Assalamu Alykum , First of all a little bit about my preparation.

I booked my exam last year

whch got postponed, I was working as hmo too at that time so stopped studying as soon as
the exam got postponed due to my busy schedule and didn’t restart studying until Feb this
year. When I got the email for pilot exam , I was working as ED HMO with very crazy timings,
got exam leave for only 4 days before the exam. Started with Marwan file and hardly could
just finish one reading in 10 days, couldn’t do past recalls or proper p.e files , so what I think
is it is Allah’s blessing that helped me , and nothing a person can achieve without His help
and family’s prayers.

I would say the benefit of it I had was that I didn’t have recall bias since most of Marwan you
cant retain with one reading anyways. I also think that they are not very strict , unless you
do a critical error , if you manage to show them that you are a safe doctor and you are not
putting patients at harm, they will pass you and let go of your silly mistakes ( as long as your
approach is good and you play safe )

Also I wouldn’t say because I passed it in first attempt by just one week of study after an
year so it was a child’s play and all you need to do is to behave like a doctor and you will
pass , and if I can do it any one can do it, No, it is a lot of Allah’ s plan and Luck that matters
before the hardwork, the one who is passing in more than one attempts is not less
knowledgeable and the one who did in the first attempt hasn’t done something
extraordinary, it is just the right time decided by Him , so don’t lose motivation and keep
trying folks ☺

Okie , here goes my feedback for passed exam

Little about the exam:

I kind of liked the online exam , you don’t get to see or listen to the examiner though he is
there so you actually can behave like a doctor , you feel like it It is just you and your patient
and a non medical person (invigilator) so you feel more confident , all we need is a good
internet connection , also they were quite cooperative , someone missed one station and
she requested and they assessed her last station again in the end. A lot of people have
already shared about breaks and time etc , so wouldn’t repeat that. Stem with all details
was there on the big screen and small thumbnails were there for invigilator and patient but
good enough size thumbnails to see the patient as you speak to them and see there
expressions easily , stem was there all the time, Yes ID checked was done at each station , I
read some qs on whatsap group about examiner , id check time , breaks etc etc , I would say
don’t worry about the minor issues if id check would be done or examiner would be there
blah blah , as you will manage the online exam as long you have studied proeprly, just
prepare the way you would do for face to face exam and leave the non medical and online
exam problems to amc team.
Station 1 Growth and Development : 9 month Old developmental delay recall – all
milestone delayed except I think he smiled at the right time , and but no positive findings of
scissoring or any RFs for CP , PEFE was given which had nothing positive except truncal
hypotonia , I was very confused I didn’t revise the devolpmental delay topic as couldn’t get
time , I eventually said to her , see you don’t have any positive signs for CP or any specific
sign for hypothyroidism, even heal prick was normal , I am a little confused what it is , but
there is one finding for which I am thinking it could be hypothyroidism though you said all
the test were normal , I need to confirm it by doing further investigations to rule out this
and other causes , in other deferentials I said CP only , I somehow was very tired by that
station after 6 .5 hours as it was one of the last stations and Global developmental delay
didn’t come to my mind as the diagnosis ( silly me) which was the right ans , I didn’t even
mention GDD as Differential , but took proper history mentioned proper investigations and
they passed me in this station despite my wrong diagnosis ( they gave me score of 1 in
diagnosis though:P ) but they passed me as predominant assessment area was history and I
had good marks in that

Predominant area History taking

Approach 4

History 5

Dx 1

GS 4 pass

Station 2 – SOB / Examination

you are a HMO at a hospital. Patients history obvious heart failure signs and symptoms are
given in the stem. She has a pacemaker.
Tasks – Explain the procedure and steps of CVS examination to the medical student

