Sublitted by S.Binnemangala  February 2011

Single stations

 

1.    This  young man has visited the drug and alcohol clinic. Pls take a history of his substance misuse and assess the extent of his problems. (Opiate misuse)

 

2.    Young man brought by the police to A&E. He threatened the neighbors with an iron rod. Pls assess and look for any psychopathology (Psychosis station)

(He said that he has been affected by the UV or radio waves which has been deflected by his neighbours. Other people are also doing the same. He said to neighbours to deflect their antennae so that they do not direct the waves towards him. He has developed a rash as a result of these waves. his mother has also been affected by these waves and she has developed some ulcers on her leg. However, when he asked her about this she said to him that there no such thing and he is imagining things. He is sure that all these are done by George Bush. He believed I have been sent by Mr Bush).

 

3. This young lady has been complaining of low mood. She was treated with Fluoxetine. Some improvement was noted but ----------------. She was started on Venlafaxine and she is on 150mg but complaining of weight gain. She has ---------- (given a long list of her current difficulties mainly her current depressive symptomatology; the information was lengthy). You can assume her diagnosis is one of depression. (Treatment resistant depression, management)

Please discuss the pharmacological and psychological treatment with her.

Please discuss if you would like to do any investigations as well.

(This lady was well dressed. I vaguely remember the history information included that she has no risk of self harm or suicide. The lady was not speaking much).

 

4.    Somatoform Pain disorder

This gentleman has been complaining of pain in his ?buttocks. He has been seen by many doctors but he is not convinced. Please take a history of his pain and any other associated complaints to come to a diagnostic conclusion. Please do not discuss the diagnosis with him. (I am quite sure this was mentioned).

 

5. This is a ---yr old man who has been diagnosed with Vascular dementia. he has diabetes, some notes regarding vascular problems was written which I can’t remember. He complains of not able to see in his left eye and ?partially in his right eye. His daughter has brought him to the clinic. Please do a relevant cognitive examination.

The elderly man was speaking with some disinhibited behaviour. He said that he cannot see the diagram (copying) and he cannot write any sentence as he cannot see.

 

6. You are a doctor working in CAMHS. A Nurse working with a 16 year old girl is concerned about this girl’s symptoms. One week ago she was diagnosed with Anorexia Nervosa. GP has done some blood tests a week ago which are normal except she has slight low phosphate levels. Explain the cause of the symptoms she has noted and management. (Refeeding Syndrome)

The nurse says that she knows this girl for the last one week. She has gained 3kg in a weeks time. Girl’s mother is very keen to re-feed her and has forced her to eat bit more. The blood results are one week old by GP. She has noticed that the girl has some oedema in her hands and difficulty in swallowing. Denies any chest pain, difficulty in breathing or other symptoms. She is asking what could have caused this. What is refeeding syndrome? What to do now? Does she needs admission to psychiatric ward? what could be done to prevent this? etc

 

7. Young lady who has self harmed by cutting her thigh deeply today and she was admitted to the (?general) ward. Do a suicide risk assessment.

 

She said that she cut herself after she had an argument with her girl friend. today morning. she was upset. when ever she cuts she feels relieved. Denies having had any thoughts of ending her life with this self harm attempt. she was hearing a voice of her previous girl friend (pseudo hallucinations) asking her to join.  She has done self harm like this for a long time. for years. when ever she feels upset she harms herself. she denies any past psychiatric involvement. no medical history. no medications. was not under the influence of alcohol or drug when harming herself.

 

8. PTSD

This young man was noted to hide behind the car. he is increasing drinking alcohol. he is/was in the army at Afghanistan. please do a diagnostic assessment.

 

The man said that he heard a loud sound and then he started seeing series of images of his friends getting burnt in a bomb fire etc. hence when ever he hears a sound he will suddenly goes and hides somewhere.

 

Linked stations

 

1.    This young man was arrested by the police as he broke in to his (ex-girl friend or this girl’s) home whom he knows from his college about 20 years ago. He has made contact with her about 6 months ago and has been pestering her. She has brought an injunction order against him but today broke in to her home. Pls do a mental state examination and assess any risk. In the next station you are going to discuss the assessment with the Crisis team member.

 

2a. You are going to speak to the grand-daughter of Mr XY who underwent a recent DAT scan and a diagnosis of Lewy Body dementia has been made. He has been having worsening problems with memory for the last 18 months. He has developed features of parkinsons for the last 9 months. He has had falls. Discuss the diagnosis with her and answer any questions she has.

 

2b. Mr XY’s another grand-daughter has come to speak to you as Mr XY has been having increasing difficulties at home mainly agitation and aggression, visual hallucinations. The carer is getting distressed with this. He was started on Rivastigmine 3mg bd about 3months ago when you saw him in the clinic. Please explain how you are going to manage him.

