CASC Stations - Past Exams

Pilot | June 2008 | November 2008

Pilot Exam

Station #1 (Clinical) Station #2 (PMP)
You have to take a history from a mother to assess whether her son has ADHD. She has brought in a letter from her GP (you have to read this in the station). Once you have determined the diagnosis, you are asked to discuss the management plan with the boy's father.
You are asked to take a history from a 15-year-old girl with a history of depression. There are some trauma-related symptoms, related to bullying, which are unlikely to meet diagnostic criteria for PTSD. Discuss your management plan with your consultant.
An old man has been brought into A&E by his daughter. He has some paranoid ideas about his neighbours. You are asked to assess psychotic symptoms and "any other psychopathology". You have to discuss your findings with his daughter, who has apparently got some information from the Alzheimer's society. It would appear that the most likely diagnosis is dementia.
You have been asked to assess a young male patient who has recently been discharged from hospital. He is asking/ demanding to see one of the nurses. He apparently has handcuffs and a knife in his bag. You meet with the nurse in question. She asks you about her safety and wants to know what the patient said to you.

June 2008

Station #1 (Clinical) Station #2 (PMP)
You are asked to assess a 15-year-old girl following an overdose. She has a history of bullying. Discuss your findings and your management with the consultant.
You have to assess a 21-year-old man who was in a road traffic accident with his father two weeks ago (his father died). He develops (double-vision and) blindness at the funeral.

You are asked to take a take a focused history of visual loss, examine visual fields, eye movements, and perform fundoscopy, and any other relevant physical exam. You instructed not to take a history of bereavement.
You have to speak to his mother, addressing her concerns.
You are asked to assess an 80-year-old woman who has had a recent fall. She is hostile to staff in the nursing home and towards other patients. She is saying that they've taken her belongings and replaced them differently.

You have to assess for psychotic symptoms and conduct a cognitive examination.
Discuss your treatment plan with the woman's daughter.
You are asked to assess a man in his mid-40's who is depressed and supposed to be on fluoxetine. However, he is not taking it.

[He is apparently experiencing sexual side effects but doesn't volunteer this unless you ask].
Speak to his wife, listening to her concerns.
You must interview a man who is convinced that his wife is sleepting with his neighbour. There is a past history of assault on a previous partner.

[He apparently gets annoyed if asked directly about psychotic symptoms].
Your consultant has apparently suggested admission. You have to speak to his girlfriend about this.
You are interviewing the mother of a 23-year-old man who had a head injury following a pub fight two years ago. There is a history of personality change. According to your history from the mother, you must perform a focused cognitive examination on the young man.
Interview the mother of a 8-year-old boy with symptoms of ADHD. You are asked to confirm diagnosis. Discuss your management with the boy's father. He apparently reports that there is a family history.
You must interview a female teacher following a paracetamol overdose. She is socially isolated.

You are required to obtain a history of the overdose, and a social history.
Consent is given for you to discuss management with the patient's friend.
You have been asked to interview a man who had been brought to hospital with haematemesis. The suggested treatment/ investigation is endoscopy but the man is refusing.

You must assess capacity.
Discuss your findings and management with the on-call psychiatrist.
You must interview a woman with post-natal depression and a 7-month old baby. She is now 10 weeks pregnant again.

You are asked to take a history of depression and not required to assess risk.
Discuss your management with the woman's husband, addressing his concerns.
Take a "sympathetic" history from a 25-year-old man with chest pain. His father has angina and his uncle had an MI. He has been investigated by the cardiology team and has been told that it's in his mind. He's not happy... Explain the physiology to his mother and allay her anxieties.
Interview a man with erotomania, with intentions towards a psychiatric nurse. Discuss with your consultant, focusing on risk issues.
Interview an alcoholic man in an orthopaedic ward [with clouding of consciousness]. Take a history of his abnormal experiences. Discuss your findings with the orthopaedic nurse.
Take a history from staff in a care home in connection with an elderly man who has recently assaulted another resident. Speak to the man's son, who is irritable about his father being on Olanzapine.
Interview a 15-year-old girl following an overdose of 80 paracetamol tablets. There is a possibility of alleged rape by a step-father. Discuss your management plan with the medical nurse.

