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CASC EXAM STATIONS - 17-20 January 2017

Discussion in 'CASC - STATIONS BY EXAM DATES [LATEST]' started by Johnson, Jan 17, 2017.

  1. Johnson

    Johnson Subscribed

    Another very useful psychiatric forum discussions in america [bringing us together]
    https://forums.studentdoctor.net/forums/psychiatry.44/

    If you find anything helpful in passing your casc, I would welcome voluntary contributions to my paypal account jojosri@yahoo.com as I would like to keep anything related to exams free for life and keep the access without the need for any registrations and have plans to extend to other specialities.

    This forum is created for the sole purpose of sharing each others experiences and help one another.
    "TAKE SOME USEFUL TIPS FROM HERE, BUT DO WHAT YOU ARE BEST AT"

    Sorry no discussions allowed in these threads, except posting the stations, but can discuss here CLICK ]. Every page is https: :).

    17 Jan 2017
    Paired
    1. Pregnant, on methadone, take hx: she is taking heroine and cocaine on top.. next is talk to husband and explain risk of using drugs on pregnancy +management plan. [CLICK]
    2. Mild ld, refusing treatment after upper GI bleed, asses capacity: he had delusion about police ( had problems with police in the past and doctors wanting to harm him .. next is talk to carer and explain lack of capacity and management plan( she asked if mother can agree for him - I think yes if lasting power of attorney LPA for health is available) [CLICK]
    3. Erotomania : wants to see the nurse who saw him in A/E a month ago.. next is speak to the nurse and make management plan Did he have a bag:rolleyes: and DID HE HAVE "THE" KNIFE;) and was he an escapist :rolleyes:
    4. Post natal depression.. 7 months old boy and 10 weeks pregnant.. take hx+ risk assessment.. next is speak to husband and make management plan Maudsley Prescribing Guidelines in Psychiatry 12e page 559-571 [breastfeeding] [CLICK]

    Single
    1. Agoraphobia explain diagnosis and treatment of desensitisation
    2.Thyroid (hypothyroidism low T4 High TSH ) screen for symptoms and examine [CLICK]
    3.Lithium augmentation with Amitiptyline, explain and address concerns NEW!!! [ I want to speak to the consultant who has initiated this treatment, seriously... check anything to do with serotonin syndrome, as Amitriptyline is not that commonly used, stick to task but consider playing safe...] [ Maudsley Prescribing Guidelines in Psychiatry 12e page 238] [CLICK]
    4. Collateral history of dementia from wife ( forgetfulness for 9 months) but later said that he had itching and strange taste? No physical problems apartment from hypertension, no new meds , no alcohol no wt loss .. eventually reassured that we need further tests to diagnose dementia [ consider to verbalise to see the patient [ a must] and also advise to take him to see the GP/OOH GP if not already seen]
    5. Angry mother hears nurses talking son diagnosed with schizophrenia and wants explanations [might be a communication skill station - tape/zip your mouth for first few minutes and let mother vent her anger and frustrations - listening and empathy skills]
    6. Cognitive exam for vascular dementia [pain in the neck station again and again :mad:, but I know some passed doing MMSE and frontal lobe, some passed doing MMSE and parietal lobe, but who knows, can be tweaked, read the brief well and perhaps luck matters here:rolleyes:] [CLICK]
    7. MSE of psychotic patient , he had delusion that step dad control his thoughts [ please guys next time it might be the devil, and please NO history taking NO cognitive examination, but cognition is part of MSE, comment on appearance and behaviour, insight etc... - as no examiner can yet read the candidates mind :rolleyes:]
    8. Mother worried about SSRI will make her son commit suicide .. explain risks and benefits of SSRI NEW !!! [Maudsley Prescribing Guidelines in Psychiatry 12e page 244]
     
    Last edited: Sep 17, 2017
  2. Johnson

    Johnson Subscribed

    18 Jan 2017

    If Erotomania has repeated, most likely many might have failed on Monday, normally difficult stations come the next day[only a personal opinion from a casc retake expert;)]

