CASC is an OSCE-style clinical exam made up of 16 stations in total. There is one circuit of eight stations in the morning and one circuit of eight stations in the afternoon. They have scrapped previously linked stations.  Any clinical topic can come up, and only the most impractical scenarios are off-limits. Commonly tested stations include: Brief history-taking e.g. psychosis, depression Collateral history e.g. in dementia Risk assessment following self-harm information-giving e.g. ECT, medication, psychological therapies Discuss management plans with consultants and other members of staff, e.g. nursing students and ward managers. Physical examination e.g., EPSEs, cardiovascular, neurological The CASC tests knowledge and communications skills such as history taking, explanation & advice, breaking bad news, and managing challenging consultations. When you first look into the CASC exam, the pass rate may not fill you with optimism about passing it. However, having a rough idea

A 40 years old man attends your outpatient carrying his CT scan brain which is suggestive of space-occupying lesions in the parietal lobe. a) What clinical signs would you look for while examining this patient? b) How would you elicit those signs?

Single-photon Emission Tomography SPET Principle uses single-photon (gamma-ray) emitting isotopes given IV or inhaled the resolution is lower than PET Uses SPET can give information about: regional cerebral blood flow ligand binding Clinical uses include: Alzheimer’s disease When the symptomatology (e.g. hallucinations, epilepsy) occurs when the patient is not near a scanner; we can give a suitable ligand at the material time and the patient scanned afterward Schizophrenia reduced rCBF in frontal regions—‘hypofrontality’ Affective disorders as that in schizophrenia, with reversal after antidepressant therapy Alzheimer’s disease decreased rCBF in posterior parietal and temporal regions Xenon inhalation Shows the failure of activation of frontal lobes in schizophrenics performing the Wisconsin Card Sorting Test

FCPS-2 March 2006 College of Physicians and Surgeons  Q.1 A 55 years old feudal - lord presents with over six weeks' history of inability to ” face the world”, disinterest in sex, suicidal thoughts, and weight loss. He relates his current plight to losing a large sum of money and a part of his fortune in gambling: What will be the differential diagnosis in this case? What investigations you should undertake? Draw a comprehensive management plan for this patient

History taking, Mental state examination, and making a diagnosis What body language and behavior used are most suitable while taking psychiatric history? What is an open-ended question? What question could you ask the patient after they have stopped volunteering their symptoms? "What other changes have your partner/family/friends noticed in you?" What is the definition of Command hallucinations? A voice or person telling them to do things PMH relevant to ask about in a psychiatric history Developmental problems  Head injuries  Endocrine abnormalities  Liver damage Esophageal varices  Peptic ulcers (can show if alcohol problems)  Vascular risk factors What to ask about alcohol/illicit drug use? Regular or intermittent Amount (know the units) Pattern Dependence/withdrawal  Impact on work, relationships, money, police  Screening questionnaires e.g. CAGE What to ask in a forensic history Offenses including sentences Recidivism  Particular attention to violen