Table of Contents

December_2020_Canberra.........................................................................................................................8
December - Canberra..............................................................................................................................8
1- Mania..............................................................................................................................................8
2- Dyspareunia- Endometriosis............................................................................................................9
4- Hyperthyroidism............................................................................................................................11
5- Peanut butter allergy.....................................................................................................................12
6- Back Examination..........................................................................................................................15
7- Post op assessment.......................................................................................................................17
8- Endometritis..................................................................................................................................18
10- Pleural effusion............................................................................................................................20
11- Ankle examination.......................................................................................................................21
12- Burn.............................................................................................................................................22
14- cervical radiculopathy..................................................................................................................24
16- MMSE..........................................................................................................................................25
17- Ureteric coli.................................................................................................................................26
19- Type 1 DM pre pregnancy counselling.........................................................................................27
15- Cerebral palsy - Pilot....................................................................................................................28
20- Dizziness -Pilot.............................................................................................................................29
March 2021...............................................................................................................................................30
5th March 2021 – Pilot exam..................................................................................................................30
Tips from 1st candidate.....................................................................................................................30
Tips from 2nd candidate....................................................................................................................31
Tips from 3rd Candidate....................................................................................................................31
Station 1 – Developmental delay.......................................................................................................32
Station 2 – Rash.................................................................................................................................34
Station 3 – Neck pain.........................................................................................................................35
Station 4 – Shortness of breath - CVS examination...........................................................................37
Station 5 – Behavioural change - Delirium Greek lady case (old recall).............................................39
Station 6 – Osteopenia......................................................................................................................40
Station 7 – Apixaban counselling.......................................................................................................41
Station 8 - ?ITP...................................................................................................................................43
Station 9 – Unwell patient / Allergic rhinitis......................................................................................45
Station 10 – Obstetric examination/Pre-eclampsia...........................................................................47
Station 11 – Obesity with asthma (old recall)....................................................................................48
Station 12 - Another delirium case....................................................................................................49
Station 13 – Headache/Somatization................................................................................................50
Station 14 – WEIGHT LOSS................................................................................................................51
 Station 15 – Dysmenorrhoea - Pilot...................................................................................................51
Station 16 – Anaemia in pregnancy...................................................................................................52
12th March 2021 – Pilot exam................................................................................................................53
Station 1: Mastitis..............................................................................................................................53
Station 2: GAD:..................................................................................................................................53
Station 3: Postpartum psychosis........................................................................................................54
Station 4: Neonatal examination, explain to the students.................................................................54
Station 5: Somatization......................................................................................................................54
Station 6: Abdominal pain in mid cycle..............................................................................................54
Station 7: PTSD..................................................................................................................................54
Station 8: Pneumothorax...................................................................................................................54
Station 9: Respiratory PE in Adult......................................................................................................54
Station10: Respiratory PE in child......................................................................................................54
Station 11: Scarlet fever....................................................................................................................54
Station 12: Alcohol cessation counselling..........................................................................................54
Station 13: Prolonged QT syndrome..................................................................................................54
Station 14: HRT..................................................................................................................................54
16th March 2021.....................................................................................................................................54
Tips from 1st Candidate:.....................................................................................................................54
Tips from 2nd Candidate.....................................................................................................................55
Station 1: Breast lump PE..................................................................................................................56
Station 2: Rubella in pregnancy.........................................................................................................58
Station 4: HTN – noncompliance to medication................................................................................60
Station 5: Mood change – MDD with psychosis.................................................................................62
Station 6: Abdominal pain.................................................................................................................64
Station 7: GAD...................................................................................................................................65
Station 9: Difficulty breathing............................................................................................................66
Station 10: Groin pain – testicular torsion.........................................................................................68
Station 11: Shortness of breath – CVS PE..........................................................................................69
Station 12: Pallor...............................................................................................................................71
Station 14: Funny turn.......................................................................................................................73
Station 15: Headache.........................................................................................................................75
Station 16: Rash - PE..........................................................................................................................76
Station 17: Pilot – Eye swelling - PE...................................................................................................77
Station 19: Placenta previa................................................................................................................78
Station 20: Pilot – Sleep problem......................................................................................................80
17th March 2021.....................................................................................................................................81
Tips from Candidate:.........................................................................................................................81
Station 1: Thyroid PE......................................................................................................................82
 Station 2: Pre-eclampsia................................................................................................................82
Station 3: Haematological PE.............................................................................................................83
Station 4: Respiratory PE...............................................................................................................83
Station 5: Adenoid – Paediatrics........................................................................................................83
Station 6: Pneumonia........................................................................................................................83
Station 7: ANC visit............................................................................................................................84
Station 8: OCP Request..................................................................................................................84
Station 9: Thirsty guy – Diabetes Insipidus Drinking too much water – Pilot.........................84
Station 10: Obstructive jaundice........................................................................................................85
Station 11: Warfarin Pre-op..........................................................................................................85
Station 12: Autism Spectrum........................................................................................................86
Station 13: Temazepam.....................................................................................................................86
Station 14: Serotonin Syndrome...................................................................................................87
Station 15: Knee pain – ACL Tear.......................................................................................................87
April 2021 Recalls...................................................................................................................................87
6th April 2021.........................................................................................................................................87
Tips from the candidate.....................................................................................................................87
Station 1: Forearm cut - PE................................................................................................................88
Station 2: Acute Knee injury..............................................................................................................88
Station 3: REST...................................................................................................................................89
Station 4: Hernia & undescended testes counselling.........................................................................89
Station 5: Distressed parent..............................................................................................................90
Station 6: Shaky movements of hand...............................................................................................91
Station 7: Anemia in Pregnancy.........................................................................................................91
Station 8: REST...................................................................................................................................92
Station 9: Ankle exam........................................................................................................................92
Station 10: Non-compliance to anti-hypertensive.............................................................................92
Station 11: Global Developmental Delay...........................................................................................94
Station 12: Smoking cessation...........................................................................................................95
Station 13: REST.................................................................................................................................96
Station 14: SOB.................................................................................................................................96
Station 15: Eye examination..............................................................................................................98
Station 16: Mood change in nurse.....................................................................................................99
Station 17: Neurological exam.........................................................................................................100
Station 18: REST...............................................................................................................................100
Station 19: Headache.......................................................................................................................101
Station 20: 1st ANC with Home pregnancy test +ve.........................................................................102
7th April 2021.......................................................................................................................................104
Tips from 1st Candidate:...................................................................................................................104
 Tips from 2nd Candidate...................................................................................................................106
Tips from 3rd Candidate....................................................................................................................106
Station 1: Hay fever.........................................................................................................................108
Station 2: Depression.......................................................................................................................110
Station 3: REST.................................................................................................................................112
Station 4: OCP Counselling..............................................................................................................112
Station 5: Heroin Counselling..........................................................................................................115
Station 6: NAI...................................................................................................................................119
Station 7: Mania - Pilot....................................................................................................................122
Station 8: REST.................................................................................................................................124
Station 9: Foot pain.........................................................................................................................124
Station 10: Unsteady gait - PE..........................................................................................................127
Station 11: Abdominal pain.............................................................................................................130
Station 12: Anaemia in pregnancy...................................................................................................132
Station 13: REST...............................................................................................................................136
Station 14: Migraine........................................................................................................................136
Station 15: Compartment syndrome...............................................................................................139
Station 16: Encopresis.....................................................................................................................142
Station 17: STI..................................................................................................................................145
Station 18: REST...............................................................................................................................147
Station 19: Abdominal pain - PE......................................................................................................147
Station 20: HSP – PE - Pilot..............................................................................................................151
13th April 2021.....................................................................................................................................154
Case 1. Breast PE.............................................................................................................................154
Case 2. DKA......................................................................................................................................154
Case 3. Mechanical back pain..........................................................................................................154
Case 4. Rash case in a mentally retarded patient............................................................................155
Case 5. Respiratory PE.....................................................................................................................155
Case 6. Placenta Previa....................................................................................................................155
Case 7. Anxiousness........................................................................................................................155
Case 8. Young woman getting more irritable and outburst.............................................................155
Case 9. Infantile colic / irritable Baby..............................................................................................155
Case 10. 52 years with painful urination..........................................................................................155
Case 11. Pneumothorax PE..............................................................................................................155
Case 12. 18 months old with diarrhoea for 3 weeks........................................................................155
Case 13. lady with hot flushes and irregular periods.......................................................................155
Case 14. 42 vaginal bleeding for 3 months......................................................................................155
Case 15. Headache 9 year old..........................................................................................................155
Case 16. Overdose case of MDMA / alprazolam..............................................................................156
14th April 2021.....................................................................................................................................156
Case 1. SOB & chest pain.................................................................................................................156
Case 2. Tingling & numbness...........................................................................................................156
Case 3. Fever and difficulty breathing..............................................................................................156
Case 4. Behaviour change - MSE......................................................................................................156
Case 5. Behaviour change................................................................................................................156
Case 6. PVD PE.................................................................................................................................157
Case 7. Vasovagal syncope..............................................................................................................157
Case 8. Dysmenorrhea.....................................................................................................................157
Case 9. Cervical spondylosis with radiculopathy..............................................................................157
Case 10. Chlamydia counselling......................................................................................................157
Case 11. Itchy vulva.........................................................................................................................157
Case 12. BCC....................................................................................................................................157
Case 13. Anaemia in pregnancy.......................................................................................................157
Case 14. Antibiotic-induced diarrhea...............................................................................................157
Case 15. Flank pain..........................................................................................................................157
Case 16. SOB....................................................................................................................................158
20th April 2021.....................................................................................................................................158
Case 1: Placenta previa....................................................................................................................158
Case 2: Funny turn...........................................................................................................................158
Case 3: Vomiting & diarrhea............................................................................................................158
Case 4: ITP.......................................................................................................................................158
Case 5: Thyroid examination...........................................................................................................158
Case 6: Obstetric exam....................................................................................................................158
Case 7: Paedi CVS exam...................................................................................................................158
Case 8: SOB......................................................................................................................................158
Case 9: Blocked & runny nose.........................................................................................................158
Case 10. Change in behaviour..........................................................................................................158
Case 11: BCC counselling.................................................................................................................159
Case 12: Chest pain & breathing difficulty.......................................................................................159
Case 13: Recurrent abdominal pain.................................................................................................159
Case 14: HRT for 6 years..................................................................................................................159
Case 15: Knee pain...........................................................................................................................159
21st April 21..........................................................................................................................................159
Case 1. Headache in paeds patient..................................................................................................159
Case 2. Schizophrenia patient defaulted meds, now says god is talking to him..............................159
Case 3. Resolved acute abdominal pain...........................................................................................159
Case 4. Rhinitis in child for 12 mths.................................................................................................159
Case 5. IDA with SOB.......................................................................................................................159
 Case 6. CVS PE explain to med student............................................................................................159
Case 7. Bulimia nervosa- dental caries............................................................................................159
Case 8. HRT counselling...................................................................................................................159
Case 9. Excessive thirst....................................................................................................................159
Case 10. Foot and ankle PE..............................................................................................................159
Case 11. Rash PE..............................................................................................................................159
Case 12. Shoulder dislocation..........................................................................................................159
Case 13. ANC in 42-year-old............................................................................................................160
Case 14. Asthma recurring...............................................................................................................160
Case 15. Prostate ca counselling......................................................................................................160
Case 16. STEMI................................................................................................................................160
27th April 21.........................................................................................................................................160
1) down syndrome (adjustment disorder).......................................................................................160
2) IBS with gastroenteritis not sure.................................................................................................160
3) SCC...............................................................................................................................................160
4) Rash PE........................................................................................................................................160
5) Acute abdomen PE......................................................................................................................160
6) UTI male......................................................................................................................................160
7) Temporal arteritis........................................................................................................................160
8) vaginal bleeding...........................................................................................................................160
9) Delirium-......................................................................................................................................160
10) ankle pain- don’t no...................................................................................................................160
11) ANC counselling with alcohol counselling..................................................................................160
12) Red eye PE.................................................................................................................................160
13) Infantile colic-............................................................................................................................160
28th April 21.........................................................................................................................................160
Case 1: Lady with Headache............................................................................................................160
Case 2: Anaemia..............................................................................................................................161
Case 3: Hypertension in 42 year old................................................................................................161
Case 4: Spirometry...........................................................................................................................161
Case 5: Pre-eclampsia......................................................................................................................162
Case 6: TIA.......................................................................................................................................162
Case 7: Post-Op Delirium.................................................................................................................162
Case 8: Fever & cough.....................................................................................................................163
Case 9: Hip replacement counselling...............................................................................................163
Case 10. Rash...................................................................................................................................163
Case 11: Syncope.............................................................................................................................164
Case 12: Depression........................................................................................................................165
Case 13. Lethargy.............................................................................................................................165
 Case 14: Leg pain.............................................................................................................................165
Case 15: Influenza vaccination.........................................................................................................166
Case 16: OCP Counselling................................................................................................................166
May 2021 Recalls.....................................................................................................................................166
4th May 2021........................................................................................................................................166
5th May 2021........................................................................................................................................167

December_2020_Canberra
December - Canberra
1- Mania
Mania - typical uni student case - history, diagnosis and immediate management
Pass- PREDOMINANT ASSESSMENT AREA -
MANAGEMENT/COUNSELLING/EDUCATION Approach to patient/relative 5, History 3,
Diagnosis/ Differential diagnoses 5, Management plan 3
History: The patient was fidgeting and kinda restless. I greeted the patient and asked
how i could help her. She said that she is here because the university counsellor asked
her and she didn't wanted to come. She said that she knew everything better than
others and she feels that others are jealous about it. I appreciated her coming to me
even though she felt fine. Confidentiality statement
It was given in the stem that she had increased sexual encounters. About the mood she
said she feels really good. She didn't feel that her mood was low at any time. Regarding
sleep she said that she didn't have the need to sleep. Appetite was good
Does not hear, see or feel things that others don’t. Don’t think people are trying to harm
her or spying on her. Don’t think peoples actions are directed towards her
HEADS- Apart from feeling that others are jealous of her knowledge, no other stress in
uni. Not employed. living in hostel with some people. Living away from family
SADMA- nothing significant, no history of drug use
No personal and family history of psychiatric illnesses.
No past medical and surgical history
No history of head injury, fever or weather preference.
Diagnosis: From the history most likely you are having a condition called Mania. That is
when your mood is very high and you don’t have the need to sleep. And the patient
asked me whether there was something wrong about feeling good. I said that it was
good to feel good about herself but i thought her mood was a little bit too high and that i
was a bit concerned that she was not sleeping well. I reassured her that i was there to
help her and i would like to admit her to the hospital to be seen by the specialist. I asked
her if it was okay. She said if you say so. I said that during admission we will run some
routine blood tests, drug testing.. At this point the patient was like “I told you that i don’t
use any drugs”. i don’t remember what i said in reply exactly.
Anyways i told her that the specialist might start her on some medications as well. and if
it was okay with her i would like to talk to the family as well.
She asked me whether the admission was absolutely necessary. I told her that i was a
bit concerned about her and want to make sure that everything was okay and thats the
reason why i wanted to admit her. I asked whether she was happy with the plan. She
said yes.
i forgot to ask whether she had thoughts of harming herself or others, forgot to check
judgement and cognition as well. Although i didn’t directly ask about insight it was
obvious from the answers that the patient gave that her insight was impaired. I also
forgot to do STI screening which was important since the patient had history of
promiscuous sexual activity. Forgot to do other investigations to rule out other organic
diseases. This can be reflected from the marks that i have got. I didn’t think i would pass
this case, the only thing that might have helped me to pass is most likely the way i
talked with the patient. I was empathetic with the patient and tried to talk to her in a non
threatening way. I maintained eye contact with her and nodded along as she spoke and
i showed that i was interested in what she was saying.

2- Dyspareunia- Endometriosis
young female in her 20’s presenting with painful intercourse.
Task was to take history, PEFE, diagnosis and differentials
Pass- PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION,
Approach to patient/relative 6, History 6, Choice & Technique of examination,
organization and sequence 7, Diagnosis/ Differential diagnoses 5
History: I greeted the patient and asked how i could help her. She said that she is
having severe pain during sexual intercourse. I said sorry that she was going through
that and that i knew she must be very concerned about it. I also appreciated her coming
to me to get herself checked and wanted to ask more questions to know what was really
going on.
I asked whether the pain was present during superficial penetration or deep
penetration? she said that it was on deep penetration.
5P’s
Period: regular, normal flow and duration. LMP? 3weeks back. Severe pain during
periods. Pain starts 1-2 days before the periods and persists throughout the period. No
bleeding or pain in between period
Partner: in a stable relationship, no history of STI, practicing safe sex
Pills: Don’t remember.
Cervical screening: haven’t started yet
Pregnancy: nil
Have received gardasil vaccination
No history of any pain during micturation or passing bowel motion
No history of tummy pain, fever, discharge from down below.
SADMA- nothing significant. No past medical or surgical history. Not on any regular
medication
PEFE
General appearance- PICCLED negative
Vitals- normal
Abdomen- soft and non tender, no masses palpable
Pelvic examination- on inspection: no discharge, rash, bleeding.
Speculum- no discharge, rash, bleeding or dry atrophic vagina. Cervix looks healthy.
P/V- uterine size and position normal. mobile and non tender. No CMT. No adnexal
mass and tenderness. Tenderness in pouch of Douglas. Asked whether there was any
nodularity and the examiner said No.
Don’t remember whether i asked for DRE findings
Office tests: UDT and UPT. nothing significant
Diagnosis: From the history and examination most likely you are having a condition
called as endometritis (instead of endometriosis :P). I drew a diagram of the uterus and
showed the lining of uterus and explained her that when this lining is present anywhere
else other than the womb is it called as endometritis (again said that. i guess the
examiner understood what i was explaining.) I told that this lining might be present on
the uterus and in the tummy as well while showing it on the diagram. I told her that it
could also be due to PID and STI. Explanation in one line and why it was unlikely.
Couldn’t tell anymore DDs.

4- Hyperthyroidism
47 year old female Patient feeling anxious since last 1 month. Task was to take history,
Dx and DDx
Pass- PREDOMINANT ASSESSMENT AREA - HISTORY TAKING ,Approach to
patient/relative 5, History 5, Diagnosis/ Differential diagnoses 5
History: I greeted the patient and asked how i could help her. She said that she was
feeling anxious and irritable. I said sorry that she was going through that and I
appreciated her coming to me to get herself checked and I wanted to ask few more
questions to know what was really going on.
She said that she was feeling like that all the time and that there was no specific
situation or time of the day when it is worse. I asked whether it was getting worse and
she replied No. This was the first time. She had no weather preference. When asked
about bowel motion she said that she has to pass motion very frequently and it was
loose. No dark stools, No tummy pain or Fever. History of increased sweating and
shakiness in hand. No history of any lumps in the neck
No history of funny racing of heart, SOB, chest pain. No history of feeling dizzy or
bleeding from anywhere
No history of LOA, LOW or lumps and bumps
When asked about mood she said that she is irritable and she gets angry easily.
Difficulty getting to sleep. No history of nightmares and flashbacks. Decreased
concentration present.
She is working in an office and finds it a bit stressful. Other than that no other stresses
in life. Doesn't worry about any trivial things in life.
LMP: few days back. Her periods were irregular. No history of hot flushes but feels
irritable.
SADMA: alcohol drinking above the safe level as far as i remember.
No past medical or surgical history
Diagnosis and differentials: From the history most likely you have a condition called
hyperthyroidism. Have you ever heard of this condition? I drew a diagram of thyroid and
explained that it is a gland in the neck and when it over produces a hormone it leads to
feeling anxious, increased sweating and increased bowel motions. Most likely this is the
reason for your symptoms. It could also be due to various other reasons such as GAD,
but you don’t worry about trivial things in life. It could also be due to a heart problem, but
you don't have any funny racing of heart or breathlessness. It could be due to
menopause, but although you are in the age you are still getting your periods so its
unlikely. It could also be due to anemia which is when there is a decreased level of iron
rich protein in the blood. it could also be due to pheochromocytoma which is a tumor in
the gland which sits on top of the kidney. I did check the patients understanding in
between and told her that we will do further investigations to come to a definitive
diagnosis and that i would take good care of her.

5- Peanut butter allergy

2 years old with rash and facial swelling (around eyes and lips) brought by father. The
swelling has decreased but the rash is still present. Task was to take History, PEFE ,
Diagnosis/differentials and Management
Pass- PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION,
Approach to patient/relative 3, History 4, Choice & Technique of examination,
organisation and sequence 4, Diagnosis/ Differential diagnoses 4, Management 5

History: I entered the room and greeted the father and introduced myself. I told him that
i knew he must be very concerned about his boy and that he is in very safe hands. I
really didn't give any time for the father to speak before turning to the examiner to ask
vitals. I could see from his face that he wanted to say something and yet i wanted to
check the vitals first. Maybe thats why the marks for the approach was low. Anyways
vitals were like PR increased, O2 sat 97% , RR was 30/mint and temperature was
normal (had to ask vitals separately one by one from the examiner) Since the RR was
high, with high PR i said i would hook the patient to a monitor and start oxygen which i
didn't need to, i guess.
I turned to the father and said that we will take good care of his son and to please tell
me how it happened. He said that the boy suddenly developed an itchy rash and
swelling on his face. I asked him what he was doing at that time and he said the boy
was having breakfast. I asked him what he was having for breakfast. He said that it was
his usual breakfast cereal and he also had a bite from his sisters sandwich. I asked
what type of sandwich it was and he said it was a peanut butter sandwich. I asked
whether this was the first time he had peanut butter and the first time he had such an
episode and the father said yes. The boy did not have any noisy or fast breathing. No
history of tummy pain, vomiting or diarrhea. No history of fever. No history of loss of
consciousness. No history of changing shower gels or lotions. I forgot to ask about the
rash in detail.
The general health of the baby was normal. He did not have any recent viral infection.
BINDSMA- nothing significant. No personal history of eczema or asthma. Family history
of allergic conditions positive. Sister and father had history of eczema. Happy family.
PEFE- GA : the examiner gave a picture of a kid with a rash on the cheeks with some
swelling of lips. No swelling around eyes. i asked whether there was any rash anywhere
else in the body and examiner said No. No pallor, icterus , dehydration,
Lymphadenopathy. Forgot to check for bruises
Vitals: same
Forgot to ask growth charts and ENT
Chest: B/L Air entry equal, clear. No added sounds
CVS:S1S2 + and no added sounds
Abdomen: soft and non tender
Office test: not available
Diagnosis and differential:
From the history and examination most likely X must have had an allergic reaction to
peanut butter. Since he has never had peanut butter in the past and peanut butter is
one of the very common allergen, this is the most likely diagnosis. And since he has a
family history of allergic conditions its very likely that this condition could run in the
family. But this is not a severe allergic reaction called anaphylaxis reaction where the
child tends to have severe breathing difficulty, tummy pain with vomiting and diarrhea.
For now i will admit him for some time for observation and he will be started on
antihistamine which will help in reducing the itching. I will also give a cream to apply
over the rash. In the future please don't give him any peanut containing food. Please
read the ingredients before giving him any new food. If any time he develops breathing
difficulty, noisy breathing, tummy pain, vomiting etc please bring him immediately to the
ED. I will also refer him to the specialist for allergy testing. Briefly told about the epipen
in case a severe allergic reaction develops.

other Feedbacks:
I started off by saying I am really sorry for all this that happened to your son, but now
that I am here, I will try my best to find out why it happened to him. Is it okay if I ask few
questions from the examiner= he said that’s fine Asked examiner about the vitals= he
said what do you wanna know, asked him all the vitals and only PR was 130 and rest
were normal I think. Started with hx: how did it happen? Can you explain the whole
incident to me= we were on the breakfast table and I think he took one bite from his
sister’s sandwich and his lips got swollen and he started having this itchy rash. Has it
ever happened before = he said no this is for the first time. Were there any eggs or
peanuts in the sandwich= yes there was peanut butter. did he have any sob or swelling
of the tongue or any noisy breathing from his chest? Any nausea, vomiting or tummy
pain= so it was a no to all the anaphylaxis symptoms. Did he lose his consciousness=
no does he have any rash elsewhere in the body like his hands or feet= no have you
recently changed any shower gels or soaps for him= no has he come in contact with
someone with similar complaints= no about the rash, does he have any discharge or
bleeding from the rash= no just itching could it be an insect bite= no any family history of
allergies or any chronic conditions like hay fever, eczema asthma= mum has hay fever,
sister has eczema and allergy to eggs I think, and father has asthma any pets or carpets
at home= no does anyone smoke at home= no WELL BABY Qs: all normal BINDS:
normal as well and they are a happy family, no contact and UpToDate with
immunizations. PEFE: vitals still the same GA: itching continuously, the swelling of the
lips has gotten better, but rash is still there, no stigma of non-accidental injury, no
bruises or rashes else where in the body, no lymphadenopathy or pallor or signs of
dehydration growth charts were normal ENT: examination normal respiratory: no signs
of respiratory distress, no wheezes or noisy breathing. abdominal examination: normal
offices tests: Not available Diagnosis: allergic reaction to peanuts, it can happen in
someone who has strong family history of allergies, but the good things in his case is he
didn’t get any severe allergic reaction like anaphylaxis and u brought him just on time.
The other unlikely causes could be eczema just like your daughter, contact dermatitis,
viral infection but no contact history, some other infections by bugs or an insect bite.
Management: what we will do is now we will give him some antihistamines for the itchy
rash that she has and will refer to specialist to get the allergy test done but after 6
weeks as there is a chance of false negative cuz of the medications, am I making
sense= he said yes doctor all clear. for the future, make sure to read all the ingredients
at the back before giving him any new food and keep an eye on these symptoms like
difficulty talking, or sob, LOC, if any of these develops, please bring him back to us
immediately or call 000
PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION STATION 16
Approach to patient/relative 6 History 6 Choice & Technique of examination,
organisation and sequence 6 Diagnosis/ Differential diagnoses 7 Management plan 6

Another Feedback - facial swelling and rash Father of young boy, I think 3 or 4 years
old.
About 2 hours before presentation, he suddenly developed a rash on his face, along
with swelling of his lips. I asked him what the boy was doing when this happened, and
he casually replied that they were having breakfast. I asked him about the breakfast,
and the role player was so sneaky, he just said the boy was eating his usual cereal. I
asked him if he was sure that the boy hadn't had anything new or unsusal to eat, and
then he told me he had a bite out of his older sister's PB&J sandwich. I told him the
peanut butter was the most likely culprit. Asked about any breathing difficulty (absent).
Brief past medical, surgical history, bindsma, well baby questions. Family history (father
had egg allergy as a child) Pefe: urticaria rash on face, angioedema of lips, heart rate
130, otherwise he was all well. Explained that he had most probably had an allergic
reaction. Explained the whole mechanism of histamine release, leaky blood vessels etc,
and that it was common in children, especially those with a family history of allergies. In
most instances, it is not serious, but it can sometimes lead to anaphylaxis which can be
life threatening. He's stable at the moment so no need to worry. Other possibilities could
be due to insect bite, new shampoo/soap/detergent, contact dermatitis, but we have a
very clear winner with the peanut here. Immediate management: I said I would like to
retain him for observation. Give short course of steroids for 3-5 days, antihistamines to
prevent rash from worsening (but also told that the rash that has already appeared won't
disappear with the antihistamines. Iv fluids. I didn't say adrenaline since he had no
respiratory distress, and was also tachycardic, but later this decision kept haunting me
􀐪 Further management: once stable, will discharge him home. Avoid eggs, nuts, shell
fish for the time being due to Allergic reaction. Should always carry an epi-pen, and will
teach him how and when to use it. Will refer to immunologist for RAST or skin testing.
Avoid foods which you know he's had a reaction to in the past

6- Back Examination
Back pain after lifting something heavy. pain was radiating to the buttocks. Sensory
examination was done and normal. Task was to do physical examination, Dx and DDx
Pass- PREDOMINANT ASSESSMENT AREA - EXAMINATION, Approach to
patient/relative 6, Choice & Technique of examination, organisation and sequence 6,
Accuracy of Examination 6, Diagnosis/ Differential diagnoses 6,
Examination: I went in and introduced and greeted the patient. It was a middle aged
male wearing a hospital gown. Washed my hand and I started off by saying I was sorry
that he was having this pain and in order to know what was really happening to him i
would like to examine him. He said ok. I asked him whether he was in pain at the
moment and whether he wanted a painkiller. i think he said he has already received a
painkiller. I explained to the patient that my examination would involve checking his gait,
having a look at his back, touching his back and asking him to do some movements and
doing some special tests. While i was saying this the patient took off the gown on his
own. Anyways i started with checking the gait. He was able to walk but seemed to be in
a little bit of pain. I said sorry and asked whether he could walk on his heels and toes .
He was able to do it as well. While he was standing i did the inspection of the back.
There was no swelling, skin changes, scar marks, deformity, muscle wasting and
normal lumbar lordosis. Started palpation by checking the temperature, then checked
for tenderness. There was tenderness at around L4, L5, S1 region. Gave a running
commentary to the examiner with findings while doing the examination. Apologized
every time the patient had pain. checked for any paraspinal muscle tenderness. After
that checked for the movements by asking the patient to do flexion, extension, left and
right lateral flexion. Patient had pain on flexion and right lateral flexion. Before asking
the patient to sit to check for the left and right rotation, i said that i will do the schober
test while he was standing. The examiner said that there was limited flexion due to pain.
After that i asked the patient to sit and checked for left and right lateral rotation. Patient
was able to do this without any pain. I did the SLR test which was positive at around
30 degree on the right side. When i asked the patient to raise the left leg the examiner
said it was normal. When i started to check the Power from the hip, examiner said to
do on the ankle. So i checked the power of ankle dorsiflexion, plantar flexion,
eversion and inversion which was normal. when i went to get the hammer to check
the reflex there were all equipments needed for sensory examination ( tooth pick, tuning
fork, cotton etc) kept in the same tray which made me a bit confused. Anyways i
focused only on the motor examination since the stem clearly mentioned that the
sensory examination has already been done and its normal. Checked the ankle reflex
which was normal. At this point the examiner asked me to talk to my patient. I said that
i would like to complete my examination by doing a full neurological examination of the
lower limb and examining one joint above and below.
Diagnosis and Differentials: I told the patient from the examination most likely he was
having a condition called mechanical back pain. Because of lifting a heavy object
suddenly might have lead to the spasm of the muscles around the spine causing the
pain. He nodded. It can also be due to a condition called sciatica. We have some discs
in between our spine bones and when these discs slips out it can cause compression on
the nerves which comes out in between the bones and may lead to similar pain. But
since the power in your legs and sensation is normal, it is unlikely. it could also be due
to a fracture of spine bones, but unlikely from examination. It might also be due to
trauma to the back, but you don't have any history of direct injury. It might also be due to
osteoarthritis and rheumatoid arthritis but unlikely since this pain started today after
lifting the heavy object and you didn't have any pain before.

7- Post op assessment
Male patient (dont remember the age) 48 hours ago who has undergone
cholecystectomy (lap which was converted to open). Specialist has advised him to stay
in hospital till 72hours but the patient wishes to be discharged today. The patients was
on antibiotics. Task was to take history, PEFE and counsel the patient
Fail- PREDOMINANT ASSESSMENT AREA -
MANAGEMENT/COUNSELLING/EDUCATION Approach to patient/relative 3, History 4,
Choice & Technique of examination, organisation and sequence 6, Patient Counselling/
Education 3
History: I entered the room and greeted the patient. It was a male patient wearing a
hospital gown, lying down on the bed. I asked how he was feeling. He said that he was
fine. i asked whether he was in any pain. He said that he has some pain at the operation
site but other than that he was fine. I asked why he wanted to get discharged today and
he said that he has to take care of his mom who lives with him. i said that i would like to
ask few more questions.
There was no cough, breathing difficulty, chest pain, fever. No history of any discharge
from the wound. Micturition was normal. Passed bowel motion after surgery and was
normal. Have been mobilized after surgery. No history of pain in IV cannula site and calf
pain.
No past medical or surgical history. SADMA- nothing significant
PEFE:
GA, PICCLED- Normal
Vitals: examiner asked to check the bedside chart. vital chart was given with everything
normal. temperature was 36 point something. PR was normal.Oxygen saturation also
normal. BP i thought was normal as well. But other candidates who did the examination
said that it was 140/85 mmHg which i must have missed.
Chest clear, CVS normal
Abdomen: on inspection: no distention of abdomen, dilated veins, no discharge or signs
of infection at the operation site
palpation: all normal except slight tenderness at the operation site. No guarding, rigidity
Auscultation: Bowel sounds normal
I asked whether there were any drains attached and examiner said No. No catheter as
well.
No calf tenderness or swelling
office test: BSL normal. UDT showed RBC+ and leucocyte in traces.
i thanked the examiner and turned to the patient.
Counseling/ Education: I said that i have examined him and everything seems to be
normal except for the UDT. The urine test shows few leucocyte which is a type of cell
responsible for fighting against infection. So it might be possible that he might be having
a urine infection. The urine also shows some blood cells as well and it might be due to
catheterization for the surgery or maybe because of an infection as well. Therefore i
would like to do a urine microscopy and culture test to just make sure everything was
ok. I checked whether the patient understood what i was saying. I also mentioned that i
would like to arrange a social worker to take care of his mom until he gets better and
gets discharged. I said that even if he gets discharged now, it would be best to take
some rest since he underwent a surgery. I also offered to talk with the specialist
regarding the patients situation and see whether he could be discharged sooner. I
asked him whether he was happy with the plan and he said yes

8- Endometritis
Young female 10 days post partum presenting with bleeding from down below. This is
her second baby. She is also feeling flushed. Task was to take focused history, do
abdominal examination, Dx and DDX
Pass- PREDOMINANT ASSESSMENT AREA - EXAMINATION, Approach to
patient/relative 6, History 5, Choice & Technique of examination , organisation and
sequence 5, Accuracy of Examination 5, Diagnosis/ Differential diagnoses 5
History: I entered the room, greeted the patient and asked how i could help her. She
said that she is having increased bleeding from down below and she has delivered her
second baby 10 days ago. I appreciated her coming to me to get herself checked and
told that i would like to check her vitals. she nodded. I asked the vitals from the
examiner. i think PR was 100, temperature 38 and others were normal. I thanked the
examiner.
I turned to the patient and reassured her that she was in safe hands and that i wanted
to ask a few more questions to know what was really going on.
Bleeding: i think she changed 3 pads so far that day, there were some clots, not foul
smelling, bright red, no dizziness or tiredness. No history of bleeding from any other
site. No history of any bleeding disorders, does not bruise easily, does not take any
blood thinning medications.
delivery: it was a NVD, no complications, no instruments used, baby was fine
Lower abdominal pain present, 4-5 in severity, non radiating. When asked whether she
had fever she said that she feels flushed since today. No Bladder and bowel complaints.
I asked how the baby was doing and she said that the baby was fine. I asked her
whether she was coping well and whether she had good support. she said yes. She said
that she was breast feeding the baby and the breast felt sore at times but no crack
nipples or anything like that.
No significant past history.
Examination: I told the patient that i would like to examine her in order to know what
was really going on and my examination will involve doing a tummy and pelvic
examination. Told about the chaperon as well. Asked her whether it was ok and she
agreed. I asked her to lie down on the bed while i washed my hand.
I started with hand while giving a running commentary. Looked for any pale nail bed and
checked CRT which was normal. Checked the skin turgor which was normal as well.
When checking the pulse the examiner said normal. Then went to face and checked for
pallor and jaundice in eye. Asked the patient to show her tongue to see for any dry
mucous membrane which was normal. Chest, CVS and breast examiner said normal.
For abdomen i asked the patient to expose her abdomen and show with one finger
where exactly she had pain. she pointed towards the lower abdomen. Therefore i
started superficial palpation from the upper abdomen and looked at the patients face to
see for any tenderness. Patient had slight tenderness on lower abdomen. After finishing
superficial palpation examiner read the findings for the superficial palpation. I did deep
palpation and after finishing the examiner read out the finding as well. On deep
palpation there was a mass in the lower abdomen and you cannot palpate the lower
border. i said that since the patient had pain i would like to skip percussion. When i tried
to check the bowel sound the examiner said it was normal. Then i said i would like to do
the pelvic examination. Examiner asked me what i wanted to know.
On inspection: there was some bleeding from vagina, episiotomy wound healing
speculum: no tears or lacerations in vagina or cervix. bleeding coming from cervix and
OS slightly open
Bi manual: uterus is enlarged and tender. No CMT or adnexal mass and tenderness.
Office test: i think it was not available. Thanked the examiner and asked the patient to
come and sit at the table.
Diagnosis and Differential: Drew a diagram and explained that most likely from the
history and examination you are having a condition called as endometritis. Have you
ever heard of the condition?
It is the infection of the lining of the womb which is a common complication after
delivery. It could also be due to retained products of conception when there is tissues
remaining in the womb after delivery. It could also be due to any injury to the birth canal
during delivery but i could not find any cuts. Could not say any more diagnosis as the
bell rang

10- Pleural effusion

Middle aged male patient presenting with breathing difficulty. Task was to take history,
PEFE, diagnosis and differentials
Pass- PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION,
Approach to patient/relative 5, History 4, Choice & Technique of examination ,
organisation and sequence 4, Diagnosis/ Differential diagnoses 5

History: I entered the room, greeted the patient and asked how i could help him. He
said that he has been having this breathing difficulty for past few months. I asked
whether he was breathless at the moment and he said No. He said that the
breathlessness is present on exertion, started gradually and is getting worse. Before he
use to get breathless only when going up hill but now gets it when walking on flat areas
as well. When asked whether he gets up at night with breathlessness he said he feel
breathless when he lies down and he has increased the number of pillows he used to lie
down on. I think there was history of on and off dry cough as well. He doesn't have any
chest pain, palpitation, fever, LOA, LOW, lumps and bumps in the body. No swelling of
legs or any part of the body. Bowel and bladder habits normal. No history of trauma to
chest, No history of travel. SADMA- chronic smoker. He works in an office. No history of
bleeding from anywhere
PEFE
GA- PICCLED: negative
Vitals- don’t remember. Nothing alarming though
Respiratory
Palpation: decreased expansion on left side, trachea central
Percussion: Dullness on lower left side
Auscultation: Absent breath sounds on left lower zone, no added sounds
CVS: S1S2 audible, no added sounds, JVP normal
Abdomen: Soft, non tender, no organomegaly
Office tests: not available
Diagnosis and Differentials: From history and examination most likely you are having
a condition called pleural effusion. Have you heard of it?
Drew a diagram and explained that it is the accumulation of fluid between 2 membranes
surrounding the lung. As there were some dullness and absent breath sound in the
lower zone of the left lung. It might be due to several reasons like any heart problem,
kidney problem and if there was a tumor in the lung as you have a long history of
smoking. At this point i can’t say this for sure, but we need to do further tests. There
could be other reasons for the breathlessness as well. It could be due to a condition
called Chronic Obstructive Pulmonary Disease. This is when there is damage to the
airways due to smoking for a long period of time. It could also be due to anaemia, which
is when there is a decrease in hemoglobin which is an iron rich protein in the blood but
your examination findings are not suggestive of it. Checked the understanding of the
patient. Reassured him that he was in very safe hands and will take good care of him.
11- Ankle examination
young female with history of ankle pain for around 1 month. history of extensive sporting
or exercising. Pain is more on waking up in the morning and at the end of the day. Task
was to do physical examination, give diagnosis and differentials.
Pass- PREDOMINANT ASSESSMENT AREA - EXAMINATION, Approach to
patient/relative 6, Choice & Technique of examination, organization and sequence 6,
Accuracy of Examination 5, Diagnosis/ Differential diagnoses 5
Examination: I started off by introducing myself and washed my hand. I said I was
sorry that she was having this pain and in order to know what was really happening i
would like to examine her. I asked whether she was having pain in one ankle or both.
She said it was on the left side only. Offered her painkillers. I explained to the patient
that my examination would involve checking her gait, having a look at her ankle,
touching her ankle and assessing the movements and doing some special tests. Will
that be ok? She agreed. The legs were exposed till the knees.
I assessed the gait. She was having an antalgic gait with short stance phase on the left
side. When asked to walk on heels and toes, she said that she can do it but it was
painful. I apologized and told that it was ok and she could lie down on the bed and that i
didn’t want to cause her any pain. This case was a bit confusing because the role player
was wincing her face for everything. Anyways i started with inspection of the ankle and
foot. There were no scars, no skin color changes, no ulcers, swelling, deformity, wasting
of muscles. Did inspect the back of the ankle as well.
After inspection went to palpation (TTCP). I first checked the temperature which was
normal. I wasn’t able to assess CRT as the patient had some nail polish, anyways i did
mention it to the examiner. When i placed my hands to check the pulse, examiner said it
was normal. I checked for any tenderness in the 5 groups as mentioned in Marwan. The
patient winced her face for all groups so it was hard to tell where exactly the pain was,
but i felt that she had more pain on achilles region and around the ankle and not on the
fore foot. Asked her to do all the movements of ankle. Again she had pain on all
movements on the left side with maximum pain on ankle dorsiflexion. I did passive
movements as well.
I did inspection, palpation and movements on both ankle and told the examiner that due
to time constraint i would focus my other examinations on the left foot only. Examiner
didn’t say anything. I did Windlass test and the patient had pain. Did mulder’s click
which was negative. Then moved on to anterior drawer test and the patient had pain.
Also did the talar tilt test and the patient had pain on all the 3 positions. i did apologize
whenever she had pain which was pretty much the whole time. Anyways i asked her to
kneel with the foot hanging out of the bed and did the Simmond’s squeeze test. The
patient had pain on that as well.
Diagnosis and Differentials: I told the examiner that i would like to complete my
examination with examining the knee as well. I asked the patient to take a seat and
started explaining the reason for the pain. I was kinda confused with the findings. I said
from the examination most likely you are having a condition called as plantar fasciitis
and the patient asked what it was. I explained it to her with the help of a diagram. I also
said that it might also be due to achilles tendinitis. told a few lines about it. I didn’t say it
was unlikely. Told her that it might also be due to any ligament injury around the ankle.
Might also be due to osteoarthritis or rheumatoid arthritis but unlikely. It might also be
due to a Morton neuroma (explained the condition in one line), but unlikely.