    Paired[ seems all repeat stations]
    1. Mania most likely old age speciality that I know off, farmer - gun etc.. and speak to son
    2. Mirtazapine + lithium. Recurrent Depression most likely treatment resistant depression, Maudsley Prescribing Guidelines in Psychiatry 12e page 255-257, think of STAR D studies [CLICK]
    3. Erotomania [ most likely he might have hid the bag, no one would have ask about it :rolleyes:, there might be a "catch"]
    4. Capacity assessment social care [old age, did he have stroke? and speak to daughter]

    Single

    1 Wandering old man , do cognitive exam [ I did MMSE only and failed, I might ask for any alcohol and for sensory deficits before doing MMSE, and continue testing for other lobe impairments , also verbalise finally like to admit and speak to his GP to contact his family:rolleyes:] [CLICK]
    2.Lithium augmentation, explain rationale [ If too many fail a station, might be taken off , as I was thinking whoever set this station yesterday might not have done his/her re validation:rolleyes:] [ I hope this was not similar to yesterday's station] [CLICK]
    3.ECG ,on quetiapine, heart block , explain , management [ my friend passed - sent patient to cardiology ] [ if more keen can read about mobitz type I and II blocks, I also passed similar station where QTc 550ms - urgent referral to cardiology] [CLICK]
    4.Man with anxiety , being treated by his GP , found to have high GGT , establish pattern of drinking and risk assessment, link anxiety with drinking. [might be the chicken and the egg case, stick to task, this has 2 tasks, allow time for both, under risk - consider driving and consider to verbalise whether you could speak to his family ] [CLICK]
    5. Agoraphobia explain desensitization
    6. Anorexia collateral history from mother
    7. Man 24 yrs with depression, asked for emergency appointment with you then showed up 5 hours later in the ER requesting to see his notes , try to find out what is going on. (he was found to be hypomanic)
    this should be history taking to arrive at a diagnosis [ Hey I did this RECENTLY - this is secret between two only, others please ignore]
    8. PTSD [CLICK}
     
    Last edited: Aug 24, 2017
    Najeeb and xxx222 like this.
  3. Johnson

    Johnson Subscribed

    19 Jan 2017
    I feel CAMHS day - OD, ADHD, LD, conversion, personality, explain antidementia meds

    Now the college knows that I am good at predicting:rolleyes:

    Paired
    1.Old age mania and speak to son [ If he is "still" a farmer :rolleyes:, access for guns ?. In real life, showing that you are interested to listen to what he/she has to say, the patient will tell all his delusions even without prompts]
    2.OD, aliens in tummy and speak to nurse [ Is that banging the head with the ward manager ?]
    3. Conversion disorder and speak to husband [this is an old station which is straight forward, but I had a tricky one in Jan 2016 [ son and speak to mother], for which please read the brief very well, esp. the TIMELINE, and I failed, i.e - right eye blindness and diplopia on ? left lateral gaze....] [this time i will be asking since when he had double vision as some can have from childhood] [CLICK] worth having a look at this youtube video, if you have extra time [CLICK]
    4. Changes related to frontal lobe history, take a chronological history from wife and do cognitive examination [ please read the brief as I do not want to mislead anyone giving too many info, stick to TASK,worth also ruling out dementia as in FTD- memory might be intact - worth reading around it, also consider starting with orientation +/- registration, recall and attention [already done 10-21/30] even its frontal lobe examination then if you have time continue with it or other relevant lobe examintions] [ just thinking there might be a good reason even MMSE to start with orientation :) - starting to think like a professor of psychiatry :rolleyes: - its a good feeling - please don't even think of grandiosity as I got news for you, there is a saying " aim for the stars, then at least someone might reach the chimney top;):cool:]

