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You are seeing Mrs. Howard, a 37 year old school teacher in your outpatient
clinic, who was referred by her GP. She was involved in a serious road
accident 6 months ago. The patient initially saw her GP because of difficulty
in coping with her job. Obtain history to arrive at a diagnosis and rule out
co-morbidity.
A
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The GP has referred Mrs. White, 35-year-old woman whose husband died
seven months ago. She is not coping well following the death of her
husband. Take an appropriate history to assess whether this is normal
bereavement reaction or determine if she has features of abnormal grief
reaction
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BREAKIND BAD NEWS
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A- Good pass B-Borderline pass C-Borderline fail D-Fail
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A B C D
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You are asked to see Ms. Rose, a 24-year-old lady who has insulin
dependent diabetes mellitus.
The GP was concerned about her poor diabetic control and the patient
admits to omitting insulin in order to lose weight. Take a history to assess
for the presence of eating disorder and assess prognostic factors
9 Fluency of interview, A B C D
Lack of clear structure, Lack of appropriate focus
on the task
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Mrs. Rachel Smith is a 31-year-old lady who delivered a female baby three
months ago. She was referred by her GP and following your assessment in
clinic, you think that she might be suffering from post-natal depression.
!"#$%"&'%()*!& A B C D
PANIC DISORDER-HYPERVENTILATION
Addressing Concerns-
8 ? Getting back to work A B C D
? Medications
9 Agreeing to talk to patient later and
reassure him A B C D
Sources of information- leaflets etc
A
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You are seeing Mrs. Pauline Smith in the out-patient clinic. Take history
from her, as she is feeling low in her mood, and assess her suitability for IPT
(Inter Personal Therapy).
A
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Mrs. Turner is a 35-year-old lady who suffers from mixed anxiety and
depressive disorder with dependent personality disorder traits. She also has a
past history of traumatic childhood.You have seen her in the outpatients’
clinic and have decided to refer her to the psychology department for
psychodynamic psychotherapy. She would like to know more about it.
Explain the principles involved and structure of this therapy and Address her
concerns
Do not take history.
A
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You are seeing Miss. Sarah White, a 27-year-old lady who has seen her GP
complaining that her eyes are wide apart. Obtain history to explore the
nature and extent of her problems. Assess her to clarify her diagnosis.
Risk assessment:
7 1. Suicidal ideation A B C D
2. Risk of actually performing surgery themselves
3. Risk of unwanted tests and investigations
Past psychiatric history
8 Rule out co-morbidity-Depression, social phobia, A B C D
schizophrenia
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Mr. Tony Gordon, a 32-year-old gentleman was seen in the drug and alcohol
outpatient clinic following referral from his GP, as he has a history of
multiple drug use. Take a history of drug misuse and try to establish features
of dependence syndrome.
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PHYSICAL EXAMINATION-EXTRA PYRAMIDAL SIDE EFFECTS
You are a junior doctor in accident and emergency department. The nurses
have asked you to see this young gentleman Mr. Paul Brown who is restless,
angry and agitated. The A&E doctor mentions that he went to his GP three
days ago who gave him some new tablets. He thinks his problems started
after taking those tablets.
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A B C D
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Mr. John Abraham is a 28-year-old gentleman with a long-standing history
of paranoid schizophrenia. He has been admitted to a low secure forensic
unit and is now been charged with serious assault. You have been asked by
the court to assess him.
a. Assess circumstances leading to index offence.
b. Ask him relevant questions to identify risk of future violent offending.
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B C D
SEXUAL OFFENCE- PAEDOPHILIA
You have been asked by the court to see Mr. Kenneth Roberts, a 44-year-old
man who has been arrested for child molestation. Obtain history and ask him
relevant questions to assess risk of future offending. Do not conduct a
mental state examination
A
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FITNESS TO PLEAD
Mr. Peter Curtis is a 35-year-old gentleman, who has been charged with
assault 24 hours ago. The alleged victim had sustained multiple injuries in
his face and abdomen and required an overnight stay in the hospital. Mr.
Curtis has been remanded in custody and is due to appear in court tomorrow.