12- Burn
Toddler brought my mom to ED after spilling hot soup over the chest few minutes back.
Task was to take focused history, PEFE and immediate management. burns -12%
Pass- PREDOMINANT ASSESSMENT AREA -
MANAGEMENT/COUNSELLING/EDUCATION, Approach to patient/relative 5, History
5, Diagnosis/ Differential diagnoses 4, Management plan 4
History: Entered the room, introduced myself. There was an anxious mother, crying
with a tissue in her hands. She asked me whether her daughter was going to be ok. I
told her that her daughter was in very safe hands and that i am here to help her. Firstly i
would like to check her vitals and will get back to her. She said ok. I asked the vitals
from the examiner which was ok except for the child being tachycardiac. Examiner at
some point did say that the child was crying, i don't know whether it was here or during
PEFE. Anyways i forgot to give the child painkillers at the start.
I turned to the mother and reassured her that the vitals of her kid was normal. I asked
her how it happened. She said that she made a hot noodle soup and kept on the table
and she turned around to do something and the child grabbed the table cloth (or
something like that) and spilled the soup all over her. She was crying while she
explained. So had to reassure and show empathy. Did offer her some water as well. I
asked her what she did after that. She said that she took the child to the shower and put
her under the shower for 5 minutes and drove her to the hospital. I appreciated her for
doing that. I asked her which area was involved. She said only the chest. I asked
whether there were any blisters (yes) and whether the child had any noisy or fast
breathing and she said no. I forgot to ask whether it was the first time. BINDSMA-
nothing significant. The child was well and active until now. No past medical or surgical
history. I asked who took care of the child most of the time and she said it was her. I
asked whether everything was good at home and whether she had good support and
she said that her husband was supportive.
PEFE
GA- PICCLEDR and bruising- negative,
Vitals- same
Forgot to ask growth chart
I asked for the severity of burn and the surface area involved. For this the examiner
gave a sheet with the burn area marked. Had to explain the chart to the examiner. it was
12% superficial partial thickness burn on the chest.
I remembered about painkillers during PEFE and told that i would like to give painkiller
to the child. The examiner said ok.
Chest auscultation: NAD
Abdomen: NAD
Genitals: NAD
The chart was something like this. The burn area was shaded on the front of the chest
according to the depth. The total area burn was mentioned in the box as 12%.
Management:
I told the mother that i have to admit the child since the burn area was 12%. There is a
risk of dehydration since the skin acts as a barrier to prevent water loss from the body.
Since the barrier is no longer there, there is a risk of increased water loss. Reassured
her that her daughter was in safe hands. Told her that we will pass a cannula and will
take some blood for investigation and start her on fluids. She will also be seen by the
specialist. We will also start her on antibiotics to prevent any infection of the burnt area.
We will put some non adherent bandage over the burn area after applying some cream.
We will also give her painkillers to reduce her pain. The mother asked what painkiller
will you be giving during the admission. I said that i will give her intranasal fentanyl now,
and some IV painkillers during admission until her pain is controlled and later on will be
shifted to oral painkillers. Talked about TT.
I had to reassure the mother a lot during this case. I did tell her that accidents do
happen all the time and children at this age tends to be very active and unpredictable.
So please don’t blame yourself. In the future please make sure you keep any hot
objects out of reach of the child.

14- cervical radiculopathy

Middle aged female presenting with neck pain. Task was to take focused history, PEFE
card, diagnosis and differentials
Pass- PREDOMINANT ASSESSMENT AREA - HISTORY TAKING, Approach to
patient/relative 6, History 4, Diagnosis/ Differential diagnoses 5
History: I entered the room, greeted the patient, introduced myself and asked how i
could help her. She said that she was having neck pain. I said i was sorry that she was
having this pain and I appreciated her coming to me to get herself checked. I asked her
whether she was in pain currently and needed a painkiller. She said that it was ok.
I asked the SOCRATES questions. I think the duration was 1 month or so. The pain
was getting worse and pain was radiating to the shoulder and arm. History of
stiffness in the neck. No history of stiffness in shoulder or hip. No history of trauma. No
other joint pain. No fever. She worked in IT and her job required her to use the computer
a lot. I think there was some numbness or tingling along the outer aspect of the
hand involving the thumb. SADMA- nothing significant
PEFE card: As far as i remember there were some sensory findings along the outer
aspect of right hand, not too sure.
Diagnosis: From the history and examination most likely you are having a condition
called as cervical radiculopathy. Have you heard of it?
Drew a diagram and explained it to her. It could be due to a condition called Cervical
spondylosis which is the wear and tear of the disc in the spine which in turn causes
compression on the nerves coming out from the side. It could also be due to the slipping
of the discs outside and causing compression on the nerves. It could also be due to the
entrapment of the nerve called median nerve in the hand, but unlikely. It could also be
due to a condition called polymyalgia rheumatica but you dont have any stiffnesss in the
shoulder or back therefore unlikely. It could be due to rheumatoid arthritis as well, but
unlikely

16- MMSE
Male patient with history of type 1 diabetes on insulin and history of chronic alcohol
intake. The patient was non compliant with the insulin and his diabetes was poorly
controlled. The patient had stopped taking alcohol and his last drink was 3 weeks back.
Task was to Perform MMSE, explain the findings to the patient and give diagnosis and
differentials
Pass- PREDOMINANT ASSESSMENT AREA - EXAMINATION, Approach to
patient/relative 6, Explanation of procedure 4, Performance of procedure 5,
Interpretation of investigation 5
Explanation: I entered the room, greeted the patient and introduced myself. The patient
was funny but pretended to be a bit nervous about the test. Asked me whether he was
having Alzheimers or something. I explained the test to him. I told him that this was a
screening test to check his cognition and mental functioning and that we won’t be able
to give a confirmatory diagnosis based on this test alone. I told him that i would be
asking him some questions and will ask him to perform some actions for me. He said
ok. I also told him that it wouldn’t take much time for the test.
MMSE chart was provided. I asked all the questions according to the chart.
In orientation just the date was wrong, others he answered correctly
In Registration he took 2 attempts to learn the 3 items
In Attention and Concentration, he spelled “WORLD” backwards wrong
In Recall, he was able to say the name of only 1 of the 3 items
There was no problem with language and construction
I explained to the patient the things he performed correctly and the things that he
performed wrong. I told him that from the test he had a little trouble learning new things
and recalling what he has learned. This is called as a short term memory loss. and in
addition to this he also had a bit of trouble in attention and concentration. There could
be several reasons for that. Firstly it could be due to alcohol induced brain injury since
he had a long history of alcohol intake before. He said that he was not taking it
anymore. And i said that i really appreciated that, but sometimes the effect of it still
could be there due to taking it in large amounts for a long period of time. It could also be
due to increased blood sugar level for a long period of time. It could be due to mini
stroke as well. It could also be due to hypothyroidism which is when gland in front of the
neck does not produce enough hormones

17- Ureteric coli

Male patient presenting with abdominal pain. Task was to take focused history, PEFE,
diagnosis, differentials and investigation
Pass- PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION, History
6, Choice & Technique of examination, organisation and sequence 6, Diagnosis/
Differential diagnoses 6, Choice of investigations 4
History: I entered the room, greeted the patient and introduced myself. It was a middle
aged male sitting on the chair, in pain. I told him that i was sorry that he was having this
pain and asked him whether he wanted to lie down on the bed because he seemed very
uncomfortable sitting. He said that he would prefer to sit as the pain is more when he
lies down. I offered him painkillers and he told that the nurse has already given him
some oral painkiller and the pain has reduced as compared to before.
I asked the SOCRATES questions. When i asked to point where exactly the pain was
he pointed to right flank. Severity of pain was around 9 before but after painkiller it was
around 5. Pain was radiating to groin and it started suddenly, few hours back.
Never had a similar pain before. Didn't have any trauma to tummy. Passed bowel
motion in the morning and was normal. Able to pass flatus. No urinary complaints. I
asked specifically for any blood in the urine as well but he said he didn't notice. No
history of fever. No vomiting, but felt nauseous. No history of yellowish discoloration of
skin. No past medical or surgical history. SADMA- drinking but within safe limit as far as
i remember.
PEFE (had to ask each finding separately and was only provided with the information
that i asked for)
GA- no PICCLED
Vitals- normal
Abdomen inspection: all quadrants moving with respiration, No distention, visible
masses, scars, dilated veins.
palpation: no tenderness on superficial and deep palpation, no guarding, rigidity, no
masses
Renal angle tenderness was positive
Auscultation: bowels sounds present
Genital examination: no rash, redness, swelling, discharge,
DRE: BPH features
Office test: UDT positive for blood and protein

Diagnosis and Differentials: From the history and examination most likely you are
having a condition called Ureteric colic. Have you heard of it. Explained it to the patient.
There could be various other reasons for the pain, it could be due to a condition called
Pyelonephritis which is the infection of kidney but unlikely since you don't have any
fever. It might also be due to UTI but you don't have any urinary complaints therefore
unlikely. It might also be due to bowel obstruction but unlikely as you have no problem
with your bowel motion and you are able to pass flatus. It might be due to trauma to
your tummy but you don’t have any history of trauma. It might also be due to
cholecystitis which is the inflammation of gallbladder, a small organ near the liver but
unlikely from my examination.
I would like to keep you under observation and run some tests. I would like to do some
blood tests which will include some routine blood tests and kidney function test and
electrolyte level including calcium level and uric acid level as increase in these
substances can predispose to stone formation. We will also do urine microscopy and
culture test to look for any infection. You will also be seen by the specialist and the
specialist might decide to do a non contrast CT scan of the tummy. Further
management will depend on the size and the position of the stone (i had time so i
explained the management as well). If the stone is less than 5 mm the specialist might
decide to discharge you with painkillers and you might be asked to strain your urine and
pass it in to a container. Once the stone is passed you might be asked to bring it back
so that we can check what type of stone it is. if the stone is not passed within 48 hours
or if the stone is big then the specialist might decide to do some procedure to remove it.
if the stone is high up in the kidney a surgery might be required, or else the stone might
be destroyed by sound waves or retrieved by instruments.
Asked whether the patient had any questions and he asked me whether he needed to
know anything else. I told him to drink a lot of water and take care of his diet.
I don’t remember mentioning Xray KUB, i also didn't do any investigation for BPH as the
patients didn't have any urinary complaints and the features on examination were all
benign.

19- Type 1 DM pre pregnancy counselling.

Young female living in rural area, wanting to get pregnant and wanted to know whether
she could deliver in the rural hospital because her husband is a farmer and she wants
her husband to be there. Type 1 DM wants to delivery at rural hospital - focused hx,
PEFE, counselling
Pass- PREDOMINANT ASSESSMENT AREA - HISTORY TAKING, Approach to
patient/relative 6, History 6,Choice & Technique of examination, organisation and
sequence 5, Patient Counselling/ Education6
This is the same exact case in Marwan notes. Please read the case from there. I started
off by appreciating her coming to get herself checked before getting pregnant. I told her
that it was a very good decision.
History: The answers given were the same. last HbA1c was 7 months back and it was
11%. she couldn’t attend the last specialist review because there was some family
function. PEFE did same as Marwan. Only positive thing was UDT showed 3+ glucose,
no ketones and BSL was 8.
Counseling: I started by telling that many woman with diabetes can have normal
pregnancy and can get through safe deliveries with healthy babies.We need to keep the
sugars controlled before and during the pregnancy as there could be some adverse
effects on the baby and the mother if not. Told about the complication to the mother and
the baby. Told about the complications that could happen during the delivery and for this
reason it is best to deliver in a tertiary level hospital where all the facilities are available
in case something happened.
I told her that her sugars at this point is on the higher side and i would like to repeat her
HbA1c level and do all the first antenatal visit tests as well (didn't mention the tests
separately). I told her that i would refer her back to the diabetic physician for control of
her sugar levels. (forgot to refer to eye specialist) Once the sugars are well controlled
the specialist will advise when it is safe to get pregnant. Once you are pregnant you will
be taken care of in a high risk pregnancy clinic under the care of a multidisciplinary
team. You will be asked to do more frequent check ups, scans and blood tests, just to
make sure everything is fine with you and your baby. We will try to maintain a tight
sugar control to prevent any complication. The insulin requirement might increase
during pregnancy and the insulin doses will be adjusted accordingly. and after delivery
the insulin doses will be reduced to prepregnancy level.
I will also start you on folic acid now and it is advisable to continue it till first three
months of pregnancy. While explaining i checked the patients understanding in
between.
I asked whether the patient was happy with plan and she smiled and nodded

15- Cerebral palsy - Pilot

10 month boy brought by father because the child cannot sit. Task was to take history,
PEFE, diagnosis and differentials.
History: I greeted the patient, introduced myself and asked how i could help him. He
said that his son was unable to sit and that he just wanted to check whether it was
normal for his age. I told him that it was a very good decision that he made to come
here today to get his son checked and i really appreciated it. Asked him whether he had
any other kids and he said this was his first child.
Milestone: gross motor: the child was unable to sit with or without support. When asked
whether he could crawl the father replied that the child was able to army crawl. When
asked at what age he started that he said he didn’t know.
fine motor: Pincer grasp positive. Father didn't know when it started
language: the child was able to say “mama”, “dada”
Social: able to wave bye bye
pregnancy: mother didn't have any history of fever, rash or infection. No history of any
medication use or drug use. Everything was good according to the father
Delivery: NVD, term, baby was fine, did not require any resuscitation after delivery. heal
prick test was normal
Immunization up to date, feeding well, gaining weight normally. Pee and poo was
normal.
General health was normal, child didn't have had any major infections or illnesses which
required hospitalization, no history of any trauma to head
No history of scissoring of legs. When asked about arching of back the father asked
what that was. Explained it to him and he said No. No history of fits. No history of
decreased activity or dry skin.
Home situation was good.
PEFE: (had to ask each finding separately and was only provided with the information
that i asked for): the positive findings was that hypereflexia and hypertonia in lower
limbs. no dysmorphic features.
Diagnosis: From the history and examination, i am sorry to tell you that X is most likely
having a condition called as Cerebral palsy. Have you heard of this condition? It is a
disorder of movement and posture. It might be due to any infection that your wife had
while she was pregnant with him, or maybe due to decreased oxygen delivery to the
brain during labour or maybe due to any infection of the brain. At this point i can’t say
anything for sure as we need to do further investigations to confirm the diagnosis.
Reassured the father that his son was in safe hands and i was there to help him. I also
told that it might be due to other conditions such as any head injury, infection of brain,
tumor of brain, hypothyroidism. Explained a little bit and reassured again.
20- Dizziness -Pilot
Male patient presenting with history of dizziness. The task was to take history and tell
possible contributory factors.
History: I greeted the patient, introduced myself and asked how i could help him. He
said that he has been feeling dizzy for the last few weeks. I told him that it was a very
good decision that he came to me to get himself checked and i really appreciated it. The
patient felt dizzy all the time. When asked what he meant by dizziness he said he felt
unsteady. No h/o falls or head injury. No history of spinning sensation. No ringing in the
ears, discharge, ear infections. No vomiting. No postural hypotension. No weakness or
numbness. No blurred vision or difficulty talking. No funny racing of heart, chest pain,
fever. Bowel and bladder habits normal. Patient was hypertensive on thiazide diuretics
and some other medications too. Don’t remember exactly. SADMA- Taking alcohol i
think 1-2 drinks per day. Using Marjuana on and off.
Differentials
 ear problem
 heart problem
 stroke, brain tumor, infection in brain
 Anaemia
 postural hypotension
 electrolyte problem as one of the medication he is on can cause mineral imbalance in
the body which might lead to dizziness
 anemia
Explained the differentials in a short sentence and explained why it could be likely or
unlikely. Told him that i would need to run some tests to see why exactly he is having
this dizziness and that i would take good care of him.
Forgot to mention Marijuana and Maybe cerebellar ataxia.

March 2021

5th March 2021 – Pilot exam

Tips from 1st candidate:
● There was one invigilator for 5 persons.
● 20 candidates, 4 groups.
● There were no interactions with the examiner at all.
● One you enter a station, invigilator checks your ID, then leaves you.
● You’ll get 2 mins to read the candidate information and full 8 mins to perform the
case.
● No PEFE at all. Just card. No need to ask one by one from the examiner.
● Physical examinations are as well describing only with no findings.
Tips from 2nd candidate:
With Allah’s grace, I managed to pass this exam. There are various queries about online
exam. Let me assure you the AMC team is doing great to give you an idea. As soon as
exam is booked, they send guide to online exam, it has step to step guide to exam
delivery method. It also tells you that examiner and invigilator will be present in every
station and you will communicate to only patient/ relative/student. Though exam was a
roller coaster of emotions for me especially early on as I initially dropped out and missed
going in my first station, but the team is there to support you. They got me in again.
They even provide you with mobile number for the day of exam so don’t worry about
technical issues, they will support you. ID checks are done before each station and stem
is there throughout the station. It was long hours for us but you get regular breaks on
your rest station. We got lunch break too in mid exam so overall exam is fine as it is in
your home environment and nerves play less as you don’t see your examiner. Its just
you and your patient. I am sort of a person who forgets as soon as exam is done and
just remembers what went wrong so I might not be able to recall much but will do my
best.
All the best to you all.

Tips from 3rd Candidate:

Assalamu Alykum, First of all a little bit about my preparation. I booked my exam last
year which 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 – Developmental delay

Stem: 9 months old child cannot sit with support.
Tasks: history for 5 mins, PEFE card, DDx to the mother. (old recall)
In the history, all milestones delayed but nothing positive in the birth history, infection,
CP features or hypothyroidism. PEFE card appeared after 5 mins, showing everything
normal except truncal hypotonia. (invigilator said this is your prompt time and you can
ask 1-2 important questions if you haven’t finished with the history). When the candidate
mentioned that it’s a global developmental delay, the role-player agreed and told that
I’m thinking the same too Dr. And gave the differentials for the Global development
delay.
Another feedback:
Stem: 18 months old child brought in by mum for some milestone delay
Tasks were Hx, PEFE card was provided when I was 4 min into station and it stayed
there along with stem for rest of the station, Dx with reasons
I started with presenting complaint, did all milestones starting from recent ones. Baby
was delayed in all; gross motor, fine motor, language and social. Did differentials
hypothyroidism, seizures, kernicterus, fetal alcohol syndrome, cerebral palsy, cystic
fibrosis, Congenital heart disease. Did detailed pregnancy, birth and postpartum history,
rest of Bindsmac, social hx. Well Baby qs. Overall recent health including recurrent
infections, fever, lumps, bumps, ENT etc. Don’t remember what was positive in Pefe
card, I think was all normal may be hypotonia was there. Explained mum developmental
delay in all domains, cant find the reason, may be physiological or due to cerebral palsy,
explained other differentials and said need specialist and multidisciplinary input.
PAA: history taking
Approach:3
Hx:5
Dx/ddx: 4
GR:5
Another feedback: 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 – Rash
Stem: 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 patient for 2 mins, do the relevant head and neck
examination (head and neck are mentioned specifically in the question

No response or more finding will be given, you just need to tell what you are going to
check to the patient ? Seborrhoic dermatitis?
DDx: Seborrheic dermatitis; Psoriasis; Scabies; Dandruff; Fungal infection (Tinea
corporis); Sq cell Ca
Another feedback: Rash behind ear, silvery scaly. I could see a lump as well. Patient
had history of dandruff or some rash which was responding to particular shampoos.
Tasks were to explain rash, do relevant head and neck examination and 3rd was to do
rest of relevant examination that will refute or prove your diagnosis.
I didn’t do well in this one and my mind was so much engaged in it that I didn’t perform
well in next one either. It was pilot thankfully.
Another feedback: 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 neck 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 3 – Neck pain

Stem: 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, Prognosis
Another feedback: Patient came to see you complaining of tingling numbness in hand
and neck pain. Various inx given all normal previous hx of breast cancer, on tamoxifen.
Tasks were hx, most likely cause , mx
I took Socrates, other differentials but somehow, I started breaking bad news. I took it
as recurrence of cancer and explained other causes including spondylosis with
radiculopathy, carpal tunnel, cubital tunnel etc. messed up this case. I knew it when I
was doing it. I was stressed because of station 2.
PAA: MX/COUNSELLING/EDUCATION
Approach:4
Dx/ddx:4
Pt education:3
Mx: 4
GR:3 as I failed PAA
Thankfully I got rest station after 2 and 3 and I collected myself
Another feedback: Neck pain / Cervical spondylosis
Stem: 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 4 – Shortness of breath - CVS examination

Stem: You are an HMO at a hospital. Patients history obviously 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 student
Another feedback: Patient complaints of shortness of breath, has orthopnoea too. Also
has ankle oedema. You have a student with you. Explain how you would do
examination, to student with you. Will write in detail as many are asking about exam
approach.
This was the station that boosted my confidence. I started off with asking student’s
name even though it appears on screen all the time. Which year he is in. Explained to
him bit about symptoms that our patient has and why we would do cardiovascular
examination in him. Explained for any examination we do wash our hands following
hand hygiene protocol, introduce ourselves explain our examination to patient and take
consent. After that proper exposure which is full chest exposure and put patient at 45
degrees. We will do general appearance if patient is in distress/not and start off with
hands looking for pallor, peripheral cyanosis, splinter haemorrhages in nails, painful
osler nodes on dorsal aspect and Janeway lesions on palmer aspect. Told about
clubbing and how to look for it. Then will do radial pulse for rate, rhythm and strength
along with radio radial delay. With patient consent do radio femoral delay. Explained
about manouvere for checking aortic regurgitation. Will do BP now with palpatory and
then auscultatory method and on all 4 limbs. Will also see for postural drop. In face we
see eye signs including pallor, icterus, xanthelesma and sub conjunctival
haemorrhages. Mouth and nose for central cyanosis. In neck we will do JVP by asking
patient to look sideways, will see between 2 heads 0f sternocleidomastoid. Ask patient
for pain in tummy and press on liver if you don’t see raised JVP in first instance. Will
auscultate carotids one by one first for any bruits if none, will do palpation as we don’t
want to dislodge any clots. Now chest inspection, then palpation of apex beat should be
in mid clavicular line 5th intercoastal space. Will palpate for heave by heel off maneuver
and thrills by placing hand over left and right second intercostal space. Explained 4
areas of auscultation. As I was doing it I was using my own hands to show what I will
do. You naturally try your best to convey what you are doing. In auscultation I did both
with diaphragm and bell. Also told that at same time I will be palpating carotid to listen to
S1 S2 and any added heart sounds. Did maneuvers and explained that for aortic
stenosis will listen carotids, for aortic regurgitation we will listen in left 3rd intercoastal
space and asking pt to lean forward. For mitral regurgitation in axilla and mitral stenosis
put patient on his left side. Kept asking did he understand or has any questions but did
that in end more as I wanted to finish my exam and was going at 100k speed.
Auscultated bases of lungs did sacral oedema and ankle oedema. He asked me how we
would do sacral oedema. As I was explaining him invigilator said times up and moved
me.
PAA: EXAMINATION
Approach:5
Choice, technique, organization and sequence: 4
Explanation of procedure: 4
GR:4
Another feedback: SOB / Examination
Stem: 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 appearance 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 5 – Behavioural change - Delirium Greek lady case (old recall)

Stem: blood test result given as hyponatraemia.
Tasks: Explain the tests to the daughter, history, Tell the possible causes
(recent Frusemide for her pneumonia)
Another feedback: Greek lady case usual recall all labs were given. I think tasks were
explain labs that were given further investigations and counselling. I think her temp was
high. Very long stems.
Explained delirium to her that it is acute confusional state. Various reasons. Explained
one by one with investigations for each. Right now our priority is to put patient at ease,
will try our best that she doesn’t come inContact with changed facies all the time and
have same nurses with her, will dim the lights, sedate her if needed esp until we find out
the cause. Its good if she see someone from family. She asked about family doctor
and Greek language. I said it is a good idea if she can see her regular doctor and if
dotor can make it too. And if you know Greek speak to her in same language as hers.
PAA: MX/COUNSELLING/EDUCATION
Approach:4
Dx/DDX: 5
Pt education/counselling:4
GR: 4

Another feedback: Behavioural change

Stem: 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 – Osteopenia
Stem: A man comes to see you with osteopenia in bone dosimetry. He also has COPD
which he is taking oral steroids frequently. (really a long stem). This man has fracture in
the history.
Tasks: Explain the results, history, causes, Management
Another feedback: SMOKER HEALTH REVIEW
Patient had a fall. Some investigations were done osteopenia was there . He was a
known case of COPD and active smoker. On steroids
Tasks were interpretation of investigations, further management
Stems are quite long there, can’t read or remember everything
I was quite happy about my performance in this one. It only occurred what critical
mistake I made that cost me this station. I Explained T score, Z score, made a bone on
my paper and held it against screen to explain normal bone, osteopenia and
osteoporosis. I also made a circle of smoking leading to aggravating copd which in turn
increases steroid dose and put him under risk of bone fractures and that we must break
this cycle. I explained lifestyle modifications, smart and safe sun exposure, calcium rich
diet, exercise and referred him to resp physician to see if something can be done with
steroid use or decrease its dosage. Asked him to talk to me more about smoking in next
consult. Critical I didn’t refer him to specialist for starting bisphosphonates
PAA MANAGEMENT/COUNSELLING
Approach: 4
Interpretation of Inves:4
Pt education:3
Counselling:3
GR : 3
Another feedback: 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
everything 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

Station 7 – Apixaban counselling

Stem: A patient in a hospital with diverticular abscess. A surgery may be needed, He is
now on antibiotics.
Tasks: history, Explain about management and address his concerns
He is an anxious patient and challenging. Opening statement was ‘the surgeon might be
not knowing what I have and told me to about the surgery. I am having Apixaban. I am
worried about having clots during the surgery if you stop this medication’
On history, he is taking it for his AF which is well controlled now, No other significant
history of recent clots or any medical history.
After explaining the need for the surgery and reassuring that it is safe to withhold the
medication for a while, he complained ‘what if I bleed’ – so has to address this concern
too.
Another feedback: Patient admitted in hospital for diverticular abscess. He is on
apixaban and I think had pace maker or some cardiac pathology. Lots of things were
there for risk stratification. He is on antibiotics currently, if doesn’t respond might go for
surgery in 48 hours.
Tasks were all about concerns
Ask concerns
Address concerns and blab bla
When I started patient was acting very good and was hyperventilating as he was really
anxious. I introduced myself and asked if he is ok and he is like doc is going for surgery
and I don’t want that. First I asked him to take deep breaths with me and then asked
what is bothering you. Any previous concerns about surgeries? Hana once did this case
in her blog and I did it according to her approach. Asked his concerns, told him that it is
very brave of him to talk about his fears to me and that I will address them. He talked
that he wants to see his cardiologist but he can’t b/c it is weekend. I told him we have
very good specialists here at hospital too, I will try my best to get you in touch with them
including his GI surgeon. He was concerned about bleeding and then clotting. Told him
will do surgery after 48 hours if it is needed. By that time apixaban effect will wear off,
during surgery we will keep blood and blood products ready. Team is very competent
and will be ready to tackle any such event and after surgery will start you other type of
blood thinning medication and when surgeon gives thumbs up sign will start you on
apixaban. We don’t have antidote for apixaban but we do have antidote for other type of
blood thinning medication that we will start you on after surgery so don’t worry about
clots or bleeding after surgery. You are in safe hands. Talked about blood investigations
we will do, preparation of bowls surgery procedure and when I reach upto the temporary
colostomy part only then he told me it was one of his concerns too. Explained that we
might not end up with colostomy, even if we did most likely it will be temporary. He
thanked me. His phone was beeping in between and later on I was thinking I should
have asked him to attend it and I can wait, may be it was part of roleplay to ease anxiety
but turned out it wasn’t😉
PAA MX/COUNSELING/EDUCATION
Approach: 5
History:5
Counselling/education: 4
GR:5
Another feedback: Apixaban counselling patient
Stem: 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 - ?ITP.
Stem: A 27 years old man coming with rashes on the legs which clearly looks like ITP.
Also there is a history of URTI 10 days ago. Temperature normal. ENT normal.
Task: 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.
Another feedback: ITP Rash photograph was given
Patient had rash and had URTI few days back. Some other findings given
TASKS: Explain rash in picture
What other examination you will do
Dx/ddx
When I went in, I didn’t see anyone on screen, I started off thinking I must give to
examiner who is definitely is not on camera. I explained rash hesitantly following site
size surface approach, said about erythema, no discharge or oozing present. Margins
not demarcated seems raised will confirm on palpation. No signs of any entry point,
scratch marks. Will do put on gloves, explain procedure, and will do relevant exam. first
palpate rash for tenderness, raised temp, borders and will see if it blenches by putting
glass on it.
I think then I started with regular haematological approach
General appearance if patient cachetic or in distress acutely
Hands for pallor, icterus, cyanosis, clubbing. Bruising , scratch marks or IV drug marks
in arm, epitrochlear lymph nodes told where to look for and then do axillary five groups
ant, post med, lateral and apical. Go on face, see eye signs pallor, icterus , , mouth for
gingivitis, stomatitis, bleeding or gum hypertrophy. See if tonsil are enlarged. Cervical
ant and pot groups along anterior head of stern and posterior to it, do supraclavicular,
and occipital lymph nodes. Do bone tenderness on clavicles spine amd sternum.
Explained how to do for hapatospleenomegaly , and do paraaortic lymph nodes. With
patient consent dre for any bleeding on finger and do inguinal lymph nodes. I follow
HELIM
HIV, HEPATITIS, HSP
EBV
Leukemia, lymphoma
ITP or Post Infectious rash or lymphadenopathy
Other Malignancies/ Meningitis
Patient/ student Screen popped middle of the way and I apologized that I didn’t know he
was there. Introduced myself and said so you heard me before😊? He said yes. I said
let me know if you have any qs . Explained him ItP
PAA Examination
Approach:6
Accuracy: 5
Choice, technique, organization and sequence: 6
Dx/ddx: 5
GR: 6
Another feedback: Examination ?ITP
Stem: 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: 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 differentials 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 haematological 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
haematological 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 / Allergic rhinitis

Stem: A man with 2 weeks history of cough and stuffy nose.
Tasks: History, DDx
In history – main complaint is stuffy nose, happened yearly in this season. Cough – just
a dry cough. Watery eyes also present. SOB in evenings as well. He has an attack of
asthma 5years ago and got a relief by using inhalers from his wife who has asthma. He
also has some pain in the face when touched (sinus tenderness) , He is a smoker, no
idea about any allergens he has.
Another feedback: UNWELL PATIENT
Stem: Patient not feeling well
Tasks: Hx, DX/DDX
This was the shortest stem, went inside pt complained of cold like symptoms and
blocked nose, did Socrates, asked and ruled out all DDX, allergic rhinitis, asthma, acute
URTI, cardiac cause, Gord, pneumonia etc. He gave me history of recent onset
shortness of breath on exertion and night-time cough. Got better when he used his
wife’s puffer. He had hx of childhood asthma. Tried excluding risk factors of asthma
ABCDEFGHIJ as given in JM and TOPES. He was passively exposed to smoking as his
partner was a smoker. I think he also mentioned about cat. Gave him Dx of relapse of
asthma due to recent URTI. Will do spirometry to confirm once he is over viral infection.
Also mentioned about seeing wife for smoking and exposure about trigger factors
though mx wasn’t task. Gave rest of all respiratory differentials
PAA: History taking
Approach:4
Hx:5
Dx/ddx: 4
GR:4

Another feedback: Unwell patient

I didn’t 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 – Obstetric examination/Pre-eclampsia

Stem: 36 weeks pregnant woman, BP is 155/90mmHg, fundal height 35 cm, longitudinal
lie, head is 4/5 palpable. Urine protein 3+.
Tasks: Do the relevant examination telling what you gonna do to the patient, Explain the
condition, Order further investigation
Another feedback: OBSTETRIC EXAMINATION
Very long stem 36 weeks pregnant lady. A student was doing examination, his exam
findings were given including BP 155/100 . He noticed fundal height to be 35 weeks,
and normal liquor
Tasks: hx, further examination and instruments you will use, ix, dx/ddx
I wasn’t sure as they mentioned about liquor outside and there was 1 week discrepancy
between gestational age and examination findings.
Anyway I took hx of initial pregnancy, initial iinv, blood group folic acid, down scan, 18
week scan, position of placenta, baby position or any birth defects concerns, sweet
drink test done, any repeat ultrasound. New symptoms like headache, blurring of vision,
abdominal pain, waterworks , bowel works, baby movements, bleeding or discharge
from down below etc.
Explained in examination your BP is high , my student has done this examination .
There was something in vitals told her that I will do that , will do abdominal exam again
to see any changes/ to confirm student findings and with your consent will do vaginal
exam to see neck of womb and if there is any discharge. Will do reflexes and other
examination in legs and will see behind eyes using an instrument called fundoscope for
w/c I will be coming very close to you. I will call my senior , will do urine dipstick and
further send urine for protein creatinine ratio. Will do US and CTG to confirm baby size
and wellbeing. Will send initial bloods too. Reassured you are in safe hands.
PAA: Examination
Approach:4
Hx: 4
choice, techn, organ and sequence:4
Ix:4
Dx/ddx:3
GR:4
Another feedback: 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 – Obesity with asthma (old recall).
Stem: Growth chart was given 97th percentile. The child is coming to see you with his
father for regular check-up and you found this obesity.
Tasks: Explain the growth chart, take history, explain the reason
Lack of exercise (afraid of asthma attack), eating junk food and watching TV most of the
time were positive in the history
Another feedback: HEALTH REVIEW
Mum came as she concerned about her daughter’s weight. Growth charts were given.
Height was normal; weight out of healthier range.
Tasks: Explain charts to mum
Hx
Dx/DDx
I tried avoiding term obese or overweight. Sensitively addressed that it is out of healthier
range. And appreciate mum that you brought her here so we can do something about it
together. Asked hx and tried to exclude any organic causes like hypothyroidism,
asthma, stress, steroid use, any developmental issues, bullying etc. General heath,
Then came to lifestyle factors and explored in detail especially activity level in school
and after school. Activities she like, foods she eat. Touched bit about social factors and
family situation. Talked about strategies we can implement including life style
modifications and dietitian visit. Even if she doesn’t lose, we will try to maintain weight
initially as she will grow into it bringing BMI in heathier range eventually.
PAA: HX TAKING
Approach:4
Hx:4
Dx/ddx:4
GR:4
Another feedback: 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 a lot of YouTube 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 - Another delirium case

Stem: 25 years old, all features of chronic liver insufficiency, drinking 25 cans of beer a
week, blood result given – macrocytic anaemia and deranged liver function test (not so
high though). Now delirium after total hip/knee replacement surgery on 3rd post op day.
Tasks: Explain the blood test result, Dx and management (further investigations) (no
history required).
Another feedback: POST SURGERY DELIRIUM
I failed this case, I don’t know what went wrong, did it same way as prev delirium case. I
think I couldn’t interpret stem properly as it was 2 pages long and couldn’t get
appropriate findings.
Another feedback: post-surgery delirium
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 – Headache/Somatization
Stem: Chronic headache – coming with normal MRI. Previously some dysuria, tummy
pain and other problems but not now. Main complaint here is headache. (old Recall)
Tasks: History, Explain the Dx
She has some other problems in multiple systems but they are not there anymore, so
have to rule of headache differentials. She is not sexually active, divorced with her
husband and looking after the kids which is a stressor.
Another feedback: HEADACHE
Failed this one too, no clue about it too, People saying it was somatization but she
denied any other symptoms apart from headache and all ix were normal. I did Socrates,
tension, migraine cluster, meningitis, TA, sinusitis, meniningitis, trauma, tumour then did
psychosocial.

