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Exam (elaborations)

CASC Exam: Questions & Accurate Answers (Rated A+)

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  • MRCPsych
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  • MRCPsych

CASC Exam: Questions & Accurate Answers (Rated A+)

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  • October 17, 2024
  • 60
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers
  • MRCPsych
  • MRCPsych
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CASC Exam: Questions & Accurate Answers (Rated A+)

General structure Right Ans - Play around depending on station

-HPC
-MSE for Dx (mnemonics)
-Ddx
-Risk (can be lower)
-History (can be higher)

MSE Right Ans - HPC: useful to start by getting circumstances around. Try
to link things temporally.

A+B+S: may be pointed out by commenting ('I notice you appear quite
agitated')

M: mood, appetite, sleep, self-harm, suicide;

T:
· Delusion questions
Do you have any beliefs that you feel aren't shared by others?
Have you been feeling worried about something in particular?
Grandiose: do you have any special purpose or calling?
Religious: do you feel like you are more connected to god these days?
Paranoid: do you feel like someone is targeting you?
Nihilisti delusions if depression: do you believe you are dead? Do you believe
your insides are rotten?

· Thought form: do you feel like your mind is racing
· Thought insertion, withdrawal, broadcast, control (if no time, are people
interfering with thoughts in any way?)
· Passivity phenomena
· Ideas of reference

P:
· Have you ever heard sounds that sound out of character to you?
· Have you seen things that seemed strange recently?
· Any strange sensations in your body?
· Any strange smells or taste?

,C: may be worth very quickly asking orientation questions if worried about
delirium

I: can you think of any alternative explanation to this? can your mind be
playing tricks on you? I think you may have a mental health problem, what do
you think about that?

Management Right Ans - Bio-psycho-social

Bio - meds
Psycho - therapies
Social - support groups, etc

Short-medium-long
-'We should start by'
-'In the event this fails' - go all the way

Actions Right Ans - Every ball raised needs a shot - if mentions diabetes,
discuss diabetes

Every concern needs adressing - if family/patient is concerning, say 'we
assure you we are doing our best and this measure is proportionate' etc

Think of the task! Right Ans - Forget the mnemonics if the task is not asking
you - focus on what is expected of you

Finish with, or in the middle, ask 'are there any questions you want to ask
me'? - that helps guiding and tayloring the station.

Risk!!! Right Ans - Remember risk, you are leaving this behind!

To self
To others
From others

Main differentials Right Ans - •Depression: physical health problems
(hypothyroidism), grief reaction, manic depression, adjustment disorder

,•Anxiety - rule out OCD, ask about panic, agoraphobia, specific fobia

•BDD - rule out OCD, psychosis, eating disorder, anorexia

•Gender dysphoria: rule out OCD, BDD, psychosis

-----OLD AGE
•Wandering: delirium, dementia, head injury (falls), depression (w/ cognitive
change)

•Dementia (7 main): medical conditions underlying, vascular dementia
(stepwise), lewy body (visual hallucinations or movement
problems/tremors), frontotemporal (personality changes, impulsivity,
disinhibition), depression (mood), psychosis, substances (quick screen,
specifically alcohol)

-----CAMHS
•Struggling in school/not achieving milestones - genetic disease, LD, ADHD,
depression, psychosis, trauma at home, separation anxiety

Borderline mnemonic Right Ans - ERAS E DIAS
-Emotional instabity
-Relationships (unstable) - ask about violence when risk ax
-Abandoment (fear)
-Self-image (disturbed)
-Emptiness
-Dissociative/psychotic (transient)
-Impulsive
-Angry
-Self-harm/suicide

Mania Right Ans - MESTIDIP
-Mood
-Energy levels
-Sleep
-Thoughts (fast)
-Irritability
-Disinhibition (sexual)
-Impulsivity (spending/money)

, -Psychotic symptoms (visual, auditory)

-Ask about medications probably causing this (e.g steroids, levodopa); ask
about dose changes if positive
-Other history

-Risk

Escapes Right Ans - •Politely cutting off manic patients
'I'm really interested in what you are saying and would like to come back to
this, but my time is short today and I would like to ask some questions - would
that be ok?'

•To take a step back and move to HPC before answering Qs:
'I need a bit more information so I can address your questions better, if that's
ok?'

•Dealing with someone angry about the wait
· 'I apologise for the delay. I understand that's frustrating. My time is yours
now, let's think about ways to help you'.

•Priming before difficult questions
'There are some questions that may be sensitive that I need to ask, if that's ok'

•Can I leave now?
-Are you ok to talk to me a bit more? Maybe I can help in any way.

Depression Right Ans - AH PESAMIS
-Anedonia
-Humor (low - depressed)
-Pensamento (cognition)
-Energia (anergia)
-Sono (disturbance)
-Apetite (disturbance)
-Motor (disturbance - agitation, slowness)
-Inutilidade (sentimento)
-Suicide/self-harm

In psychotic depression:

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