful? Management of EPSEs. Confidentiality issues)

45. You are asked to write a pre sentencing court report on a man with Borderline IQ, who has been convicted for indecent assault on 2 children. He had been physically and sexually abused as a teenager, when he was in a boarding school. He had counseling from the clinical psychologist in the past, but that did not help. Write a court report regarding your assessment and recommendations. (What is the relationship between the index offence and his past history? How will you manage? Counseling did not help in the past.

Any medication? (SOTP, CBT, abused becoming abuser, cyproterone acetate!)

46. A GP refers to you a 47 year old divorced lady who is being treated for depression for the last 10 years with various antidepressants without much improvement. She finds very difficult to go out and becomes very anxious. She lives with her 27 year old daughter who looks after her and herself become depressed now and is on antidepressants. They cannot cope any longer and are desperate for help. How will you proceed? (What are the options you have? Will you see them together? Treatment resistant depression for mum (Nice/ IP v OP/ ECT). Then touched upon family dynamics and possible change of role (as a carer) for daughter. Mentioned seeing them together and then apart.)

47. 84-year-old lady admitted to medical ward for repeated fall and confusion. The medical team would like to send her to nursing home, but the client refused. The staff asked you to come and assess her. (How to assess capacity; who could assess the capacity; who you would like to involve during the assessment; what are u going to do if the lady continue to refuse to go to nursing home.)

48. 48 year old man admitted to surgical ward after presented with acute abdominal pain. 48 hours later, he became agitated, aggressive and confused. You were asked to see him, how would you approach to do your assessment? (What medical illness you need to rule out, besides acute abdominal pathology; Likely DDx; For alcohol withdrawal, what management you would advise the surgical team; What other medications are needed, besides benzodiazepines, Vitamins B)

49. An 18 year old, with long history of AN since age of 13, she was admitted to medical ward after taken an overdose of paracetamol, soon after a therapeutic session with psychotherapist and she was told that she needed to be in hospital. Her BMI is 13.5 and low BP. She has 2 previous long admission for treatment of AN, and she also has OCD. How you would manage this patient. (Complication of rapid re-feeding; What is the protocol for re-feeding; What other route of re-feeding if patient refused to eat voluntarily; Could you use mental health act in the medical ward for this patient, or you would transfer her back to mental health unit for continuing the medical treatment. Prognosis of AN.)

50. A gentleman admitted to medical ward repeatedly for abdominal pain. All investigation negative. Assess and Mx. (DDx and Mx along the line of somatization disorder.)

51. 65 year man. Hx of psychotic depression. On Lithium and paroxetine. Admitted to medical ward for increased agitation. Wife said he presented with a very different clinical picture this time. CT brain showed generalized atrophy. (DDx; How to diagnose Li toxicity. Clinical features and lab results. What is the significance of the CT findings?)

52. A recently widowed man wants to take his brother of the psychiatric ward. Patient has chronic schizophrenia and has been an inpatient for 30 years. How to Mx? (What are the criteria for allowing discharge? What is the role of the inpatient team? Would you take patient's views into consideration?)

53. Lady in 30s or so referred to you with history of resilient depression and recurrent self harming. Has been few years in psychotherapy with no improvement. How will you assess and manage? (What may be responsible for failure to improve? What factors may make her not benefit specifically from psychotherapy? Which psychotherapeutic interventions are available in this case? Briefly describe what each entails? Which has best evidence in this case-recurrent DSH? What is the natural history of this case if left untreated?)

5

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54. A chap with mild learning disability, epilepsy, diabetes and cardiac problems has leg to be amputated but refuses to give consent. (How would you assess capacity? Who else would you involve, what if he has schizophrenia with residual symptoms would it change your management, what if the condition is not immediately life-threatening yet the surgeons decide to go ahead quoting pt's best interest- what may happen in such case.)

55. A middle-aged woman is suffering from long standing depression. How will you assess her and manage her? (Tell me about Maudsley’s guidelines)

56. 73-year-old woman comes to A&E after a fall. She is confused, tearful and frightened. She lives with her son who has mild L.D. Her G.P thinks she has dementia. What will you do? (Will you send her home? Where will you admit her? Whom will you involve? Differential diagnosis)

57. 52-year-old man who is on high dose antidepressants has become irritable and suspicious since 2 days. He comes driving his car to the clinic. He has a family history of cardiovascular accidents and is on antihypertensives since 3 years. Assess and manage

probes-differential diagnosis? (Investigations, what about him driving)

58. Middle aged lady with chronic pain, treated for many years. GP referral for ? depression. Pain relief is opioids and non-opioids plus amitriptylline. How do you assess and manage? Probes were about her analgesia and mechanism of action of amitriptylline for pain relief.

59. 40yr old barrister with alcohol dependency syndrome admitted to medical ward following a fit. He is asking for an in-patient detoxification. How would you assess and manage? Probes were all about management of detoxification and then further follow up in community.

60. 55yr old man charged with making obscene phone calls by police. GP referral. Wife says he lost his job a year ago and hasn't been the same since. (Sexual history and risk and the eventual diagnosis was impotence with some questions on management of impotence and risk of re-offending.)

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