Another feedback:
So i failed it too, same old recall of somatization or adjustment , i.took.the history for all
differentials 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 – WEIGHT LOSS

Stem: CT liver metastasis and blood result anaemia given.
Tasks: Explain the results, DDx, Management (old recall)
Another feedback: WEIGHT LOSS
Usual recall, liver mets case
Tasks: Interpret inv to pt
Dx/ddx and further inx
Did it as breaking bad news. Talked about that it is most likely metastasis from
somewhere most likely colon but can be from stomach, lung , prostate and lung. Can be
multiple liver cysts but very unlikely . have to confirm by doing further ix w/c will be
upper and lower GI endoscopy, liver biopsy, iron studies , PSA and Cxr if needed to
exclude lung CA. I finished it quite early so started explaining procedures of biopsy and
endoscopy and colonoscopy. Reassured
PAA: Diagnostic Formulation
Approach:4
Interpretation of Ix:5
Dx/DDx:5
Ix:5
Another feedback: 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 15 – Dysmenorrhoea - Pilot

Stem: A 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 got this pain since menarche since 9 years ago, now she came to clinic as she has
some difficulties taking leave for this pain. The ultrasound was taken 2 weeks after her
last period, She was never sexually active. No dysuria, No dyschesia. Probably just
simple dysmenorrhea?
Another feedback:
23 years old complaining of abdominal pain. You did US scan on last visit, showing
some cysts in ovary/ies.
Tasks: HX, dx/ddx
I did Socrates, excluded UTI, IO, APPENDICITIS, RENAL, PID, PCOS symptoms, STIs
she wasn’t sexually active or had ever been so didn’t ask rest of 5 Ps. Asked about
bowel habits, painful defaecation but urination was normal. She was having pain during
periods since she had menarche. Said most likely endometriosis.
It was pilot.
Another feedback: Primary dysmenorrhoea
Stem: 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

Station 16 – Anaemia in pregnancy.

Stem: 15 weeks pregnant lady with a blood result showing microcytic anaemia. Iron
profile was not given.
Tasks: explain the blood result, history, possible causes, Mx
Have to rule of all causes of iron deficiency anaemia and also thalassaemia. She is from
Norway and her husband too, She has a heavy bleeding in her previous child birth (the
child is 18 months old now) and also one time of heavy period before this pregnancy.
(nothing positive in diet history)
Another feedback: PREGNANCY COMPLICATION
Stem: 15 weeks pregnant lady low Hb, Low MCV, low MCHC
Stem also mentioned about BP 130/100 AND pulse 103
I remember these as I was bothered by these details as to how to proceed
Tasks: hx, dx with reasons, further ix
Took history initial preg qs, sign symptoms of anaemia, 5ps, diet etc. She was
vegetarian, had another baby who was 18 month or two-year-old, no other miscarriages
etc. She said initial blood checks were done, she took folic acid until 12 weeks, DOWN
wasn’t done. Didn’t develop htn in previous pregnancy, doesn’t know her usual BP.
Asked about her and her partner origin and hx of any chronic conditions. I told IDA
most likely due to less spacing and increased demand and diet intake discrepancy. Will
do iron studies to confirm. Meanwhile will start you on iron supplements. Will send you
to specialist to evaluate BP. It could be just white coat HTN but can’t take chances as
you are pregnant
PAA: Diagnostic Formulation
Approach:4
Hx:4
Dx/ddx:4
GR:4
Another feedback: 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

12th March 2021 – Pilot exam

Station 1: Mastitis
Swollen breast. No crack
Station 2: GAD:
Patient was worried about everything, was in stress, no new changes in life or work
Station 3: Postpartum psychosis
Station 4: Neonatal examination, explain to the students.
Station 5: Somatization
Station 6: Abdominal pain in mid cycle
Mittelschmerz with fluid in Douglas pouch and non-symptomatic gallstone in ultrasound
Station 7: PTSD
Station 8: Pneumothorax
One lung was totally black in X-ray, explain the x ray for patient, Dx and DDx
Station 9: Respiratory PE in Adult
Station10: Respiratory PE in child
Station 11: Scarlet fever
Station 12: Alcohol cessation counselling
Not very motivated. Her wife forced him.
Station 13: Prolonged QT syndrome
No ECG. Patient had fallen. In vital sign, PR was low. History of sudden death in family
Station 14: HRT
56 y lady on HRT for 6 y. wants to repeat her script. No menopausal symptoms. Not Up
to date with PAP smear and Mammogram. Counselling and order investigations.

16th March 2021

Tips from 1st Candidate:
Assalamualikum. I am Nudrat Miraj Tulee. I have passed exam on 16th March (Online) in
1st attempt Alhamdulillah. It was Allah's Marcy completely; I just tried my best and the
exam is very unpredictable, it is not possible to pass exam for me without Allah's Marcy.
I booked exam on last 25th March and my exam was cancelled just 4/5 days before the
exam. Then AMC offered me a date just 5 days before the exam.
Let's talk about my exam preparation. I took 5-month online course from First aid clinical
and did 3 days physical examination workshop from Alan Roberts. The 5-month course
was really helpful as it was very concise and help me to build up my basic. I followed the
same structure given by the tutor during the exam. I had an amazing Reading partner,
which I think most important in AMC journey and Alhamdulillah she was so supportive,
punctual, and flexible throughout my difficult time. We studied 12 month recalls,
Handbook (Selected case), Marwan and course note. We roleplayed all of them couple
of times. We roleplayed most of the time in the week for last 1 year with a few gaps in
between. We practiced within 7 min and I will advise to do it, because in exam I found
the time management issue is very difficult. Address the question and tell to the point,
just what question is asking to you, You can’t tell everything, it is not possible, so don’t
be stressed about it. Please practice recall as much as possible because every recall is
different and time management is very important.
About online Exam: I know its new version but believe we are over thinking. It is not
that much horrible. Gab a good internet, 14-inch laptop, window 10 and good
headphone. That’s it, you are done; other work AMC will do for you. Its really easy to
download the SEB, just follow the instruction. During my time I had no internet issue
other few second in my one case, but it didn’t cost me to repeat the station. I think its
normal to have some internet issue. So, be relaxed…..
Yes exam is for long time about 7hrs but you will be fine because they structure it like
that. You will get 2 min rest after each exam which is quite helpful, I think to come you
down. 4 rest restation for 10-14 min. Lunch break. You can have your food and drink in
break time. In my time I need to show the room once but now-a-days there not even
asking to show the room. But don’t keep anything which they forbid and be honest. They
will prompt you after 3/6 min according to question but in PE station there is no prompt
timer. So practice like this way because in PE station it can be difficult to manage the
time.
I tried to give you as much details as possible because I know its really important, I was
also struggling to have a detailed feedback earlier. But sometime it can be boring, sorry
for that.

Tips from 2nd Candidate

Please follow 16 march list of exam questions give in the group earlier
I only studied from Marwan notes. Did 6 months of recalls, got them from this
group. Lost my hand book so dint do that at all and luckily dint get any question
from that either . I also did Allan course last year that was very very very helpful.
They do a mock exam at the end of the course that is exactly like real exam.
I studied for 3 months last year from dec 2019-March 2020 but then exam was
postponed. Dint study a word the whole year and then This year I studied for
only 2 weeks that Amc gave us to study. I studied for around 5 hours a day with
a 3-month-old baby whenever she slept. But what helped me was that I am
currently working in emergency department in Australia so that helped a lot as
the communication improves a lot and so does the confidence.
Main thing in this exam is communication skills and confidence. Trust me we all
have equal knowledge as we all study same stuff and some study more honestly
and have more knowledge. What I have heard is they are mainly making sure
that we will be safe doctors, have good communication skills and confidence as
well as basic knowledge. They don’t expect specialist level knowledge from us.
Here goes my feedback whatever I can jot down with my baby screaming on my
head lol

Station 1: Breast lump PE

A patient came with breast lump in one breast, 62 years old, had screening 1.5 year
back, everything was fine that time. A medical student came to you, today is her first
day.
Task: Tell the student how to do PE in this patient
Tell which step you need to do and why
Name any instrument which you need to use during examination (Throughout the
station I though which instrument we use during breast examination, I don’t know really)

Introduce myself, ask name. Today we have got a patient who is having lump, we need
to examine the patient. Today we are going to do breast examination. I will tell you how
to do examination step by step but if any time you feel like you are understanding at any
point feel free to ask me, I am more than happy to repeat it again.

Be fore stating any examination, you need to wash your hand, introduce yourself with
the patient and ask permission for proper exposure. Here as we are doing breast which
is private part you need to keep a chaperon after getting patient permission, need to
maintain privacy also.
Start with GA, patient sitting comfortably or not, any protective posture. Then check
vitals, you need to make sure your patient is vitally stable before doing examination.
Inspection: In 4 position
Tell the patient to keep her hand on their thighs and relaxed. See any Scar/ swelling/
redness/rash present or not which give you idea about any infection or inflammation
patient is having or not. Any visible asymmetry/ masses present or not, any Skin
changes/Puckering or dimpling /Peau de orange to check any sign of nasty growth. See
any nipple changes present or not.
Ask patient to place hands on their hips and push inwards (to tense pectoralis
major).Repeat inspection. Observe for any masses once again, If a mass is noted,
observe to see if the mass moves with the pectoralis muscle. This is known as tethering
and suggests invasive malignancy.

Ask patient to place both hands behind their head and push your arm backward: Look
for any Masses, Asymmetry, Dimpling / puckering, look for any accentuation of tethering
of nipples or skin, Also note if any visible masses in the axilla.
Ask the patient to now lean forwards, keeping their hands behind their head. Repeat
inspection of the breast tissue as above. This position will exacerbate any skin
dimpling / puckering which may relate to an underlying mass.
❑ PALPATION: You need to check both breasts, you can start with the good one.
Ensure to warm your hands before touching the patient. Keep the patient in 45
degree angle. Ask the patient to place their hand on the side being examined
behind their head (RT breast rt hand). Start from the areola and work outwards
in a circular motion, I will palpate all 4 quadrant and axillary tail. Repeat
palpation on the other breast, asking the patient to place their alternate hand
behind their head.
❑ If you got mass examine it separately: Check the size, site distance from the
nipple, check the consistency weather soft or hard. If not is soft more chance to
have benign growth but if hard more go towards malignancy. Check border
regular or irregular, check it is fixed to they underlying structure or it is mobile.
Do fluctuation test, Hold the mass by its sides then apply pressure with another
finger to the centre of the mass. If the mass is fluid filled (e.g. cyst) then you
should feel the sides bulging outwards.
Axilla: Ask the patient to sit at the edge of the bed, I want my patient to rest her arm in
my hand. Support the patient’s arm on the side being examined with your forearm. If
you’re examining the right axilla, use your right arm to support the patient’s. Palpate the
axilla with your free hand, ensuring to cover all areas of the axilla. Medial / lateral /
anterior / posterior walls and the apex of the axilla. Check any lymph nodes enlarge or
note which because on malignancy lymph node enlarge often.
Nipple: Ask the patient to squeeze the nipple.
❖ Yellow / Green / Milk – suggestive of infection.
❖ Bloody discharge – more suspicious of malignancy.

Finish the examination by doing cervical LN from the back. Wash your hand.
I had some time so I told do you want me to ask anything, he told me do you think I
should know anything else, then I told as it is old patient you should check carefully to
see any sign of malignancy present or not. Like the mass should be hard, irregular
border and fixed to the underlying structure.
Another feedback: breast lump-PASS
Mrks- 4,4
I followed the Marwan notes breast lump exam exactly.
But I forgot to mention WIPES . I just started explain the examination to the student. I
think that’s why I scored low here
Station 2: Rubella in pregnancy
A young girl come to your surgery, she thinks she is pregnant and recently came
exposure to a child who had rubella. She was working in the childcare. She is concern
whether it can have bed effect on her upcoming child.
Task: Hx for 3 min
Inv
Counselling accordingly
Hx for 3 min: Here Hx in just for 3 min, so you need be very specific, you cannot ask
everything.
My approach: Patient was quite anxious, I calm her down, Introduce myself and asked
name. Followed the structure
HOPC: Have you been feeling unwell or feverish? Have you noticed a rash, or lumps
and bumps behind your ears and the neck, or do you have sore throat, runny nose?
She had no problem just worried
When was the exposure?: Yesterday
How long: Whole day
Did the parents confirm you about the diagnosis? Yes
Have you had a previous rubella infection, or have you been vaccinated for rubella? No,
vaccinated according to Australian guideline.
Have you done pregnancy test: No
When was you last period: 6 week back
Did you notice any early morning nausea, vomiting and breast soreness: Yes
So you did not visit any dr or have not done any antenatal check up: No
First pregnancy?
Miscarriage?
Investigation and Counselling:
Rubella is a mild infectious disease causes by a virus which is usually transmitted
through air droplets. For you, rubella is a mild infection. However for the baby, if you
contact a rubella infection at this time of the pregnancy, there is a high chance that the
baby gets infected and it results in congenital rubella syndrome. Birth defects
associated include deafness, blindness, heart defects, limb defects, and mental
disability. I need to check for certain factors called antibodies in your blood which tells
us if your body has the power to fight the infection or not. There are two antibodies that
we have to check for, and there are 3 possible scenarios.
 If IgG is positive and IgM is negative, it means you do not currently have
rubella infection and it is safe for you to continue pregnancy. I would arrange for
your antenatal blood tests, start you on folic acid until 3 months of your
pregnancy, then we'll proceed as in a normal pregnancy, ultrasound at 8 weeks,
at 18 weeks, sweet drink at 26 weeks, bug test at 36 weeks and regular
antenatal checks where your BP and weight will be recorded along with other
assessment to note any alterations.

If IgG is negative and IgM is positive, unfortunately it means you have a

current rubella infection. I will have to refer you to the high risk pregnancy clinic
where you will be seen by the obstetrician and infectious disease specialist, and
you have two options at this point. You can terminate this pregnancy or you can
continue with this pregnancy, then we'll monitor the baby through repeated
ultrasound scans. Whatever your decision is, you will be supported through that.
Also, rubella being a reportable disease, it has to be reported to the Department
of Health services.

If both IgG and IgM are negative, then we have to repeat the test in 3 weeks
time just to confirm the results. During this time, do not come in contact any
other rubella cases. If both antibodies remain negative, it will be safe for you to
continue pregnancy. After delivery, you will again be checked for your rubella
status, and if still negative, you will be given the MMR vaccine. After you've been
given the vaccine, you should not try to be pregnant within 28 days or better 3
months.

Another feedback: Antepartum care - PASS

Score- 4,5,5,4
I followed the rubella case exactly from Karen notes. Remember that flow chart given
that’s the main thing.i am unable to attach that in here.

Station 4: HTN – noncompliance to medication

Patient came to you due to HTN, she came here for vaccination but nurse got the BP
high. Nurse advise the patient to talk to you.
Task: Take Hx to address the non-compliance for 6 min
Counsel the patient for 2 min
I was sure that I am going to pass this station but fail

Take Hx to address the non-compliance: I followed following structure just miss to

ask the financial problem. Patient recently move this area and was not very serious
about the medication because she was not getting any different even after taking
medication. She is taking chicken pox vaccine and today is her last dose, I did not tell
anything about that whether she can give vaccine today or not because I was not sure.
HOPC: headache, N, V, blurring of vision, weakness in any part of your body.
Hypertension Ques: Have Diagnosed with HTN before or not: When was it diagnosed?
Who diagnosed it for you?- 7years, Did he prescribed any regular medication?, Can you
remember the name of the medication?- Ramipril, How many times do you have to take
it?- 2 times, Are you taking your medication regularly at the right dose?
► Causes of non-compliance:
► Medicine related:
❑ Any side effects from the medication?
❑ Any issues with the cost or understanding the prescription?
► Doctor related:
❑ When you were diagnosed, did you understand the causes, the risk and
complications of hypertension?
Did you understand the effects of not taking the medications regularly
► Causes of non-compliance:
► Patient’s Belief:
❑ What is your view about your condition and your medication?
❑ Do you think this drug is beneficial?
❑ Are you trying any alternative treatment?
► Adherence to SNAP Model/SADMA:
❑ Do u take healthy balanced diet? Do you exercise regularly?
 ❑ How is your mood? Home situation?
❑ Stress at work? Enough Support
❑ SADMA, PMH/FH>any past medical history other than HTN
❑ I asked her whether it is primary or secondary HTN, she don’t know, so I asked
some Qs according to TRACKPADS to rule out secondary HTN. Here, when I
asked about changes in the weather preference, patient said what it is, so I told
that anything happen like you used to like summer now you prefer winter, she
said no

Counselling: Talk a little bit about HTN and then told most likely primary HTN. I
understand you are not feeling any changes, but the thing is that you will not feel any
problem until it damages your organ. She said “oh, I didn’t know that”. Yes that’s true,
and if you have HTN for long time it can damage your eye you can have vision loss,
damage kidney it can affect your heart.

Another feedback: - Medical management -Fail

Was hypertension
I totally forgot to address memory issues with hypertension I think that was critical

Station 5: Mood change – MDD with psychosis

This is the old recall where nurse had suicidal attempts and came with husband.
Task: Take psychosocial Hx for 6 min
Tell diagnosis and Differential diagnosis with reason to the examiner
Tell risk of patient to the examiner

History: The patient cry from the beginning to end. I need to give lots of reassurance
and need to show empathy a lot. But she was giving answer.
Introduce myself, gave confidentiality, ask name
Took psychosocial hx but I forgot to ask about the suicidal attempt when I remember my
time almost finished. Just ask one qs and times up.

Tell diagnosis and Differential diagnosis with reasons to the examiner and Tell
risk of patient to the examiner:
This part was really funny, you cannot see the examiner, so I started like that….
Dear examiner most likely the patient is having MDD with acute psychosis as the patient
is not sleeping well, appetite not good……………. And it is going on for long time. On
top of that she is having auditory hallucination. It can cause due to other reasons as well
like bipolar disorder, substance abuse, schizophrenia, Mania.
To me she is in high risk as she is having active hallucination, not sleeping and eating
well, has history of suicidal attempt, had positive family Hx mental disorder.
I have some time then I discover I didn’t tell ddx with reasons, then again started telling
about ddx with reasons…
Bipolar disorder: As patient not had any Hx of high mood so it is less likely
substance abuse: No Hx of alcohol or any other recreational drug
schizophrenia: Not having it for long time, started recently
Mania: The clinical feature not match with mania

Another feedback: mood change- fail

A nurse had a kid who died in her care and now she is suicidal and depressed . I said
ptsd but now I think it was depression . Not sure

Station 6: Abdominal pain

Patient had intermittent tummy pain for 6 month- gp setting
Task: History for 6 min
Diagnosis with reasons, tell the differential diagnosis
Hx: HOPC- SOCRETES, associated features, DDx, bladder and bowel, SADMA, past
Hx and family Hx
Findings: She told me it is not pain, it is more like ache. She had weight loss and she
notice some blood in tissue paper only, she is also having constipation for long time,
using laxative on and off. She with her husband run a farm. No other issues, completely
fine everything.

Diagnosis with reasons, tell the differential diagnosis: There could be couple of
reason for your condition but what I am thinking that as you are having this for 6 month
and lose your weight, notice blood, it can be due to some nasty growth on your body,
Patient give some anxious look, then I said see this is my working diagnosis, I am not
100% sure yet, your condition can causes due to many reasons as I told earlier
Can be due to IBD, People often lose weight in IBD
Can be due to Anal fissure but you have no pain while passing stool
Can be due to diverticulitis but not having severe pain
Can be due to coeliac disease, mesenteric ischemia, and IBS but unlikely

Another feedback: Abdominal pain PASS

Score-4,4,4
I asked all the pain questions first.
Then dd questions like protruding mass, blood, pus, mucous in stools, alternating
diarrhoea, there was long term constipation, weight loss was positive, I also asked
about nausea, vomiting, distension, all negative. fever. stress.
Gave ads of cancer, crohns, haemorrhoids, don’t remember exactly what ads I gave
honestly

Station 7: GAD
Patient already diagnose with GAD, dr did some test after doing all the thing they came
in conclusion that she is having GAD.
Task: Justify why this is GAD
Management and counselling
I did not perform well in this station, the patient was very irritating, she even didn’t give
me any chance to talk according to my structure. She just asking me qs one after
another as a result I lost my structure. Please see some other passed feedback.
Her qs was
What investigation you are going to do next
What you are going to do now with mw
What treatment you are going to give me
One of my friend taking sleeping pill do you think that it would be good for me
When told that we will try with sleep hygiene first, she told me what it is?
Another feedback: GENERAL MAIALSE- PASS
SCORE-5,4,4
THIS was explain generalised anxiety disorder to patient and its management

Station 9: Difficulty breathing

A mother came for her child. Child is having breathlessness which started 2 days ago.
He also has some cough and mild fever.
Task: Hx for 3min
PEFE will appear in the screen for 3 min
Diagnosis with reasons
Management

I was expecting to pass this station but fail. Here is my approach

Hx for 3 min: I asked about HOPC, For cough asked the cough Qs. Associated feature
and DDx, well baby and BINDS.
Findings: Just mild cough no barking cough, breathlessness in more, urine become
very scanty but not smelly.

PEFE will appear in the screen for 3 min: in the PEFE,

Temp: a little bit high
Resp rate: 55 b/min
Puls: High
Cyanosis: +

Diagnosis with reasons: I said, most likely he is having bronchiolitis. Then explain a
little bit. Management: Need to admit to hospital, seen by the specialist dr, they will start
oxygen, no need to give antibiotics as it is a viral infection. If necessary specialist will do
x ray
Then she asked me what about the urin dr? I said we will do investigation and if found
any infection will give antibiotis (I think this is the mistakes I have done, she was asking
me about fluid, may be urine scanty due to dehydration, after finishing this station I
realize it).

Another feedback: difficulty breathing- fail

This was 4-month-old with wheeze and exp wheeze. I said bronchiolitis. Don’t know
what was this. I Think I forgot to rule out foreign body. Not sure.

Station 10: Groin pain – testicular torsion

A child was playing basketball, suddenly started having groin pain. Mother is here to talk
to you: Emergency setting.
Task: Hx for 4 min
PEFE will appear in the screen after 4min
Diagnosis with reason
Choice of investigation
When I was seeing the qs I am thinking about lymph node and hernia. But as soon as
the station started the game changes. I calm down the mother and introduce myself.
Said how can I address you and what is your son name (The son name was really weird
so I just skipped it)
History: Again, I just followed my structure. Ask HOPC, ask where exactly he is having
pain? She said in the scrotum. Then I asked about socretes, associated feature and
DDx. After 4 min they prompt me and PEFE appear in the screen and its written
No injury mark
No redness
Pain did not reduce while lifting up the scrotum.
Diagnosis with reason: Most likely your son is having a condition which we called
testicular torsion. Then described it and draw.
Investigation: We cannot waste our time by doing investigation because it is a
emergency condition and it is important to go for immediate surgery within 6hr, which
we told the golden hour. How long aga it happen, she said 2 hr ago (I dint weather it is
written in the qs or not, or I asked in the Hx but as the qs is important I asked again). I
said, so as you came within the golden hour the outcome of surgery will be good
hopefully. Then assure her……

I had some time so ask her, do you want me to ask anything else, she said me dr do
you want me to tell anything? I said just let me check the qs weather I missed anything
or not (I was actually giving myself sometime to remember anything I missed or not), so
I told her, as I said no need to do Inv, diag is mainly clinical but as he is going for
surgery so If surgery want can do some basic blood test just to make sure that he is fit
for the surgery.

Another feedback: GROIN PAIN- PASS

SCORE-6,6,6
This was testicular torsion question.
Followed Marwan notes testicular torsion topic entirely

Station 11: Shortness of breath – CVS PE

Patient have breathlessness, HTN………… (All the feature of CHF). A medical student
came to you, today is her first day.
Task: Tell the student how to do PE in this patient
Tell which step you need to do and why

Introduce myself, ask name. Today we have got a patient who is having lump, we need
to examine the patient. Today we are going to do breast examination. I will tell you how
to do examination step by step but if any time you feel like you are understanding at any
point feel free to ask me, I am more than happy to repeat it again.

Be fore stating any examination, you need to wash your hand, introduce yourself with
the patient and ask permission for proper exposure. Here as we are doing breast which
is private part you need to keep a chaperon after getting patient permission, need to
maintain privacy also.
 Start with GA, patient sitting comfortably or not, any protective posture. Then
check vitals, you need to make sure your patient is vitally stable before doing
examination.
Start from hand, check any pallor, clubbing, tremor present or not. Check the face for
any xanthelasma, eye to check any anemia/jaundice present or not. The student asked
me how to check, I told check any yellow colouration of the eye present or not to check
jaundice, for anemia check the lower eye lid become pale or not.
NECK: Come to the neck, check JVP raised or not, it lies between 2 head of
sternocleidomastoid muscle..I will keep my patient in 45 degree angle, ask the patient to
turn your neck to the left side, I will check any visible palsation present or not. Confirm it
is venous impulse or not, like venous inpulse change with respiration, posture and it is
not palpable. Drow a line from height point level of the venous impulse to the sternal
angle. Measure the length between sternal angle to the horizontal line. Add 5 cm as
sternal agle lies 5 cm ablve the rt atrium. More than 10cm h2o (4-10 cm normal) indicate
HF, Pul embolism, hypervolumia.
Check Carotid pulse is of good volume: I will auscultate the carotid bruit by diagphrame
of the stetho, can you hold your breath. If absent, now I will check the volume by
palpating the carotid pulse. Then auscultate for c. bruit- It indicate stroke or coronary
artery disease
Come to chest: Inspect for visible scar/ deformity/ redness/ visible apical impulse.
Palpation: Check apex beat by keeping your hand on the left side of the chest, as soon
as you feel it check it is in which intercostal space and how many cm away from the
midsternal line. Check Parasternal heave by keeping my palm in your left side of the
chest, you will feel some palsation which should not be present normally. positive in rt
vent hypertrophy (Left side). Check palpable P2- By keeping my palp of finger in left
second intercostal space.
Auscultation: Keep the diaphragm above the space where you got apex beat. Check
other than s1 s2, are you getting any added sound, you can keep a finger on the carotid
pulse.
Go to the abdomen: Chen weather liver enlarge or not. Start palpation from the right
iliac fossa with radial side of your index finger, ask the patient to take deep breath, go
upward with each respiration, as soon as you feel the lower end mark it. Percuss from
the second intercostal space, as soon as you feel dullness mark over there. Join 2
marking check how many cm, normal is 15cm.
Check abdominal bruit by stetho: Drow a line from xiphi sternum to umbilicus then select
a mid point for aortic bruit and then 2.5 cm away from the mid point you can get renal
bruit.
Check leg for swelling, press to see pitting edema or not, any pain present or not, also
check any colour changes in the skin.
Time finished
Another feedback: SHORTNESS OF BREATH
Pass
Score- 4,3,4
This was explain chest exam to student.
Followed Marwan notes examination.

Station 12: Pallor

A child came with intermittent pallor for around 6 months. Otherwise, fine. Father came
here to talk to you- GP setting.
Task: History for 4 min
PEFE and investigation will appear in the screen after 4 min
Diagnosis with reason

History: This was my first station. I was a little bit confused as I didn’t practice it. I don’t
know how old recall it is. I just follow my structure. HOPC, Associated features and then
DDx. I think this is a good structure which you can follow in every case. In ddx honestly,
I have no idea, but I asked about IDA, Thalassaemia (But I forgot to ask country of
origin just asked anyone in the family having similar issues or not), Ca history, short Hx
of binds, TMAC and well-baby, just a little bit.
Findings: Patient had intermittent pallor, when he had pallor that time, he feels tired.
Other than no other issues, everything is fine. I was really surprised to get the Hx but
got relieved after seeing the PEFE.

So after 4 min they will promt you them PEFE and investigation will appear in the screen
PEFE and investigations: They will give you everything here.
Findings: Anaemia +
Spherocytes ++
Splenomegaly
 Bilirubin +
Other I can't remember sorry....
Diagnosis with reasons: I said that most probably he is having Hereditary
spherocytosis. Hereditary means run in the family and spherocytosis means presence of
spherocytes in the blood. Let me tell you more about spherocytes.
In our body there are three types of blood cells red blood white blood and platelets the
red blood contain a specific type of pigment called hb that helps to carry oxygen in our
body, in ur child case we called it anaemia also the volume of each of the red blood cell
also low which shows by the MCV which is low, now normally the shape of red blood
cell is normally a little bit of elliptical ,but in ur child case when we looked it under
microscope it is quite a little like spherical shape which we called spherocyte, and this
spherocytes are prone to breakdown easily rather than the normal elliptical red blood
cell, normally, in our body in the left side under the ribs there is an organ is called
spleen,and this spleen does the job of clear away the red cells which are not working
properly ,and that is y when this spherical size RBC are going into the spleen ,the
spleen are breaking this spherocyte rbc more quickly than it should be breaking,and
that’s is y we are getting more bilirubin. The spleen is enlarged as I said spleen is
working a lot more harder than before.
I got some time at the end so ask if he had any more concern, he told me I think you
have described me well. Then I told don’t worry it’s a manageable condition and he is in
safe hand. Time finish Alhamdulillah.

Another feedback: Pallor

Fail
This was spherocytosis case in a 2 year old. I said thalasemia although I knew it wasn’t
but I couldn’t think of spherocytosis.

Station 14: Funny turn

Patient had funny turn, brought by her friend. Now she is completely fine and came here
to talk to you, Blood glucose level is normal- Hospital setting.
Task: Hx for 6 min
Diagnosis with reasons
History: I followed my structure, HOPC, Associated features. I ask can you tell me what
happen exactly, she told me she wakes up from bed went to open freeze for breakfast,
suddenly lost consciousness and had jerky movement for few second then was
completely fine. I asked what happen before, after and during the episode of loss of
consciousness and some DDx. This is the first time she had it and she had a Hx of
binge drinking of alcohol last night. Normally used to drink safe limit.

I am little bit confused when they give us finding that blood glucose level is fine, either it
can be after the Hx for 6 min or at the beginning, but I am sure it was written that blood
glucose level is fine.

Diagnosis with reasons: I said most likely you have a condition called syncope where
you have temporary loss of consciousness (Here I was confused with seizure and
syncope so I said syncope). It can be due to many reasons but in your case I am
thinking most likely due to your binge drinking. Now, binge drinking can cause syncope
many way, by reducing blood glucose level, by causing abnormality in electrolyte
balance and sometime within 72 hours of withdrawing alcohol you can have this type of
syncope. In your case we have found that blood glucose level is fine, to check any
electrolyte imbalance we need to do test.

Said some DDx

Another feedback: Funny turn

PAss
Score-5,5,5
This was binge drinking case from Marwan notes.
I followed the notes entirely
Station 15: Headache
Patient came with headache for long time- GP setting.
Task: Hx for 6 min
Diagnosis with reasons

Hx: This is Migraine case. Often come in the exam. I don’t think I need to talk much
about it. Just followed the structure like SOCRETES for pain, associated features and
DDx, SADMA, past Hx.
Findings: Patient was co-operative, typical Hx of migraine- one sided pain, can't
tolerate noise, had family Hx positive, feel better when take rest...........
Diagnosis with reasons: Most likely you are having a condition called migraine, the
causes is exactly not known but it can run in the family like your case and the
characteristics of your pain is also similar like migraine as you said that it is one sided,
you can't tolerate noise, you feel better when take rest.
I also told some DDx although it was not my task.
Another feedback: HEADACHE
PASS
SCORE-5,66
t was migraine station
I asked pain questions first
Then ads quest, fever, head trauma, nausea, vomiting, weight loss, aura, migraine
triggers, dental pain, temporal area pain, pain on chewing, sinusitis questions, ear ache,
eye sight cues, stress cues.
All migraine questions were positive
Station 16: Rash - PE
A child had sore throat, got antibiotics- penicillin, started having rash. Father is very
worried and came here to talk with you. You need to do Physical examination.
Task: Tell the patient what step you are going to do
Tell what finding you are looking for to the examiner
Diagnosis with reasons

Believe me, I don’t why I pass this station, the qs was really weird and I had no structure
in my mind. I was very nervous and patient irritate me a lot. But let me tell you what I
have done.

The father was very anxious, I calm him down and introduce myself. Then told that we
need to do examination and I will start from the hand. Basically I was trying to follow the
haematological examination step and I added ENT also. But from the beginning patient
was interrupting me, at first he asked me what is pallor, then ask me what is tonsil. I
describe him in a layman term each time.

There was no examiner, so its really hard to tell the examiner but still I tried to tell the
examiner in which step what I am wanting to see.

Diagnosis with reasons: I said most likely he is having EBV infection. Patient give a
weird look at told me what it is, I explained him.

Another feedback: RASH

PASS
SCORE-4,4,4
This was a kid with rash.
I started with general inspection
Then rash, site, size, colour, extent, surface, warmth’s tenderness, flat/raised, blanching
or non blanching.
THEN did lymph node exam
And that’s all
I think you had to do haematological exam here , I totally forgot about that

Station 17: Pilot – Eye swelling - PE

7/8 years child had eye swelling which suddenly started, One sided and the face is also
swollen. Child had egg allergy earlier but clear up later. No other problem. Here is a
medical student, today is her first day.
Task: Describe how to do physical examination to he medical student.
This was pilot station. The picture was similar to the following. I did Inspection of the
face, palpation, full eye examination then time finished.

Station 19: Placenta previa

Emergency setting: Patient is 34 weeks pregnant, she is having some bleeding from
down below, no tummy pain. Till now pregnancy is going fine, this is her second
pregnancy, fist time she need to go for C/S (Forgot about why), blood is O- Negative.
After coming the emergency she had done USG.
The USG findings: Placenta previa, cover fully the birth canal. FSR normal, position
cephalic. Other are normal.
The Qs was very big, can’t remember everything.
Task: Explain the USG to the patient
Tell what investigation you need to do
Management

Patient was very worried, so I come her down and introduce myself and assure her that
she is in safe hand. Tell her that the baby is doing fine so no need to worried at the
moment. She was very worried but listening to me, I don’t know how make a big tummy.