Okay it was not that bad actually , there was a medical student , I was on round and had to
teach him CVS examination in the context of HF, I started like how you would actually teach
someone , we need to do HF focused CVS examination, we will go from organized sequence
from hand to arm to head ,neck , chest ,, abd and then legs ,start with general appreaance
any visible pallor cyanosis tachypnea respiratory distress and then start with hands to go up
and then uptil legs I kept explaining like fr HF in hands we look for cyanosis and clubbing in
finger nails , then you check pulse , also check radio radial delay at the same time , when we
move to arm we will check the BP, do you know how to check the BP , he said can you
explain then I theoretically explained the procedure of bP measurement then I said we wil
go to face and look for malar flush and high arched palate , come to neck , in theneck a very
imp finding we need to see is JVP if it is rasied or not ask the patient to turn te neck t his
left and look for raised JV , then listen to carotid bruit , after that we move to chest look for
any visible pulsations any sternotmy scares of any other abnormalities of abdominal wall,,
then in palpation we need to check 3 things , apex beat , para sternal heave and any
palpable murmurs, then I explained the location of apex beat verbally, and location to feel
parasternal heave , then we will go for auscultation , for heart failure most imp murmur is in
mitral area , then explain the location of all four areas verbally and told listen to murmur in
aortic and mitral area importantly , told him the manouveurs to listen to the murmurs
better , I missed persussion, and then I said move to back of chest to listen for basal crackles
and feel for sacral edema then said then we will move to abdomen , said look for ascites
and hepatomegaly , and then l said in the end we will finish with checking for pedal edema ,
then I asked did you get it all , is there any qs , asked couple of times in the middle if I am
going too fast

Predominant assessment area examination

Approach 5

Choice / technique organization / sequence of examination 4

Explanation of procedure 5

GS 4 Pass

Station 3 Pilot – Rash , Pics given similar to the following but less severe. The patient has a
history of bad dandruff and now well controlled with a special shampoo,

Tasks – Explain the pictures to the examiner for 2 mins, do the relevant head and neck
examination (head and neck are mentioned specifically in the question
I just explained this rash and did normal head and examination with focus on lymph nodes
and and to look for other skin conditions . it was like I was speaking to myself since there ws
no video or audio of examiner

Station 4: Neck pain

 Cervical spondylosis - Patient presenting to you with tingling and numbness in the hand and
neck pain. Has a history of breast cancer treated with surgery, axillary clearance and
radiation. (old recall)
Task : History, More Invx, Dx, DDx, Prognosi

It is the old recall which normally comes like history p.e and diagnosis , this time they asked
to do more inv ad prognosis , i made the diagnosis of cervical spondylsis like all the prev
recalls , explained the condition, but then also checked of prev mammogram and screening
in history and for inv said we will do ca, vit d , mri,, dexa if needed and will rule out
recurrence of breast cancer though it is unlikely and it is what we call cervical spondylisis but
it is always best to play safe so we will make sure your cancer is not back bt then reassured
it is highly unlikely and what I think it is then she said thank you I was very worried if my
cancer is back since my friend got her breast cancer back and in prognosis and management
I said physio and good prognosis after physio , differential same as old recall and also said I
will also check with my senior if I need to add any more investigations Pre dominant area :
management / counselling

Approach 5

Dx / DDx 6

Counsellig 5

Mx 5

GS 5 Pass

Station 5 – Behaviourial change

Delirium Greek lady case (old recall) – blood test result given Tasks ; Explain the tests to the
daughter, inv, DDx , counsel daughter
It is old recall of delirium , I did the usual delirium work up including septic screen , there
was no particular cause found in the stem based on labs , and history was not allowed I
think, so I just mentioned possible cause , work up fr delirium as mentioned multiple times
previously in recall and then daughter asked the same qs , which language to speak so I said
if you know greek and she is speaking in greek, then prefer greek , as most imp thing is to
keep her comfortable and in familiar environment and at ths time greek is more familiar to
her
Predominant area “ Mx , counselling
Approach 4
Dx / DDx 5
Counselling 4
GS 4 pass
Station 6: smoker health R/V

