Saturday, 9 June 2012

General Advice for Written Papers (MRCPsych Paper A and B)

General Advice for Written Papers (MRCPsych Paper A and B)

We need preparation for the written exams, and we would suggest you think about starting your revision at least three months before each one. Although it’s difficult to balance examination revision with a full-time job, it is possible with wonderful organisation and discipline. Furthermore, many people have other responsibilities, such as children, which makes it much more difficult to fit in. It may have been years since you took your medical school examinations, and getting back into the swing of things can take some time. One technique is to start with half a day on weekends or a couple of evenings each week, then escalate the time as the examination approaches. There will be times when you can’t do any revision, for example, during weeks of night shifts. Although individuals strive to cram as much studying as possible into the weeks leading up to the test, it is equally crucial to relax and enjoy yourself. Rather than making your preparation less time-effective, scheduling some relaxation time will make your revision period more productive.


A good first step would be to study the Royal College of Psychiatrists’ examination web pages. There are details of the syllabus, regulations, frequently asked questions, and lots more useful bits and pieces. Google’ MRCPsych examinations’ to find the official College website.


Regarding what to revise, make sure you look carefully at the syllabus for each examination on the Royal College website to check the areas you need to cover in your revision. There is no point in covering areas that don’t appear in the examination, and you would better spend your time learning things. Although the proportion of questions in each subject area is worth bearing in mind, it isn’t the only factor. It would likely be better to allocate your time to concentrate on the areas you find most challenging.


The biggest change in the written exams has been moving from 3 written papers to 2. There are now 2 written exams, papers A and B, each comprising 200 questions over three hours. The exams contain multiple-choice questions (MCQs) and extended matching items (EMIs), with a rough split of 2/3 MCQs and 1/3 EMIs.

Examination online sites from the Royal College of Psychiatrists are a fantastic place to start. There are syllabus details, restrictions, frequently asked questions, and a slew of other valuable information. The official College website may be found by searching for "MRCPsych exams."

Friday, 11 May 2012


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 of what the CASC involves at the start of your training and looking at the requirements in more detail when you are preparing for the papers is a good idea. When studying for the written papers, start thinking about how you would make history for the topics you are preparing and read the relevant leaflets for patients - imagine you are explaining it to a patient or relative. It may even make revising for the written papers less abstract!!

Speak to trainees who have sat the CASC. There is also information available online about past stations. You will need to train your body to recognize what seven minutes feels like - timed practice as early as possible is very important. Mock exams are a good way to prepare for the range of skills you have to show in a short time and also develop the ability to quickly change from one task to another. There are ‘OSCE timers’ apps available that have a one-minute warning bell and an ‘end of examination’ prompt which creates the right amount of anxiety/anticipation to prepare you for the big day.

Practical issues during the exam

You get a short time before each station. There is no defined way to use it this time, but make sure you use it! You may decide to take notes but don’t let this distract you from thinking about the question. You may just want to write the name of the patient and the key task that they have asked you to undertake, and a few areas you’d like to cover. You can also take notes during the first stations of each linked pair details will stick in your mind and they will give you another task with some information for the linked station. Taking notes can be a welcome distraction to the station, and you won’t be as present in the station.

The UK sitting of the CASC takes place at the English Institute of Sport in Sheffield. They hold it in a sizeable room with several circuits going on at once. Noise carries, and this includes the examiners and role-players talking to each other between candidates. Listen, but it might not always be positive comments and may derail you if things have not gone, and you thought. Remember, it’s only the opinions of people who have seen you for a few minutes in an already stressful setting.

There are no rest stations on the circuits, but you potentially have several hours to wait between the morning and afternoon sessions. There is enough time to have an excellent lunch and get focussed on the afternoon (though don’t rely on the cafĂ© in the venue being open) Some people like to talk through the stations they have just sat with friends, others might find this frustrating and unhelpful Remember, there is nothing you can do to change things and you need to focus instead on the afternoon stations. What has gone on, however, may also highlight things you have missed out on which can then be remembered for the second circuit?

During each station, let the role-player set the initial agenda but make sure you steer things in the right direction later on if needed. Summarising is useful to double-check information and re-focus the interview. Listen for cues and address anxieties when they appear. Don’t be afraid to answer questions, even if the answer might not be something the patient might want to hear—this may be the only way to move on. Be careful not to ask double questions—the actor might only answer one part.

Books we found helpful for CASC

‘Pass the CASC’

CASC books are far from perfect. One of the most popular is ‘Pass the CASC’ by Dr. Seshni Moodliar. This has a list of all the stations that have previously come up and is a good way to map out your revision. The content is comprehensive, but some phrases suggested in the book have not served candidates well.

Psychiatry: Breaking the ICE Introductions, Common Tasks, Emergencies for Trainees

Although not written for the MRCPsych exam, "Psychiatry: Breaking the ICE Introductions, Common Tasks, Emergencies for Trainees" by Sarah Stringer is an excellent all-rounder book. It’s a practical guide to working as a psychiatry trainee and covers all commonly encountered situations. Many of these give good advice that would help in passing CASC.

The Maudsley Handbook of Practical Psychiatry 

The Maudsley Handbook of Practical Psychiatry has a section on special interview situations. This has some excellent advice about how to manage challenging situations.

Preparing for CASC:

Have a plan and stick to it. Plan out each day where you work through a list of previous stations together. Find someone you want to spend the day with and practice regularly. Make it fun and schedule in breaks. Be honest with each other when giving feedback. Check that your practice is going in the right direction by asking trainees who have passed the CASC for feedback. Many trainees find that organizing a small group of three to four trainees who are all about to sit CASC and meet regularly to go through stations, practice your approach, and learn from each other can be a great way to prepare. If you are in a more rural location and struggle to meet up, consider regular Skype meet-ups instead.

Friday, 1 January 2010

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?

Friday, 8 June 2007

Single-photon Emission Tomography SPET

Single-photon Emission Tomography SPET


uses single-photon (gamma-ray) emitting isotopes

given IV or inhaled

the resolution is lower than PET


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


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

Tuesday, 28 February 2006

FCPS-2 March 2006 College of Physicians and Surgeons

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:

  1. What will be the differential diagnosis in this case?
  2. What investigations you should undertake?
  3. Draw a comprehensive management plan for this patient

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