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Spring 2007 Part 2 PMPs Feedback

21 posts in this topic

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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wednesday 3.20 PM

1. 29 yr old junior doctor.

  delivered 3 wks ago

  unplanned pregnancy

  child premature

  needed incubator

  husband also doctor

  complaining wfe is irritable, lethargic

probes: how will you differentiate mat blues, post partum psychosis and post partum dep.

where will you manage??

what are the non pharmacological options?

does the fact that the baby is in incubator have any significance?

whats the significance of both being doctors??

what will you do for husband?

2. intravenous heroine addict

  arrives at 2am in AE

  no corraborative info

  no previous psych history

  threatening to committ suicide if not admitted

Probes: what will you tell the staff on admission

(i told regarding risks-suicide, withdrwals and aggression to other patients but he

wanted me to speak about personality which totally skipped my mind)

how will you manage heroine withdrawal?

3. 26 yr old man

   on ward for 9 mnths

   tried on full doses of 2 antipsychotics and one depot

   still floridly psychotic

   how would you manage??

Probes: what is maintaining this illness

what apart from clozapine?

side effects of clozapine

how will you manage siallorhea?

what will u do if patient says he has put on 5 kilos?

non pharmacological options in the management of this case

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Wednesday 16th May, 10:20am

PMP1:

       Young man with diagnosis of schizophrenia who is stable on typical neuroleptic  

       presents with partner saying he wants to stop his medication. How do you assess and  

       manage.

     They probed into the nuts and bolts of EPSE and other S/E of antipsychotics.

      Also asked why someone who has relapsed would want to stop medications.

      Lastly, asked what i would do if the patient refuses to change his mind and insists on  

      stopping the meds.

PMP2:

       Man with learning disability who lives with elderly mother and attends day centre

       has recently become irritable and aggressive. Also rubbing genitalia agaist furniture  

       and masturbating openly on occasions. He has also begun to approach school children  

       on the primary school nearby.

   Probed me on what concerns i would have about his sexual behaviour and exactly how  

   one would asses risk in this case including 'instruments' that  could be used.

PMP3:

       Psychiatric nurse who has been involved in an accident which threatened her life  

       presents with poor sleep and nightmares...cannot remember exact details.

   After i mentioned PTSD as main differential probes included exact ICD-10 criteria

   for PTSD, Treatment for PTSD, bad prognostic factors in PTSD and lastly which was

   more effective pharmacological or psychological tx, in this condition.

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WED 5PM

1. Middle aged lady with h/o chronic pain, on opiods and non-opiod analgesics. Started feeling depressed. Referred by GP- Assess and Manage.

Probes- DDX

           Could it be her medication.

           Indirect question- about opioid dependence

2. 14 year old girl took 40 paracetamol OD. wrote a suicide note. found accidently by parents. Started feeling depressed recently following bullying at school. Now she is on a paediatric ward.

Her mother is on Li. Assess and manage.

Probes- DDX, Is it high risk?, Will u admit her, management of childhood depression.

3. 32 year old man reluctantly attending clinic at the insistence of wife. He is making his wife and young children to repeatedly wash as he is worried about germs.

Probes- DDX, Rx of OCD, How do u do exposure and response prevention, Will u involve family and how, prognosis

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Centre princess marina , northampton. Its the IPA I am worried about

Here goes

1. 70yr old , single, OD 15 tablets of paracetamol and has got long term alcohol problems

2. a man brought to A & E for bizzare behaviour from a park

3. long H/O schizophrenia all sort of psychotic symtom , non compliant with meds, threatening school children.

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Center Bedford

1 ] 27 Female. Referred by plastic surgeon, where she attended asking for reduction mammoplasty, which the surgeon feels is not required. But helpfully he agrees to go ahead if the psychiatrist agrees with patient. Probes : would you measure her breast to see if she needs the surgery #£$%^&% what the hell :-) Is it an appropriate referral!

