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16 Cards in this Set
- Front
- Back
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Explanation station (4) Fluoxetine 20mg OD for depression |
General info - SSRI, start low, does not work immediately Adverse effects - N/V/H, agitation, tremot, dry mouth, night sweats, sexual dysfunction Duration of use: 9-12 months if effective and tolerable Dependency not an issue |
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Explanation Station 19 y/o with first episode of psychosis - auditory hallucinations + delusion - resolved with resperidone Explain psychosis |
General info - abN mental state, hallucinations, delusions and disordered thoughts, common as 3% ppl have psychotic episode DDx - Drug induced psychosis, brif psychotic episode, schizophrenia, delusional disorder, bipolar, schizoaffective, psychotic depression Prognosis - wide variation but most make full recovery with treatment, recurrence difficult to predict |
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Marks Common for all Explanation Stations Process of discussion (6 marks) Relationship building (4 marks from examiner) Also 2 patient marks |
- Explores prior knowledge - Links new info to prior knowledge - Provides new info clearly - logical sequence, manageable chunks, important points highlighted, summary - Checks understanding of new information Invites ideas, beliefs and feelings Acknowledges emotions Picks up non-verbal cues Good attitude, non-judgemental Uses non-verbal communication |
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History station - Panic attacks At a GP clinic - Ms X has had 2 attacks Take a history covering medical and psych conditions Clinical term for attacks? Most likely DDx? |
PC Psych - Intense anxiety, fear of going crazy/dying Cardiac symptoms Respiratory symptoms Neuro - dizzness/syncope, trembling/shaking, paresthesias PMHx - Cardiac, thyroid, seizures, substance misuse, Caffeine intake, FHx Panic attacks (not panic disorder) DDx - any reasonable DDx from PMHx |
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History Station - Alcohol dependence Bill 38 y/o with drinking problem Dx and justification? |
Consumption pattern Problems - legal, interpersonal, hazardous, role obligation failure Depression - mood, suicide, substances, anxiety, gambling FHx - dependence, depression, suicide PMHx, family impact Alcohol dependence - Criteria met and dependence trumps abuse |
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Explanation/planning station - Depression Discuss management of 6M of moderate depression with Jane Green - Low mood, relationship trust, insomnia, appetite, weight loss, energy, concentration |
Medication AND psychological Rx Relationship counselling +- children Explain specific drug and delay in beneficial effects Side effects x2 + reduction Explains psych Rx - links with knowledge Explores cost to patient Explores likelyhood of benefit of Rx and sexual dysfunction |
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History station - Alcohol withdrawal Orthopedic ward seeing man with broken ankle who is agitated, restless and tremulous |
Dependence criteria - Unsuccessful attempts to stop - Drink more or for longer than intended - Salience - Recovery time - Use despite knowledge of harm - Tolerance - Withdrawal Asks about Fam Hx Co-morbidity (anxiety/dep) Dx - Alcohol dependence (and withdrawal) |
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History station - Deterioration of intellect Mr Brown 78 y/o has pneumonia, confusion and cognitive difficulty. Interview relative to establish possible history of cognitive impairment |
Time course + degree of concern previously Recent memory and long term memory Concentration/attention and problem solving Performing daily tasks Evidence of memory problems Change in personality/behaviour Medications and effects Alcohol use past or present Depression and anxiety Dx - Mild dementia/impairment |
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Explanation station - Antidepressant use and pregnancy Jane Smith at a GP clinic wants to know about medication during pregnancy and is keen to stop Fluoxitine 20mg |
General risk - Mostly safe but best avoided 1st trimester as with all meds Post-partum / breast feeding Mention specific effects low birthweight, jittery newborns, cardiac abN with paroxetine Relapse of depression while stopped Pros vs cons with past hx of 2 previous episode CBT/IPT and other like relaxation Postpartum risk increased with past episode Fam Hx lowers risk Early warning signs vs normal pregnancy Social support, rest, sleep, diet |
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Cognitive assessment station Mental state exam of cognitive function on Chris 64y/o retired
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Explains procedure Administers test appropriately and with sensitivity Empathetic Evidence of cognitive impairment Requires further investigation |
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Explanation station - Bipolar disorder Explain mania and bipolar disorder to Beth who's partner has had a manic episode |
Check's knowledge Describes bipolar disorder Explain diagnosis and how it depends on the course Worries - treatment, recovery, future Empathy and concern, attitude, non-verbal |
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History station - Depression history Mr Johnson 26y/o wants prozac + Management |
Depression - DAWIMECS + guilt, self-esteem Suicide - What happened - what stopped Associated features - psychosis, anxiety, cognition, alcohol, stress PMHx, PPHx, FHx, SHx, life story Management - Safety, decrease stress, educate, drug Rx, psyco Rx, ECT, review and follow up |
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History station - Difficulty concentrating Mr Lambert 30y/o has difficulty concentration after motorcycle accident |
Depression DAWIMECS + guilt, self-esteem Associated features PMHx, PPHx, FHx, SHx |
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History station - Hallucinations Mr GH 25y/o Maori man with odd behaviour + Management and prognosis |
Hallucinations - when, what, progression, insight, not sleep associated Associated features - substance use, positive and negative symptoms suicide PMHx, PPHx, FHx, SHx
Poor prognosis - if FHx, early onset, single/male, negative features Management - Antipsychotics, counselling, living skills, relapse |
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History station - Memory loss Mrs HG 52y/o with memory problems, husband gives history + Examinations and investigations |
Memory loss - Progression, short Associated features - Head trauma, drugs, strokes/TIA, depression, hypothyroid PMHx, FHx, SHx DDx - Alzheimers/dementia, hypothyroid, depression Examinations - Neuro, cardio, mini-mental Investigations - Head CT, ECG, TFTs |
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History station - Psychotic patient George 23y/o mental health act believed he was rightful Maori king |
Mood symptoms Psycotic symptoms PPHx, drug/alcohol use Confidentiality, attitude, empathetic |