 

3a. This a young man Mr XY with mild LD who has been diagnosed with schizophrenia. He was admitted yesterday to the medical ward as he was found to be vomiting large quantities of blood. He has been refusing to get OGD and also refused to give any bloods for investigation. The medical team have asked to see if he has capacity to give consent for the procedure. In the next station you are required to speak to his key worker.

3b. Ms XX has come to speak to you about your assessment of Mr XY. Her questions were why did you have to see him? What is this capacity assessment?  So, if he is refusing to go ahead with the procedure, can u go ahead with this procedure against his will? Is it very urgent that he has to go through this procedure in the next 24 - 48 hrs? Can you not wait for a day or two so that when he changes his mind then you could do the procedure? Can any thing be done to prevent the procedure being done against his will?  Can I speak to him?

 

4a. This young lady who has a 7 month old baby and she is now 10 weeks pregnant. She is very worried about her baby and her husband took her to the GP who advised to  see a psychiatrist. You are going to speak to her husband in the next station. (She said that she is worried her 7 month old son, is suffering from leukemia. She can see that he is in pain. She can’t see him suffering and she wants to help him die. Her husband and her mother-in-law doesn’t feel that there is anything wrong with the baby including her GP. She has plans to put the pillow on the face of the baby and help him to die)

 

4b. Speak to her husband about your assessment and Mx plan

CASC Stations 23^rd September 2010

submitted by Pandit Chhaya f rom Leeds

 

Morning stations Linked

 

1a. Post Natal Depression

 

Young lady 10 weeks pregnant having 7 month old baby presenting with difficulty coping.

No medical or previous Psychiatric history.

Assess her and find out intensity of her difficulties.

 

Next station you need to speak to her husband

 

1b. PND diagnosis and Management

 

Speak to her husband regarding Diagnosis, management and address his ideas, expectations and concerns.

 

2a. Overdose assessment and risk history

 

A 15 yr old girl took 80 paracetamol tablets overdose yesterday. Admitted to the paediatric ward and now medically fit.

 

Take a history focussing on the O/D and do risk assessment

 

Next station you need to talk to the Nurse in charge on the ward.

 

2b. Discuss management with Paediatrics nurse in Charge

 

Speak to the nurse in charge and discuss the management plan with her short term and long term.

 

3a. Hypochondriasis history

 

Talk to the 26 yr old man referred to you by the neurologist for C/O headaches.

 

His CT scan brain is normal but he is convinced that he has brain Tumour.

 

Take a history to arrive at a diagnosis.

 

Next station you need to talk to his partner regarding management

 

3b. Discuss diagnosis and Management

 

Discuss the possible diagnosis and treatment with her. Address her ideas and concerns and impact of his illness on his life.

 

4a. Dementia behavioural change

 

Take information from the key worker at the Nursing home regarding a patient who has become increasingly agitated and has become confrontational with another patient in the nursing home.

 

Take a history with regards to finding the aetiological factors

 

Next station you need to speak to his son

 

4b.Aangry son

 

Talk to the son of the patient living in a nursing home. Pt had received Olanzapine for his agitation. Now his son is upset and wants to see you as the outpatient appointment has been arranged with you as your consultant is on Holidays hence he is not able to see him.

 

Address his concerns, ideas and discuss the alternative treatments for his father.

 

 

Afternoon stations- Single

 

1. Lower limb examination

 

Patient presented with loss of power of both lower limbs. She noticed it suddenly 3 days ago. She is incontinent of urine. Please do not examine genitalia. Do not test for pin prick.

 

Carry out the lower limb examination.

Discuss the findings with her.

 

2. ECT explanation

 

55 yr old man with diagnosis of depression had Fluoxetine max dose for 8-10 weeks. Recently increased the does of Venlafaxine to 225 mg with no improvement in the symptoms.

 

Discuss the ECT with him and consent for the same.

 

3. Opiate history- harmful use

 

Talk to the man presented himself to A&E. He is a heroin user.

 

Take a history of the illicit drug use and look for harmful use of the same.

 

4. Psychotic symptoms- assessment

 

A man is brought to the A&E as he was accusing his neighbours of trying to kill his mother and him. He has some unusual thoughts about radiation and neighbours.

 

Assess his symptoms

 

5. Psychotherapy assessment

Young woman was referred to psychotherapy for low mood and difficulty with job.

She wants to discontinue the therapy.

Talk to her and find out the cause of the discontinuation. Discuss with her and have a management plan.

 

6. Cognitive examination

 

70 yr old man presented with memory difficulties. History of hypertension and Type 2 Diabetes for many years. Having name finding difficulties.

 

Do cognitive function tests for the diagnosis of Vascular dementia

 

7. Opiate history- extent of the problem

 

Man presented to you with drug use. Take a history to find out the extent of the problems with drug use.

 

8. Breaking Bad news

 

Elderly lady presented with sudden on set of confusion poor memory. Scored 8/30 on MMSE.

 

CT Scan report showed metastatic deposits to left temporal lobe. Blood tests normal

 

Speak to her son and discuss the test results and further management.

 

 

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