Explain the USG to the patient: Here I draw the picture. Normal uterus and said that
this is normal uterus, placenta used to remain at the top (Draw), but in your case it is at
the bottom (Draw). We called it placenta previa. But the good thing it that baby is doing
fine. Assure her again. When you come near the last trimester the baby started going
down and press over the placenta and you can see some bleeding as a result which
exactly happening with you. From the USG, I can also see the placenta fully cover the
birth cannel, so I am thinking it can be 3 or 4 degree. Now it can causes due to many
reasons but in your case I am thinking it is due to your previous C/S.

After that, Like a mad I asked the patient do you know what is placenta previa, patient
said, you just describe me dr. I lough suddenly but control my self immediately as
patient giving me anxious look. Ha ha……….

Tell what investigation you need to do: I said we need to do some investigation like
FBC, ESR, CRP, Blood grouping and cross matching, coagulation profile. We will do
CTG 4 hourly to check your baby’s condition.
Management: We will admit you, you will be seen by the specialist dr. As we are
thinking that it can be 3 or 4 degree so specialist may decide to go for elective CS
in 37 week. Are you still bleeding? She said no. So, in that case specialist may wait till
37 week and then plan for elective cs. But if your bleeding continue and your baby had
foetal distress, specialist may decide to go for emergency C/S by giving you steroid to
bring lung maturity of the foetus. But if you stopped bleeding and you want to go home
there are some condition you need to follow like, stay closer to the hospital, have a
constant companion and whenever you see bleeding come to the emergency
immediately. But don’t be stressed as I had told you you are in safe hand and we will do
whatever is best for you and let you know time to time.

Do you want me to call your husband? She said: he is on outside. I said if you need any
social worker for your other baby I can arrange it.
I had time, so I asked her, do you have any other concern? She said do you want me to
tell anything elsa? I said let me check the QS if I missed anything or not. The I again
checked the qs and found that she was o negative. So I told her as your blood group is
B negative we will give you anti-D injection after delivery. Have you had in your last
pregnancy, she said yes. Time finished…

Another feedback: late pregnancy complication

PASS
SCORE-5,44,3
Placenta prevue, explain scan to the patient and management. There was a report
given that was in a lot of detail we just had to explain it to the patient.
I drew on paper and told patient in simple language whatever was written in the
report.’Kept on asking her again and again if she understood.
And management was to do c-section, regular checks, high risk clinic,
Best wishes to everyone .

Station 20: Pilot – Sleep problem

A young boy not sleeping properly, anxious for few month, there are many more finding
cannot remember properly.
Task: Take psychosocial Hx
Tell diagnosis with reasons

Take psychosocial Hx: I took full psychosocial Hx after giving confedentiality, patient is
smiling all the time not a good roleplayer I think but answering qs
Findings: Patient mother died 2 years ago due to pancreatic cancer, from that time the
problem started, 2 years back he was completely fine, sleep is breaking in the middle,
fight with step mother, stay away from the family for 1.5 years and now come back
again. His mother anniversary is also coming.
Diagnosis with reasons: Anniversary grief, abnormal grief, PTSD and explain why
Gave some other ddx also
17th March 2021
Tips from Candidate:
I decided to seat for exam with just 7 days in my hand after a nasty surprise of
immediate exam offer from AMC. My spouse forced me to seat for the exam, and I
gave a go! Big thanks for the support. Anyway, I was preparing for a long time and its
not my first attempt. I just finished studying for PESCI couple of weeks ago too. I passed
11 stations. I scored above the average exam scores in thirst, Autism and Pneumonia
cases, a bit higher in physical exam cases. Other stations were average scores.

This time my preparation was different from other times. I was familiar with cases, I took
brief notes myself on approach to cases (fever with rash or rash following fever or no
fever but rash, or acute SOB with or without fever) and I did enough roleplay to track my
faults. Wrote down d/ds in notebooks, mistakes I did during role play and very briefly,
the way cases coming on a particular topic (ex- Postpartum fever/SOB, anticoagulant
counselling).

Later part of the preparation I stopped following or reading recalls totally (it was not
rewarding for me at least, made me biased easily) and I tried to think age specific
d/ds(specially Pedi and gynae cases are age specific), key points, risk factors and
learning to differentiating those 4/5 d/ds(IBS,IBD,AB induced, malignancy, infections or
Migraine/ SOL/ tension headache or mono / binocular diplopia or stress disorder vs
depression). You guys pls try this way or something similar way… exam works that way.
Imagine how will you approach a particular case in ur very own way….... I did an Alan
Roberts course and 4/5 multiple small or subject wise classes, Physical exam courses.
Did join free classes including DR Majid’s and First aid AMC. All of those classes
helped, and I am grateful to them.

Before the exam I tried to do marathon roleplay (4-5 hours in a row/ 8 cases in a go)
with my study partner so that I do not get fatigued easily. My amazing study partner
happily agreed with this stressful training and just before my exam we did all physical
exam cases revision (Thanks for his support and cooperation---we both go anonymous:
😉, his exam is approaching u might create unnecessary pressure on him😉 requesting
more roleplay). I had many other study partners, many hours I did spend in roleplay and
discussions—u know unexpected long AMC journey😊! My gratitude to them also…I
have learned from you guys too.
Finally, I can manage little bit more time in park with my kid.
Best of luck for your exam.

Thanks to this amazing group, group admin and salute to all of your contributions.

Station 1: Thyroid PE
Another feedback: Thyroid exam case: pass
I am good at physical exam at least! Passed all physical exam in this exam. I had good
slides from courses classes. I practiced with my study partner very well in AMC way and
also had to prepare cases this way for pesci exam.
I tried to practice PEFE in a sequence as we do always, make your own sequence and
approach for each pe topic. Practice with twists with different positive findings.

Station 2: Pre-eclampsia
Task: Short Hx, Further Ix & Mx
Another feedback: Pre-eclampsia: fail.
I was expecting to pass this after so much of roleplay on this case. Follow your own
approach and instinct. ¾ tasks were there including mx.
HOPC is headache in a 3rd trimester pregnant lady. A medical student did the exam for
you ..its PET clearly.
Probably My history and mx was not enough… did not ask key points or did not explore
headache complain much. AMC clinical is an exam of key points, not touching those
points clearly will lead to fail.
Station 3: Haematological PE
ITP- DDx with reasons
Another feedback: Non blanching rash: did a haematological pe as in Handbook.
I said 4 d/ds of non-blanching rash and explained why its ITP and why not others
relating it to history and positive findings already given in stem. In exam stem it is
mentioned that no positive viral serology of throat swab, urine test normal etc to exclude
other causes. I just relate those points. No positive findings given on asking and role-
player would speak minimum.

Station 4: Respiratory PE
Another feedback: Case: pass
acute shortness of breath case for hours actually. If it was face to face exam, then it
would be pneumothorax case😉! Panic Or pneumonia. As its acute SOB I followed
DRSABCD protocol, in every pe case I followed WIPER approach too
Station 5: Adenoid – Paediatrics
Task: History, Counselling & Mx
Another feedback: Adenoid case: pass
stem is a bit detailed with pefe findings and it is clear that it’s an adenoid case. My
Score is average except mx plan. I excluded allergic rhinitis and asked a bit to confirm
that its adenoid. Asked about complications of adenoid- hearing, speech, behaviour etc
these were all affected according to role-player. I addressed it in mx plan. Referred the
pt to specialist, hearing test, speech therapy etc. ordered neck x ray for adenoid
shadow.

Station 6: Pneumonia
Fever + cough + CXT – Dx & DDx
Another feedback: Pass:
Fever and cough 5 days. Pedi case.
Task- history, pefe given, explain x ray and say about dx.(3/4 tasks)

P/E clearly points to consolidation and x-ray it points to consolidation too.

Its was short history but I asked detailed about cough (it was dry according to role-
player) and fever separately. Who knows it might turn into sepsis or Kawasaki,
epiglottitis, UTI.

I gave frantic effort not to miss anything and my history sounded like interrogation😉 to
myself even. (sometimes I forgot its roleplay and I am doing roleplay of a doc according
to the AMC script! However, no one should ever forget nice approach to pt.) I passed
with low score in approach. role-player asked twice to explain the x ray. I did with
second time with more medical jargon…so that examiner listens at least. Also role-
player asked why its pneumonia (very clear in x ray)—I pointed pefe : particular
auscultation findings and x ray finding. Dx – I gave pneumonia, effusion, 2 0r more
others dx etc etc.

Station 7: ANC visit

Explain all ANC Ix + Advice
Another feedback: Antenatal case: fail
Pt had irregular period and home pregnancy test positive.
Task is : do explain the investigation you are going to do, give antenatal advice.
I don’t know where I messed up. I thought I was good at gno cases but actually not😉!
should not try this field in future.
I said dating scan and other routine antenatal screens. Gave a detailed antenatal advice
pt was drinking asked to stop during pregnancy.

Station 8: OCP Request

Another feedback: OCP case: pass
In ocp cases exclude C/I, know about HEADSS history bcz pt would need to take
medicine regularly whether its suits her lifestyle, ask about mood- ocp affects mood, any
drug or pre-existing disease pt having that might interact with it or affect its efficacy or
affect the disease. Pt was epileptic and taking a non-enzyme inducer antiepileptic
medicine even though I said I would check whether it interacts with your current
medicine or not. Please follow typical ocp counselling approach including missed pill
etc. whether as a junior doc you take opinion from epilepsy treating specialist or not : it’s
a dilemma for me. I did not mention that and passed.

Station 9: Thirsty guy – Diabetes Insipidus Drinking too much water – Pilot

Another feedback: Thirst: Pass (its scored case according to my feedback, not a pilot)
Some what known case to me… came across recall solving.
If u want to read little bit of theory, then check JM and oxford Handbook.
I focused on HOPC. Excluded DM, DI, loose motion, diarrhoea, little bit of dry eye+dry
mouth +joint pain syndrome, anxiety disorder, past history, medication history, any
recent surgery, brain injury etc.(positive is lots of calcium supplements in a day). Ask
about amount of urine and nocturia. She was drinking water in between roleplay, when
asking anxiety qs role player was laughing.
I gave dx of possible hypercalcemia/this drug leading to excessive thirst (bcz nothing
other than this was positive), mentioned other d/d.

Station 10: Obstructive jaundice

(tea color urine, itching + stool color changed)

Another feedback: Obstructive jaundice case: Pass

HOPC: A small to medium sized stem a middle aged pt with high colour urine.
Task- History, PEFE in description, give differentials.

History: In HOPC I tried to ask what colour actually. He was tricky and gave me a non-
specific answer. Started with duration, which part is red etc. I had to differentiate UTI to
AGN ,trauma. On asking he gave history of jaundice, stool colour change and urine
colour change. I excluded other causes of jaundice including travel, sexual history,
recent drug history etc. gave confidentiality when needed.
I asked surgery history somewhere at the very end in case—positive GB surgery 18
months ago.

PEFE: key findings I looked for urine bilirubin positive, rbc cast, rbc was neg.
I gave dx as obstructive jaundice with possible causes. 3rd d/d I said it could be nasty
growth in head of pancreas. Pt started drama I said its possibility only.

Station 11: Warfarin Pre-op

Another feedback: PASS:
Warfarin, metformin, and atenolol now waiting for routine hernia surgery. Very well-
known case, I knew the theory behind it also.
I passed with average score don’t know why. Should learn from books/guidelines (?!
probably they don’t want that much theory we know or learn ) and apply your own
approach. I also asked little bit of hernia history, SADMA, blood clot history, FHx etc
too…. Along with CHADS2vasc points.
Station 12: Autism Spectrum
Another feedback: Autism spectrum: pass
It was my first case, and I was nervous as first online case of the exam.
I did not expect to pass the station however passed with a good score.
Stem was like handbook ADHD case and HOPC is aggression in school in a toddler.
I tried to explore what is meant by aggression--- nonspecific answer came.
Tried to understand home behaviour in my second or third question. Usually,
behavioural issues will be present in both setups. A tricky answer came as he is only
one we can’t understand. Then I started asking direct questions of Autism, adhd, ODD
etc. to save my time.
On detailed developmental milestone check it showed isolated gross speech delay and
echolalia. Then I got clue of ASD. I excluded organic cause, hearing, eye sight issues,
family history,family stress, BINDSMA .Said multiple d/ds…including normal
phenomenon, family stress, hearing issues, adhd.

Role-player asked how do you confirm it? I said I cannot, specialist will do, I can suspect
only. Gave reassurance. In mx I arranged formal eye, hearing test, speech therapy and
refer to specialist.

Station 13: Temazepam

Give reasons for Insomnia – Dx – Depression
Another feedback: Pass:
Young pt came for benzo repeat prescription.
Task: 1. psychosocial history and task 2 give cause of insomnia.
A bit theory u can remember: every benzo taking pt should be checked for mood or in
other way; in insomnia u should exclude depression (with suicidality) and anxiety while
searching secondary causes of insomnia. No cause found then its idiopathic/primary
insomnia.
I gave dx of moderate to severe depression. It was actually mild depression. (got less
score for that)
Anyway, I took typical psychiatry history including suicidality and any recent stressor.
Also explored other causes of insomnia. Pts accent was difficult and mixed with OZ
dialect. I actually understood one or two words in a sentence😊.

Station 14: Serotonin Syndrome

Another feedback: Serotonin syndrome:
could not sort out whether it was pilot or either of the physical exam cases was a pilot
for me. But it was in GP set up with typical stem of one SSRI plus? mirtazapine going on
together.
Serotonin syndrome I did not do well, as I felt tired and headache at the end of exam.
He was complaining of fever and tummy pain. Pt was moaning all the time and I could
not soothe him.
I tried to exclude organic cause, but I felt like my approach was haphazard.

Station 15: Knee pain – ACL Tear

Another feedback: Knee pain: Pass
In history, it was obvious that its ACL injury…. During sport knee twisted and now giving
away.
But did not stay firmly on that dx only. Excluded other causes. I asked about detailed
history of presenting illness, excluded other d/d in history, I missed past injury and
surgery probably. I got 6 in this case in history and approach. Dx—I scored less bcz
probably I did not correlate well history and exam findings, or I said only trauma related
dx. Anyway, Dx is ACL tear because Lachman test was positive and knee giving way. I
did study about differentiating these conditions during PESCI exam too. That helped
certainly.

April 2021 Recalls

6th April 2021
Tips from the candidate
I cleared my exam on 6th April 2021 in first attempt thanks to my good study partners
and this group.
I did not participate any cources and I think reading the feedbacks at least from 2017,
Hand book and doing lots of role play would be enough. It is not a hard exam if you
really be prepared.
Wish you all the best
Station 1: Forearm cut - PE

A man with deep cutting injury on the anterior part of his RT forearm has been brought
to the ED. Primary survay and dressing has been done.
Task is to explain PE to the medical student
I did as the hand book case:
First intriduced my self to the medical student and asked how to address her.
Then explain for her first I will wash my hands and introduce my self to the patient. Ask
regarding his pain score and offer pain killers if needed after checking allergies.
Check if he is hemodinamically stable.
Explain for him that I want to do inspection, feel your forearm, check the sensation and
movements. Ask permition.
Then explained like Hand book case 50.

Station 2: Acute Knee injury

Right KNEE INJURY in a 32 y man in net ball

Tasks:
History for 5 min
PE was given
Diagnosis & DDx

STEM: Pain score was around 6 so I offered pain killer after checking allergies. Plz
never miss the allergy question. Pain questions SOCRATES, he told me he was injured
in net ball. He said he was standing and suddenly turned to right. Developed effusion
after 30 min. He heard a clicking sound from his knee and now he has pain and swelling
on right knee Role player was sitting on a chair.
He had pain all over knee joint. Decreased range of motion. Could not stand on it. I
checked if gives away while coming down the stairs. He replied I’m not confident to try
stairs. He denied any redness or warmth.
After 5 min the PE findings were shown on the screen:
Effusion +
Restricted all movements due to pain
No redness
I gave lat meniscal injury as diagnosis and medial meniscal and ligamental injury,
osteomyelitis, osteoarthritis, psoriatic arthritis as DDX
I forgot to mention fracture and muscle strain as DDx.

Station 3: REST

Station 4: Hernia & undescended testes counselling

Case: A 7-month old baby was brought to your GP clinic by his mother because she
noticed a lump in his groin area and another at the belly button. You diagnosed it as
umbilical and inguinal hernia and you also noticed that the left sided testicle is
undescended.
Task
a. Discuss the condition with the mother
b. Advise further management
c. Answer question Counselling
- Do you have any particular concern before I explain anything about your son’s
condition?
This happens when part of the gut goes out into the umbilical or inguinal area.
For umbilical hernias, no treatment is necessary. They will usually disappear by 1 year
of age. Some larger ones may recede at 4 years of age.
- Inguinal hernias: this hernia is the one that I’m concerned about. It carries risk of
incarceration and strangulation. Incarceration is the type wherein it goes out but it
cannot be pulled back, while strangulation occurs in an incarcerated hernia which is an
emergency. If at any time you notice the child always crying, vomiting, or you see that
the lump cannot go back, then you need to go to the emergency department. - 6x2: at
birth – 6 weeks: within 2 days; 6weeks6months: within 2 weeks; 6months onwards: 2
months refer to specialist.
For cryptorchidism: in 90% it usually goes with indirect inguinal hernia. It is common in
preterm patients (20%). If it is found at birth then we can review for 3 months. Referral if
still not descended. Right now, since he’s 7 months old, I will need to refer him to a
surgeon to repair because this is the optimal time for surgery to take place (6-12
months). But it is up to 2 years. What happens if it doesn’t get fixed? Decreased fertility,
increased cancer (5-10x) and increased risk of trauma.
Do not put a tape or strap because it can cause strangulation.
RED FLAGS: If a child cries a lot, if the area is painful to touch, if it is irreducible or the
child has fever, nausea or vomiting, then immediately bring the child to ED.
Reassurance
Reading materials

Station 5: Distressed parent

A middle-aged lady whose daughter was hospitalized due to acute psychosis 2 weeks
ago. She is very worried and don’t know how to manage her stress. She has a younger
son as well. Both her husband and she are busy persons. She had no personal or family
history of mental illness and was not an anxious person previously.
I did MSE for her. Everything was NL.
I gave acute stress disorder and adjustment disorder as diagnosis. Explained it for her.
Explained regarding CBT, Relaxation technique (yoga and meditation), Healthy diet and
exercise, reduce caffeine, Stress management, Sleep hygiene
Refer to psychologist
Refer to psychiatrist and drug treatment if persistent situation.

Station 6: Shaky movements of hand

Shaky movements of hand without loss of consciousness at work for 22y old girl with
history of epilepsy as a child.

Station 7: Anemia in Pregnancy

8 w pregnant lady with anemia

Tasks:
History 3 min
Explain results
Order more investigations
Management

Hb: 112 hypochrom microcytic

It was an easy station but unfortunately the invigilator did not announce the 3 min
prompt time to me and I ran out of time.

Is it planned?
How it was so far?
Is it your first pregnancy?
How many pregnancy and age of children? First pregnancy
Did you used Iron tablets? No
How much was your previous Hb? Didn’t know
Heavy periods? No
Bleeding from anywhere else? Black stool? No
Any other surgeries? No
Any travel? Hx of malaria or hookworm? No
ANC? US? Single baby? Blood test in this pregnancy? This is the first blood test
Any vaginal bleeding in pregnancy? No
Diet? Meat? Green vegetables? Regular diet
FH of thalassaemia? Anemia? Heritage? Didn’t know. She was adopted
Enough support at home? yes

Ix: FBE, Iron study, If suspicious to thalassemia do electrophoresis

If is thalassemia the partner must be checked as well, if he also be thalassemia minor
need to check foetus for thalassemia major. 25% risk to be maj, 50% min, 25% non-
carrier if both parents be minor
No Iron tablet if be Thalassemia
Reading material
Red flag
Reassurance

Station 8: REST

Station 9: Ankle exam

Explain to medical student
Station 10: Non-compliance to anti-hypertensive

Non-compliance with antihypertensives

A 40-year-old woman came to for Flu vaccine. She was diagnosed with hypertension 2
years ago and was prescribed perindopril. For the last 6 months, the patient has
stopped taking medications. Recent blood tests for lipids, urea, creatinine, electrolytes
and blood sugar level was found to be normal. Her blood pressure at the moment is
165/100.
Task a. Assess patient’s compliance with medications
b. Explain the complications of uncontrolled hypertension
c. Counsel accordingly Causes of non-compliance (AHA)

Causes can be: Medication-related, Cost, >1dose in a day, Side effects, Long-term
usage, Difficulty understanding the leaflets
- Patient-related: Beliefs (herbal medications better for LT use), Feel well, Reduced
awareness about the risks, complications and importance of treatment
- Physician-related: Short-time consultation, Insufficient information, Use of medical
jargon History

- How are you today? My nurse just informed me that your blood pressure is high, From
the notes, I can see that you are diagnosed with high blood pressure around 2 years
ago. You were started on perindopril. Can you please tell me who diagnosed
hypertension for you? My previous GP
What symptoms did you have at that time? No symptoms
Were tests done on you? all were NL
I understand you were given perindopril? How much? Once daily
Were the causes and complications of high blood pressure explained to you? yes
Were the dosage, side effects and importance of medications explained to you? yes
Did you have any side effects like dry cough, headaches, visual problems, muscle
cramps, tiredness? No
Did you have any problems with the prescription? Any problems with the cost? No
Do you think this medication is good for you? I’m OK. I don’t think I need medications
Have you tried any herbal medications? No
Have you had regular visits with your GP, eye specialist and cardiologist for the last 2
years? No
- At the moment, do you have complaints like chest pain, palpitation, SOB, swelling of
feet, any weakness of your body part? Any history kidney problems, sleep apnea (snore
a lot, breathing problems during sleep), or obesity. No
- FHx: hypertension, IHD, CVA, and lipid abnormalities. No
- SADMA : no smoking or alcohol
Do you exercise at all? No
Any stress at home or at work? Has moved home recently which was stressful. Has
stress at work
Counseling
- As you know your blood pressure helps to maintain a constant oxygen supply to all
parts of your body. Usually, the blood pressure rises under stress. Sometimes, it
remains high even when the patient is calm and relaxed. You may not experience any
symptoms. It is sometimes incidentally diagnosed. It is quite a common problem. It is
very important to control to prevent the risk of complications for example heart disease,
strokes, kidney failure, and visual loss. It also increases the risk of lipid abnormalities,
diabetes and loss of memory.
- I need to do cardiovascular risk assessment
These charts are important as they help determine the optimum treatment and the
urgency of controlling the blood pressure. It gives the 5- year cardiovascular risk for
urgency of controlling the
- You need to come for regular follow-ups. We will check your BP. Ideally it should be
less than 140/90.
Refer to cardiologist
Reading material
Reassurance

Station 11: Global Developmental Delay

Global Developmental Delay

Case: A father presents to you concerned that his 21-month-old child has not started
walking yet.
Task
a. History (spoke 1st word at 14 months, sits with support, plays with other children
b. Physical examination (active but with no dysmorphic features; growth chart height
and weight 50 percentile, head circumference 10th to 25th percentile, hypotonia,
jerk/reflex brisk)
c. Advise on further management
Features - Delay in two or more important areas of development

History - I understand that you are concerned because your child is not yet walking, can
I ask a few more questions? When did he lift his head (2-3 months)? Father was not
sure
When did he start sitting with support (6months)? Father was not sure
Without support (8 months)? Around 1 y
Can he stand while holding on to things? No
Can he hold things with his hand and pass it from one to the other? Pincer grasp? With
difficulty
When did he speak his first word? Father was not sure
Does he turn around when you call his name or to loud sounds? yes
Does he play peek-a-boo? Does he play with other children? yes
Can he indicate what he wants (15 months)? yes
Can he drink from a cup (17 months)? No
Do you have other kids? How would you compare their development? No
- Does he get sick often since birth? no
How was the delivery? Were there any complications?
He stayed in hospital for a week after birth, father doesn’t know the exact reason
Have her mother ever been sick while pregnant? Did they do the heel prick test? Is the
immunization up to date? NL
Is he eating well? yes
Any problem with urination or bowel? No
How are things at home? Good

It seems he has a condition called global developmental delay

- Causes: genetic or hereditary disorders such as Down syndrome, or other
developmental disorders such as CP or spina bifida); premature birth, infections or
various metabolic diseases, neurologic (epilepsy)
- Investigations: metabolic tests and screening, genetic testing, hearing and vision test,
lead screening, thyroid screening, EEG, CT scan, psychologic assessment,
Refer to specialists
Reassurance
Reading material
Review after specialist
Station 12: Smoking cessation

Station 13: REST

Station 14: SOB

65 years old lady complains of shortness of breath for 3 months

Tasks
-History
-PEFE
-explain the reasons for his shortness of breath

History
-shortness of breath questions
-for how long have you been short of breath: 3 m
-has it begun suddenly? (pulmonary embolism): gradually
-is it constant or come and go? Comes and goes
-is it getting worse? yes
-are you short of breath at rest or exertion or both? Both
-if on exertion ask how much distance is necessary before you get SOB? 500 m
-can you lie flat without feeling short of breath? no
-do you wake up at night short of breath? No
How many pillows? 3, recently increased

Cough
-have you had any coughs? (Yes)
-do you cough up anything? Yes. Yellowish phlem
-do you cough up blood? have you seen any blood in the phlegm? (TB, cancer): No
-is it smelly? No

Chest pain (No)

-do you have any pain in your chest? (heart disease, pneumonia, pneumothorax,
embolism)
- Wheeze. (No)
-any noisy breathing?
Palpitation (No)
any funny racing of the heart?
Fever (No)
-have you had any fevers? (pneumonia)

other Symptoms No
-any ankle or leg swelling? (heart failure)
-any LOW, LOA, Lumps or bumps? (cancer)
-urine output? (kidney)
-weather preference and bowel motions? (thyroid)
-yellowish skin colour? (liver)
-General questions all NL
-Past medical history (HPT, DM, LIPID, Clotting)
-Past surgical history
-medications
-travel history (embolism)
-trauma (pneumothorax)

-occupation: what do you do for living and what have you done in the past (occupational
lung D): truck driver

-smoking? (Cancer) alcohol? (smoker for 40years)

-contact and family history
Physical examination findings after 5 min was shown on the screen

1-General appearance
-cyanosis, dyspnea, oedema, pallor , jaundice, LAP: Neg
2-Vital signs and O2 sat: NL
3-chest examination
inspection: chest movement with respiration
palpation: tracheal position, chest expansion, apex beat
percussion: dullness (dullness on right lower zone).
auscultation: air entry, breathing sounds, wheeze or crackles, vocal resonance
(decreased breath sound right lower zone)
4-CVS NL
-heart sound and murmurs.
-JVP
5- abdomen NL

from history and examination. There could be several possibilities why you have SOB:
-could be pleural effusion, which is accumulation of fluid between 2 membranes
surrounding the lung. As there is some dullness and absent breath sound in the lower
zone of the right lung.
-could be fibrosis, lung collapse or reduce in lung size.
-COPD smoking history
-could be pneumonia or lung infection, pulmonary embolism or clots in one of the
vessels supplying the lung, pneumothorax or air around the lung but the symptoms are
for a few months and there is no fever, cough.
-could be nasty growth or lung cancer smoking history which is just a possibility at the
moment but we need to rule out.
-could be due to heart failure but no SOB at rest or lying flat no PND, chest pain. Kidney
problem but normal urine output.

Station 15: Eye examination

22 y man with red, itchy eyes since morning, watery discharge

He was wearing sunglasses all the time.

Task: explain for patient what you are going

I introduced myself and confirm the patient’s name and mentioned after washing my
hands with your consent I’m going to do
inspection,
First I will look at your face and eyes to see if there is any swelling, discolouration,
scratch marks around the eyes, check pupil size, shape, check the eye lids, any
dropping
See if there is any runny nose
I will feel your face is there is any tenderness around the eyes, on the eyes (glaucoma),
on the cheeks for sinusitis.
I will see back of your throat for any discharge or inflammation.
Then I will check your visual acuity by Snellen chart. I will ask you to wear your glasses
if you have any, close one eye by your hand and read from the top. And the same for
the other eye. If VA is decreased, I will use Pinhole to see if any changes.
Fine print reading
Ishihara chart for colour blindness
- Peripheral vision
I will sit directly opposite to you, at a distance of around 1 metre. Ask you to cover one
eye with your hand. If you cover your right eye, I will cover my left eye (mirror the
patient). I will ask you to focus on my face and not move head or eyes during the
assessment. First ask you if any part of my face is missing or distorted. I will use a red
hat pin start from the periphery and move the target towards the centre until you can
see it. I will repeat this process for the other eye as well.
I will check your eye movements by moving my finger through the various axes like a H
shape.
I will check pupil reflex by Pen torch
By using a device called Ophthalmoscope after Mydriatic eye drops I may check back of
your eye if there be no contraindications ( after R/O Glaucoma)

Station 16: Mood change in nurse

A man who is a nurse was brought by his wife as he wanted to attempt suicide by
overdosing. His wife found him Infront of a pile of opened tablets. His patient recently
died due to pneumonia.
He seemed so sad, had no eye contact, while taking history started crying and I had to
wait few seconds after offering water and tissue till he become better for continuing.
He had auditory hallucination, hearing a sound that telling him he is a murderer. Had
guilt delusion and still wants to kill himself.
My task was doing MSE and reporting to examiner.
I think I forgot to say maj depression as diagnosis and giving DDx. So failed although I
did this station very well.
Station 17: Neurological exam

A middle-aged man brough by his wife after feeling numbness in arms and legs.
Task:
Explain for medical student how to do motor upper and lower neurology PE. Sensory
exam has been done.
I introduced my self to the medical student and after asking how I can address her
mentioned:
First we need to wash our hands, introduce ourselves to the patient and confirm his
name.
Checking if he is hemodynamically stable.
Starting from upper extremity. First inspection for any change in shape, shoulder girdle,
muscle wasting. checking Tone by moving arms, elbow and wrists
Power, movements and reflexes. Explained every thing in details by using medical
terms.
While explaining reflexes she said can you show my how you do it ? and I brought my
arm in front of the screen and showed her.
Repeated the whole process for lower extremity. Mentioned regarding gate as well.

Station 18: REST

Station 19: Headache

A father was there whose 9 y girl gets severe headaches since 6 m ago
Scenario: 30-year-old male with Headache. HR and BP given.
Task: Hx Dx and DD
History in 5 min
PE was shown on the screen: all NL
Diagnosis/ Differential diagnoses

Approach – first checked she is stable and has pain at the moment, father said no pain
at the moment
History – Pain questions – LOTRADIO – Unilateral, feel the attacks are progressive.
Started from 6 m ago. Sometimes misses school due to pain. No change in weekends
or holidays.
D/D questions – Fever, neck stiffness, Rash -
Nausea/vomiting, Photophobia +
Pain around eye (Cluster headache)
Red eye, blurring/reduced of vision (Glaucoma, temporal
arteritis)
Cough, sore throat (Upper Respi Infection)
Sneezing, runny nose (Sinusitis)
Ear pain discharge, pain behind ear (Otitis media,
Mastoiditis)
Wt loss, LOA, Lumps and bumps, fits (space occupying
lesion)
Trauma, assault, MVA
BINDS: NL
Family h/o: Father has Migraine

HEADS – parents got divorce 8 m ago

Diagnosis – Migraine
DDx: tension headaches, cluster headaches, sinusitis, tumour, trauma, meningitis

Station 20: 1st ANC with Home pregnancy test +ve

40 y lady with positive home pregnancy test. Has come for ANC
History
Confidentiality, is it planned pregnancy? If yes congratulation
-when was you LMP?
-were they regular?
-how many days of bleeding and how many days apart?
-any pain or heavy bleeding during menstruation?
-any bleeding in between menstruation?
Sexual history
-are you in a stable relationship?
-do you have good support?
-are you or your partner ever been diagnosed with STI?
Pregnancy
-Is this your first pregnancy?
-any previous miscarriages?
Pill
-what contraceptive methods you were using?
-do you still use pill?
Pap
-is your HPV or pap up to date?
3-Lifestyle
-can you tell me briefly about your diet?
-do you do regular exercise?
-SAD ( if alcohol say it is better to quit alcohol once planning for pregnancy as it can
cause birth defects)
-any PETS
4-Occupation
5-vaccination status
-are you immunized against chicken pox and German measles?
6-General
-PMH (DM, hypertension, thyroid, epilepsy, chicken pox, German measles)
She had polyuria

-family history of miscarriages or birth defects –

Mother had HTN

-are you aware of your blood group? No

PE:
BMI: 32
Others NL

Counselling:
make sure you stick on healthy diet with no raw meat or unpasteurized dairy products,
no soft cheese.
-limit tea or coffee intake up to 2 cups a day. Avoid smoking and alcohol.
-Do regular exercise (30 minute/ day for 5 days/ week)
-all these life style measure need to continue even during pregnancy.
-I will start you on folic acid 0.5 mg to be take 3 months before and the 1st 3 months od
pregnancy
-book you onto hospital for ANC visits which is a shared care that we usually give with
GP, obstetrician and Midwife. You may need high risk pregnancy clinic due to age,
weight, history of HTN in mother and polyuria which may be due to high blood sugar

-we will offer you Down syndrome screen in the first trimester, which is combined
Ultrasounds and blood tests specially recommended according to your age
-sugar test will be done at 28 weeks to test for DM or high blood sugar during
pregnancy. Along with this FBC also will be done. But if your blood sugar be high we
may need to do it sooner.
-Bug test at 36 weeks by taking a vaginal swab.
4-Advice
-it is advisable to take flu shot anytime during pregnancy and also whooping cough
vaccine for you and other family member after 28 weeks.
-it is normal to get a bit of leg swelling. Back pain and also as the pregnancy goes you
can feel a bit breathless.
-you can continue going to work even up to 1 week before date of delivery.
5-Rs
-review once blood tests results appear.
-reading materials (normal pregnancy and what to do once becoming pregnant)
-folic acid prescription

-Investigations
I would like to do some tests like:
-bHCG to confirm pregnancy, FBC, HbA1c, FBS, UCE, LFT, BSL, blood group and RH,
Vitamin D level
-chicken pox and German measles antibodies to look if your body has the power to fight
against these infections.
-Urine sample
-if HPV not up to date do one now.
STI with consent
Genetic counselling due to age

7th April 2021

Tips from 1st Candidate:

Alhumdulillah! All praise to ALLAH!
Hello everyone, I am Dr Tasrifa Jahan, By the Grace of Almighty Allah I have passed
my clinical exam on 7th April (online) in my first attempt. I would say believe on you
and Hard work will be paid off. I think this exam is all about your luck and approach to
 the patient. So, if you focus a little less on medical knowledge (but structure is imp)
and more to develop your communication skills you can easily pass.

I thought its high time to pen down my journey a bit detail. First of all, preparation
depends on person to person. I started my prep from June 2019 with First aid online
clinical course and HB. Then I started roleplaying with multiple partners (they were
the imp part of my prep. I learned a lot from them). After finishing that course, I did
8weeks Alan Robert Clinical bridging course (ARIMGSAS) in Melbourne, booked for
clinical exam in April 2020. Due to covid exam postponed but did not stop my
preparation. every day I practiced PE 2 hours which I was confident however I got 4
PE in my exam among them 1 failed don’t know why and another 1 became pilot. Did
all KT file recalls, Marwan, Alan notes and HB many times. I am extremely poor at
prediction that’s why had to study hard and covered almost 2017-2021 recalls and all
HB cases by heart so that I won’t miss any cases. As last 1 year there was no clinical
exam, I felt frustrated, sometimes lost my motivation to study however my study
partners always with me to give me motivation and cheer me up. I am extremely
thankful to them. I practiced random roleplay with different study groups, sometimes
noticed some people tries to judge others knowledge but please believe on yourself u
r knowledgeable and avoid those people who made you low.
Last 7 days my routine:
Morning: random PE (2hrs)
Rest of the day: try to revise subject wise topics & focus on weakness alongside
performed random roleplay. My weakness was time management, so I worked
on it.
Night: Went thru quickly HB cases key points and critical error.
7 days before my main exam I gave formal trial exam in Alan Robert course which I
passed all stations so guys if possible, I would say go for trial exam, it’s really
worth taking. few tips from my experience, I hope it will help you in your prep.
TIPS:

 Roleplay Roleplay Roleplay! If you practice the same case repeatedly

you will be confident in the exam. This is the first key step. :P

 talk LOUD and CLEAR.

 SMILE during the roleplays. (ofcz not in breaking bad/ depression cases
but you can start these cases smiling then when you go to explanation
stop smiling)

 Finish cases in 7 mins and PE in 6 mins when you practice.

 Focus on your task it’s the key point you have to cover.
  Say sorry, please and thank you multiple times in practice only then you
will be able to say this in the exam.

 Address the patient multiple times with their names. it will make
them comfortable with you.

 As it’s a online exam so Drawing is difficult try to use your hand to make your
patient understand.

 when you are asking DDX ques try to write down the disease name in the
shortcut on the paper so that when you are explaining you don't miss any ddx
you asked

 Respond to the patient whatever they are saying.

 Go structure-wise like in hx HOPI>DDX>RF , in explanation follow 5C, in

management 4R. follow this from the very beginning of your practice so that it
will come in yourreflex.

 IF you have good communication skills develop your structure. If you have
structure develop your communication skills. They both are very imp.