The court wishes to know if he is fit to plead. You have been asked to attend
the police cell and assess him.
Pritchard Criteria: A
5 Ability to understand charge (What and B C D
why they have been charged
A
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EROTOMANIA- ASSESS DANGEROUSNESS
Mr. John Brown is a 45 year old gentleman who was recently treated as an
inpatient for mental health problems and was discharged. He came back to
the acute psychiatric unit and wanted to speak to a particular nurse as he
believes that she is in love with him. When the receptionist refused to allow
him, he waved a knife at her. The police was called and they want the duty
psychiatrist to speak to him. Assess his beliefs and establish the level of
dangerousness.
9 Fluency on interview/discussion A B C D
Lack of appropriate focus on the required task
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D
Mr. Brian White was admitted to the acute Psychiatric ward two days ago
following a first episode of acute psychosis. Brian was very agitated and
required rapid tranquillisation with IM Haloperidol. Unfortunately he
developed Neuroleptic malignant syndrome and was subsequently
transferred to medical unit for treatment. His father who is angry & upset
has come to the ward and demanded to see a doctor to find out what has
happened.
a. Address his concerns and allay his anxiety
b. Explain the nature of his son’s condition and the prognosis.
c. Do not take history
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FRONTAL LOBE FUNCTION TESTING
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460$7:;1)8#$>)*$!!?@$'+*$AABCD$
Perform frontal lobe function tests to complete cognitive assessment and
arrive at a diagnosis.
Do not take history.
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COUNSELLING-LITHIUM AUGMENTATION
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>2?0,@A238,8;69,>056:@862=B,)55?099,;69,:2=:0?=9B$
Do not take history.
Risk
8 1.Risk of relapse on stopping medications A B C D
2.Ensure adequate hydration (Salt and water
balance) - Holidays-avoid sunbathing
(dehydration)
Addressing concerns
9 3.? Addictive potential A B C D
4. Drinking alcohol to moderation
5. ? Rash
Range and depth of information covered,
10 Significant omissions, Analysis of problems A B C D
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PSYCHOSIS-EXAMINATION
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Mrs. Young is a 32-year-old lady attending the CAMHS Clinic with her 6-
year-old son Abraham. The GP referred her son to the clinic for psychiatric
evaluation.
a. Obtain history from his mother looking for features of attention deficit
hyperactivity disorder.
b. Rule out co-morbidity.
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CHILD PSYCHIATRY- ADHD COUNSELLING
You have assessed Mr. Abraham, a 6 year old boy attending the CAMHS
Clinic and have been diagnosed with ADHD. Mrs. Young is curious to know
about the diagnosis and drug treatment options available for her son’s
condition. She is worried about other siblings. Address her concerns and
allay her anxiety.
Concerns
5 1. ? Blood tests to confirm diagnosis A B C D
2. Growth suppression
3. Stimulant and effect on sleep
4. Need for special diet
Other Concerns
7 1. Effect on other child A B C D
2. ? affect unborn child
9 Significant omissions, A B C D
Analysis of problems & synthesis of opinion
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Miss. Amy Morris is a 14 year old female who was brought into the A&E
Department by her mother after taking an overdose. Assess this young lady
to identify the reasons for taking it and seriousness of the overdose.
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A- Good pass B-Borderline pass C-Borderline fail D-Fail
7 Risk assessment A B C D
(Clear suicidal plans, fixed or Fleeting suicidal
thoughts, future plans etc)
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You are assessing a 14-year-old girl in the A& E department who has taken
an overdose of paracetamol tablets. Whilst assessing her, she showed a paper
on her hand reading ‘RAPE’ and during discussion, she discloses that her
stepfather has been sexually abusing her.
Her stepfather was seated in the waiting room. How would you proceed?
Discuss how you would manage this situation with the consultant.
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A B C D
PUERPERAL PSYCHOSIS
Miss. Nicola Palmer is a 21-year-old lady who was admitted to the maternity
ward. She delivered a boy baby five days ago and was discharged three days
after the delivery. She re-admitted herself at the early hours of this morning
in a distressed state complaining of feeling anxious and frightened. There are
no concerns obstetrically. The obstetrician requested for psychiatric
assessment. Assess her mental state and perform risk assessment.