Lots of Q about BDD, depression, overvalued ideas, capacity, delusions, reasons for her wish etc.

2 ] 87 granny want to go home from a medical ward. Staff feel she can't cope. Bog standard q about capacity, delirium, mdt, ot, physio, next of kin etc.

3 ] 35 female, chronic Schizophrenia, was on typicals, poor compliance, currently detained, does not want depot. what options! About family therapy, why noncompliant, dissolvable meds, atypical depot, side effects, mother and husband involvement etc.

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PMP 1: Man in clinic for depression. Reveals he has bought a hand gun on the black market. Hx of ASPD & Polysubstance misuse. How would you manage?

PMP 2: 79 year old woman (who lives with son with mild LD) recently in hospital after suspected fall. GP thinks Dementia. How would you assess and manage.

PMP 3: Usual one about young female in A&E who has taken 80 paracetamol and is refusing treatment.

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measure her breast?

did you laugh at this?

oh dear ...!

;)

Center Bedford

1 ] 27 Female. Referred by plastic surgeon, where she attended asking for reduction mammoplasty, which the surgeon feels is not required. But helpfully he agrees to go ahead if the psychiatrist agrees with patient. Probes : would you measure her breast to see if she needs the surgery #£$%^&% what the hell :-) Is it an appropriate referral!

Lots of Q about BDD, depression, overvalued ideas, capacity, delusions, reasons for her wish etc.

2 ]  87 granny want to go home from a medical ward. Staff feel she can't cope. Bog standard q about capacity, delirium, mdt, ot, physio, next of kin etc.

3 ] 35 female, chronic Schizophrenia, was on typicals, poor compliance, currently detained, does not want depot. what options! About family therapy, why noncompliant, dissolvable meds, atypical depot, side effects, mother and husband involvement etc.

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Poster 6, I got exactly same PMPs as you. 11.15 on Wednesday 16th? I seemed to get slightly different probes though. And sounds like you did well with the PTSD one - I couldn't remember specific prognostic factors.

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Ellie,

The PTSD prognostic factors one caught me off guard but i mentioned premorbid personality, social support/stable social situation(eg job etc) and time it takes for onset of symptoms after the traumatic events. Wasn't sure but vaguely remembered reading something like that in a textbook somewhere...

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18th may at 11.30AM

1. A lady at post office stolen money to fund her irresistable urge to gamble. assess and manage. :-X

2. A lady with BPD had exploratory psychotherapy but continues to self mutilate. Assess and manage.

3. A conscientious child has threatened a fellow student with a knife. Assess and manage.

I was thrown a bit with PMPs . God help me.

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Sounds like you did well Poster6. I think I mumbled something about premorbid functioning and the fact that she was also depressed may affect her recovery. Good luck anyway!

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1)a man has had several unsuccessful treatments for depression.

he has now developed erectile dysfunction.

has a wife and two children.

how will u assess and manage?

probe: how will u assess the quality of marital relationship?

how will u differentiate b/w organic and psychological causes....i only managed to mention that i will review the history with a view of a temporal relationship with the onset of sexual sysmtoms and depression,metabolic,endocrine,meds (e.g antihypertensives)probs...i have definitely failed this one b/c i did not mention morning erection ets :'(

how will u treat...i mention review of predisposing/perpetuating factors,checking wether the protocol for treatment resistent mx followed as per nice guidelines..also cbt,family therapy,supportive therapy...again forgot sexual clinics..so again a big fail for me :'(

2)37 year old female with long history of self harm/overdose.family history of bipolar disorder.difficult childhood,now self harm has turned into shoplifting.has now developed low mood with diurnal variation

also takes an unknown substance which relaxes her

assess and manage

probe..how will u assess the risk of shoplifting?

why has shoplifting started?