 Pray pray pray to your God. :D

Tips from 2nd Candidate

Hello everyone I am Dr Suprova Rakshit. By the grace of Almighty I passed AMC
clinical examination (ONLINE) on 7th April in my 1st attempt. I am so happy that finally I
am able to write my feedback and let me tell you in this exam everything should click
together; Gods mercy and your hard work. I am writing a little bit about my preparation
here. I took 5-month online course from First aid clinical and did 3 days physical
examination workshop from Alan Roberts. I had an amazing reading partner throughout
this hard time and with Gods mercy we both passed in 1st attempt. We did role play
every weekdays and finally hard works paid off. Few things I should highlight here; do
role play as much as possible, practice every case within 7 minutes because time
management is really difficult, read the feedback very carefully and try to find out why
the candidate passed or failed.
ABOUT ONLINE EXAM: DO NOT take too much pressure about this. You need a
good internet connection, that’s it. Rest of the thing will be taken care of by AMC.
Though it is very lengthy exam but you will get proper rest in between. Before exam
they will send you email what you need to do during the exam, just follow that and be
honest during the examination.
I will try my best to write detailed feedback.
Tips from 3rd Candidate
I would like to thank Almighty God as my pass result is nothing less than a miracle, only
by God’s grace it has been possible. At the same time, my family has been super
supportive. And most of all my study partners- it has been an amazing journey and truly
speaking that’s where I have learnt the most.
It was my first attempt and I got the exam date just few days prior, although I had been
practicing roleplays since almost a year.
Preparation:
 I undertook Alan Roberts course- 8 weeks. It was super helpful as it gave me an
understanding of the exam, the expectations from us and very good basic structure
for most of the topics. Even for my PE, I used and modified their structures. In
addition, meeting different kind of tutors was a learning experience in itself.
 I met my amazing study partners through this course and we started roleplay
practice after the course ended via zoom. We practiced our course notes,
handbook, recalls 2020- 2019 (thanks to AMC exclusive group and its lovely
members 😊).
 I also did an after-hours course from HEAL, it helped as well.
 I made mostly handwritten notes as it helped me learn and remember better and
revise esp just before exam.
 Just a few days before exam- I read my notes topic wise, gave a few trial exams but
I didn’t do roleplays with anyone due to lack of time- this was a mistake I guess as I
felt a bit out of practice during main exam :/

Tips-
*Everyone has different journey and it totally depends on what works the best for
you.
 Roleplays are the most important aspect of preparation
 Handbook is a must
 Working on empathy and making a genuine rapport with role player is very helpful in
real exam. It is be a bit difficult with online setting but with practice it will get easy
and natural- eg calling RP by their names, listening actively, using open ended
ques.
 In exam lot of info is given in stem and also role player tells lot of things when an
open-ended question is asked. So pls be aware that don’t repeat same ques and try
to remember key points in each topic as they expect us to ask limited number of key
questions only. It was a difficulty I faced as I tried hard to identify what next
important thing should be asked.
 For PE stations- I used the usual structures but in greater technical details- 1
problem I faced was time management as I got a bit carried away with technique,
 but if practiced well, I believe these stations are actually easier online rather than
face to face.
 Always follow authentic resources- John Murtagh, RACGP, RCH (Paeds), Mayo
clinic (for differentials), health.vic.gov.au, better health channel (for layman
terminology), Marwan notes are always a savior. For PE- Geekymedics
Most importantly be patient, positive and believe in yourself!!

Station 1: Hay fever

A young guy come with runny blocked nose and it is going on for few days. He had past
history as well. He has some atopic family history. No history of asthma or eczema.
Task: History about the medication he is taking
Investigation
Management plan and counselling to the patient
I failed this case though it is very known old recall. Please guys follow the passed
feedback.

Another feedback:
A young guy come with runny blocked nose and it is going on for few days. He had past
history as well. He has some atopic family history. No history of asthma or eczema.
Task: History about the medication he is taking
Investigation
Management plan and counselling to the patient
I failed this case though it is very known old recall. Please guys follow the passed
feedback.

Another feedback:
STATION 1: PASS- 6,6,6,6,6
Domain- management/counselling
Seasonal runny nose, itchy eyes, strong family history of atopy, now very trobled with
symptoms, been using some meds-
Tasks: Ask about current treatment being taken, immediate treatment, investigation and
long-term management
He was a good role player; I empathized a lot with him. He gave info when specifically
asked- antihistamine, otrivin for 3 weeks, tried steroid spray from friend was helpful but
can’t afford as expensive. No known allergies.
Immediate management- stop otrivin and start steroid- I told him will check PBS if any
subsidy or find a cheaper brand. Investigations- skin prick test, serum IgE, Ct scan for
sinuses if required.
Long term- antihistamine, avoid triggers, general allergy advice and use otrivin only 2-3
days max in future.
Another feedback:

PREDOMINANT ASSESSMENT AREA - STATION

MANAGEMENT/COUNSELLING/EDUCATION 1
Scenario: Hay fever Grade: Pass

Question was patient has H/o allergic rhinitis. Was using otrivin (steroid spray) takes
antihistamine. Ask about current self-management.
Take history and counselling

My Approach- Asked about how long he has been having this problem, what have you
been using (he said uses antihistamine, Otrivin steroid spray, asked about how long he
has been using it (on and off). Asked about current symptoms like runny nose, sore
throat, earache, cough, h/o asthma in family (positive FHx of asthma, eczema). Has
carpets, no pets, usually gets it in spring season. Asked about SADMA,
Investigation- not sure if I said anything, can mention RAST/Allergy test
Counselling- to vacuum carpet every day, can take histamine at night when he gets
runny nose, wash with saline water. I said you can use Otirivin but only for short period
as it has steroid in it, can cause thinning of nasal mucosa and cause bleeding.

Station 2: Depression
Patient come with tiredness for few weeks. He has a history of temporal arteritis
previously and taking steroid now. Along with tiredness he has loss of appetite as
well.
Task: History for 6 min Dx and DDx

My performance:
-HOPC.
 -associated s/s,
-all tiredness dd, nothing positive except LOA, loss 5 kilos wt in last
month and gain 2kilo in this month
-medication hx (he followed exactly doctor’s prescription)
-while asking sleep, in the mid night wake up, living alone, gave
confidentiality and asked depression all Msigecaps positive ( I forgot
to r/o suicide q and mood q that’s make me failed)( the funny thing
was pt was jolly minded and very cooperative never ever thought it
could be depression case due to pts approach)
-Pmh/psh/fhx
-SADMA(only alcohol intake)

Ddx: PMR (why I said it 1st it’s my mistake☹), side effect of steroid, flare
up of TA, Depression (but I should say depression as 1st dx ) , cancer
, infection, thyroid problem, others dd
I failed this case please follow passed feedback.

Another feedback:
Patient come with tiredness for few weeks. He has a history of temporal arteritis
previously and taking steroid now. Along with tiredness he has loss of appetite as well.
Task: History for 6 min
Dx and DDx
My approach:
I started with HOPC. I thought it was previous recall but I was wrong when I asked
question to the patient. Patient is taking the steroid regularly and he was regular with his
specialist as well. Then I got really nervous but I asked all dd of tiredness to exclude
iron deficiency anaemia, DM, Infective endocarditis, addison disease, Thyroid, etc.
Everything negative. When asked about snoring during sleep that time he told me he
doesn’t know about snoring because he is living alone, that time i thought about psychi
case and directly give the confidentiality and ask about mood, sleep, apetite and there I
got all positive. His mood was low,he was not enjoying anything ,he was not eating
properly and he has history of loss of weight as well. I asked about hallucination and
delusion of guilt. But I was not able to take full psychiatry history.
DX: I told dx as depression
DDX: Iron deficiency anaemia, addisons disease, DM, infective endocarditis,
polymyalgia rheumatica, OSA and all tiredness dd
Another feedback:
STATION 2- PASS- 5,4,4
Domain- history
 Middle aged man, known case of temporal arteritis, on steroids, being tapered
gradually under medical advice, now feeling tired
 Task- history, dx/ddx
I followed HEMIFADO approach+ SADMA. On regular med, features of depression
since 2-3 weeks, couldn’t find a trigger.
dx- depression, could also be steroid induced/ withdrawal and gave other ddx as less
likely

Another feedback:
PREDOMINANT ASSESSMENT AREA - HISTORY
STATION 2
TAKING
Scenario: Health review Grade: Pass
Assessment Domain Domain Score (see key
Global score- 4 below*)
Approach to patient/relative4 4

History4 4

Diagnosis/ Differential diagnoses4 4

Patient comes with tiredness. Has h/o temporal arteritis was on tapering dose of steroid.
My approach- HEMIFADO questions, positive was living alone, low motivation to get out
of bed in morning. loss of appetite. I asked ASEPTICJR questions, past medical hx, any
joint pain or muscle pain at present (PMR), nothing positive, SADMA
DX- depression
DDX all the HEMIFADOs including could be steroid induced tiredness

Station 3: REST

Station 4: OCP Counselling

A Young lady came for OCP. This is old recall. Task: History taking for
6 min
Counselling for 2 min (no further mx required)

My Performance: (my favourite case 😊)

-history with 5 P q (patient had period 10 days back. started sexual
life using condom) No history of discharge from down below.
Everything is normal.
- r/o contraindications where I can’t give ocp like breast cancer, liver
problem, DVT, migraine, family history of cancer, heart disease,
stroke. She is regular with cervical screening test.
-while asking pmh she told me having epilepsy and taking medication. Asked details
about that
..SADMA.. She has history of smoking.

COUNSELLING: - what is ocp, ideal candidate but give her high dose microgynon
50 , tell the reason why,
-missed pill
-administration, when to start, advantage, S/E, disadvantage
- appreciate to use condom and tell her if she concerns for STI she should use it
-4R and asked her for any concern? Does she happy with it?
Another feedback:
A Young lady came for OCP. This is old recall.
Task: History taking for 6 min
Counselling for 2 min
My approach: I started with 5 P. patient had period 10 days back haven’t started sexual
life. No history of discharge from down below. Everything is normal. Then I asked about
contraindications where I cant give ocp like breast cancer, liver problem ,DVT,
migraine, family history of cancer, heart disease, stroke. She is regular with cervical
screening test. When I asked about any other medication she is taking or not she told
me some drug name which I cant understand properly .So I asked her why exactly she
is taking this drug and she told me she was diagnosed with epilepsy and that’s why she
is taking it for long time,no recent change of dose. She has history of smoking.
COUNSELLING: it just for 2 mins so I quickly told what is ocp and as she is taking
antiepileptic drug I will prescribe high oestrogen containing OCP. Normally I prescribe
30 microgram but for her I will give 50 microgram. OCP will not give protection against
STI. So if she is concern she should use condom. I also told about missed pill and if she
had vomiting within 2 hours of taking pill she should take again. Bell rang!

Another feedback:
STATION 4- PASS- 6,6,6
Domain- history
 Young female for contraceptive advice.
 Task- history (6min), counsel
I started with confidentiality, period, sexual history, specific contraindications- all
negative, on PMx she said epilepsy- asked detail, on meds, good control
Counsel- I just mentioned she might be a good candidate for ocp but needs higher dose
as epilepsy drugs decrease effectiveness of ocps by quick breakdown. She can also go
for other options like- depo, Mirena, - she said she doesn’t like those things. So, I said
then you can use these high dose pills but be aware it might cause more side effects
and also good to use condoms to prevent STI and contraceptive failure just in case.

Another feedback:

PREDOMINANT ASSESSMENT AREA - HISTORY TAKING STATION 4

Scenario: Health review Grade: Pass

Assessment Domain Domain

Global score 4 Score

 (see key
below*)
Approach to patient/relative 4 4
History4 4
Patient Counselling/ Education4
4

22 yrs old girl comes for OCP counselling

My Approach- 5 p questions, all contraindications normal, epilepsy history positive, seen

specialist on meds.
Counselled about ocp, mechanism, her lmp was 2 weeks ago. Can start now but needs
to use barrier method for 7 days
Increased dose 50 mg due to epileptic drugs are enzyme inducer, can reduce the effect
of ocp. If vomiting, diarrhoea, antibiotic needs to use condom for 7 days. Does not give
protection against STI. Can get s/e of weight gain, nausea, breakthrough bleeding.
Benefit of regular period, no pain during period (she did not have period pain)
I forgot to do office pregnancy test but maybe it was not critical error as her lmp was 2
weeks ago but if it was 1 month ago then don’t forget to do pregnancy test.

Station 5: Heroin Counselling

You are a GP. 35 years old female, presented in GP with heroin addiction for 5
years. She wants to quit it because she is afraid her husband might leave her if she
continued with it. She has 1 kids, general health is ok, never sharing needle and
never took heroin in front of the children.
Tasks: History for 4 mins Inv & Mx
My performance:
Hi I am Tasrifa one of the doctor in this GP practice, How may I address u?
Hi X , how are u doing? I Acknowledge her problem, gave confidentiality and
appreciate her effort to come to me- Takes lot of courage to come and discuss this.
Start with general history and follow 5A approach.
ASK:
How are you doing?
What happened?
Confidentiality
Are you happy to discuss the details of your heroin usage?
Assess
Ask since how did she start.
When, how much, how often, what sort of drugs ,route Ask her about needle sharing.
Have you ever tried to quit-withdrawal signs?
Any side effects of the drug
any Violence associated with the kids while she was on drugs psychosocial hx and
Headss very quick
Advice
benefits of quitting – life will be better definitely, reduce cost and also can have more
time with family and friends.
Effects of heroin on body – heart, chest and respiratory problems,
Effect on social life - can lead to emotional problems and affect relationships with family
and friends. Long-term use can lead to serious health and financial problems, which can
also affect relationships.
Needles’s problems and raised chances of contracting an infection blood borne disease
and appreciate her not to sharing needles..
Assist:
-you require a referral to the drug addiction centre and the usual preferred mode is
complete abstinence from Heroin like cold turkey manner.
-once you cut it down completely you can get withdrawal symptoms like nausea and
vomiting, abdominal cramps, agitation, insomnia or inability to sleep, sweating, chills,
goose bumps, rhinorrhoea. In order to minimise these symptoms you will put on
medications like methadone or buprenorphine to help relieve cravings and other
physical symptoms.
-psychologist for CBT
-motivational enhancement therapy, which will motivate you
-with your consent, family-based therapy can also be arranged.
Arrange: Inv: Fbc, lft, tft, kft, urine , all blood borne disease screening like hiv hepb
hepc hepd, STI screen (forgot to do urine and blood drug screening still passed)
-support groups are available
-Life style advice+ sleep hygiene+ relaxation technique
-reading material and refer to drug rehab centre
-any specific concern I’ll be here to help you

Another feedback:
A lady came because of her heroine addiction. Her husband sent her .there are lots of
family problem going on due to this. This is old recall of heroine addiction.
Task: History
Investigation
Management and patient counselling
My approach: I showed here lots of sympathy and give the confidentiality. I asked her
for how long she is taking heroine, she was taking by using needle , no history of
sharing needle. Asked about dependency, tolerance , withdrawal symptoms question.
She is motivated only 5-6. There are lots of family problem going on,. I asked a little bit
about mood and sleed but I didn’t get time to take history of other illicit drug or alcohol.
Investigation: I did investigation of all blood borne diseases like HIV, hep B, Hep C etc
with her consent as she is using needle and here I also appreciate the patient as she is
not sharing needle. Forget to tell about blood and drug screen still passed the case.
Management and counselling: Refer you to a drug addiction centre and usually the
preferred mode is complete abstinence
-You could get withdrawal symptoms if you go cold turkey like anxiety, irritability,
aggressiveness, , sweating, chills, tremors, restless sleep, nightmares and also craving
for marijuana.
-But these will be effectively dealt with medications ( methadone) if needed
-The therapy that they give you is CBT which will help you to stop your drug use,
enhance your self control, and also addresses other problems that often co occur with
these
-Motivational enhancement therapy where you will be motivated to give up marijuana to
change your habits and to engage better in treatment
-Family based therapy
Your family will also be involved with your consent
-Support groups are also available
Another feedback:
STATION 5- PASS- 4,4,4,5
Domain- management
 Usual recall of Heroin counselling as per Marwan
 Task- history, counsel, give ix
I asked all tolerance, dependency, motivation ques, social history, other SAD, trouble
with law etc
mx- Drug rehab, counselling, meds like methadone, support groups, family meeting etc
ix- full STI including hiv, hep; ecg, echo, fbe, uec, lft, esr/crp for infections
I missed upt, toxicology screen.
Another feedback:

PREDOMINANT ASSESSMENT AREA - STATION

MANAGEMENT/COUNSELLING/EDUCATION 5
Scenario: Health inquiry Grade: Pass
*
Assessment Domain Domain Score (see key below )
Approach to patient/relative4 4
History4 4
Patient Counselling/ Education4 4
Management plan 5
5

Heroin counselling
Counselled as Marwan file forgot to do urine drug screen. But it was not critical I guess

Station 6: NAI
Your next patient in GP clinic is a 19-year-old mother who has brought her 3 months old
baby boy because he cries a lot, poor feeding and rash on the cheek for last 2 days.
Both parents are university student. Baby growth at birth was 70 centiles now its 50
centiles.
TASKS:
Take a history from the mother (4 min)
Dx
Immediate management
My performance:
Hi I am Tasrifa one of the doctor in this GP practice, How may I address u? X How r u
and how s ur baby doing?
-HOPC: SIQORA (Patient is not making eye contact. You seem stressed, what
happened?
If not speaking, assure confidentiality)
-Associated S/S
-Well baby Q
-BINDS
-Pmh/psh/fhx
positive finding was no fever, S/s for 2 days, while changing the nappy by her partner
baby fall down from the table, partner was biological father non supportive, they were
stressed, having financial issues, PEFE card on the screen showing growth decline,
bruise in 3 different area
Dx: Well X, based on ur hx it could be many possibilities like meningitis but no fever,
some blood problem like ITP,viral infection, allergy , drug reaction but I couldn’t find it , it
could be Accidental injury or what I am concerned most it could be ‘Non accidental
injury’
X what NAI? Look it must be very hard for u as u both are student lots of stress going in
family, looking after a baby is very difficult. Saying some polite words,
Immediate mx: at this stage as he is 3 months old and having bruise First, we need to
admit him in hospital, call senior, doing inv to rule out possible causes of these bruises,
such as bleeding and clotting disorders.
X as this is my legal responsibility as I am suspecting non-accidental injury, I must
inform child protection services. Again mom screaming.

Oh my god, they will take away the child from me:

It is not always the case X. They will talk to you and ur partner separately and assess
your condition. And if they decide that the child is not safe with you, then that's the
moment that they'll take your child. (I forgot to address centerlink support)

Another feedback:
Mum came with baby because the baby is crying a lot for couple of days.Baby has
some bruises on cheek. Old recall of child abuse.
Task: History
Diagnosis
Immediate management
My approach: I started with HOPC here. Take the history of crying and trying to exclude
all dd question of crying like injury, fall, intussusception, infantile colic, septicaemia etc.
Everything negative. Then I gave confidentiality and asked about any stress going on in
the family or not. Then she said both of husband and wife are student, they have no
support, some financial issues also present. I showed here lots of sympathy because
mum was really stressed.
DX: I gave dx as NON ACCIDENTAL INJURY. After hearing this word the role player
asked me what is that? I told her there are 2 types injury; one is accidental and another
is non accidental and as the baby has no history of accident and that’s why I am
suspecting non accidental injury. Again I showed her lots of sympathy.
Immediate management: I told about admission in the hospital and involve child
protection authority. Again she got mad an d I need to calm down her. Told about social
worker and financial support.

Another feedback:
STATION 6- PASS- 6,7,6,5
Domain- diagnosis
 Few months old child crying for 1 day, nurse noticed a bruise on cheek like
fingerprints, mom worried
 Task- history, tell diagnosis to mom, give immediate management (no further
management details)
I gave lot of empathy, took details of crying- like siqoraa1, ruled out infections, bleeding
disorders, BINDSMA, again confidentiality asked social history- relation with partner,
SAD, financial stress+, support. Both were uni students, lot of stress, partner gets angry
easily, uses alcohol, yesterday he was changing nappy and said baby fell down and got
bruise
I explained that there could be several causes but im unable to rule out NAI and baby’s
safety is my most important concern im not blaming anyone but it is my duty to be
cautious even if slight chance I know your social situation is not very good but let me
assure you we will support and help you all. For now, I will call CPA- they will assess
and help and might admit baby to hospital.
Another feedback:

PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC

STATION 6
FORMULATION
Scenario: Irritable infant Grade: Pass
Assessment Domain Domain Score (see key below*)
Approach to patient/relative 5 5
History 3 3
Diagnosis/ Differential diagnoses 4 4
Management plan 5 5

Bruise on cheek. Child is crying for long period. Mom works. Was with partner last day.
She does not give you any history of child falling while in care with partner unless you
ask about it. I asked all the questions regarding infections, recent URTI, BINDS, stress
at home, partner been stressed lately, having fights. I told all other negative DDX before
telling non-accidental injury. As soon as I told I have concern with non-accidental injury,
roll player got upset. But I keep telling the negatives and unrelated bruise on the cheek
made me concern about the child’s wellbeing. So, I will admit the child, run all
investigations, call CPA. Also told her don’t worry, CPA will ask only questions to you
and your partner.

Station 7: Mania - Pilot

Son BIB police in ED due to weird behavior in outside of a shop, shouting, disturbing
to the customer and saying ‘die evil’(something) .. in ED CAT assessed him and try to
admit him in hospital but pt refused to be admitted called his father and asked father
to take him from hospital.
Task: -Hx for 3 mins from father
-Describe the Mental health act
-Why it’s important for involuntary admission under MHA

My performance: introduction same ensure confidentiality (multiple

times) making father calm bcz he was shouting.
Hx; HOPC
Psychosocial hx; HEADSS
Sadma Pmh/psh/fhx
Positive findings: some thoughts in mind last 6 months, delutional idea,
manic f/o, no hallucination, no suicidal idea, no paranoia or
 persecutory , family is supportive , father doesn’t aware of Street
drug, sexual hx or spending money
MHA: look X based on ur hx and we called CAT team ur son is not real
state of mind, he is detached from reality and not aware of the
surroundings. Under Mental health act if we notice someone having
those f/o , possess risk to himself and others our legal obligation to
admit him in hospital bcz pt health is our main concern.. (I have no
idea what I should say bcz it’s a new case for me)
Ur son having mania explain it laymen term, or acuty psychosis,
substance abuse, drug withdrawl some organic cause but less likely
so um going to do inv to confirm my dx and call my senior.
Level of risk: I am concerned ur son Y is in high risk as he is detached
from reality, he could accidentally harm himself and could do harm to
others as well, and his health is our prime concern .. we are going to
admit him in the hospital where he will get best treatment.

Q from RP: dr should I call a lawyer? I said no. we are going to give him best
possible care and arrange family meeting to make family member aware of his
situation … ( don’t know what else I could say, thank God its pilot 😊)

Another feedback:
PILOT Son brought in by police due to inappropriate behaviour in shops. This was long
stem, I am sorry guys because I couldn’t recall properly.
Task: History from parents for 3 min
Dx and Explain Mental Health Act (MHA) [not very sure about this task]
Reason to involuntary admission
My approach: I gave confidentiality to father and started with mood, sleep and apetite of
his son. He is not sure about anything. When I asked about hallucination question father
told me that His son is responding to unseen stimuli for last 6 month and always stayed
in his room. Father was not sure about any delusion question. There is no past personal
or family history of psychiatry problem.
DX: I told acute psychosis as he was shouting at the shop and didn’t tell mania
because he was responding to unseen stimuli for last 6 month according to his father. I
told father that as his son is behaving inappropriately that’s why police brought him to
the hospital and its our legal duty to admit his son under MHA. Father asked me about
does he need to talk with any lawyear? I was not not very sure so I told him; look I am
very junior doctor in this hospital and I am not sure about this.so I need to talk with my
senior and then I can tell you about that. He was happy to hear that. But please guys
check this particular things before going to exam.
Another feedback:
STATION 7- PILOT
A 22 yr old male bib police, for abusing and shouting outside shops, was assessed and
admitted involuntarily. Now his father is here to know about mental health Act and what
it means for his son.
Task- take history, talk to father and talk about mental health act (MHA)
I had no idea about this case, just proceeded with usual psych history. Father heard son
shouting/ talking to himself, son eating everything orange in color, lost weight, lost job
recently, denied drug use, living on street,
I just talked about MHA and that it is for his son’s and others safety as he seems to
have lost touch with reality and we will take care of him etc etc. I did not have anything
else to say.
Father asked if he should get a lawyer, I just said you can, if you want to know more
about it.

Another feedback:
Pilot case- involuntary admission of patient being abusive at the shop. Talk to parent
and give reasons for involuntary admission under MHA. Approach was bad. I totally
forgot I am talking to parents. I asked him all mania questions, how stupid. Look what
stress can do to you. Please be confident and keep your head clear.

Station 8: REST

Station 9: Foot pain

A middle-aged guy came with ankle pain for last 2 day. He had a history
of gardening before starting the pain.
Task: history for 3 min PEFE on card DX/DDX with reason Investigation
My performance:
-HOPC.
-associated s/s q .. Pain was in ankle. He had a history of gardening before starting
the pain. I asked about any cut over there during gardening and it was negative,
there is no history of trauma, insect bite. Patient had redness and swelling over
the ankle and it was very painful and hot to touch but pt didn’t have any fever.
-all dd for leg pain.. when asked about pmh told about HTN + then
asked about medicine thaiazide he took ..asked all q for GOUT . I
asked about diet, alcohol, medication., taking 4 glass red wine
every day and take lots of red meat, love sea food..
-Pmh/psh/fhx/Sadma
PEFE card: everything normal. just redness and swelling over ankle and tem was
 37.1.
DX and DDX: I told dx gout as he is taking alcohol, due to medication
and dietary habit or it could be cellulitis need to confirm by doing
inv other DD trauma, fracture, insect bite, PVD, DVT, SA,
INVESTIGATION: FBC, ESR, CRP, blood culture, BSL, lipid profile,
uric acid level, Xray of foot and ankle to exclude fracture, urea,
electrolyte and creatinine to check kidney condition, joint
aspiration to r/o SA.

Another feedback:
A middle-aged guy came with ankle pain for last 1 day. He had a history of gardening
before starting the pain.
Task: history for 3 min
PEFE on card
DX/DDX with reason
Investigation
My approach: I started with HOPC. Pain was in ankle. He had a history of gardening
before starting the pain. I asked about any cut over there during gardening and it was
neagative, there is no history of trauma, insect bite. Patient had redness and swelling
over the ankle and it was very painful and hot to touch but pt didn’t have any fever. So I
quickly go for GOUT questions. I asked about diet, alcohol, medication. Patient started
thiazide for hypertension 1 month back, taking 5-6 standard drink everyday and take
lots of red meat.
PEFE card: everything normal. just redness and swelling over ankle and tem was 37.5.
DX and DDX: I told dx gout as he is taking alcohol, due to medication and dietary habit.
DD was pseudogout, cellulitis, trauma, fracture, insect bite
INVESTIGATION: FBC, ESR, CRP, BSL, lipid profile, uric acid level, Xray of foot and
ankle to exclude fracture, urea, electrolyte and creatinine to check kidney condition, joint
aspiration when pain subside if needed
Another feedback:
STATION 9- PASS- 4,6,4,3
Domain- diagnosis
 Middle aged man with foot pain since 1 day, was gardening, no other significant
history
 Tasks- history, pefe card at 5 min, tell diagnosis and differential, tell investigation
I gave painkillers, full siqoraa, differentials like cellulitis, trauma, ankle sprain, sciatica,
dvt, pvd, arthritis, gout, SADMA. He had very very severe pain on rt ankle, no rash,
fever, scratches, insect bite, took beer, thiazide for htn, no dm
Pefecard- vitals temp 37.5, rest normal, systemic normal, bmi 27, foot- slight erythema,
minimal swelling movements painful
Diagnosis- I said im not very sure it looks like gout in ankle but I can’t rule out infection
like cellulitis/ septic arthritis
ix- fbe, esr/crp, uec, lft, bsl, foot xray
I forgot to mention s. uric acid- probably that’s why 3 in ix

Another feedback:

PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC

STATION 9
FORMULATION
Scenario: Foot pain Grade: Fail
Assessment Domain
Domain Score (see key below*)
Global score - fail
Approach to patient/relative 4 4
History 2 3
Diagnosis/ Differential diagnoses 2 2
Choice of investigations 4 4
My approach- I thought it was cellulitis, but it was gout probably. He did give me
medication history when I asked him about regular medication taking thiazide, but I did
not given attention to that. I did all blood test but diagnosis was wrong. He gave me
history of gardening, ankle pain, red and hot to touch.

Station 10: Unsteady gait - PE

A patient came with unsteadiness. Patient had history of alcohol drinking for many
years. Previous history of wrist fracture 5 years back while drunk.
Task: explain examination procedure to the patient All limb tone, power, reflex done
and all normal.
My performance: I asked my pt might be I will use some medical
jargoon for my examiner I will explain to u later.
-WIPE
-GA: sitting comfortably, no asymmetry of face/ posture, no
involuntary movement, no tremor, no walking aid/
wheelchair
-GAIT: Romberg open eye +ve [cerebellar ataxia], tandem gait
-Hand:
1. Finger nose test: can you touch your nose and then touch my
finger (Intention tremor + past pointing]
2. Dysdiadokokinesia: can u follow my movement ( do it in both
hands)
3. Rebound phenomenon:
-FACE:
EYE: Follow my finger with your eyes , pls don’t move your head. (nystagmus) , in
eye I forgot to do nystagmus after finishing speech came to eye again and did
nystagmus and pt was sooo happy and told me very good , so I was pretty sure
examiner acted as RP
Speech: Pls say the sentence after me. (British Constitution)
-Leg: Lying position:
1. HEEL SHIN TEST: can u run your heel up and down the shin of the other leg?
2. TOE TAPPING: can u tap over my hand by your toes?
3. Truncal ATAXIA: can you cross your arm around your chest and try to sit up
from lying down.
4. Pendular reflex to r/o parkinsonism
-Complete by doing liver exam, cranial nerve and fundoscopy for
papilledema but (forgot to mention UL & LL sensation).
Ddx: Cerebellar ataxia explain laymen term, alcoholic neuropathy,
stroke, TIA, SOL, SAH, trauma
Another feedback:
PILOT
A patient came with unsteady gait. Patient had history of alcohol drinking for many
years. Previous history of wrist fracture 5 years back.
Task: explain examination procedure to the medical patient /medical student [I am not
sure]
Lower limb tone ,power,reflex done.all normal.
My APPROACH:
 GA: sitting comfortably, no asymmetry of face/ posture, no involuntary
movement,
 no tremor, no walking aid/ wheel chair
 GAIT: Romberg open eye +ve[cerebellar ataxia]
 Sitting down position=🡺
 FACE:
o EYE: Follow my finger with your eyes , pls don’t move your head.
( nystagmus)
o Speech: Pls say the sentence after me. ( British Constitution)
 Hand:
o Finger nose test: can you touch your nose and then touch my finger
( Intention tremor + past pointing]

o Dysdiadokokinesia: can u follow my movement ( do it in both hands)

o Rebound phenomenon:
 Lying position:
o HEEL SHIN TEST : can u run your heel up and down the shin of the
other leg?
o TOE TAPPING: can u tap over my hand by your toes?
 o Truncal ATAXIA: can you cross your arm around your chest and try to sit
up from lying down?

o Complete by doing full UL and LL neurology , cranial nerve and

fundoscopy for papilloedema

Another feedback:
STATION 10- FAIL- 4,3,3
PE station
 Middle aged man who is chronic alcoholic and drinks 8-10 beers/ day is getting
unsteady and has difficulty walking. He is here in your practice clinic and wants
to know how you will examine him. Vitals stable. Power, tone, reflexes normal.
 Task- explain to patient what all examination will be done with reason.
It is a recent recall from 2020 and I lost this station due to silly mistakes and time
management. Role player was very good and cooperative. I started with explaining
WIPE+ hds, hands- tremors, finger nose test for cerebellum, pulse, bp, drug marks,
jaundice. Face- asymmetry. Eyes- jaundice, pallor, PEARL, nystagmus, mouth- fetor
hepaticus, say British constitution, neck- lymph nodes, chest- gynecomastia, spider
naevi, auscultate for heart and lungs, abdo- hepatosplenomegaly, ascites, genitals-
testicular atrophy, DRE, legs- power, sensation – with cotton wool, pin, vibration,
proprioception this all I explained by telling full details on how I will perform on him and
then TIME UP.
I think critical mistakes- missed gait and rhomberg sign, office test- udst, bsl, I went in
direction of CLD exam, should have focused more on neuro exam.

Another feedback:

PREDOMINANT ASSESSMENT AREA - EXAMINATION STATION 10

Scenario: Examination Grade: Fail
Domain Score (see key
Assessment Domain
below*)
Approach to patient/relative 4
Choice & Technique of examination, organisation and
1
sequence
Explanation of procedure 2
Unsteady gait PE
I got so nervous in exam I did wrist PE. So failed

Station 11: Abdominal pain

57/60 years Patient in ED with severe epigastric pain for 2 hours. Now
 pain subsided. He is generally healthy, no alcohol hx ..Blood result
pending. CT scan done and report are written down showing multiple
composed GB stone, but no GB wall thickness, no acoustic shadow,
extensive diverticula in sigmoid colon, hypodense liver lesion 5*7
mm/cm , no portal vein dilatation. The stem was long, I couldn’t
remember properly.
Task: explain the CT scan result to the patient ; DX /ddx
Choice of investigations
My performance: (it’s a new case for me)
-Same intro + offer him
pain killer.
-draw pic of biliary tract and start explaining ct report and asked 1 / 2 q in between
-ddx: less possibilities are cholecystitis, cholangitis, hepatitis, pancreatic
pseudocyst, benign liver tumor but I am concerned about nasty
changes either liver or pancreas though there was no hx wt loss (I
didn’t mention pancreatitis / MI/ Pneumonia/ PUD ☹)
-inv : I am going to admit u in hospital , call my senior , will do inv to find
out the cause like fbc, esr,crp, lft, kft,tft, liver biopsy , tumor marker,
colonoscopy and endoscopy , ECG, urine ( but forgot to tell serum
amylase, lipase ☹)

I failed this case plz follow passed feedback.

Another feedback:
Patient in ED with severe epigastric pain. Blood result pending.CT scan showing GB
stone ,diverticulosis ,hypodense liver lesion .The stem was long, I couldn’t remember
properly.
Task: explain the CT scan result to the patient
DX /ddx
Choice of investigations
I failed this case.pls follow passed feedback.

Another feedback:
STATION 11- FAIL- 4,3,2,2
Domain- diagnosis
 Middle aged patient with very severe abdominal pain, first time in life, came to
ed. Painkiller given, now all good, underwent bloods and ct scan. Blood’s report
awaited, ct shows-
  gall bladder calcified stone, normal wall thickness, no fluid around gb
 several diverticula in sigmoid colon but no evidence of inflammation
 single hypodense lesion in liver, blood supply normal
 tasks- tell findings, tell diagnosis, further investigations
I was very confused on what to say as diagnosis I told him all findings and said gb
stones unlikely to cause pain- asked if he gets pain with fatty meal, he said no,
diverticulitis unlikely he denied any constipation or bowel problems, fever, told him about
lesion in liver, he asked what is nasty growth? I said could be cancerous but we need to
rule out, he denied low, loa, blood in stool
Then said I don’t know why you got pain but will talk to senior and assess further
Ix- bloods, endoscopy, ercp

Mistakes- I didn’t ask site of his pain, urinary symptoms, could have talked about more
dds, must do colonoscopy, urine and elaborate blood ix like fbe, lft, uec, amylase,
lipase, vbg, fobt
I think this case was a variant of liver mets ct scan recall, but not sure!

Another feedback:

PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC STATION

FORMULATION 11
Scenario: Abdominal pain Grade: Fail
Assessment Domain
Domain Score (see key below*)

Approach to patient/relative 4 4
Interpretation of investigation 4 4
Diagnosis/ Differential diagnoses 2 3
Choice of investigations 2 3

This case was very confusing. Patient came with severe epigastric pain. Bloods are
pending. Ct report present. In CT there was gall stone but cbd normal. Diverticula
present. Otherwise, normal
I got stuck with investigation interpretation. Only said acute pancreatitis for dx and
pneumonia and MI for ddx said chest xray, ecg, blood test but but did not say
specifically amylase, lipase, troponin. Probably that’s why failed. See passed feedbacks

Station 12: Anaemia in pregnancy

A pregnant lady came because she did some inv due to tiredness. This is old recall of
iron deficiency anaemia during pregnancy. In lab investigation HB
reduced,MCV,MCHC reduced
Task: history Explain the inv
DX and DDX with reason Choice of investigation
 MY Performance:
-HOPC and asked why she did this test.
-all anemia Q.. diet and she is vegetarian.
- I asked about pregnancy, antenatal check-up. Everything was good.
She has a child age 14 month. Here less gap in between pregnancy.
I asked about any heavy period before getting pregnant and it also
positive. To exclude thalassaemia, I asked all question and she is
Norway origin, also asked about per rectal bleeding and digestion
problem and these are negative.
Explain inv: Some blood tests have been performed and the
results are now with me to explain to you so let us see the
results together.
-We have three types of blood cells the red blood cells, which contain an
iron rich protein called Haemoglobin, which is responsible for
carrying oxygen to the tissues. White blood cell to help fighting
against infection and platelets to help with blood clotting.
-Platelets and WCC are normal.
-But there is a decreased level of hemoglobin we call this anemia.
-Also this MCV is less than the normal range this mean that the size of
the red blood cells are small. So result showed hypochromic
microcytic anemia
-There are few possibilities .
DX/DDX: I told iron deficiency anaemia due to less intake of iron
containing food, less gap in between 2 kids and heavy period and
all the ddx thalassaemia, anemia in chronic disease, PUD, cancer
less likely.
INV: basic blood and Total iron studies including ferritin and
transferrin. If come normal, then we will do Hb electrophoresis

Another feedback:
A pregnant lady came because she did some inv due to tiredness.This is old recall of
iron deficiency anaemia during pregnancy. In lab investigation HB reduced,MCV,MCHC
reduced
Task: history
DX and DDX with reason
Choice of investigation
MY APPROACH: In history taking I started with HOPC and asked why she did this
test.Then quickly asked about diet and she is vegetarian. I asked about pregnancy
,antenatal check up.Everything was good .She has a child age 12 month I guess.Here I
found less gap in between pregnancy. I asked about any heavy period before getting
pregnant and it also positive. To exclude thalassaemia I asked all question and also
asked about per rectal bleeding and digestion problem and these are negative
DX/DDX: I told iron deficiency anaemia due to less intake of iron containing food,less
gap in between 2 kids and heavy period and all the ddx
INVESTIGATION: Total iron studies including ferritin and transferrin.If come normal then
we will do Hb electrophoresis.

