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Akathesia [ EPSE ] [updated 17.9.17]

Discussion in 'CASC - GENERAL STATIONS' started by Johnson, Jan 25, 2017.

  1. Johnson

    Johnson Active Member

    Casc Jan 2017 [pre results :)]
    Akathesia - I went through a brief history why it was started , when , any previous incidents like this,mentioned I would contact GP for more details, asked for all EPSE symptoms as per modified simpson angus scale

    http://keltymentalhealth.ca/sites/default/files/SAS.pdf

    Impact on life, other comorbidities, and discussed the treatment plan and I mentioned admission, physical examination, bloods and starting propranolol as medication[ they say no to procyclidine] and she caught me here and mentioned that she had previously propranolol for anxiety and did not help [ i think i missed the cue that it was for anxiety and I could have mentioned that we are treating the side effects now] but what i did ask was the dose [which she couldn't remember] and I told we could start on a higher dose........
    At the end she smiled when I almost finished close to 7 min as I mentioned I will stand but kept looking for the chair. The examiner appears to be serious ...

    From a peer [comments related to Jan casc 2017]
    "Well to me the akathisia station was very unclear...I mentioned that it could be akathisia and I asked her whether triflu was trifluperazine? And she said not sure...I wondered why gp would have prescribed trifluperazine for anxiety at work! (And since when do they prescribe antipsychotics and that too triflu) so I said I would like to get in touch with the surgery to get more information from the staff (gp was away) then she said what will you give me for now? I said I will give you something like promethazine LOL to calm her a bit and then discuss further definitive treatment when I am sure about what medication she took....a nightmare station for me which I think is an absolute goner! And I stood with her for a while and then I sat :-( TLE was another station, sounded more like complex partial seizures or just aura.

    Reference
    Oxford handbook of psychiatry 3e, pages 944-55
     
    Last edited: Aug 30, 2017
  2. Johnson

    Johnson Active Member

    CASC - Jan 2017 [post results :(]
    We could share our failure and success as both can equally help us. Task mentioned no physical examination.
    I failed this station in spite of thinking I did well. I don't remember the task exactly], but mentioned something on the line of "history", but I spent more time asking about all the symptoms of EPSE under the sky.

    This is worrying because I am missing the task or not reading the instructions properly or not understanding the wording of some tasks in some stations.

    On reflecting
    Read the task if anything says "history" take a sleek history
    Open mind
    I should NOT have spoken about management
    I could have done risks [ not in detail]

    One important thing that comes to my mind is that in the instruction its says "YOU ARE A JUNIOR DOCTOR", hence I would verbalise that I would discuss with my senior colleague.. [ junior doctors take history , hmmmmm..]
    Perhaps team work might be checked
    BUT BE MINDFUL THAT STATIONS CAN BE TWEAKED

    Again these our my inferences who have failed CASC many times, so do take with a pinch of salt
     
    Last edited: Aug 30, 2017
  3. Johnson

    Johnson Active Member

    Recently had a 7 min practise session [proper casc like - 90 sec reading etc..] with a English consultant [ very nice person ] with casc teaching experiences.

    Feedback
    -Try not to shake hands with patients
    -To take a sleek history [psy , medical history, family history etc..]
    -I was repetitive, but was told, to say " please could you do it"
    -Other candidate's feedback was to explain to the examiner what we do, but consultant's feedback was EXPLAIN TO THE PATIENT as we do
    -To ask to raise the tongue to look for drooling and also tell the patient try not to blink while doing the Glabellar tap [forehead]. But confirmed that while doing this that we ought to stand behind the patient
    -To give clear instructions [example I asked the patient [consultant] to walk, he walked and stood by the door, did not turn back]
    -Avoid complex explanation/jargons - instead of EPSE, to tell signs of .......[ will ask]
    -Family history - "Has anyone had xyz in your family "
     
    Last edited: Aug 30, 2017
  4. Johnson

    Johnson Active Member

    Useful link [ I find his videos very useful]


    Parkinsonism symptoms explained. While watching this video my wife popped in and said why on earth you are watching these high tech videos as examiners wouldn't have a clue what you are trying to elicit:eek:.
     
    Last edited: Aug 30, 2017
  5. Johnson

    Johnson Active Member

    September 2017
    Second time, I knew I had to do this differently as I failed in Jan 2017. Same scenario, Trifluo.... 3 days ago, hasn't slept for 3-4 nights.
    Nowadays even in 7 min stations you get 3 tasks, I found it difficult this time. I believe there were 3 tasks in this station [don't remember any of them - again its best not to ponder on them, as I am very sure the tasks were different in Sep 2017 and Jan 2017]
    Not giving much info
    Kept repeatedly asking for sleeping tablets until I said yes, did not give any other info, later became sort of cooperative. I am here a junior doctor hence was slightly reluctant to give sleeping tablets straightaway without much history.
    Nevertheless this time at the end I verbalised that I will discuss with my team, contact GP to gather more info, including short term sleeping tablets
     
    Last edited: Sep 17, 2017
  6. Hossam

    Hossam New Member

    I did not pass this station . i guess there is missing piece which might be one of the following.
    -ask about the cause of separation with his girl friend and if there is any psychosis behind this to make the gp .
    -Other symptoms of anxiety or depression
    write trifluperazine .
    -medical cond- or any other medications.
    -Detailed symptoms of ext pyramidal.
    -Treatment :
     

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