Same old recall of osteopenia in smoker with steroids , had to explain dexa scan to patient
and management plan , I failed this station due to my own silly mistake , I said every thing in
management plan , abt steroids , cut down on smoking , life style mx, somehow missed to
say Ca Vit d supplement and bisphosphonate I think which was critical error , patient was
happy to in the end , but it was a very silly mistake on my part

Approach 4

Interpretation of inv 3

Patient counselling 4

Mx 3

GS 3 – Fail

Staion 7 : Apixaban counselling patient – A patient in a hospital with diverticular abscess. A

surgery may be needed, He is now on antibiotics. Tasks : Ask concerns of patient ,explain
the concerns to the patient himself and address the concerns

He is an anxious patient and challenging. Opening statement was ‘the surgeon might be not
knowing what I have and told me about the surgery. I am having Apixaban. And kept on
saying my cardiologist said I cant stop the medicine I am worried about having clots and die
and if you dont stop this and proceed ill bleed to death he is taking it for his AF which is
well controlled now, No other significant history of recent clots or any medical history.
Explained first why surgery could be needed and what would happen if we don’t do it , and
addressed his concern to clot or bleed by saying that we do coag profile to see the bleeding
tendency of your body and it exactly tells us if you can bleed or clot if we stop the medicine
or continue it , if needed we can also do bridging therapy though unlikely needed with
noacs he was still little confused then I said how about if we arrange your meeting with your
cardiologist or with the one on hospital panel and you discuss your concerns with him
before the surgery and he very much liked the idea and then he was happy , didnt talk abt
chads or rft for apixaban
Pre dominant : Mx / counselling

Approach 5

History 5

Mx 6 GS 5 pass
Station 8 : Examination ITP

?ITP. A 27 years old man coming with rashes on the legs . Also there is a history of URTI 10
days ago. Temperature normal. ENT normal. Task is : There is an intern and explain how to
do the relevant examination.
Looks like ITP but the rash was mentioned as blanching in the stem

Same as cvs station, explained the appearance of rash to student and then teach him Rash
examination and then ddx and dx , did the same as prev , explained the rash features, then
said see when you see such kind of rash few differntials come in your mind like itp hsp
leukemia lymphoma , we need to rule out them in our examination , we do organized
approach from hand to up to had neck then abdomen and then leg , then started the
haematological exam , look for this this in nails , check crt, then chk pulse, then on arms
check epitrochlear LN

Then continued to face just follow the hematological exam sequence and keep telling you
should look for this to rule out this , like look for any enlarged LN to rule out malignancy ,
then check ent for any signs if viral inf specially tonsillitis for ebv then on abdomen you look
for hepatomegaly and you continue till legs systematically the normal hematological exam
sequence i am not mentioning each detail and explain what findings you are looking for and
why then in the end i said see my more likely dx is itp because he had history of viral
infection but the rash looks like hsp too , so we definitely need more workup to find out
what exactly it is.

Predominant area examination

Approach 5
Examination accuracy 3
Choice techniques organisation of examination 6
Dx ddx 5

GS 5 Pass

Station 9 unwell patient

I didnt know what to think in those 2 minutes Because that is what it said young unwell
patient comes to you, any how just introduced hi I am one of the doctors here then started
history he told me he feels his nose is blocked , then same history both nostril or one then
ruled out sinusitis foreign body polyp urti lrti asthama he said i just feels my nose is blocked
and i dont feel my self no other complain also said he had h/o asthama in childhood, his
mum had hay fever and his son had cold recently then i also checked for triggers of asthama
none positive non smoker, so in the end i literally said to him oh i have asked you all sort of
qs you are saying no to all of them what else it could be , nd he was smiling and then i said
ohkay what i think is it is allergic rhinitis and since your son was sick recently it might have
triggered it too plus your background of asthama you are prone to catch allergic rhinitis and
he was nodding and then he said what is allergic rhinitis doctor and time was finishing so i
said it is hay fever which your mum had and time finished and he smiled big time and said
great and thumbs up. Didn’t mention Covid or pneumonia in my ddx since he has no fever