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A B C D
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Mrs. Lewis was referred by his GP to your outpatient clinic for psychiatric
assessment. He is not happy about it as he thinks that he suffers from severe
chronic pain and there is nothing wrong with him mentally. Obtain history to
arrive at a diagnosis.
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A B C D
PSYCHOSIS- EXPLANATION
Mr. Peter Hill is a 19-year-old university student, who is currently an in-
patient on your ward and was admitted few days ago with bizarre behaviour,
persecutory delusions and auditory hallucinations. He is recovering from his
first episode of psychosis and is being treated with Olanzapine. His mother
is angry to know from the nurses that he has been diagnosed with
schizophrenia. Ms. Linda Hill wants to discuss with you about Peter’s illness
and Prognosis of his condition
Name of the candidate:
A- Good pass B-Borderline pass C-Borderline fail D-Fail
Address concerns-
6 1. Violent behaviour A B C D
2. Other children to be affected.
3. Worries about son getting back to normal
life
8 Explain prognosis A B C D
Support –MDT, CMHT, CPN etc
Sources of information-Information leaflets and
website
Range and depth of information covered,
9 Significant omissions, Analysis of problems A B C D
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B C D
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A B C D
ANTIDEMENTIA DRUGS
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,:"115*54$*5<1,6*4&6*25,$8&<1$527$>115$:2+;(1613#$=*,$!!AE$,:2"1$7&,$
FGHI.#$?2'$&"1$,11*54$8*+$*5$681$+1+2"0$:(*5*:$&53$02'$8&<1$31:*313$62$
,6&"6$8*+$25$J*<&,6*4+*51$KEL1(25M#$=*,$>"2681"$!"#$N250$A+*68O$782$*,$&$
PI$01&"$2(3$,:822($61&:81"O$7&56,$62$3*,:',,$+2"1$&>2'6$681$3"'4#$$$
Talk to him about effects and side- effects of this drug. Address his concerns
Do not take history.
Sources of information-
9 Leaflets, web sites A B C D
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A B C D
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Addressing concerns:
6 a. Future A B C D
b. Care home
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Obtain Collateral history from Mr. White whose 81-year-old wife was
referred to you by her GP as she has problems with her memory for the last
2 years.
• Obtain history to identify her cognitive difficulties
• Also look for evidence of functional impairment.
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COGNITIVE EXAMINATION
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A B C D
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You are in the learning disability outpatient clinic. Mr. Daniel Benjamin,
who is the manager of the Seven seas care home, attends your clinic with
Ms. Pauline Baker who suffers from severe Learning disability and has poor
communication skills.Mr. Benjamin mentioned that the care staffs at home
are finding it increasing difficult to cope with his challenging behaviour.
Elicit more history, to identify possible cause of challenging behaviour and
explain it to him briefly
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A B C D
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Mr. Alan Smith is a 25-year-old gentleman with mild degree of mental
retardation, who was referred to your clinic by his CPN as he was concerned
about his deteriorating mood.
Elicit features of depression and perform risk assessment for Suicidality.
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A B C D
LEARNING DISABILITY- ANXIOUS RELATIVES
You are seeing Mr. Robert Lawrence, a 26-year-old gentleman with mild
learning disability in your clinic. He lives with his girl friend in a residential
home who also has mild learning disability. She is now 6 months pregnant.