3)55 year old man..now self neglect and forgetful.

assess and mange

probe..how will u establish the aetiology?

what r the organic causes...i mentioned metabolic,endocrine,infection,head injury and forgot vitamin b12..so failed this too :'(

how will u mx because he refuse rx?

again i acted oversmart soul and said capacity is the issue here,described it but he asked again where will u manage...i said inpatient  but MHA did not come out of my big mouth >:(

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I attended Coventry on 16th may

The examiners keep interrupting from 2nd minute and i lost the flow..I was really annoyed at their attitude..

nOW I AM STRUGGLING TO MAKE OUT I DID WELL OR NOT BECAUSE I HAVEN'T ANSWERED IN A FLOW..

DOES ANYONE ELSE HAVE THE SAME EXPERIENCE

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1. a 26 year old patient with depression and ASPD informs you on phone that he has brought a gun on the black market.he also has problems with opiate abuse...assess and manage

2. a 79 year old lady had a fall and feels tearful,and confused,her son who has mild learning disabiity is refusing to cooperate with the assessment.

3.26 year old in A&E after claiming to take 80 paracetamol tablets...she is under the influence of alcohol...she is refusing consent for blood investigations.

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Hey Lad,

I feel you are being too harsh on yourself. No one fails coz they have not made some points (out of a long list) What matters is how you have presented what you have and have you acted sensibly.

What do you feel on those counts??

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1. A 28 year schizophrenic, stabilised on clozapine 750mg for a year in community, has relapsed 2 months before, still actively psychotic. How will you assess and manage.

(Asked about ICD-10 of schizophrenia, mangement, checking non-compliance with sr. clozapine etc., how to CBT for schizo)

2. A 17 year old woman (biological mother is a known schizophrenic) who was adopted at 6 months of age. Had odd behaviour, magical thinking. Joined college recently, now poor perfomance and psychotic. How will you assess and manage?

( mostly around diagnosis, off-spring risk of schizo, schizotypal to schizophrenia link, ICD-10 about schzophrenia)

3. A 45 year old female counsellor, 'recently' divorced, burdened by her patients mood problems, a dysthymic picture for 2 years, yet active suicide ideas.....

(discussed all possible D.D., CBT for depression, off-sick advice etc.)

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I attended Coventry on 16th may

The examiners keep interrupting from 2nd minute and i lost the flow..I was really annoyed at their attitude..

nOW I AM STRUGGLING TO MAKE OUT I DID WELL OR NOT BECAUSE I HAVEN'T ANSWERED IN A FLOW..

DOES ANYONE ELSE HAVE THE SAME EXPERIENCE

I had a very similar experience..

But I heard other candidates commenting about the PMPs of the same and I was in a way prepared to be stopped.

So I just answered in short sentences and waited to let them ask me questions..

I cant guess about the outcome but I dont think we need to be worried about this..

Let us be patient and see what happens.

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Hey Lad,

I feel you are being too harsh on yourself. No one fails coz they have not made some points (out of a long list) What matters is how you have presented what you have and have you acted sensibly.

What do you feel on those counts??

hi surajshenoy

i kept in my mind that i have to show them i am a safe doctor who can think broadly.but u know the above pmps i thought were vague so all my skills revolved around assessment and broad d/d and niether i nor they made me discuss treatment in detail...i do not know....i just cant find comfort...thanks for ure reply...

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thusday 17th of may

1 lady believes there is a problem with the nose and has contacted the plastic surgeon for surgery. says boyfriend says nose is ugly

She is also so preocupied with this worry with the nose that she does not go out anymore.

Probe What will you do?

Role of psychologist in your assessment

2 Man with mild to mod LD brought to A/E from LD home very aggressive, broken all furniture, agitated,

Probe How will you assess and manage

What will you ask staff on the ward to do

What is the role psychologist

3 19 year old man from college , confused, believes TV talking about a plot against his life. Addmitted to taking some white tablets and white substance a few days ago, said he smoked cannabis occaisionally up to about 28 days ago

How will you assess/ manage

significance of 28 days

drugs that can cause psychosis and type of psychosis caused

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