Predominant area history Approach 4

Hx ,5
Ddx dx 6
GS 6 pass

Station 10 examination obstetric

So i worked for an year in obstetrics here and i failed it , failed it because i worked in it i
think because i was doing what we used to do practically and not theory, it was the station
which said half of the p.e was done by yr student and based on those findings continue yr
p.e and tell patient what technique and instruments you would use. Took history as per
marwan , Her bp was raised rest abdominal exam was nad so i explained her preclampsia
and told her i will check for reflexes told her what medical hammer is and how would i do it
also told how i will check her tone and clonus and urine dip stick and ruq tenderness and
will check her for edema , what i didnt say was fundoscopy because we didnt use to do it
here in o and g routinely in maternity emergency for preclampsia we infact never did
fundoscopy but i think it was critical error probably also i said i wouldn't do speculum
examination because you dont have any indication for this at the moment she didnt have ,
and we didn't just do speculum in every obstetric patient because it is very painful but i
think in our exam i shd have done it so I didn't do fundoscopy and speculum exam in this
and i failed it. For inv i did urine dipstick plus urine pcr fbe lfts uecs coags
Predominant area examination
Approach 4
History 5
Examination technique organisation sequence 3
Investigation 4
GS 3

Station 11 Health r/v

That was young girl with obesity had to take history ruled out hypothyroid pcos dm stress
then checked for eating habit exercise and genetic, she had sedentary life style watch alot
of you tube less exercise junk mum dad used to eat junk too explained to mum the reasons
and lsm in mx
Predominant area History
Approach4
Hx 4
Ddx 5
GS 5 Pass
Station 12 post surgery delerium

Same handbook scenario of cld and Wernicke's ecnceph told him abt wernicks and cld
causing it and the signs , just followed handbook pattern

Predominant area diagnostic formulation

Approach 7
Interpretation of inv 4
Accuracy of exam 5
Ddx dx 7
GS 6 pass

Station 13
So i failed it too, same old recall of somatization or adjustment , i.took.the history for all
differntials of headache including stress adjustment and also took history of somatization,
she was not fitting.into the criteria of somatization so even i despite knowing that people
diagnosed it as somatization in the past i said adjustment because the criteria for
somatization was not filled anyhow i failed that so look for the feedback from someone who
passed it

Predominant area History

Approach 3
History 4
Mx counselling 3
GS 3

Station 14 pregnancy complication

Same old recall of Iron deficiency anaemia , just followed marwan pattern did iron profile
told her it is iron.defiiciency anaemia but i also said in the end that i am mostly sure that it is
ida but i would stil want to check for hb electrophoresis for thallesemia minor too just on a
safer note

Predominant area diagnostic formulation

Approach 6
Hx 5
Inv 7
Ddx dx 7
GS 6 Pass

Station 15 weight loss

Same old recall of liver mets from marwan , i failed it because of my silly.mistake i said
everything as per marwan did all inv to rule out primary source except for liver biopsy
y i said all the investigations as per marwan except for biopsy of liver silly of me, just
missed it , it was also one of the last stations and i was exhausted and did this error which
was probably critical error

Predominant area Diagnostic formulation

Approach 5
History 4
Investigation 3
GS 3

Station 16 Another pilot

Primary dysmenorrhoea
Dysmenorrhoea - 23 years old patient coming to see you with a pain during period. USG given – there was
a maturing follicle and, 8mm endometrial thickening. (normal for a female of reproductive age) UPT –
negative, pelvic examination findings not given. Tasks : Explain the result, History, Management
She had dysmenorrhoea since ten years no signs/symptoms.of endometriosis , or pid, was
never been sexually active ,nothing positive in history uss has had nothing to do with her
dysmenorrhoea, looks like she had primary dysmenorrhoea

Good luck guys