    Single

    1 Take alcohol hx and link with anxiety [I think he is taking alcohol to cope with something...]
    2 PTSD
    3 Cardio exam in vascular dementia
    [CLICK]
    4 Explain OCD psychology treatment [ worth reading college leaflet under OCD] [CLICK]
    5 MSE of a pt that's refusing to see dr. Pt psychotic thinking psych dr is shooting rays of radiation causing cancer.
    6 Sodium Valproate explain risk and benefits to pt. who pregnant with hx of bipolar
    [CLICK] [UPDATED on 21 Feb 2017 - click on the hyperlink for useful links]
    7. Asperger's hx. having difficulty at work [ might be related to anxiety- just a guess]
    8. Girl setting fire in hostel [ an old station]
    It seems college has fallen in love with cognitive examinations - just a thought
     
    Last edited: Aug 26, 2017
  4. Johnson

    Johnson Subscribed

    20 Jan 2017
    [Updated on 19.2.17 , the tasks required from the letter sent to me on the CASC results - highlighted in pink]
    On reflecting, I might have failed as there are discrepancies about what I thought was the tasks and what's on the letter. As mentioned the first station always starts from the left hand side, as if you miss this you might never know where improvements can be made, esp. if you are expert CASC retaker:rolleyes:. Hence the conlcusion is no matter how much of your knowledge, its just sticking to the tasks might be the key thing. No wonder why consultants say "you have the knowledge to pass CASC, why are you failing". its something to work on...:)


    [Today's prediction- ADHD, antidementia meds explanation , child OD/psychosis, todays frontal lobe station with cognition and Aspergers and anxiety, conversion, DT, delirium, morbid, paedophile, schizophrenia first episode, depressive stupor [ guys I am bit crazy, so please don't even believe a word here :rolleyes:]
    Can exclude - old age mania, ptsd, alcohol and anxiety, agoraphobia and systematic desensitization]

    Paired [ I from 1-8 stations as it important to reflect when the results are out to know exactly passed and failed stations, normally if you facing the cubicles , 1st ALWAYS starts from your left ]

    1 Lewy body dementia - speak to son and grand daughter[ seems family business, key things - difference between Parkinsons disease and LBD as memory problems started 18 months ago, equally this can be tweaked next time, explain what is DAT and why its done, and try to answer this question " my dad is aware that he is seeing thing, how this is possible?" [ Illness explanation and Management] [CLICK] [UPDATED on 10 May 2017]
    2. Child OD and speak to nurse [alien is gone out today for a ride] [ ALWAYS look for clues in their hands in CAMHS - this time its RAPE last time BULLYING, next time ALIEN in the TOMMY:rolleyes:] [ SCHOOL AND FAMILY dynamics is important] [risk assessment and risk management, but I do remember in the first linked station the task was history and risk assessment not just risk ax] [CLICK] [see under the thread pdf format on The National Confidential Inquiry 2014-15] [UPDATED 21 Fe b 2017]
    3. Frontal lobe change take chronological hx from wife and do cognitive exam next [ worth sticking to the task] [ History and cognitive examination] [CLICK] [UPDATED on 11 May 2017]
    4. Agoraphobia - speak to wife and husband [ 5 years history , worth asking why now?:( ] [History and psychotherapy] [CLICK]

    Singles [I have updated what was task required from my letter sent to me
    1. LD explain blood test and medicine [specific treatment explanation] [CLICK]
    2. Temporal Lobe Epilepsy [history] [UPDATED 23 Feb 2017 - worth reading under the thread] [CLICK]
    3. Asperger problem at work [history] [CLICK]
    4. Akathsia, where GP started on triflu. for anxiety etc... , this is a old station [I think she was tired after sometime stopped moving, but I stood throughout..] [history] [UPDATED 3 March 2017 - worth reading under the thread] [CLICK]
    5. Breaking bad news [communication] [CLICK]
    6. Metabolic syndrome on Clozapine [illness explanation] [CLICK]
    7. Fire setting [risk assessment, but was not explicitly asked as I felt the task was about a differential, I might need to improve my comprehension in English :rolleyes: before next CASC] [CLICK]
    8. DT MSE [mental state] [CLICK]
     
    Last edited: Aug 24, 2017
  5. Najeeb

    Najeeb New Member

    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.
     

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