Another feedback:
STATION 12-PASS- 4,4,4,4

Domain- diagnosis

 10 weeks pregnant female has done her first trimester tests and scan, all good
except- Hb dec, low MCV, low MCHC
 Task- explain results, history, dx& ddx, ix
It was the old recall- this is second preg, previous baby 15 months ago, NVD, had PP
blood loss 400ml, didn’t take any supplements except folic acid, vegetarian, heavy
periods just before second pregnancy, ethnicity from Norway (I don’t think its
Mediterranean origin, but pls check)
dx- micro hypo anemia probably due to Iron def
ix- iron studies, if not positive- hb electrophoresis, uec, celiac screen, stool test.

Another feedback:

PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC STATION

FORMULATION 12
Scenario: Pregnancy complication Grade: Pass
Assessment Domain Domain Score (see key below*)
Approach to patient/relative 4 4
History 4 4
Choice of investigations4 4
Diagnosis/ Differential diagnoses4 4
Iron deficiency anaemia
Did as Marwan file.

Station 13: REST

Station 14: Migraine

Middle aged female patient comes to your GP. Has had headaches on and off.
-Relevant history for 6 mins
-Explain most probable diagnosis and other diagnosis to the patient with reasons
My performance:
-Do you need some painkillers?
-Since when are you having this pain? How bad is it?
-What type of pain is it? Is it pulsating, throbbing or a dull ache?
-Is it one sided of all over your head? ( all migraine Q were positive)
-When the pain starts, where does it start first? How does it progress?
-is it aggravated by movement, noise or light?
-Do you get any symptoms before the headache starts for example visual problems,
changes in your sense of smell, nausea or vomiting?
-Is this the first time? How many episodes have you had previously? How long does it
last?
-What relieves your pain?
-Is it worse in the morning?
-did you have fever recently? Any infection recently?
-Do you feel numbness or weakness in any part of your body? Did you hurt yourself
in your head?
-Do you think your headache is related to food especially red wine, cheese, chocolate,
bananas, Chinese food, coffee?
 -How's your general health? Any history of HPN or DM?
-What is your occupation? Any stress at work or home? Stress
positive. Any financial problems recently?
-How are your periods? When was your LMP? Do you think your
headaches are related to your periods?
-Any family history of migraines? SADMA?
Diagnosis – Migraine: explain it, check understanding.
Ddx: TTH, cluster headache - SAH - Meningitis - subdural hematoma -
temporal arteritis, SOL, referred pain

Another feedback:
A young female came with headache since 9 years old.This is popular migraine case
and pretty straightforward.
Task: history for 6 min
DX and DDX
MY APPROACH: I started with HOPC. Then ask all migraine risk factors, pain increase
before period and had family history of migraine. Patient is not taking any OCP. Patient
feel better after taking rest.

DX/DDX: I told migraine and told about the risk factor for her. Then give dd as
meningitis, trauma, temporal arteritis, dental pain, stress, referred pain etc
Another feedback:
STATION 14- PASS- 5,6,5
Domain- history
 25 yr old girl with long standing headache for 6 months, MRI normal.
 Task- history, give diagnosis, ddx
It was easy case with good role player- asked SIQORAA-1, differentials, social history,
SADMA, period history, Fhx + migraine. All features of migraine+, now frequency
increased, recent stress at work, no triggers as such
dx- migraine triggered due to stress, could be tension also and gave other ddx with
reason- cluster, infections- meningitis, URTI, dental, SOL brain, trauma,

Another feedback:

PREDOMINANT ASSESSMENT AREA - HISTORY TAKING STATION 14

Scenario: Headache Grade: Pass

Assessment Domain Domain Score (see key below*)

Approach to patient/relative 4 4

History 5 5

Diagnosis/ Differential diagnoses 5 5

Headache since 9 yrs old. Has some stress relating job due to covid.
Has all symptoms of migraine. DX migraine DDX tension headache, cluster headache,
SAH, SOL, infection
 Station 15: Compartment syndrome
Patient came in ED with excruciating pain of lower leg in ED and
suspecting compartment syndrome.
Task: explain the examination to the medical student with anatomical land mark
My performance: I practiced this case soooo many times but I failed , don’t know why
☹
-WIPE approach
Inspection of the leg:
- open / closed wound
-any diffuse bruising and swelling on the shin
- any color change of the foot
Palpation:
1. Temperature
2. CRT
3. Pulse [dorsalis pedis, posterior tibialis, with anatomical landmark]
4. Tenderness
5. MOVEMENT: Dorsiflexion (ant compartment), plantar
flexion( post compartment), eversion ( lateral compartment) ,
inversion,
i. Patient unable to move: can you wiggle your
toes?
6. SENSATION: 1st web space (deep peroneal) = ant
compartment Dorsum of foot (Sup peroneal) =lateral
Sole (tibial) = posterior
Finish with full secondary survey and chest exam to exclude any fat embolism and
tonometry to check pressure in leg
Office test: UDT, BSL, xray of leg
I explained 6P regarding compartment syndrome (pain, pulselessness, paresthesia,
poikilothermia, pallor, paralysis)
In this case role player asked me initially to be slow so that she could get me and
asked a lot of questions like what is pallor, why we checked movement?
May b she wasn’t satisfied my ans and failed ☹, plz follow passed feedback

Another feedback:
Patient came in ED with excruciating pain of lower leg in ED and suspecting
compartment syndrome.
Task: explain the examination to the medical student
My approach: I started with WIPE approach
. Inspection of the leg
- open / closed wound
-any diffuse bruising and swelling on the shin
- any color change of the foot
 FEEL :

 Temperature
 CRT
 Pulse[dorsalis pedis, posterior tibialis, popliteal, femoral with anatomical
landmark]
 Tenderness
 MOVEMENT: Dorsiflexion( ant compartment), plantar flexion( post
compartment), eversion ( lateral compartment) , inversion, I also told knee
flexion and extension
 Patient unable to move: can you wiggle your toes?

❑ SENSATION:
First I saw sensation according to dermatome and told with anatomical landmark,
then
st
1 web space (deep peroneal)=🡺 ant compartment

Dorsum of foot (Sup peroneal)🡺 lateral

Sole (tibial) 🡺 posterior
Finish with full secondary survey and chest exam to exclude any fat embolism.
In this particular case role player asked a lot of questions regarding anatomical
landmark.so be prepared for it.
Another feedback:
STATION 15- FAIL- 5,5,2
 Young male with tibia fibula fracture, severely comminuted, stabilized, now
suspecting compartment syndrome. You are HMO in ED.
 Task- explain to medical student how you will examine with anatomical
landmarks and what you are looking for in such a patient of compartment
syndrome
This was my first station and didn’t have much idea about this, started with explaining
WIPE and check HDS, inspection- compare with other leg and check color of limb,
swelling, visible bones/ open fracture. Palpation- temp, tenderness on bones for other
fractures, feel muscles if tensed, check crft, pulses all till femoral with anatomical
location (for vascular compromise) sensation- nerve wise ( lateral leg, 1st web space on
dorsum, sole). Movements- ankle, wriggle toes, passive stretching of big toe if
excruciating pain suggests. And my time finished! I thought I did okay in this station, not
sure what I missed.
Another feedback:

PREDOMINANT ASSESSMENT AREA - EXAMINATION STATION 15

Scenario: Painful leg Grade: Fail
Domain Score (see key
Assessment Domain failed
below*)
Approach to patient/relative 3
Choice & Technique of examination, organisation and
2
sequence
Explanation of procedure 2
I had no idea about this case in exam. I did look feel sensation, did pulses and
dermatome but was not specific to compartment syndrome. That’s why I failed maybe
as the question was to tell medical student what they would find in compartment
syndrome.

Station 16: Encopresis

10-year-old boy soiling in his pants. history of constipation. Mum came because for
last few wks child was soiling his pant. This is Handbook case Encopresis.
Task: History
DX with reason Management
My performance:
-HOPC
-Associated s/s, diet: don’t like vegetable and fruit Pass stool every 4 days, big hard
stool.
No previous history of anal fissure.
-well baby q
-BINDSMA
 Just a bit of stress but no bullying in school
Mother frustrated about his soiling and he is hiding his soiled underwear.
Dx: encopresis due to constipation, explain it ( forgot to mention some
ddx)
initial mx: Laxative or enema to get rid of the faecal mass now..
Don't be stressed, it is a manageable condition. At this time the treatment is to empty
his bowel now by giving an enema. Once he empties his bowel, we can start him
on stool softeners.
Long term management: diet: increase fruit and vegetable, make it colourful and
change different type Oral laxative for long time to soft stool and help the recovery
of the bowl
I also encourage you to start toilet training him again, and encourage him to go to the
toilet right after meals for a set period of time. You may use an egg timer for this.
I can only imagine how distressing it is to wash his clothes every day but please do
not scold him. This takes a long time to get better, and needs a lot of patience on
your part. You can start a star chart to motivate him to empty use the toilet when
necessary.
I would also like you to talk to his teacher about his condition. Please give him extra
clothes which he can wear whenever he has soiling episodes in school.
I will arrange a regular review with him to ensure that his constipation is not recurring.
-4R, However, If the he develops severe pain, nausea, vomiting, or different pain from
what he feels now, please come back immediately for a review. Here are some
reading materials which can give more insight about your child's problem. Do you
have any questions?

Another feedback:
Mum came because for last few days child was soiling his pant.this is Handbook case
Encopresis.
Task: History
DX with reason
Management plan
My approach: I started with HOPC. The child was soiling pant for last few days and the
poo is hard.previous history of constipation and doesn’t like to take vegetables or fruits.
There is no history of school bullying but mum was stressed bcz she needs to wash all
cloths.
DX: Encopresis or involuntary of passing stool. I gave reason behind it constipation and
less intake of fibre containing food.
MAMAGEMENT: first I told enema then I told about stool softner. Told about fibre
containing food and I told mum to start the toilet training again. i showed a lots of
sympathy.Follow the HB

Another feedback:
STATION 16- PASS- 5,5,4,6
Domain- management/ counselling
 Encopresis case from handbook
 Task- history, counsel mom
Child is leaking bowel for 2 months, parents blame him, classmates teasing,
constipation for 2 years, doesn’t eat fruits, veggies, only junk food, drink less water,
social history all normal, BINDSMA normal
Counsel like HB, I missed thyroid test- consider checking that as well
I made sure to be empathetic, acknowledged mom’s frustration and told repeatedly that
it’s not child’s fault and not to punish him.

Another feedback:

PREDOMINANT ASSESSMENT AREA - STATION

MANAGEMENT/COUNSELLING/EDUCATION 16
Scenario: Bowel disorder Grade: Pass
Assessment Domain Domain Score (see key below*)
Approach to patient/relative 4 4
History 4 4
Diagnosis/ Differential diagnoses 4 4
Management plan 4 4
10 yrs old boy having soiling in the underwear. Talk to mother

Did same as Marwan file encopresis. Emphasize on drinking water, healthy diet, bowel
training, stool softener. Ruled out bullying and other organic cause and home situation

Station 17: STI

A young guy came with urinary difficulty for few days.
Task: history for 6 min
DX/DDX
MY performance:
-HOPC.
-associated s/s.. Patient had no pain, he was telling about sting during passing urine.
Then asked about burning sensation during micturition or any blood in urine and all
negative.
there is no swelling or puffiness, no urgency, frequency, hazitency or dribbling. Loa,
LOW,
-all ddx q
- Asked sexual hx with confidentiality and ask all STI questions. He had multiple
partner history and had some discharge from penis no rash in private part. I asked
about safe sex and he was not using condom.I also asked about sexual
preference, Anal or oral sex history. Also asked about partners like did he see any
rash or discharge in partners private part.
- SADMA, pmh/psh/fhx
- DX: I told DX STI as he has history of unprotected sex. But to confirm I need to do
some investigations.
- Ddx: gave dd of urinary difficulty like UTI, stone in different part, prostatitis,
glomerulonephritis. Bph, prostatitis, urethritis, cancer
- ( RP at the end told me its too much information and showing facial expression he
was very irritated) (I told STI but not mentioned chlamydia or gonorrhoea and
failed ☹.but I mentioned HIV whatever , plz follow passed feedback)

Another feedback:
A young guy came with urinary difficulty for few days.
Task: history for 6 min
DX/DDX
MY APPROACH: I started with HOPC. Patient had no pain, he was telling about sting
during passing urine. Then asked about burning sensation during micturition or any
blood in urine and all negative.there is no swelling or puffiness, no urgency, frequency ,
hazitency or dribbling. Then I gibe confidentiality and ask all STI questions. He had
multiple partner history and had some discharge from penis no rash in private part. I
asked about safe sex and he was not using condom.I also asked about sexual
preference, Anal or oral sex history. Also asked about partners like did he see any rash
or discharge in partners private part.
DX/DDX: I told DX STI either chlamydia, gonorrhoea or syphilis as he has history of
unprotected sex. But to confirm I need to do some investigations.
For dd I draw picture of urinary tract and gave dd of urinary difficulty like UTI, stone in
different part, prostatitis, glomerulonephritis .ALL I cant remember properly.

Another feedback:
STATION 17- FAIL- 4,3,3
Domain- history
 Young male with some urinary problem
 Task- history 6 min, give diagnosis and differentials
I started with confidentiality, he said he has discomfort on peeing, asked all irritative,
obstructive symptoms- all negative, discharge +, asked CCOV- clear, small amount, no
smell, differential ques- fever, tummy pain, stones, rash, trauma, recent procedure, etc-
all negative, asked sexual history- multiple sexual partners+, unprotected intercourse+,
SADMA,
Dx- urethritis due to STI
Ddx- uti, pyelonephritis, prostatitis, stones, strictures, tumors,
I am not sure what went wrong in this station, probably more details on sexual history, I
also missed occupation, travel.

Another feedback:

PREDOMINANT ASSESSMENT AREA - HISTORY TAKING STATION 17

Scenario: Urinary symptoms Grade: Pass
Domain Score (see key
Assessment Domain
below*)
Approach to patient/relative 4 4
History 4 4
Diagnosis/ Differential diagnoses 3
22 yrs old male wants to speak to you regarding urinary 3
issue.
Ddx 3 but passed the station anyway.
On history has burning in urination but no discharge. Multiple sexual partners. Forgot to
ask about sexual preference. Asked about tattoo, piercing, blood transfusion.
DX STI- including gonorrhoea, chlamydia, hep b, c, HIV
DDX UTI

Station 18: REST

Station 19: Abdominal pain - PE

A patient came with left lower abdominal pain for few hours.
Task: Perform physical examination and tell the procedure to the medical student with
anatomical landmark.
My performance:
-WIPE.
-GA and vitals, Check dehydration status
-Start examination with hand and quickly check any anaemia, jaundice present or not
-Check the eyes and inside mouth,
-After start from inspection of the abdomen, check movement. Then start with
superficial and deep palpation.
-Did organomegaly. I asked student do u know how to do it she mentioned no then I
explained details in organomegaly check
-did percussion & rebound tenderness how to do explain properly, shifting dullness for
ascitis
-Check bowel sound.
-did all special test and mentioned properly where to check with anatomical land mark
( murphys sign, mc burneys point, renal angle tenderness)
-check hernia
 -With patients consent do the DRE not told in details
-Finished with hand wash & recover the pt
-do office test : udt, BSL, ecg, xray
DDX; diverticulitis, IO, volvulus, malrotation, faecal impaction, Mesenteric ish. ,
appendicitis, UTI, renal stone, cancer..
After finishing still I had time so asked student do u know how to do dre then started
steps of dre and bell rang..

Another feedback:
A patient came with left lower abdominal pain for few hours. Perform physical
examination and tell the procedure to the medical student with anatomical land mark.
My approach: I started with WIPE. Before entering I told that LIF pain can be related
with many reasons but most commonly it occur due to diverticulitis.
 Then start with GA and vitals
 Check dehydration status
 Start examination with hand and quickly check any anaemia,jaundice present or
not
 Check the eyes and inside mouth,
 After start from inspection of the abdomen, check movement. Then start with
superficial and deep palpation.
 Did organ palpation to exclude organomegaly.
 I avoid percussion as patient had so much pain. I forgot to do rebound
tenderness.
 Check bowel sound.
 With patients consent do the DRE properly with inspection and palpation as per
geeky medics
 Finished with hand wash
 FOLLOW ABDOMINAL EXAMINATION AND DRE OF GEEKY MEDICS

Another feedback:
STATION 19- PASS- 4,4,4
PE station
 Middle aged man with severe left sided pain has come to ED where you are
working as HMO. Vitals all stable.
 Task- explain to medical student how you will proceed with the abdominal exam
telling what you are looking for
I started with explaining WIPER, check HDS, give painkillers, general appearance, signs
of dehydration, focused abdo-
inspection: - moving with resp, distension, scars, masses, bruises, umbilicus, ask pt to
cough
palpation- temp, tenderness in quadrants- I asked if he knows how to divide quadrants-
he said yes, so I didn’t tell those planes/lines etc. guarding, rigidity- RP asked me what it
means if there/s guarding/ tenderness- I said it means inflammation of underlying organ.
Then explained Renal angle tenderness
I also asked if he wants me to tell McBurney’s and murphy sign for general abdomen
pain cases- he said sure, I told details.
percussion- said can skip if pt in severe pain
auscultation- absent/ hyperactive means obstruction
I said always end with DRE, do you want to know about it? He said no its okay. Then
time finished!

Another feedback:

PREDOMINANT ASSESSMENT AREA - EXAMINATION STATION 19

 Scenario: Abdominal pain Grade: Pass
Domain Score (see key
Assessment Domain
below*)
Approach to patient/relative 4 4
Choice & Technique of examination, organisation and
5
sequence 5
Explanation of procedure 4 4
Pain in the left lower quadrant. Tell PE to med student

My approach- I first told student about what we are looking for. DX diverticulitis, anal
fissure, haemorrhoids, need to rule out intestinal obstruction, other acute abdomen
causes like cholecystitis, appendicitis but they are less likely as the pain is in left iliac
fossa.
I did abdomen examination, DRE told him about the position of DRE and what we are
looking for. The student did not ask me any questions.

Station 20: HSP – PE - Pilot

6 years child presented with intermittent tummy pain, limping and rash for 1day.
picture given for rash. Child had a history of flu like symptoms 1 week back. FBC was
done and there RBC, WBC and PLATELET count all normal. In UDT blood is ++.
Task: Explain the picture to the examiner
Explain the examination procedure to the the examiner and tell DDx
My performance: (there was no one in screen so it seems like I was talking with myself)
first explain the rash to examiner, I told rash morphology ( site, size, shape, colour,
extension, discharge, scratch mark, petechi/purpura/scaly or not , elevated/ oozing,
surroundings) I can see rash extending from buttock to the lower limb. The rash looks
reddish in colour, there is no visible bleeding and any visible oozing. I cannot see any
scratch mark over the area.
PE:
-WIPE (maybe I forgot ☹)
-GA & VITALS
-HAND: Leukonychia/ koilonychia[anemia]/ clubbing/ palmar erythema/ pallor, CRT
-FOREARM: pulse, no bleeding spots/ bruising/ petechiae/ scratch marks/ injection
marks
-EPITROCHLEAR LYMPH NODE
-Check Axillary and Cervical LN
-FACE:
 EYE: Anemia/ Jaundice/ conjunctival hemorrhage or injection

 Ask for Fundoscope[to see retinal hg]

-EAR: no obvious bleeding / discharge, Ask for otoscope
-Nose: Epistaxis
 -Mouth: no gum bleeding/ hypertrophy, no tonsillar
enlargement,exudate or any bleeding inside the mouth
-Neck stiffness
-Chest: sternal tenderness [to see leukaemia]
-ABDOMEN: para-aortic LN parallel to umbilicus
 INSPECTION: I can see abdomen moves with respiration, no
scratch marks/ bruise/ distention/ visible veins/ mass
 PALPATION: tenderness, organomegaly (I didn’t explain
detail how to check hepatomegaly or splenomegaly)
 Auscultation for bowel sound
-I didn’t mention DRE as he is a 6years kid,
-Check inguinal lymph node
-LEG: rash/ bleeding/ bruising/ purpura/ scratch mark/ popliteal LN
-As pt having hx of intermittent tummy pain I would like to check full abd PE and
having limimg would like to finish by leg PE
-Office test : UDT
-Wash my hand and recover
Ddx: HSP, ITP, meningitis, TTP, allery, drug induced, leukemia, lymphoma.

That’s all I can remember. Best of luck guys 😊..

Another feedback:
A picture was there with rash from buttock to lower leg of a child. Child had a history of
flu like symptoms 1 week back. FBC was done and there RBC,WBC and PLATELET
count all normal. In UDT blood is ++.this is Haematological examination.
Task: Explain the picture to the examiner
Explain the examination procedure to the the examiner and necessary
investigation
My approach: first explain the rash to examiner,I told that I can see rash extending
from buttock to the lower limb. The rash looks reddish in colour, there is no visible
bleeding and any visible oozing. I can not see any scratch mark over the area.
Explain the examination with anatomical land mark: I started with WIPE approach here.
Before starting I told rash can be present for many reason but I am suspecting HSP and
then start
 WIPE
 GA
 VITALS
 HAND:[ can u pls do like this?] Leukonychia/ koilonychia[anaemia]/ clubbing/
palmar erythema/ pallor
  FOREARM: pulse
 no bleeding spots/ bruising/ petechiae/ scratch marks/ injection marks
 EPITROCHLEAR LYMPH NODE
 FACE:
 EYE: Anemia/ Jaundice/ conjunctival hemorrhage or injection
 Ask for Fundoscope[to see retinal hg]
EAR: no obvious bleeding / discharge
 Ask for otoscope
o Nose: Epistaxis
o Mouth: no gum bleeding/ hypertrophy, no tonsillar enlargement,exudate
or any bleeding inside the mouth
o Chest: sternal tenderness[to see leukaemia]
o ABDOMEN:
 INSPECTION:I can see abdomen moves with respiration, no scratch marks/
bruise/ distention/ visible veins/ mass
 PALPATION: tenderness, organomegaly
 Auscultation for bowel sound
 Examiner With consent of my patient I would like to check for Per rectal
bleeding and inguinal lymph node
 LEG: rash/ bleeding/ bruising/ purpura/ scratch mark/ popliteal LN
 Can u sit at the edge of the bed/ sit on the chair pls🡺 Axillary and Cervical LN

INVESTIGATION: urine analysis for protein and blood ,urea,creatinine and as I

am suspecting HSP I will also do USG

GOOD LUCK EVERYONE. IF I CAN DO IT, YOU ALSO CAN. KEEP FAITH UPON
GOD AND ON YOURSELF.

Another feedback:
STATION 20- PILOT
PE station- picture of a child with petechial rash on buttocks, legs. History given as flu
like illness 2 weeks ago, now vitals stable, no fever and child looked healthy. Had
intermittent tummy pain, no urine change.
Task- describe rash to examiner, tell examiner how you will proceed with relevant
examination with reason, what you are looking for to make diagnosis
There was no RP here and it was like talking to yourself. I explained it as reddish dot
like rash that ranges from pin point to large coalesced/ grouped rash that looks like
ecchymoses distributed over buttocks etc etc. This rash seems petechial. No active
bleed, scratch marks, swelling. Would like to check if palpable, tender, rise in temp and
whether blanchable
Then proceeded as hematology exam+ ent exam and said dx as hsp and gave ddx like
meningococcemia, itp, viral exanthem etc
That’s all that I can remember, hope it helps. Good luck to all!

Another feedback:
Pilot case- Rash examination, my approach was so haphazard, I knew I would not pass
this one. Fortunately, it was pilot station

Good luck guys. Please be calm in exam. I lost few stations not being able to calm
myself after starting exam. I failed most stations after starting exam. Don’t worry if you
did not perform up to your expectation but you can still pass if you follow format.
Thank you all. Keep me in your prayers.

13th April 2021

Case 1. Breast PE
explain examination to medical student
Case 2. DKA
Child 4 years old with vomiting ( twice ) and diarrhoea and nausea yesterday .
Diagnosed with diabetes Mellitus 3 months ago. Managed by iv fluids now . Everything
stable now.
Task: history from father, pefe card: glucose 25 , ketones 2.5 , sunken eyes , decreased
skin turgid Diagnosis : DKA with mod dehydration ( explain to parent with causes )
Case 3. Mechanical back pain
Task: History - + stiff back only after gardening Pefe - Slr + (b/l) > 30 Diagnosis / DDx -
mechanical back pain , sciatica , fracture , trauma , oa etc
Case 4. Rash case in a mentally retarded patient
Explain rash to medical student Rest haematological exam.
Case 5. Respiratory PE
Smoker with sob Findings - decreased breath sounds , hyper resonant lung fields with
wheeze++
Case 6. Placenta Previa
Explain usd to patient , further investigations and explain management to patient
Case 7. Anxiousness
52 year old patient got more anxious then before -History - loss of weight , sweating ,
palpitations , getting more tired , sleep problems , irregular periods + , some moods
issues , headache Diagnosis / DDx - perimenopausal / hyperthyroid , Gad , coffee ,
pheochromocytoma, heart arrhythmia
Case 8. Young woman getting more irritable and outburst
Task: History (psychiatry history only) - Mood low , early morning awakening , loss of
appetite , not able to concentrate ( trigger something happening at work which is
bothering her ) test no psychotic features .Diagnosis/ DDx - mod depression ,
adjustment disorder , stress , ptsd , Gad, bipolar, drug ab

Case 9. Infantile colic / irritable Baby

6 weeks old crying more than 3 hours a day for everyday. Mother no mood disorder
History - pulling legs to chest while crying Diagnosis with causes and counselling /
management to mother
Case 10. 52 years with painful urination
History , diagnosis / DDx with causes Uti with BpH
Case 11. Pneumothorax PE
Explain to student along with anatomical landmarks
Case 12. 18 months old with diarrhoea for 3 weeks
History, pefe card and diagnosis with cause (toddlers diarrhoea)
Case 13. lady with hot flushes and irregular periods
History, cause of symptoms and appropriate management
Case 14. 42 vaginal bleeding for 3 months
History - periods heavy, passing clots + Pefe - picture of cervix given bloods, uterus
anteverted, size normal, no Aden exam mass Diagnosis / DDx causes - fibroids, dub,
Case 15. Headache 9 year old
History - bullying + Diagnosis with reasons
Case 16. Overdose case of MDMA / alprazolam.
GCS 12/15 , liver function deranged ,Short history from parent Address his concerns ,
further investigations you will order and immediate management

14th April 2021

Case 1. SOB & chest pain
23 or 33-year-old pt came to ED with shortness of breath and chest pain, sats was low
but with 2 l of o2, it is well maintained within range, other vitals do not indicate any sign
of tension pneumothorax there is a x ray showing air in the right lung upper and mid
zone.
Task: explain x ray to med student (mention position of trachea, deviated or not,
shadow of heart looks like tubular, not sure though, costo phrenic and cardio phrenic
angle clear. Explain PE to students with clear anatomical land mark.
Talk about what instrument you will use to relieve symptom or can use as part of your
assessment. (Did not get clearly what they want and it was my first station). May be
need to tell the student what we usually do to relieve symptom and the name of
equipment, I think wide bore needle,14 to 16 size to do decompress the air pressure
with sterile asesptic technique. Please have a look at the same recall, came yesterday
and also a famous recall of racgp.
Case 2. Tingling & numbness
57-year-old lady came to gp with tingling and numbness in both foot which aggravates
at night, all history given, took alcohol 5 standard drink a day for 5 years but stopped
according to advice 6 wks back but still having symptom, take, explain the pe findings
and investigation results, no blood sugar or folate level or LFT given, dx and differential
and mx, both immediate and long term.
Case 3. Fever and difficulty breathing
4-month-old baby came to ED with fever, mild to moderate dehydration, difficulty in
breathing since last night following a mild cough and runny nose. Do examination and
tell what things you will look for to the invisible examiner, then PEFE findings will be
shown to the screen, then explain MOM what is going on with the baby.
Case 4. Behaviour change - MSE
A 27-year-old man intruded to neighbor’s house, abusive and shouting brought by the
police in ED, pt was having unsteady gait with blood alcohol level 0.17 mmmol/l. Take
history to assess his substance abuse, present MSE to examiner and tell the risk he is
having.
Case 5. Behaviour change
A university student referred by supervisor for loud and disruptive behavior in the class,
argumentative, having thought of people are criticizing, may be because of jealousy,
speech was mild pressured, take psychiatric history for 6 mins, give your dds with
reason and give what is most likely diagnosis. One of the dds can be adult onset adhd,
not sure, though.
Case 6. PVD PE
77-year-old with sudden onset of rt leg pain with pallor, explain student how to perform
PE with anatomical landmarks.
Case 7. Vasovagal syncope
15-year-old girl with vaso vagal syncope, come to ED with mom, take history, give
diagnosis and dds with reason.
Case 8. Dysmenorrhea
Pt, aged 23 year, told first 4 years period was ok,same scenario like 5 th March, pilot,
but cyst 1.9 cm unilocular thin cyst found in USG 2 wks before meanstruation, explain
result, take short history, tell what PE you will perform in her to find if there any
correlation of her finding with period pain.
Case 9. Cervical spondylosis with radiculopathy
Pt told that pain in her left neck and running down to arm and hand, take 6 mins history
and give dx and dds with reason, same recalls.
Case 10. Chlamydia counselling
A 27-year-old man went to interstate and stayed 3 wks there, had 3 to 4 casual
relationships, STI screen done by colleague, explain result and give mx. Old recall.
Case 11. Itchy vulva
A photo given in 67-year-old lady with itching in vulva, probably a photo of atrophic
vaginitis?? (try to r/o any vulval growth). Take history,give dx and give mx.
Case 12. BCC
A farmer 63 year old came after biopsy taken from rt temporal region, result showed
nodular basal cell carcinoma, no invasion. Tell the dx like same breaking bad news, tell
the implication of it or course of illness then tell the management.
Case 13. Anaemia in pregnancy
Old recall of ANC microcytic, hypochromic blood picture, explain result, organize further
investigations, tell the dds with reason.
Case 14. Antibiotic-induced diarrhea
A pt came with diarrhea for 2 days after taking amoxicillin for bronchitis, taking
pantoprazole for reflux for nearly 2 years, history and exam findings were given little bit,
tell the reason for diarrhea, exclude other cause if any and give mx.
Case 15. Flank pain
A pt having flank pain, going to groin, UDT shows 3 +rbc only, take history, explain the
condition, arrange investigations to confirm the dx.
Case 16. SOB
A 66-year-old having SOB for 2 months with tiredness, orthopnea and PND positive.
Take history, give the dx with reason.

20th April 2021

Tips from Candidate:
On the 20th of April I managed to finally pass the AMC Clinical exam. Some call it luck, I
call it divine intervention, Jesus Christ be praised!

I would also like to thank all my study partners. You are amazing doctors, thanks for all
your help, effort and honesty! I wish you all the best of luck from the bottom of my
heart :)

In this file I would like to share with you my experience and some commentary. I hope
you find it helpful. Just remember that I’m not an expert on anything. This file is just my
personal experience and perspective. Hence it’s a little biased too. :)

My preparation included going through several books and files. This allowed me to get a
sound idea about the structure of the exam. It is really important to understand the
structure, because it will allow you to be more efficient with your role-play. Doing the
official Handbook in my opinion is a must. Yes, it’s outdated, but some cases still like to
reappear. Besides, it clearly mentions critical errors. You can avoid them only if you
know what these are. Familiarising yourself with the Maran file and the Combined AL file
is also extremely helpful. You can find both these in the „Files” section on this group.
After that, go through recalls. The more fresh, the better. Courses can also be very
helpful. You can learn directly about exam expectations in a faster way.

Tips from my personal perspective:

- Role-play is essential! This exam checks your knowledge to some extent, but it’s
more about the performance. There is NEVER ENOUGH OF ROLE-PLAY.
- Find good and dedicated study partners. I had the luck to be studying with the
best and most helpful people.
- During the role-play, find your strengths and weaknesses. Focus more on the
latter. Be open for constructive criticism.
- Try to finish each case in 7minutes. Always practice with a timer.
- Try to memorise the key points and try to include as many as you can. Also,
know the critical errors in order to consciously avoid them.
- In doubtful cases, reach to guidelines.
- Learn how to give the impression of confidence. Learn how to speak loud and
clear and how to build the rapport.
- Be ready that your performance might be 10-20% worse on the real exam day
than it is during the role-play, especially if you are an axious type. Try to be as
precise as possible during your prep.
- New Zoom cases require you to be extremely accurate with your timing. When
the task mentions 3 minutes for history, that’s exactly how much you have,
before examination findings appear on the screen.
- Task: “present your diagnosis with reasons” appears more often in the Zoom
exam.
- PE - try to get a sound idea about the types of PE (for example - thyroid,
pregnancy, etc.) and how to recognise which one is it from the stem. Then, learn
which elements to mention in each examination. As a third step, find out how to
describe the technique in an efficient way. Check the student’s understanding
every now and then.
- I know how hard this past year has been for all of us, but try not to give up. Good
things will come to you I promise :)

Station 1: Breathing difficulties

Young female coming to your GP practice with blocked and runny nose for the last 6
months.
Tasks: - History
- PEFE on card
- Most likely diagnosis with reasons
- Explain the mechanism for her condition
I greeted the patient, made sure she is comfortable and started with my history. Asked
about the presenting complaint, associated features.
- symptoms started about 6 months ago, are on and off, discharge is clear, she
sneezes a lot, sometimes experiences watery eyes. Worse in the springtime. No
bleeding, fevers, no travel, no sick contacts. No cough, no carpets,dust or mites.
She has a cat though.
Then I asked one question for each differential. I ruled out sinusitis, foreign body,
trauma, bleeding, surgery, infections, asthma, cancer.
PMHx:
- she used to have similar symptoms before.
FHx:
- Positive for asthma and seasonal allergies.
SADMA:
- negative

PEFE on card - all normal

Dx - allergic rhinitis, because the discharge is clear, appears during certain months and
is most likely triggered by some pollens. Mentioned about positive family history and the
cat. I did not go into details why it’s not the other causes but I should have. Just
mentioned quickly other ddx.
I explained what is hypersensitivity and that some people have more reactive immune
system. That’s why some people can easily tolerate pollens and allergens and some
people experience runny nose and sneezing. I tried to calm her and I said it’s
manageable.

Did not mention the word “histamine”.

I mentioned nothing more about management.
Station 2: Paediatric CVS examination
You are an ED intern, your next patient is a 5 year old boy brought in by his mom. The
boy is very unwell. The stem was quite long. He had sore throat 3 weeks ago, nothing
mentioned about the nature of it or treatment. Vitals were given showing features of
haemodynamic instability. CXR was given and the heart looked enormous, even for a
kid his age. I couldn’t see any obvious lung abnormalities. However, CXR interpretation
was not a task.

Task: - paediatric CVS examination to a student

- PEFE on card interpretation (after 6mins)
- Diagnosis with reasons

My flow:
- introduction, asking the name of the student
- Asked if he has any initial questions. He said no. Ensured him that he can ask
me anything anytime
- Our patient is haemodynamically unstable - 1st recheck vitals and hook up to
monitoring, follow DRSABCD protocol and call for senior. Compare vitals
threshold with norms for age.
- Ensure warm cozy and safe environment
- Take consent from the parent and from the child. Explain in lay terms what are
you going to do and why
- Check hydration
- GA - drowsy, pale, erythematous, pale, blue, rash, irritable
- Growth charts
 - Chest - inspection, palpation, auscultation. Same elements as for adults. I
mentioned the exact intercostal spaces in which we need to place the
stethoscope. I described the technique in details.I skipped accentuation
manoeuvres.
- Lung basis auscultation – super important
- Organomegaly check
- Hand - same as adults, including clubbing, endocarditis signs. I did not mention
hand features at all. But you must not forget it!
- Eye - pallor, injection, lacrimation, fundoscopy
- Head and face - malar flush, dental hygiene and throat. In paediatric exam do it
at the end, because it will most certainly upset the child
- Neck - lymph nodes
- Ankles - peripheral oedema
- Finish with lab tests and ECG and echo, CXR already done
*JVP - don’t check in children less than 7 years old

I did not properly finished, then PEFE on card appeared. It showed 2 different
parasternal murmurs. One was ejection systolic and the other mid diastolic. S3 was also
present and gallop rhythm. Apart from that, there were bibasal crepitations and pitting
oedema. Clearly no signs of endocarditis.