They expect the baby will be taken away after birth by social services. Elicit
his concerns. His mother Mrs. Dorothy Lawrence has accompanied him to
the clinic today. Elicit her fears and allay her anxiety
4 Fluency of interview/examination/discussion A B C D
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A B C D
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lithium carbonate 1000 mg. Over the last six months he has been feeling
increasingly tired and lethargic. His blood tests reveal low T3, T4 and raised
disorder
General Examination
5 Hands, Nails, Pulse rate and tremors A B C D
Examination of Eyes (Lid Lag. Lid Retraction,
Exophthalmos)
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A B C D
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Cerebellar signs
5 Eye signs (nystagmus) and Hands (intention A B C D
tremors)
Cerebellar signs
6 (Alternating movements-Dysdiadochokinesia A B C D
And dysarthria-staccato speech)
Co-ordination: Finger-Nose test,
7 Heel-shin test A B C D
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A B C D
Mr. Brown is a 57-year old gentleman admitted to the psychiatric ward with
and has had a number of falls recently. Perform cardio vascular examination
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A B C D
NEUROLOGICAL EXAMINATION
Mr. Lawrence was admitted informally to the ward this morning with a
diagnosis of depression and somatisation disorder.He complains of
numbness and tingling sensations in his right upper limb for the last 4
weeks. Perform both sensory and motor examination in his upper limb and
rule out any neurological deficits. Do not take history.
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Sensory examination
6 (Lateral column-Pain, Temperature) A B C D
Sensory examination
7 (Dorsal Column-Touch, Vibration, positional A B C D
sense)
Motor examination
8 (Tone and Power-flexors at elbow, wrist Flexors, A B C D
deltoid, biceps, triceps, Thumb extensors and
opposition)
Motor examination
9 (Reflexes-Biceps, Triceps and supinator) A B C D
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A B C D
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Miss. Sarah Cohen is a 23-year-old woman who presented to the A&E with
multiple lacerations in both her legs. The nurses think that she has a
personality disorder. Elicit history to arrive at a diagnosis and perform risk
assessment
Risk assessment
8 (Suicidal thoughts, plans etc) A B C D
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A B C D
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You have assessed Mrs. Wood a 35-year-old lady in the outpatient clinic
who has a diagnosis of recurrent depressive disorder. She has a history of
partial response to two different antidepressant drugs. You would like her to
be referred to the psychology department for CBT and the patient wants to
know more about it. Explain to the patient how CBT works and address her
concerns
Do not take history.
Structure of therapy
6 (Number, duration, therapist-trained in CBT A B C D
and supervised etc)
Outcome and offer further information
7 (Use in depression, prevents relapse) A B C D
A
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Miss. Rosie Green is a 33-year-old lady who was detained under the mental
health act and admitted last night, as she thinks she is dead and tried to burn
her body on a fire. Examine the patient to establish what abnormal belief she
holds.
Areas of Communication,
Concern- Questioning style- use of appropriate mix of A B C D
1 open & closed qns
Listening & responding appropriately to
2 interviewee, A B C D
Picking up clues
8 Risk assessment A B C D
(Self-harm, self neglect, non compliance etc)
10 Lack of structure, A B C D
Lack of appropriate focus on the task
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A B C D
OUT-PATIENT REVIEW- MSE
You are seeing Miss. Lisa Stewart who has a long standing history of
paranoid schizophrenia in your out-patient clinic. Perform a Mental State
Examination and look for features of any residual psychotic symptoms.
10 Lack of structure, A B C D
Lack of appropriate focus on the task
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A B C D
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You have been asked to assess John, 12-year-old boy in the CAMHS clinic.
He was referred for outpatient evaluation by his GP, after being picked up
by police for running away from home.
Obtain history from his mother Ms. Kate to arrive at a diagnosis. Also obtain
relevant background information.
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CHILDHOOD DISORDERS- AUTISTIC SPECTRUM DISORDER
Mrs. Young is a 32-year-old lady attending the CAMHS Clinic with her 6-
year-old son Paul. He was referred by the community paediatrician, because
he wanted a psychiatric opinion as his speech is delayed and he is reported
to be‘not normal’. Obtain developmental history from his mother looking for
features of autistic spectrum disorder and discuss your working diagnosis
briefly.
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A B C D
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!"#$%"&'%()*!& A B C D
POST-CONCUSSION SYNDROME- HISTORY TAKING
? Compensation motives
8 Embark on a search for diagnosis and cure & A B C D
adoption of a permanent sick role
Lack of clear structure, Depth of enquiry into
9 symptoms, A B C D
Lack of appropriate focus on the task
Range and depth of history explored, Significant
10 omissions, Analysis of problems A B C D
!"#$%"&'%()*!& A B C D