November 2008

Station #1 (Clinical) Station #2 (PMP)
You must take a history from a mother whose son has possible ADHD. Take a relevant history and come to a diagnosis. Discuss your findings with the child's father.

He apparently asks you about risks in future children.
You are required to take a history from a professional footballer who is complaining of anxiety after failing to score two months ago.

You are asked to elicit examples of 'maximisation', 'minimisation', and 'abstract thinking'.
You have to speak to the footballer's manager about his proposed treatment, and his ability to return to the pitch.

Issues of medication and compliance with Football Association rules arise, along with CBT and mechanism of action.
You must take a history from a young woman with a history of anorexia nervosa. She has recently split with her boyfriend and is apparently anxious about becoming unwell again.

You are asked to only assess her personal and family history so that you can discuss psychotherapy with your consultant in the next station.
Discuss proposed treatment (psychotherapy) with your consultant.
You must assess a 65-year-old man who has apparently exposed himself to a neighbour (female) whilst he was in his garden. You must then talk to the man's wife.

Issues of confidentiality arise, and she also discloses that he has had inappropriate contact with his grand-daughter.
Assess (risk in) a 15-year-old girl who has taken an overdose of 80 paracetamol.

She is apparently holding a piece of paper saying "Rape" and it transpires that she has been raped by her step father.
Discuss her management with a paediatric nurse.
You have to assess a student with a history of paranoid thinking, and elicit psychotic symptoms. Discuss the presenting problems and the management with his mother.
Take a social history of a man who is currently undergoing a cardiac rehabilitation programme after an MI. He has been feeling low for the past few weeks. Discuss the management with your consultant.
Assess a woman presenting with symptoms of agoraphobia. Discuss management with her husband, who is apparently frustrated and tired with her difficulties.
Assess a young man with mild learning disability who is about to become a father. Social workers are involved and have apparently indicated an intention to take teh child away. He has recently exposed himself and has been charged by the police.

Explore his concerns and help him to express his worries and need for help.
Speak to the mother of the unborn child. She is concerned about the father.
You are asked to assess abnormal experiences in a postal worker.

This station appears to have arisen in the old part I exams.
You must speak to the mother of a young man who has recently been diagnosed with schizophrenia. She is angry ["the angry mother"] and you are the duty doctor.  
Assess cognition in an elderly man who has been picked up by the police, wandering.  
Take a history from a man with a history of depression who is complaining of sexual dysfunction.  
Assess a woman in her late 50's who has presented with anxiety/ panic. Take a history of anxiety symptoms ini order to make a diagnosis.  
A GP has asked you to rule out Temporal Lobe Epilepsy in a man being treated for depression. The dose of his tricyclic antidepressant has recently been increased and he is complaining of strange experiences.  
You have been asked to assess a woman whose husband has recentl died. The GP is asking you to determine whether her symptoms represent a normal grief reaction or a psychotic illness.
Take a history from a young woman who has presented to A&E with restlessness. She has apparently been taking "Triflu...something" for three days. You must establish the likely cause and address her concerns.  
You are asked to see a mother whose son had a head injury two years ago. Take a history regarding personality changes.
Assess a 20-year-old girl who has taken three tablets of diazepam (total dose=6mg). Take a history, assess risk, and make a judgement on admission or discharge home.  
You are asked to see a man in A&E with a history of polysubstance misuse. Take a history of his drug misuse, and determine dependence.  
Take a history (but not assess risk) from a mother of a 7-month-old baby who is complaining of low mood. Discuss management with her.  
Assess a woman in her early 30's who is presenting with a sudden onset of paralysis in her right arm and left leg. Physical examination is normal.  
Take a history from a woman who is complaining that her eyes are too far apart.  
Perform a risk assessment in a 25-year-old man with schizophrenia who has recently threatened his girlfriend with a knife.  
Examine the mental state of a woman who tried to burn her body on a fire. She thinks that she is dead. Elicit the presence of delusions.  


Some of the above information about the stations came from the Superego-Cafe forum.


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