I said it is acute heart failure most likely due to rheumatic fever. But it can be ASD or
VSD symptomatic now because if superimposed infection. I had no idea, I was
improvising.

I’ll be honest with you, I’m still wondering if I connected the score below with the right
case. This is the only one with breathing difficulty AND physical examination. However, I
was sure it was going to be a pilot. So take this one with a grain of salt. The feedback
screenshot below may pertain to the pregnancy examination, which I’ll describe at the
end of the file. However I’m pretty sure that was a routine pregnancy checkup without
any shortness of breath.
Station 4: Thyroid examination
A man comes to your GP practice worried about a neck lump. Has family history of
thyroid diseases.
Task - explain to a med student relevant step of physical examination. Mention all the
equipment you are going to use.

I was happy to see this case. Felt quite confident about it.
Each and every pe case I started like this:
“Hello, my name is ____, I’m one of the doctors here. How can I address you? Nice to
meet you.
Today I am going to guide you through the physical examination of the thyroid gland. Do
you have any initial questions? (They’ll always say no) If anything is confusing to you,
please feel free to interrupt me and ask me.
First we need to check the patient’s vitals to make sure he’s haemodynamically stable
and safe to proceed. If not, follow the DRSABCD protocol. Then check the patient’s
presenting complaint and his notes to Learn more about the PMHx.
Then we wash our hands and introduce ourselves to the patient. Next we need to tell
the patient what are we going to do and why and take informed consent. In case of pain,
we offer a painkiller after excluding allergies. We also need to properly position the
patient, sitting on a chair is in this case perfectly enough. Next, ensure correct exposure,
ideally whole hands and neck should be exposed. If the patient is not comfortable, offer
a presence of a chaperone. After you finish, do not forget to recover the patient and
wash your hands again. Is all clear until now?”
So basically I was just describing what WIPE is without mentioning it directly. I tried to
finish this introductory part in less than 1,5mins.
Equipment: - hammer
 - fundoscope
- BP cuff
- Timer
- Sthetoscope
- A cup with water
Then I started with the hand, achropachy and reflexes. Then moved to the head and
neck in details. I checked all the eye signs. In the neck I did all inspection, palpation,
auscultation and percussion. I described these procedures in details and mentioned the
technique. Remembered about deglutition and water sip. At the end I mentioned cvs
examination, pretibial myxoedema, Pemberton sign (in case of a lump) and proximal
myopathy. I’m pretty sure I did not forget anything. I was following scenario presented in
PE files, many of them are available for download on this group.

However, my low score can be a message that more emphasis should be put on the
actual technique and reasoning explaination.
For example, instead of saying “I’m going to check the biceps reflex”, say “I’m going to
tap a neurological hammer over the biceps tendon while ensuring the patient’s hand is
relaxed and passively flexed in elbow to look for reactive elbow flexion. Exaggerated
reflex can indicate hyperthyroidism.”
That’s my guess.

Station 6: Facial lesion

Middle aged lady comes to your GP clinic to get her biopsy report. She is a farmer from
central Queensland and had a mole excised from her forehead. The biopsy report is
given in the stem. It shows superficial spreading melanoma. Diameter was small and
there was clear margin of excision.
Task: - Explain the results
- Present management

I approached it as a breaking bad news case. The lady was extremely nice and
cooperative. She was having a small bandaid over her right temple. I started by asking
how’s the wound. Offered a painkiller. Ensured that from our perspective healing goes
very well.
Then I followed the SPIKES approach. She was not at all concerned about cancer. She
said many of her fiends have it and in her understanding it’s mild.
It was a relief, I knew that at least I don’t have to deal with emotional distress.
Then I explained as much as I could about the melanoma:
- Condition - nature of melanoma, what it is
- Cause - cell mutation
- Commonality - quite common
- Risk Factors - sun exposure, sunscreen use, sunburns, surgeries, family history,
complexion phototype, etc. Each and every risk factor I mentioned as a question
to her
- Symptoms - growth, itchiness, bleeding, ulceration, etc. asked her if she had any
of these
- Outcome - what can happen if we don’t do anything. Mentioned what a spread is
in a non-threatening way. Ensured understanding

Reassured her again. I said it’s good that we picked it up early.

Management - reexcision and referral to a dermatologist and surgeon. Explained that

although the margins seem clear on the biopsy report, melanoma requires bigger
margins. Always. It can sometimes produce tiny groups of cells around the mole that
can be invisible under the microscope. These tiny groups can grow and be responsible
for relapse. I also said that reexcision will be both diagnostic and therapeutic. But she
needs a regular follow-up.
I described in details sun smart rules.
- Slip, slap, slop in details
- Reapply sunscreen multiple times, even without going to water, because we
constantly sweat it off
- SPF 50+
- Watch out for overcast, apply sunscreen even in cloudy days
- You are in a high risk of developing it again
Mentioned reading materials, red flags and invited family members for a check-up.
Station 7: Unwell patient
Your next patient in the ED is a young man who was brought in by his partner because
of sudden dizziness. The stem was really long, I just scanned it with my eyes to see if
there is anything abnormal.
The guy had some family problems, his parents got divorced a few years prior. He’s a
uni student. Occasionally he smokes weed. It was clearly written that his vitals are
stable.

Tasks: - History
- Most likely diagnosis with reasons

Long stem and family issues directed towards a psychiatry case.

I started by asking the details about his dizziness.
- it was the first time
- No loss of consciousness or fits
- He was sitting on a couch watching tv with his partner. It was a comedy, not a
horror, no flashy scenes, no sudden change in position
- All questions from the “before-during-after” cluster negative.
Then I started asking psychiatric history. Started from HEADSS. He has some stress at
the Uni and at home, always has been an anxious person. Relationships fine, no
suicidal thoughts. Uni performance fine so far.
SADMA:
- Occasional weed and alcohol
- Coffee 6 cups a day, no energy drinks
ASEPTIC:
- mood fine
- No other abnormalities
I did not ask about pheochromocytoma features or thyroid. Completely forgot about both
of these.

I said it was most likely anxiety related. I mentioned somatisation disorder and the new
DSM5 name which is somatic symptom disorder. I also said it is very likely triggered by
coffee overload and subsequent electrolyte imbalance. As ddx I mentioned panic
attack, gad, depression, mania and other loss of consciousness causes.

Station 9: Late pregnancy complication

Young lady in 32 week of pregnancy coming to the hospital with vaginal bleeding. The
stem was long, mentioned previous C-section and blood group ARh-. There was also
ultrasound report written. It clearly showed placenta praevia, I don’t remember which
degree. Vitals stable.

Tasks: - Explain the ultrasound

- investigations
- management

She was scared and a little distressed. I greeted her, ensured confidentiality. Then I
reassured her about stable vitals and said she’s in a safe hands. Made sure she has no
active bleeding at the moment, no pain or shortness of breath. The baby was kicking
well.
Then I explained the ultrasound.

Counselling - I followed this approach

 - condition - I tried to draw her a picture with a sharpie to make lines thicker and
visible on webcam. But she refused it. So I just very briefly described what it is
- Cause - low egg attachment
- Commonality - very common
- Risk Factrs - mentioned her C-section, previous surgeries, familial
predisposition, fibroids
- Symptoms - mainly bleeding
- Outcome - baby is prone to distress, she may have recurring bleedings, vaginal
delivery not possible, premature delivery is a risk

Management
- continuous CTG and vitals monitoring
- Blood tests
- I think I did not mentioned any swabs
- Urine test
- Admission
- Elective delivery at 36/37 weeks by C-section
- If any signs of fetal distress - delivery earlier
- I remembered to mention anti-D
- Lots of rest, possible heparin if she needs to stay in bed for too long
- Social worker to take care of the other kid
- I said conditions in which she could be treated at home. But I said it would be
difficult to keep proper rest with a small kid at home, hence admission.
- While I was mentioning steroid for lung maturation, the time finished
- Every now and then I checked her understanding and willingness to comply. She
was very eager to agree to all my suggestions.

I honestly thought I did well here. But gynae is my nemesis, I keep failing these cases.
Please compare with some passed feedback.
Station 10: Recurrent abdominal pain
Child 8 years old had recurring abdominal pain for the last few months. Today his mom
comes to your GP practice to find out the cause.

Tasks: - History
- PEFE on card
- Diagnosis with reasons

History:
- pain questions SOCRATES - pain on and off, now absent, chronic, all over the
tummy, cramping, can be quite severe, no radiation, happens also on weekends,
never wakes from sleep
- Associated features - all negative, could not find anything
- BINDS - normal
- Diet normal
- School performance satisfactory. No previous anxiety, no features of bullying.
- PMH normal
- Family history - I asked “anyone sick at home?” Hoping to rule out infection, but
the mom admitted that grandma has cancer. She was in terminal stage getting
palliative treatment.

PEFE on card - everything normal

Dx - anxiety related, somatic symptom disorder. I said that explaination about mind and
body being interconnected. Then I mentioned some other random DDx without going
much into details. I don’t remember which ones I mentioned, but there was about 5 of
them.

Station 11: Funny turn

This was a very old recall. Maran file number 173
You are a HMO in Ed when 22 years old girl brought in by worried parents that she had
funny turn this morning. Now she Is fine and vitally stable.
Tasks -History (6 minutes)
-PEFE card
-Dx and Ddx with reasons

That was my first station and I was trying to keep calm but it was hard. I think I asked all
the questions from the “before-during-after” cluster. Positive findings were exactly the
same as in the Maran file. She was binge drinking the night before, woke up in the
morning, went to fridge to grab some breakfast and collapsed with fits. Please refer to
the Maran file for more details, it is really nicely written there. I have nothing to add. It
was identical.
Station 12: Haematological Examination
Young man presented to your practice with a rash on thighs and buttocks. The rash was
non-blanching which was clearly mentioned in the stem. He had some unspecified URTI
3 weeks ago, from which he has recovered.
Picture was given, but it was possible to conclude everything from the stem only. It was
very detailed.

Task - describe the rash

- PE to a medical student

I knew it’s going to be haematological examination.

I started with the exact same formula that I mentioned in case number 3, but this time
exposure was different and chaperone was a must. And I mentioned DDx at the
beginning, before describing WIPE. I said it could be due to ITP, TTP,
meninggococcemia and DIC. I said it all in full names. But I forgot to mention HSP. I
was scared it might be critical. I concluded by saying that out of all ITP is the most likely.

Then I described the rash. I basically read word for word what was written in the stem. I
was too stressed to be fancy about it.
I said we need to check the whole body for distribution. But expose just one area at a
time to ensure the patient’s comfort. Next we examine detailed morphology. We check
for - blanching, scratch marks, oozing, bleeding, desquamation, vesicles,
erythemathous base, foul smell, discharge, discolouration, elevation. In gloves we check
for tenderness, texture and induration. I said anything that popped into my mind.

Then I proceeded with a standard haematological examination.

I started with the leg and inguinal lymph nodes. I was trying to be as descriptive as
possible. As anatomical Iandmarks I was using well recognisable points, such as
anterior superior iliac spine. Then I used terms like proximal, distal, horizontal, lateral,
medial to describe my technique. I tried to do this with every examination step. Then I
checked the hand, all the other lymph nodes, head and face, fundoscopy, neck
stiffness, throat. All according to the structure from Maran and other well known files.
When it came to abdominal part, my time was up. I did not have time to mention the
abdominal examination or DRE.

Station 15: OL Knee Pain

Middle aged man coming with an acute knee pain. The stem was very long. He takes
hydrochloorothiazide for the last 6 weeks for hypertension. Drinks 4 SD a day. No
history of trauma. PEFE was given on the stem - no fever, vitals normal, erythemateous
diffuse swelling in one knee.

Tasks; - explain the most likely diagnosis

- order investigations
- Immediate management

Everything pointed towards gout.

Fist I offered a painkiller and reassured about stable vitals.
I presented the case in a 5C fashion (Condition, Cause, Commonality, Risk Factors,
Symptoms, Outcome)
Every now and then I asked the patient some question to engage him and check
understanding.

Investigations - I mentioned many blood tests, but I think I forgot glucose and
cholesterol which are crucial
- Esr, Crp
- Uric acid levels
- LFTs, RFTs
- FBC
- knee ultrasound
- Knee fluid aspiration and culture
- Urine full

Management
- indometacine now- will take away swelling and pain. Told the possible side
effects, such as transient stomach upset, black poo but it usually happens with
prolonged use
- I forgot to mention ice and elevation
- Stop hydrochlorothiazide. I said that I am a very junior doctor and I cannot easily
change medication, but I’m going to liaise with a blood pressure specialist who
will change the treatment asap
- Fluids
- Long term - I mentioned A LOT about diet and healthy lifestyle, plenty of water,
fresh fruit and veggies. I gave dietician referral and reading materials. I talked
about decreasing alcohol consumption to safe limits, encouraged exercise.
Warned him about the increased risk of relapse. Mentioned allopurinol as a
preventive drug in recurrent attacks.

I did not tell about rechecking the uric acid after 4 weeks. Didn’t say anything about
medical certificate or about prednisolone and colchicine as alternatives.
Station 16: Health review
Young man coming to your GP practice for some trivial reason. But the stem shows that
he’s been having problems with binge drinking lately. He was trying to quit drinking but
with no success.

Tasks: - History
- counseling

I greeted him, briefly took care of the trivial reason mentored in the stem. Then I
mentioned that I’m concerned about his drinking habits. Ensured confidentiality. Asked if
it’s ok with him to ask more questions about it.
I followed the 5A approach.

Ask - since when?

- how much? 15 beers over weekend, does not drink on weekdays
- Occasions? Social/solitary? -social
- Which alcohol type is his favourite? -beer
- CAGE Ever tried to cut down? Annoyed? Guilt? Eye opener? -all clear
- Asked delirium symptoms specifically? Any other withdrawal symptoms? -no
- Dose increase? - didn’t notice
- SADMA - clear
- Issues with law? -no
- Driving? - He’s a commercial driver
- Family? -ok
Assess - how motivated are you on the scale 1-10? He said 10
Advise - why alcohol is bad. I mentioned physical, social and financial consequences in
details. Scared him a little. I said he may cause a traffic accident.
Assist – support programmes, offer your support, contact with anonymous alcoholics.
Be gentle with the AA, some may find that suggestion offensive. AA can sometimes
have bad reputation.
Arrange - follow-up

I said a lot about healthy lifestyle. Fresh fruits and veggies, water, exercise, avoid
smoking. Mentioned very clearly what is a standard drink and what are the safe levels.
Gave examples for each alcohol type. Gave reading materials. Warned him about
possible withdrawal effects, but there are quite unlikely in his case since he drinks on
weekends only. Suggested drinking 2 cans of juice/water in between beers and meeting
with mates outdoors instead of a pub. Suggested setting a written agreement and a quit
by date. The role-player seemed happy.

After the case was finished, it enlightened me. I completely forgot to order blood tests
and LFTs! I was 100% sure I’ll fail this case because of that. But somehow I passed.

Station 17: Diarrhoea

6 month old baby brought in by mom with diarrhoea and vomiting for the last 24 hours.
Tasks: - History
- PEFE on card
- Diagnosis and ddx
- Management
After introduction I said out loud that I would like to check the baby’s vitals to ensure
stability. There was no examiner to ask about the vitals so I proceeded with my history
right after.
History
- child is not drowsy or irritable
- every stool is loose
- Normal poop smell, no strange colour
- Vomited 3 times, milk coloured, not green or yellow, not forceful or projectile
- No signs of abdominal pain, no loss of weight or appetite
- Everything else normal
- BINDS normal
- SADMA normal
- Contact with any sick people? - yes, his older sibling has similar diarrhoea. The
sibling goes to a day care and is immunised.

PEFE on card - all normal. No signs of dehydration, no ketones in urine.

I said it’s most likely just a simple gastroenteritis caused by a viral infection. I do not
remember which ddx I gave exactly. I said it’s usually self limiting, but because the baby
is vomiting he may deteriorate. So I admitted him. I think it was a mistake, he should be
discharged home with red flags and reading materials with some oral fluids for
rehydration. Suggested a social worker for the other kid.

I forgot to ask about any new foods introduced.

Please follow a passed feedback on this one.
Station 19: Assessment of change in behaviour
Young lady was brought in by her parents because of behavioural change. She was
diagnosed with schizophreniform disorder over one year ago and started on medication.

Tasks: - History
- Diagnosis with reasons

She was a very good actor. Her affect was FLAT. She was completely indifferent about
everything.
I started with introduction and confidentiality.
Then I went with PMHx questions:
- when was her schizophreform disorder diagnosed? What were the symptoms?
Hospitalisations? Recant relapse?
- Last specialist check-up?
- Medication compliance? She said she stopped her meds some time ago
because she felt fine. And she thinks she does need them anymore. Did not
mention any side effects, issues with finances or preference for alternative non-
conventional therapies.

ASEPTIC
- she had flat affect but said her mood was very good
- Had some auditory hallucinations
- No suicidal or homicial risk
- Thought normal
- Orientation normal
- Judgement impaired

HEADS
- no issues
- Lives with parents, has support

SADMA:
- used to smoke weed
I did not ask about thyroid.

My diagnosis was schizophrenia relapse. Due to medication non-compliance and

because of her previous medical history and marijuana use. Then I mentioned some
random psychiatric ddx and delirium.
Station 20: Chest pain
Elderly lady presented to ED with acute chest pain.
Tasks: - History
- PEFE on card
- Diagnosis with reasons

I was preparing myself for an acute MI case.

Greeted the patient. She was a very good actor, pretending to have acute shortness of
breath. She had difficulties finishing a sentence. I said: “I would like to check your vitals
and call for my senior. Then I’ll ask you a couple of questions about your pain, is that
ok?” She said yes. Then I offered her a painkiller and proceeded with the history.
SOCRATES:
- sudden pain, without any trigger
- Sharp, no radiation
- One sided
- Worse on inspiration
- Nothing makes it better
- Quite severe
DDx - I ruled out cardiac origin, GERD, trauma, all infections, embolism, herpes
PMHx - she was suffering from emphysema. Denied COPD.
SADMA - used to smoke but quit

PEFE on card - unilateral hyperresonant percussion sound and decreased breath

sounds on auscultation. ECG normal
With a sharpie I drew her a picture of lungs. I said that most likely she has a condition
called pneumothorax, which is a lung collapse. Emphysema causes lungs to create
blobs of air. Sometimes they can spontaneously burst causing lung collapse. As ddx I
mentioned heart attack and GERD and a few lung related causes, such as embolism
and pneumonia.

PILOT -1 (most likely) – HRT renewal

60 year old lady comes to your practice for HRT prescription renewal.
Tasks: - History
- Investigations
- Management

I greeted her, gave her confidentiality and proceeded with history.

HRT - has been taking for 6 years
- asked each side effect I could think of, she denied having any of them
- I ruled out cancer specifically
- Recent gynae visit? She does not remember
- No mammography, no cervical smear ever
- She takes it regularly with good compliance (I forgot to ask her who has been
giving her the prescription)
- initially prescribed because of hot flashes, how she has none
Menopause questions:
- just some vaginal dryness
5Ps - last period over 6 years ago
- some pain on intercourse
PMH - nothing significant
Family - clear
SADMA - clear

I told her that we need to stop the HRT asap. Told her about the possible side effects
and risks for long term HRT. Scared her a little. Promised to liaise with a gynae
specialist immediately because I’m just a junior doctor.
Investigations - blood for FBC, glucose, LFTs, TFTs, RFTs
- ESR, CRP
- Tumour markers
- Clotting screen (I don’t think these were necessary)
- Pelvic ultrasound
- Cervical smear
- Mammography

Management: - referral
- frequent follow-up
- stopping the HRT
- screening investigations
- reading materials, red flags, education, lifestyle

I tried to justify briefly the importance of each step of my presented management.

PILOT – 2 (most likely) – Pregnancy PE

Task: Pregnancy PE to a student. Mention equipment prior.

Equipment: - sthetoscope
- BP cuff
- Timer
- Hammer
- Speculum
- Wipes
- Fundoscope
- Measuring tape
- Source of light
- Lubricant jelly
- Gloves
Started as always - introduction -> patient’s vitals (I was detailed about it, especially
about the blood pressure check because it’s a pregnancy examination) -> patient’s
notes and presenting complaint -> WIPE.
Then I was ready for the specific elements of examination. I followed exactly what is
written in popular study files. Nothing fancy. First general appearance -> hand -> face ->
abdomen and all 4 Leopold manoeuvres, FHR, fundal height -> pelvic inspection and
speculum.

Finish with CTG and ultrasound.

Obviously I forgot to mention bladder emptying prior to the examination. I always forget
this.

20th April 21: Another feedback

Gen advice:
Try to remember the ddx according to the symptoms.

Then the questions you need to ask to rule out the ddx (memorize them)

Roleplay and roleplay by putting on timer for 7 minutes.

Practice with partners and give honest feedback to each other so that
you all can grow and learn from your own mistakes.

Obviously give mock tests, it is even more helpful as you will get long
stems. So, it will reduce recall bias and will make you think and do brain storming.

Practice PE every day when you book for the exam both explaining to
med student and patients.

If you are going for the online one, then try to keep yourself calm and do
not think about the previous case performance while waiting for the next one (this has
affected my performance so badly then I failed simple case like thyroid exam and
placenta previa)

While doing mx, counselling, breaking bad news and explanation of PE

cases please check patient understanding multiple times.

Wish you guys all the best.

1.Middle aged female coming to your GP practice with blocked and runny nose for the
last 6 months.

Tasks: History
PEFE on card
Most likely diagnosis with reasons
Explain the mechanism for her condition

I started by introducing myself and them asked how May I adress her
I told her that it must be distressing for her to have blocked and runny nose for six
months, so please tell me more about it so that I can help you in a better way. Asked
about the presenting complaint is it continuous or on and off? Did it start suddenly or
gradually? Is there anything that make it better or worse?
Associated symptom : fever, cough, sob, noisy breathing
Ddx: URTI : any recent history of having flu like illness
Rhinosinusitis : any redness or pain over cheek, any headache
Allergic rhinitis: any itchiness and watery eyes? Snezzing?
Nasal polyp
Asthma : any chest tightness and noisy breathing
Travel history, family history, contact history, medication histoey, SAD
Positive points : symptoms started about 6 months ago, are on and off, discharge is
clear, she sneezes a lot, sometimes experiences watery eyes. Worse in the springtime.
No bleeding, fevers, no travel, no sick contacts. No cough, no carpets,dust or mites.
She has a cat, symtoms get worse with cat around, cold weather & spring, dust, pollen.
No sob, wheeze
positive Family h/o: mother had asthma & brother had hay fever.

PEFE on card : clear watery discharge in nose

I explained her the condition allergic rhinitis, it is a condition in which inner lining of
nasal cell gets overly sensitive in response of some trigger factors like cold weather,
dust pollen, cat hair.. Mentioned about positive family.ruled out other ddx
Then started explaining mechanism in simple term by saying that due to presence of
certain trigger factors her nasal airway gets swollen and inflammed and become
hypersensitive and runny secretion from nose happens. But it is a managable condtion.

5-year-old child came with sob in the ED, history of sore throat 3 weeks back,

Task: first explain CVS PE to the medical student (PEFE card findings was given after 6
min)

dx with reasons

It was a new case for me.

I introduced myself to the student and asked his name, then started describing physical
examination.

Firstly, I mention about making the child vitally stable by following DRABCD protocol.
proper introduction and explanation of examination to the parent and ask for consent,
WIPE approach, and keep the patient in 45-degree angle of bed position,

Gen app: check for pallor, cyanosis, sign of resp distress nasal flaring, subcostal and
intercostal recession, oxygen mask.

Then start inspection:

hand: for peripheral cyanosis, splinter hemorrhage, pulse, radio radial delay and radio
femoral delay for coarctation of aorta, then blood pressure with proper size Pedi cuff.

Eye: pallor, jaundice

Mouth: central cyanosis

Neck: carotid pulse in bet larynx and anterior border of sternocleidomastoid

JVP: turn patient’s head slightly to left then check in between the two head of
sternocleidomastoid. (was not sure whether it is checked or not in the kids but I
mentioned)

Heart examination:
inspection
any pectus carinatum or excavatum
visible pulsation
Palpation

apex beat (5th intercostal space mid clavicular line 1 cm medial and below the nipple)
heave: left sternal edge with the help of heel of the hand
thrills are palpable murmurs: check with the palm of the hand.

Auscultation with bell and diaphragm on apex by keep one thumb to the carotid pulse
tricuspid area (5h intercostal space left sternal edge)
pulmonary area (2nd intercostal space left sternal edge)
aortic area (2nd intercostal space right sternal edge)
axilla (radiation of systolic murmur of MR)

Before I could talk about checking the base of lungs for crepts and pedal and sacral
oedema I got the prompt at 6 min (but still finish them while checking the card)

PEFE card finding was given after 6 mins: no splinter hemorrhage, ejection systolic
murmur in left sternal edge, mid diastolic murmur, gallop rhythm was also there.
Crepts++, CXR film showed cardiomegaly.

Explained dx as VSD (ejection systolic murmur) with MS (mid diastolic murmur) along
with heart failure because of presence of gallop rhythm and crepts in lungs.(Just
explained what positive findings I got in the PEFE)

Told about other causes of murmur AS, AR, MR, Infective endocarditis
3.A middle aged man comes to your GP practice worried about a neck lump. He is
scared as he got positive family history of thyroid diseases.
Task - explain to a med student steps of physical examination. Mention all the
equipment you are going to use.

This is one of the case which I prepared very well, still failed this one( that’s what stress
and anxiety could do and affect performance so badly)
Please check the passed feedback

4.Middle aged lady comes to your GP clinic to get her biopsy report. She is a farmer
from central Queensland and had a mole excised from her forehead. The biopsy report
is given in the stem. It shows superficial spreading melanoma, clarke stage 2, breslow
0.25, no lymph node involved

Task: - Explain the results

- Present management
Greeted the patient, ask about having pain at the bandage site and offered pain killer.
I started explaining her that she is having superficial spreading melanoma, which
happens due to the abnormal growth of the pigmented cell of the skin.
I waited for some seconds to see her response after breaking the bad news, but she did
not look concern at all, but still i asked her whether she wants to continue the
consultation today and did she want me to call anybody for her.
I showed her empathy and ensured her by saying that as we have already diagnosed it
in this stage so we can do a lot of things to manage it effectively.
After that I started explaining melanoma with 5c approach
Explained clarke stage by saying that the cancer cells are still remaining in the
superficial layer of the skin which has got good outcome. And also the breslow depth is
0.25 mm means that the cancer cells has not spread into very deep of the skin, and
there is no lymph node involvement again these all are good sign.
From now on her condition will me managed by a MDT which consist of skin specialist
surgeon, cancer specialist, me as your gp, psychologist. Specialist will reexcise the
lesion with keeping clear margin of 1 cm and arrange ix like chest xray, ct scan of chest,
ct head, ct abdomen, bone scan to check for any metastasis to any part of the body.
Mentioned about regular follow up to check the metastasis and relapse chance.
Sun protection by putting sunscreen 30 mins before going outside and keep on
reapplying after 2 hourly, long sleeves cloths, wide brimmed hat, wear sunglasses, try to
avoid sun exposure at peak hours.

5. A young man who was brought in by his partner because of sudden sob he
occasionally smokes weed, studying in the uni. His parents got seperated when he was
8. Vitals were stable

Tasks: History

Most likely diagnosis with reasons

Was a very long stem, had to scan quickly through the stem

I started by greeting the patient and is he having any pain or discomfort or SOB at the
moment? Said no

Cont or on and off?

Started suddenly or gradually?

Anything make it better or worse?

Any fever, cough, funny racing of heart?

Any chest pain, sweating?

Recent change in weather preference?

Asked him exactly what he was doing before the sob started?( Watching a movie with
his partner

After listening to that I thought of the PTSD recall

Asked him about any specific scene that made you short of breath? He said doc it was a
comedy movie
Then asked him was it for the first time ? he sid he had prev episodes before

Asked about the prev episodes he told me that all the episodes happened suddenly and
he has a fear that those episodes may happen again

Asked about psycosocial hx and HEADSS

I said he is having a condion which is called panic disorder as he is having this sob
episode before and has the intense fear of having it again and mentioned rest organic
causes of sob, thyroid disturbance as ddx.

34 week pg lady came to the hospital with vaginal bleeding. But vitals are stable now ,
got prev hx of c sec and blood group is o negative and mentioned ultrasound report
written that FHR was 140b/min,placenta is covering the os completely.so it was clearly
grade four placenta praevia,

Tasks: - Explain the ultrasound

- investigations
- management

it was my first station. I thought I did this case good

i explained the usg finding. Ix: basic blood, blood grouping and USG were already
done.so talked about doing coomb test, CTG
Mentioned about giving Anti D
MX: admission in the hospital, specialist visit, cont monitoring of vitals, CTG. If all goes
well then arrange c sec by 37 weeks.offer social worker for the kid at home.

but unfortunately failed this one.please check the passed feedback.

6 years old boy had recurring abdominal pain for the last few months.his mom comes to
your GP practice to find out the cause.

Tasks: History
PEFE on card
Diagnosis with reasons
History: greeted them and adked if the child is having any pain at the moment?
Asked for vital stability
Then asked all the pain ques: cont of on and off, sudden or gradual, first time or
not, how many times? Anything that make the pain better or worse
How does it feel like? Exactly which part of tummy? Any radiaton of pain to
anywhere else?
(only positive point was the baby becomes pale when the pain happend)

Associated features fever, vomiting, bowel motion, change in weather

preference
Any association of pain with food like chocolate or cheese
BINDS, contact hx - normal
Diet normal, pmhx normal
Asked about stress at school, any school performance change, any history of
bullying, complain from teachers
Then ssspecifically asked about stress at home
Mom said that grand mom of the child is living with them and she is on treatment
for colon cancer. The child is very attached to her.
Then asked about variation of pain while weekdays or weekends.

PEFE on card - everything normal

As the patient gets pale when had pain so i thought the dx as abdominal migraine
initially, but when I got the attachemnt with grand ma and cancer history then i totally
forgot about that pale thing and dxed it as non specific abdominal pain and explained
that as he is close to his grand ma, so to see her going through the pain and tx is
causing lot of stress in the chlid’s mind and as a expression of that his body is causing
physical symptom like the recurrent tummy pain. And the exam was normal, then ruled
out other ddx.
I thought I lost this case as i dxed it as non specific abdominal pain instead of abdominal
migraine. But i passed this one.

You are a HMO in Ed when 22 years old girl came with complains of having funny turn
this morning. Now she Is fine and vitally stable.
Tasks -History (6 minutes)
-PEFE card
-Dx and Ddx with reasons
Please follow the marwan case for this one

Young man presented to your practice with a rash on thighs and buttocks. The rash
was non-blanching non palpable which was clearly mentioned in the stem. He had URTI
3 weeks ago, from which he has recovered.
Picture was given, it was a clear cut ITP from the stem

Task - describe the rash

- PE to a medical student

Greeted the student and started by first introducing ourselves to the pt, ensuring vital
stability and then explaining the patient the whole exam process and ask for consent
then WIPE approach. After that talked about checking gen appearance : cachetic,
anemia, jaundice, any visible distress.
Then started explaing the rash first on inspection : i could appreciated purpuric rash in
the both lower legs, could not appreciate any other bruises, bleeding, oozing, discharge,
scratch marks, now on palpation of rash we have to wear gloves and check for
tenderness, temp, palpable or not, blanchable or not by pressing by a glass on it.
Then started to do hematological exam
on hand pallor, koilonychia, cyanosis, scratch mark for lymphoma or iv drug marks for
on forearm. Pulse , blood pressure.
Epitroclear lymph node by flexing the elbow at 90 degree and palpating proxmial to the
med epicondyle, then all the cervical submental, sub mandibular, pre auricular, post
auricular. Ant cervical, post cervical. Sub occipital lympth node, axillary lympth nodes
ant, post, apical, medial, lateral. Then para aortic, inguinal and poplitial lymph nodes.
Always asked for student’s understanding in bet couple of times.
On head: anemia and jaundice in the eye
Mouth for ulcer, dental hygiene, then check enlarge tonsil for EBV infection
Neck stifffness for meningococcemia by bringing chin to the chest.
On chest bruises, bone tenderness for leukemia
On abdomen for hepato and spleenomegaly
End by doing DRE with patient’s consent and presence of a chaperone.
Again ended by saying ddx for non blanchable rash.

Middle aged man coming with an acute throbbing left knee pain. He is taking
hydrochloorothiazide for the last 6 weeks for hypertension. Drinks 4 SD a day. No
history of trauma. PEFE was given on the stem - no fever, vitals normal, erythemateous
diffuse swelling in one knee.

Tasks; - explain the most likely diagnosis

- order investigations
- Immediate management
It was a clear case of gout. As usual first greeted the patient and then asked for pain
and offered painkiller.
Followed 5c approach for explaining gout

Investigations mentioned fbc, crp, serum urea, serum UCE, Serum uric acid, LFTs, TFT
Refer the patient to specialist for knee ultrasound, Knee fluid aspiration and culture
sensitivity
Management :Start him on good painkiller which is called endomethacin
Send him to specialist so that he can stop hydrochlorothiazide and start him on other
safe antihypertensive. Checked patient understanding.
And when the acute stage will be gone then specialist might start him on Allopurinol
which will prevent frequent attacks.
Mentioned about safe limit of alcohol consumption and restricted red meat and red wine
consumption. And then ended by talking about SNAP.

Young man coming to your GP practice for a thumb cut dressing. He got the cut as he
lost concentration for a few seconds in the workplace. And the stem shows that he’s
been having problems with binge drinking lately. He was trying to quit drinking but with
no success.this is his second consultation with you regarding alcohol

Tasks: - History
counseling

after greeting and ensuring confidentiality and offering painkiller he said he has cut
down taking alcohol after his last visit but not within the safe level, he was living alone, I
asked for any withdrawal symptoms, asked for side effects of prolong alcohol drinking,
asked motivation – 6/10, HEADSS, any issues with law and driving charges.

Arranged inv (LFT, S/amylase, Lipase, BSL, Vit B12, basic bloods, BAL), counsel, what
are your thoughts/ What is your plan? Would u be interested in complete abstinence?

Support group. Appreciated him for trying his best. Also told him that after getting any
blood report abnormality will refer to specialist & rehab center.

please check passed feedback.

6 month old baby brought in by mom with diarrhoea and vomiting for the last 24 hours.
Tasks: - History
- PEFE on card
- Diagnosis and ddx
- Management
Positive points: exclusively breastfed. Wt – 8.1 last week, current weight – 7.3 kgs.
Afebrile, immunized up to date. Brother has h/o similar event last week. Mildly
dehydrated.

Pefe card: greenish stool.

fDx: I diagnosed it as viral gastroenteritis, less likely to be bacterial as temp is Normal.

Offer admission as the baby is only six months old.

Please check passed feedback.

23 yr old lady was brought in by her parents because of behavioural change. She was
diagnosed with schizophreniform disorder over one year ago and started on medication.

Tasks: - History
- Diagnosis with reasons
I started by greeting and ensuring confidentiality to the patient
Started asking about the HOPI of the behavioral change. Then asked for any fever,
change in weather preference, any head injury, is this change happened for the first
time?
Then started to ask about past episode : so I found out that she was on
antipsychotic Med for schizophreniform 18 months back, was hospitalised.
Stopped Med by the advice of specialist. Now again having auditory hallucination

Then asked full psycosocial hx, HEADSS, SADMA

My diagnosis was Relapse of schizophreniform disorder.then gave rest of ddx along
with organic causes.

Elderly lady presented to ED with acute chest pain and breathing difficulty
Tasks: - History
- PEFE on card
- Diagnosis with reasons

Greeted the patient.she was acting really well. Check pain scale and offer pain killer,
talked about vitals then HOPI and SORTSARA of pain questions I asked, ruled out ddx
like MI,PE,pneumonia,angina,COPD then PMHX and SADMA

On PEFE: Vitals unstable, O2 low with mask, left lung hyper resonant, air entry
decreased, ECG normal.
Explained pneumothorax in simple term and talk about the ddx

Obstetric exam: student want to know how you did obstetric exam on 36 weeks
pg lady along with all the equipment.

Mentioned about measuring tape, watch, stethoscope, speculum, lubricant

Greeted the student and start explaining steps of exam

First introduction, asked for consent by explaining the exam in simple term and let her
know about the presence of a chaperone. Then asked her to empty the bladder and
gave her sheet to cover herself and lie down and whenever she wase ready to call me
in.

Then first started by doing WIPE and gen app for visible distress, pallor, jaundice,
oedema. And checked all the vitals.

In lying position first exposed from xiphi sternum to pubic tubercle

On inspection: striae, linia nigra, visible fetal movement, previous scar, stretch in
abdomen whether it is longitudinal or transverse.

On palpation: check for tenderness. Then fundal height from xiphi sternum by using
ulnar border of left hand, checked the length from upper pole of uterus to pubic
symphysis, and for avoiding bias I kept inch side in front of mine.

Then lie and presentation and FHR

Pelvic exam, UDP

56 year old lady comes to your practice for HRT prescription renewal. On exam: BMI 29
and bp was 140/80 mmhg

Tasks: - History
- Investigations
- Management

I greeted her, she said me to make it quick by giving her script of HRT
Then I told her that i need to ask some ques so that I can help her properly
Asked about how long she has been on HRT and for what symptoms and has the
symptoms are gone now. After that i asked for all the possible side effects and 5P,
SADMA, pmhx. Family hx questions

Positive points :she has been taking for 6 years, no side effects, she was not up to date
with mammography and pap smear

I told her that we need to stop the HRT as it has been 6 years and we normally stop it
after 5 years because of possible side effcts. Talked about all the side effects. And told
her that we will stop it gradually by refering her to a specialist arranged following ix
FBC, serum UCE, LFTs, TFTs, RFTs, BSL, ESR, CRP, VIT D level, DEXA, Pelvic
ultrasound
I forgot to mention about this two important tests Cervical smear, Mammography
I told her that i will do regular follow up and if she again develops menopausal
symptoms then specialist can give other meds to control them and then ended by
talking about SNAP

20th April 21 – Another feedback

Case 1: Placenta previa
Explain U/S, further Ix, Mx
Case 2: Funny turn
Hx, PEFE on card, DDx
Case 3: Vomiting & diarrhea
6-month-old baby with persistent diarrhoea for 24 hours and vomiting 3 times with
greenish stool.
Task: Hx, pefe on card, most likely dx give reasons.
Case 4: ITP
Skin rash picture, all positive findings were for ITP given, explain rash, tell about further
relevant exam with landmark, give most likely dx
Case 5: Thyroid examination
Pt coming with a lump in throat, scared because of family history of thyroid diseases.
Tell relevant findings to student, what equipment you will use.
Case 6: Obstetric exam.
Student wants to know how you did obstetric exam on 36 weeks pg lady with
equipment.
Case 7: Paedi CVS exam
First explain to the student, then in the pefe card findings: ejection systolic murmur in
sternal edge, mid diaslotic murmur, gallop rhythm was also there
Case 8: SOB
Young male coming with sob, chest tightness after watching comedy movie, mom dad
divorced when he was 8 years old, couple of episodes of sob before as well.
Task: Hx, explain dx
Case 9: Blocked & runny nose
Female with blocked and runny nose for 6 months.
Task: Hx, explain the most likely dx and tell the mechanism of the condition
Case 10. Change in behaviour
22-year-old lady brought by the parent because of change of behaviour. Was on
antipsychotic Med for schizophreniform 18 months back. Stopped Med by the advice of
specialist. Now having auditory hallucination.
Task: Hx, give Dx, DDx and reasons
Case 11: BCC counselling
Task: explain report, tell mx
Case 12: Chest pain & breathing difficulty
67-year-old lady coming with chest pain and breathing difficulty.
Task: Hx, PEFE card showed unilateral air entry restriction with unilateral hyper
resonant lung on percussion, explain dx and reasons
Case 13: Recurrent abdominal pain
6-year-old boy coming with recurrent tummy pain for last couple of months. Turn pale
with pain, grand mom is living with them and she is on treatment for colon cancer.
Task: Hx, PEFE on card, dx and explain reasons
Case 14: HRT for 6 years
Task: Hx in 3 mins, order ix, mx
Case 15: Knee pain
Pt coming with throbbing knee pain, on hydrochlorothiazide for last 6 weeks on HTN, 4
drinks per day. Pefe showed no fever, slight erythematous diffuse swelling in knee.
Explain the dx, order ix, immediate mx

21st April 21
Tips from Candidate
I have been fortunate enough to pass the clinical exam organized on 21/04/2021.
Just a few information regarding the exam. First one hour is ID check and room check. It
takes approximately 5 minutes per candidate and others wait their turn quietly just
looking at the screen.

Exam started at around 10 to 10:10 am. The invigilators introduce themselves and then
turn their cameras off. They are very friendly. Examiners can’t be seen. Their cameras
are always off. We can’t ask any questions to either examiner or invigilator. Tasks are
very clear, mentioning what you need to do and what you don’t need to do (for example-
management is not a task in this station).

Regarding toilet breaks, rest stations can be used and invigilators will clearly say that if
we like to use the toilet we can go and ID checks will be done when we return. Lunch
break was around 45 minutes, where we could quickly go to grab a quick cup of tea or
coffee. But it shouldn’t be more than 5-10 minutes, because I remember those who
came after 20 minutes were asked why they were late. We had to eat lunch in front of
the screen, but could walk around the room or stretch in front of the camera.

Role players were mixed varieties, some were friendly whereas others were a bit
grumpy, but it’s safe not to go on their looks. Just listen to the answers and decide the
cases. Names were not given in any of the stations, So I asked all the role player how
could I address them.

It was a very lengthy exam and it’s very important to keep patience and confidence
throughout the exam. We got exactly 8 minutes for the whole station because ID check
was done before the questions were shown. It is not like the face to face exam where
the id check is included in 8 minutes. In this exam the ID check is done, then the
question appears for 2 minutes, and then we get 8 minutes for the role play.
During the ID check, the invigilator will say if you will have a prompt time or not. The
physical examinations had no prompt time, so the invigilator said: IN THIS STATION
THERE WILL BE NO PROMPT TIME. In those stations where there is prompt time, the
invigilator will say that IN THIS STATION YOU WILL HAVE A PROMPT TIME AFTER 5
MINTUES/ 6 MINUTES.

STATION 1- Pilot – Rash examination

Rash examination- It was a picture of a few months old child with 4-5 maculopapular
rash on the left cheek. In the question the child was drowsy, vitals were stable except
temperature was around 40 degrees.
Task was to 1) describe the rash to the examiner. 2) explain the other relevant
examinations that you will do and the reason why you will do the examination.
The picture was something like this.

In this station, the camera of the examiner, invigilator and role player was switched off. I
was basically talking to myself.
I described the rash as maculopapular rash on the left cheek, 4-5 in number, size
cannot be estimated, no redness, swelling or discharge, no entry point of the rash. I said
that I would palpate the rash for raised temperature, tenderness cannot be elicited as
the child is drowsy, I would check if the rash is blanchable using a glass slide and check
if it is palpable or not.
Regarding other relevant examination,
I said all the haematological examination.
Check the eyes for palor, jaundice.
Check the Ear, nose and especially throat to rule out enlarged tonsils and pharyngeal
erythema for EBV infection,
check neck stiffness for meningococcaemia,
check the 5 group of LN (cervical, axillary, epitrochlear, para-aortic, inguinal) and
scratch marks on skin to rule out lymphoma,
check the arms and legs for petechiae, purpura, ecchymosis to rule out bleeding
disorders.
Check for bleeding in other sites like epistaxis, gum bleeding, per rectal bleeding to rule
out leukemia, and the child already has fever.
Cannot check bony tenderness as the child is drowsy.

I’m lucky this was a pilot station as I didn’t practice any paediatric PE separately due to
shortage of time for preparation.

STATION 2- Pilot – Shoulder problem

Anterior Shoulder dislocation.
I have never read this case before. The question was very short. A young lady in 20s
came with shoulder problem. Task was 1) History 2) Describe the course of disease to
the patient.
It was said that management is not a task. No x-ray was provided.

I had no clue about the case in the 2 minutes thinking time. I thought maybe rotator cuff
injury, but no it was not the case.
In History I asked about her concern? (the role player said that her shoulder keeps
falling off). Asked her if it was first time (NO), Asked her anything particularly happened
before this? (She said she can’t use her arm much to do anything), Asked her when it
happened first? (She said that she was a footy player in school and was pushed down
by her opponent and that’s when she got it first).
I asked Pain questions, Associated questions like tingling numbness, restriction of arm
movement, repetitive hand usage, occupation (student), neck pain or restricted neck
movements, SADMA, Any medications like painkillers, PMH, PSH. There were no
positive findings to any of the questions.

Regarding course of the disease I had no idea, so I said it is not a curable condition but
a manageable condition. It can be managed by RICE therapy followed by physiotherapy
after the pain subsides. The physiotherapist will teach techniques how to use the arm
safely to prevent further dislocation of the arm.
I gave her red flags like further dislocation of her shoulder, tingling numbness of her arm
or restriction of neck or arm movements to come immediately.
STATION 4 – Advanced age pregnancy
PREDOMINANT ASSESSMENT AREA - HISTORY TAKING
Scenario: Antenatal care Grade: Pass
GLOBAL SCORE- 4
Assessment Domain
Approach to patient/relative-5
History-4
Patient Counselling/ Education-4

This is the same case from Marwan (Case-96)

42 years old woman comes to your GP clinic after her Home pregnancy test appears
positive
tasks
-history
-PE will be provided at the end of 5 minutes. (The invigilator will say that there will be
a prompt time at the end of 5 minutes)
-counsel the patient

I followed the same approach as Marwan but it was very difficult to complete the
counselling in 3 minutes. I couldn’t mention about high-risk pregnancy clinic, but I said
about confirming the pregnancy in the clinic, the Down’s syndrome screening and if the
screening test was positive to do confirmatory tests like CVS or amniocentesis. I ran out
of time.

So I would advise the candidates to concise the counselling of this case in 3 minutes
and not try and say everything that’s in Marwan because its not possible to finish the
case in less than 3 minutes. At the end of 5 minutes the invigilator will say prompt time
and show the PE card. In the card everything was normal, only BMI- 35.
So in counselling I mentioned that the body mass index, which is an indicator of weight,
is higher than normal, and there’s nothing to worry about that. I will refer her to a
dietician.

STATION 5 – Asthma

PREDOMINANT ASSESSMENT AREA -

MANAGEMENT/COUNSELLING/EDUCATION
Scenario: Cough Grade: Pass
GLOBAL SCORE- 4
Assessment Domain
Approach to patient/relative-5
History-4
Diagnosis/ Differential diagnoses-4
Patient Counselling/ Education-4

A middle-aged lady, known case of asthma since childhood, had recurrent cough and
sometimes shortness of breath. She used inhalers, both salbutamol and steroid
inhalers. She is compliant with her medications and the asthma educator checked her
inhaler technique and found it to be correct. She is troubled by her symptoms and
comes to you. Vitals are stable.
Task: 1) History 2) Management (It was 4 minutes history and 4 minutes Mx)

In history, I asked cough questions, sob questions, associated questions like fever,
chest pain, racing of the heart, recurrent flu like illness, confirmed with her about her
medication compliance, asked travel history, occupation (teacher), pets and carpets,
contact history, Sadma. She mentioned about smoking 10-15 cigarettes a day for many
years.

In management, I talked about what is asthma and the trigger factors. In her case it
was smoking. I told her if she gave me the permission, I would arrange another
consultation to help her stop smoking and hence help her to prevent her exacerbations.
I told her that I will refer her to the chest specialist. The specialist might decide to give
her some oral steroids if needed. And I will give her an asthma action plan. I briefly
described the asthma action plan including the 4x4x4 rule and what to do in case of an
asthma emergency. Reassured her and appreciated her for coming.

STATION 6 – Prostate cancer counselling

PREDOMINANT ASSESSMENT AREA -

MANAGEMENT/COUNSELLING/EDUCATION
Scenario: Urinary frequency Grade: Pass

GLOBAL SCORE- 4
Assessment Domain
Approach to patient/relative 5
Interpretation of investigation 5
Patient Counselling/ Education 4

This is one of the most common cases of prostrate cancer counselling. (Case-131
Marwan).
It is exactly the same case with tasks: 1) Explain results 2) its implications 3) Discuss
treatment options and counselling.

After ID check the invigilator will say that there is no prompt time in this station.

This case is easy to pass. It requires mainly empathy and reassurance to the patient.

STATION 7 – Chest pain

PREDOMINANT ASSESSMENT AREA -

MANAGEMENT/COUNSELLING/EDUCATION
Scenario: OL Chest discomfort Grade: Pass

GLOBAL SCORE- 5
Assessment Domain
Approach to patient/relative-5
Interpretation of investigation-4
Diagnosis/ Differential diagnoses-6
Management plan-5

A middle aged man comes to the ED with chest pain and SOB, known case of
hypertension. Monitor is attached and ECG is done. Vitals were given. Blood pressure
was a bit high, maybe – 160/95 mm Hg, SpO2 was maintained 93% on 6L oxygen.
Others were normal. Ecg was given.

Its similar to the ecg given below. Patient was in a RURAL hospital.

Task: 1) Explain the ECG to the medical student in 3 minutes

2) Tell her about the initial management that you will give the patient.

(Just an advise. Please don’t use the term ECG or MI. please say in full, such as,
Electrocardiogram or myocardial infarction. I was interrupted by the medical student for
saying ECG)
I explained by drawing a picture of a normal ECG wave. I said that the
electrocardiogram is the representation of the electrical activity of the heart. Here we
see the rate, rhythm and some waves called p wave, qrs complex, t wave. I said that the
rate was 75 beats/minute, rhythm was regular, showed the paper and told her which
was p wave, qrs complex and t wave. I said that normally these waves touch an
imaginary line called the baseline, but in this electrocardiogram, there is ST elevation in
leads V1, V2, V3, V4, meaning the wave is above the baseline. Checked her
understanding and asked her if she wanted me to explain or repeat anything, and she
said no.

Then told her that this is the electrocardiogram of Anterior Myocardial infarction as there
is ST elevation in leads V1-V4.

In initial management, I talked about MONA therapy, continuously monitoring vital signs
of the patient, reassuring the patient repeatedly, calling the specialist and doing the
blood tests especially the cardiac markers. I also said that the specialist will review the
blood pressure medications and adjust the dose if needed.

I had time so I talked about the inability to do angiogram and PCI in rural hospital
settings, so the specialist might decide to do a procedure called thrombolysis using
medications like Alteplase, Duteplase.

STATION 9 – Paediatric Neurology PE

PREDOMINANT ASSESSMENT AREA - EXAMINATION

Scenario: Headache Grade: Fail
Assessment Domain

GLOBAL SCORE- 2
Approach to patient/relative-7
Choice & Technique of examination, organisation and sequence-2
Explanation of procedure-3

Another paediatric PE case. Here the child had headache for six months and the
headache got worse, especially in the morning along with vomiting. Vital signs were
given and I think they were normal.
Task was to explain the neurological PE to mom. I failed this station as I didn’t practice
paediatric PE.

In my approach, I reassured the mom, took her consent to examine the child, told her
that I will be explaining everything I do to her child as I examine, and I will make sure
that the child is comfortable, mentioned hand washing and started the examination. My
approach was good so I got 7.

But in the PE, I started with general appearance, inspection and palpation of the face for
signs of trauma, neck movements and neck stiffness for meningitis, palpate temporal
artery for temporal arteritis, palpate sinuses for sinusitis, and then I went to the cranial
nerve examination and Described the II, III, IV, VI cranial nerve examinations namely,
visual acuity, visual field, light reflex, accommodation reflex, eye movement and
fundoscopy. I told her that I will check for changes behind the eye in fundoscopy, the
cup disc ratio, irregularity and swelling of the optic disc for signs of papilledema which is
found in case of brain tumour, haemorrhage, head injury…..

And my time was up.

Please check passed feedback for this station.

STATION 10 – Behavioural disturbance

PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION

Scenario: Behavioural Disturbance Grade: Pass

GLOBAL SCORE- 4
Assessment Domain
Approach to patient/relative-2
History-4
Diagnosis/ Differential diagnoses-4

This is the same case as Marwan 224. I have copied this from Marwan and pasted
below with some changes as per the exam.

Middle age man brought in by police to ED wandering in the street and got laceration in
the foot which has healed. The wound is ok. He also claimed that he needs to save the
world. He has a history of schizophrenia and has not been taking medications for
6 months.
Task
-History for 6 minutes
-Present the risk to this to the patient with reason.
The role player was a man with dishevelled hair and looked distracted. 
1- I started by maintaining confidentiality, asked if he had pain in his foot,
appreciated him for coming, asked him why does he think that the police have
brought him here, assured him that I will take only a short time for the
consultation and help him as best as I can. (don’t know why I got 2 in approach even
after so much rapport and reassurance)

2- Psych hx
Mood:
-how’s your mood? How do you feel? (he told he felt wonderful as God was telling him
to save the world.)
Hallucination:
-Can you tell me about God, has God told you how to save the world? ( yes )
-Any command of harming yourself or people? (Oh no never)
-do you hear other voices? (no)
-do you see God? (no)
Delusion
-do you think someone is following you or spying on you?
-do you think someone is trying to harm you? (people are jealous of me)
-do you believe that you have a special power? (Yes)
-do you think thought are inserted in your mind? Withdrawn from your mind?
-do you think your thoughts are broadcasting through TV or radios?

Rest of mood questions:

-have you ever thought of harming yourself or others? (No)
-Any plan or attempt? (No)
-Sleep, appetite (normal) 
Cognition
-where are you right now? (normal)
-what time is it?
Insight: do you think you need a professional help? (No)
Judgement: let us suppose there is fire in this room, what would you do? (was normal)
Organic causes: Any change in weather preferences? Head injury? Fever?
Asked other DD questions like anhedonia, GAD, PTSD, OCD questions.

3-HEADS
-where do you live with? With whom? (Lives on the street, no family or financial support)
- Any support?
-SADMA (doesn’t smoke but takes marijuana occasionally, recently increased, no other
illicit drugs or needle sharing.)

4-Schizophrenia hx
-since when? (he was diagnosed with schizophrenia few years back)
-do you take your medication? (No)
why you stopped taking the medication? (because he didn’t have money)
5-General
-previous and family hx history of mental problems/ PMH/ PSH/ medications.

Explain the risk to patient with reason

Thank you for sharing everything with me. I am concerned about you because you are
at a moderate to high risk of being harmful to yourself and others. I’m saying this
because you hear voices of God. This is called auditory hallucination, you think you
have special powers called as delusion of grandiosity, you are not compliant to your
medications and have not taken them for the last 6 months, you also take recreational
drugs like marijuana, you have no family and financial support and live on the streets,
you have injured your foot previously.

-So according to Mental Health Act, I need to admit you to the hospital so that you'll be
assessed by the team of psychiatrists who are specialists of mental health. Are you
okay with this? he said okay.
STATION 11 – Abdominal pain

PREDOMINANT ASSESSMENT AREA - HISTORY TAKING

Scenario: Abdominal pain Grade: Pass
Assessment Domain

GLOBAL SCORE- 4
Approach to patient/relative-4
History-5
Diagnosis/ Differential diagnoses-3

A middle aged lady presented to the Ed with abdominal pain since last night. The nurse
has already given her painkillers and her pain has improved. Vitals are stable.
Task: 1) History for 6 minutes 2) At the end of 6 minutes, PE findings will appear on
screen, explain the diagnosis and DDs.
It was clearly mentioned that management was not a task.

In History I asked pain scale, offered to give her painkillers if her pain increased. Asked
SORTSARA for pain. She told me that her pain was in epigastric region radiating to the
back. It was for the first time, no aggravating and relieving factors. She had curry last
night and the pain started after that. That’s all the positive findings I could get. All other
findings were negative.

She had no jaundice; no bloating, belching, bitter taste in mouth; no relation to leaning
forward or lying down; no LOW,LOA; no chest pain, cough or SOB; no fever, nausea,
vomiting. Her bowel bladder habits were normal. She didn’t have any trauma to her
tummy. Didn’t take any over the counter painkillers or steroids, no regular medications.
No co-morbidities like DM, HTN, no H/O of gall stones, PUD. No procedures done
before like Endoscopy or ERCP. No family history of bowel/ stomach problems or
cancer. She didn’t smoke, drank one or two glasses of wine occasionally. No history of
binge drinking the previous night.

I had 6 minutes for history and I tried to rule out all upper GI causes of pain but reached
no conclusion. Since the pain was first time, acute and only upper abdominal, I didn’t
ask any lower abdominal pain questions at all.
In PE card, all findings were normal and there was no abdominal tenderness, no
guarding rigidity, no special tests were done.

I told her that on examination, everything was normal. So I told my diagnosis as a

possible case of GERD. I told my DDs as PUD, gall stones, cholecystitis, cholangitis,
hepatitis, pancreatitis, Acute MI, Lower lobe pneumonia explaining to her why they were
unlikely.

I think my Diagnosis was wrong, so I got 3, but luckily passed in global score.

STATION 12 – Health Review

PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION

Scenario: Health review Grade: Pass
Assessment Domain

GLOBAL SCORE- 4

Approach to patient/relative-4
History-4
Diagnosis/ Differential diagnoses-3
Patient Counselling/ Education-4

A father of a 12 months old child came to you because the child had recurrent runny
nose and the father was distressed by this.
Task-1) History for 6 minutes 2) At the end of 6 minutes, PE findings will appear on
screen, explain the diagnosis and the reason for your diagnosis.
It was clearly mentioned that management was not a task.

In History, after giving reassurance, I asked about running nose, since when, how many
episodes (6-7 times), CCVO of the nasal discharge (it was clear, occasionally yellowish,
not smelly, from both nostrils, no blood present).
I asked about Any watering eyes, any sneezing, any ear infections, sore throat for
tonsillitis- All were negative. The child had no fever, cough, SOB or noisy breathing from
his chest. I also asked OSA questions-all negative, any problems with hearing or
speech, any change he could put any foreign body in the nose- All negative.
I asked if he had any recurrent flu like illness (he said yes the child gets flu very often),
any seasonal variations (no). Any pets and carpets at home? (no). Anyone smokes at
home? (no). no contact history. Child doesn’t go to child care. No history of Asthma,
allergy or hay fever, no history of hospitalization? No family history of allergy or asthma.
Child doesn’t take any regular medications like puffers. Vaccinations were up to date.
Growth development normal. Pee poo normal.

At the end of 6 minutes, In PE card, all findings were normal except nasal mucosa was
pale and congested and mouth breathing was present.
Growth chart, vitals and ear and throat examination were normal. Respiratory & CVS
were normal.

I told the positive and negative findings on PE card and told the diagnosis as Allergic
Rhinitis, explained what it was and told about the triggers. I told him that in his child’s
case I couldn’t identify any triggers. I told him that it could also be recurrent viral
infection and that it was normal for children of this age to have 6-12 infections in a year
as their immunity is not very well developed and they will grow out of it eventually as
they get older.

Don’t know why I got 3 in diagnosis.

STATION 14 - Tiredness

PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION

Scenario: Tiredness Grade: Pass
Assessment Domain

GLOBAL SCORE- 4

Approach to patient/relative-6
Interpretation of investigation-5
History-6
Diagnosis/ Differential diagnoses-4
This was the case of a young lady who presented to you with tiredness and occasional
SOB. Previously some investigations were ordered and she came for the results. FBC-
Hb- low, WBC- Normal, Platelet- Normal, MCV- low, MCHC- low, Blood film showed
anisocytosis and poikilocytosis.
Task- 1) Explain to her the results 2) take history and tell her the likely cause of her
condition.

I explained to her the results. Our body has 3 types of blood cells. The red blood cells
contain a pigment called haemoglobin which carries oxygen, in your case it is low. The
white blood cell count which fights infections is normal. The platelets which help in
clotting is normal. MCV is low which means that the size of the red blood cell is small.
MCHC is low which means that the concentration of haemoglobin in your red blood cell
is low. The blood film shows anisocytosis and poikilocytosis. This means that the red
blood cells are of different shapes and sizes.
Lack of blood in the body is called anaemia. To know more about the cause is it ok if I
ask some questions?

In history I started with a few tiredness and SOB questions very briefly. I asked about
duration (one month), continuous or on and off (present most of the time), first time, no
SOB at rest, only while exertion, SOB getting worse, No orthopnoea, no swelling of legs.

Then I asked about diet (dietary deficiency), blood in urine, melena, epistaxis, gum
bleeding (for chronic blood loss), any loose stool or mucus in stool (for malabsorption),
LOW. LOA (for malignancy), any tummy pain in relation to food, any excessive intake of
spicy, oily food (PUD), genetic origin (for thalassemia), SADMA (negative, drinks alcohol
occasionally), in medication history she took Ibuprofen for ankle pain for a few
years. No family history of cancer, no procedures like endoscopy or colonoscopy done,
No bleeding disorders- no rash anywhere in the body, no blood thinner medications.

I told her most likely it is iron deficiency anaemia, but we need to do the iron studies to
confirm our diagnosis. It could be due to dietary deficiency. I was so silly that I forgot to
mention the main cause as prolonged NSAID use but luckily passed the case. It
somehow slipped out of my mind at the last moment.

Though DD was not a task, I also said some DDs like Thalassemia, Anaemia of Chronic
blood loss, Bleeding disorders, Blood thinners.
STATION 15 – Shortness of breath

PREDOMINANT ASSESSMENT AREA - EXAMINATION

Scenario: Shortness of breath Grade: Pass
Assessment Domain

GLOBAL SCORE- 5

Approach to patient/relative-5
Choice & Technique of examination, organisation and sequence-5
Explanation of procedure-6

This was the Cardiovascular system examination. In the stem, a middle-aged man came
with SOB, orthopnoea and oedema. Explain the examination steps to the medical
student along with the instruments needed. It was clearly written that we could use
medical terms with the student.

The student asked me a lot of questions and I couldn’t finish the whole examination but I
passed with good marks.

I started by introducing myself to the student. He asked me “Doctor what examination

are we going to do today?”
I told him that we will do the Cardiovascular system examination of a patient who
presented to me with SOB, orthopnoea. We will introduce ourselves to the patient,
confirm his name and DOB, explain to him that we will examine his chest, listen to his
heart sounds and do other relevant examination like listen to his chest, feel for enlarged
liver in his tummy, and check for ankle swelling. We will seek his consent, wash our
hands, make sure the patient is comfortable and positioned at 45 degrees, and ask him
for proper exposure of his chest.

The we will check the general appearance of the patient for any signs of distress, any
cardiac monitor attached. We will check his vital signs like pulse, blood pressure,
temperature, RR and O2 saturation.
Here the student interrupted me by saying that how will we check all these doctor?

Then I explained to him that we check the pulse in his wrist where the radial artery is
present and we count it using a watch as the number of beats per minute, we check the
rate, rhythm, character, symmetry of the pulse and also radio radial delay by checking
the pulses of both the hands, and radio femoral delay by checking the radial pulse and
the femoral pulse in the groin to rule out Coarctation of the aorta.
We check the blood pressure using a sphygmomanometer and explained the procedure
of how to check blood pressure. We check temperature using a thermometer. We check
respiratory rate by counting the number of breaths per minute and Oxygen saturation
using a pulse oximeter.

I asked him if he was clear with my explanation and wanted me to repeat anything. He
sounded happy and said no.

I told him then we will examine the neck for carotid pulse and Jugular venous pressure.
We feel the carotid pulse just below the angle of the jaw anterior to the
sternocleidomastoid muscle and I showed him that on my neck. We measure Jugular
venous pressure when we see the pulsation of the Jugular vein and hold a scale vertical
from there and another scale horizontal from the sternal angle and measure the point
where they meet. Normal is 3-6 cm. if more than 6 cm it indicates raised Jugular venous
pressure.

Then we will inspect the chest for redness, deformity, subcostal muscle use, intercostal
muscle recession for signs of respiratory distress, check if there is any pacemaker
inserted, if yes, then check if there is redness, swelling and discharge at the site of the
pacemaker present or not.

On palpation, we will check the apex beat at left 5th IC space in mid clavicular line,
position of trachea, Left Parasternal heave with the ulnar border of our hand on the left
sternal margin, palpable P2 in the left 2nd IC space, palpable thrills in 4 areas. We will
auscultate the heart sounds in 4 areas as well. Mitral area in left 5th IC space in mid
clavicular line, tricuspid area in left 4th IC space, pulmonary area in left 2nd IC space and
aortic area in the right 2nd IC space. We will listen for the first and second heart sounds
and if there are any added sounds like murmur……

AND MY TIME WAS UP.. But luckily I passed.

The student was very happy in the end and He told me before leaving:- you have said
everything very clearly, thank u doctor.

STATION 16 – Dental complaint

PREDOMINANT ASSESSMENT AREA - HISTORY TAKING

Scenario: Dental Complaint Grade: Pass
Assessment Domain

GLOBAL SCORE- 5

Approach to patient/relative-5
History-5
Diagnosis/ Differential diagnoses-5

This is the same bulimia case with dental carries and callosities in the fingers.
Task was: 1) History for 6 minutes and 2) explain the diagnosis to the patient.
STATION 17 – Health Review

PREDOMINANT ASSESSMENT AREA -

MANAGEMENT/COUNSELLING/EDUCATION
Scenario: Health review Grade: Fail
Assessment Domain

GLOBAL SCORE- 3

Approach to patient/relative-3
History-2
Diagnosis/ Differential diagnoses-3
Management plan-3

This was the HRT counselling case. I thought I did well in this case but don’t know why I
failed.

56-year-old lady came to you with hot flushes and irregular periods. Vitals were stable.
Task- 1) History 2) tell her what medication you will give her and the benefits and risks
of the medication.

In history I began by reassuring her and telling her that I understand it must be very
distressing for her. I told her confidentiality and I asked her details of hot flushes and
periods, asked about the vasomotor symptoms, 5P questions and contraindication
questions of HRT, SADMA, PMH, PSH. I had 5 minutes for history. Did my best, but
still I got 2 in history. Don’t know why.

Please check passed feedback.

STATION 19 – Thirst

PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION

Scenario: Thirst Grade: Fail
Assessment Domain

GLOBAL SCORE- 3

Approach to patient/relative-5
History-5
Diagnosis/ Differential diagnoses-3

45 year old lady presented to you with increased thirst.

Task- 1) History 2) Diagnosis and DD.
I thought that I did well in this case but I failed in diagnosis and DDs.

In history and approach, I got 5.

I ruled out endocrine causes like Diabetes mellitus, Diabetes insipidus, thyrotoxicosis,
ruled out infection, malignancy, excessive exercise, excessive sweating, diarrhoea or
vomiting. The only positive finding was taking capsules 4 of Vitamin D a day because
mother got osteoporosis and fracture. She had no weight loss or polyuria.

I told the diagnosis as side effects of Vitamin D medications that she was taking and the
above DD. Maybe my diagnosis is wrong. I told diabetes insipidus as DD, don’t know if
that should have been the primary diagnosis.

STATION 20 – Ankle & foot examination

PREDOMINANT ASSESSMENT AREA - EXAMINATION

Scenario: Examination Grade: Pass
Assessment Domain

GLOBAL SCORE- 4

Approach to patient/relative-6
Choice & Technique of examination, organisation and sequence-4
This was Ankle and foot examination where a man came with ankle and foot pain and
task was to explain the physical examination to the medical student with the anatomical
landmarks.

I am happy to pass this station because there were network issues in this station and I
had to repeat some of the tests 3 times because there was poor connection and the
student couldn’t hear. I also couldn’t finish the examination. But they considered
probably because of my approach.

I told her that we will do the Foot examination of a patient who presented to me with
pain in the ankle and the foot. We will introduce ourselves to the patient, confirm his
name and DOB, explain to him that we will examine his feet. This will involve us
checking him walk, have a look at his feet, feel for pain and do other special tests. If he
felt any pain or discomfort at any point to please let us know and we will stop. We will
seek his consent, wash our hands, make sure the patient is comfortable and ask him to
wear shorts. We will ask the patient for allergies and give him painkillers.

In gait we will check if the gait is normal, or if there is any antalgic gait, wide based gait.
We will ask the patient to walk on heels to check for any problems with the L5 nerve root
or L5 radiculopathy, and walk on toes to see if there is any abnormality with S1 nerve
root or S1 radiculopathy. We will see if the arm swing is normal.

On inspection, we will see from front, sides and behind the patient. From front, we will
see for any redness, any swelling, any bony deformities, any muscle wasting. From the
sides, we will see if the arches are intact and also the medial and lateral malleolus are
normal or not. From behind we will see for any redness, swelling, deformities of Achillis
tendon or for any ulceration on the heels.

We will ask the patient to lie down with his legs jutting out of the bed. We will inspect the
sole and in between toes for any ulcerations or lacerations.

Then we will palpate both the feet on by one, checking the lower border or tibia fibula,
calcaneum, achillis tendon, navicular bone, base of the 5th metatarsal bone, the
metatarsals and the phalanges. While we palpate we will keep looking at the face of the
patient to see if he is in pain.
We will check the CRT by squeezing the great toe. Normally it is less than 2 seconds.
Then we check for peripheral pulses. We check the Dorsalis pedis pulse at the 1st
interphalangeal space at the base of the navicular bone and posterior tibial pulse behind
and below the medial malleolus.

The we do the special tests. We do Windlass test to check for planter faciitis. We
dorsiflex the great toe with our left hand and put pressure in the middle of the sole of the
patient’s foot with our right index finger. If patient complains of pain, it is positive for
planter faciitis.

We do mulder click’s test for Morton neuroma. We squeeze the toes of the patient with
our left hand and press in the 3rd interphalangeal space with our right hand. If patient
has pain, it is suggestive of Morton neuroma.

I also explained anterior drawer test, talar tilt test and Thompson test and time was up.

In the physical examinations, no positive findings will be given. So, we have to explain
everything and what we are looking for.

In the whole exam, we are not allowed to ask any questions to the invigilator or
examiner. So do your best and leave the rest to God.

I tried to help as much as I could.

Best wishes for everyone.

Another feedback: 21 April 21

Case 1. Headache in paeds patient
Task: Neuro PE explain to mum
Case 2. Schizophrenia patient defaulted meds, now says god is talking to him
Case 3. Resolved acute abdominal pain
Task: Hx, explain DDx
Case 4. Rhinitis in child for 12 mths
Case 5. IDA with SOB.
Task: Explain results , hx and likely cause
Case 6. CVS PE explain to med student
Case 7. Bulimia nervosa- dental caries
Case 8. HRT counselling
50-year-old irreg periods and got flush
Case 9. Excessive thirst
Case 10. Foot and ankle PE
explain to med student.
Case 11. Rash PE
Pic of rash and explain necessary PE (drowsy patient, explain to examiner)
Case 12. Shoulder dislocation
Task: Hx and explain course of disease
Case 13. ANC in 42-year-old
Case 14. Asthma recurring
Task: Hx and management
Case 15. Prostate ca counselling
Case 16. STEMI
Task: explain ECG to med student and immediate management
April 27th 2021 Feedback-Failed
I passed only 8 stations. Still feeling quite confused what they are expecting in
this online platform especially for PE explanation. These are all I can remember. I
hope this could help. All the best, everyone!

Station 2: Foot pain

40 woman comes with right heel pain, pain more severe at the end of day; past
history of bad injury to the foot and ankle. Take history, PE given, tell DDX
History: Asked pain history+ trauma history+ SADMA history
She has pain in the right heel, sharp pain that occurs more severe at the end of
day. Pain does not travel to anywhere.No tingling or numbness in the legs.
Her job needs to stand for a whole day. She had bad accident many years
ago that had bad fracture in the right lower leg. She smokes and drinks
alcohol. No other significant findings.
PE showing limited range of movement in the right ankle and right foot swelling.
DD: I gave most likely planta fascilitis or gout. Others could be OA, stress
fracture, ankle strain, achilles tendonopathy.

Station 4: Behaviour complaint

Nurse concerned about the client because of behavior changes ( not interested
 in anything, sometimes aggressive verbally, past history of MVA and partial
seizure and on anticonvulsant) Take history + give DDx
History: I asked all the mood questions and the HEADSSS and asked about the
behavior changes (loss of interest in activities, sometimes can get verbally
aggressive recently) No suicidal ideation, no hallucination, no memory loss.
Past history of MVA and head injury. SADMA (taking anticonvulsant, others
are not significant); Social history showing nothing significant as I can
remember.
I gave Dx as Depression disorder; DD: adjustment disorder, psychosis (but no
hallucination or disorientation) Delirium; Schizophrenia; Dementia (less likely)
I failed this one, so hopefully others can give some more feedback

Station 5: Headache

Stem: Left sided headache, 8-10 episode a year, PE given showing normal,
some stress at work;Tell Dx and Mx
Handbook Migraine case;

Station 6: Health review

Station 6 : 60 man, tiredness and lack of appetite. History + DDx

I cannot remember what is in the history. I think he feel tired all the time and lack
of appetite. Lost weight about 2-3 kg. not too much. I think there is no DM
symptoms. No skin discoloration. Bowel habit normal. I took history as
tiredess cases and gave DDx including DM, thyroid disorder, malignancy,
atypical pneumonia, polymyalgia rheumatica, hemochromatosis or other viral
infection. I may have missed something important so that I failed. Please
refer other feedback.
Station 7: Vaginal bleeding

Station 7: 42 years old women with excessive vaginal bleeding; use mirena, PE
picture given showing cervical ectropion; History, DDx
History: I asked about the vaginal bleeding history. She had bleeding since
about 8 days ago, still bleeding. Need about 4-5 pads a day. There is clots in
the bleeding. First time like this. Previously period is normal, no excessive
pain or bleeding. She is hemodynamically stable. No abdominal pain or
bloating or heaviness sensation. She is using mirena as contraception. No
easy bruising or bleeding order history. SADMA normal. Not on blooding
thinner.
PE shown a pic with cervical ectropion. I fell in the trap in this case. I think
the cervical ectropion is just a trap. Cervical ectropion causes bleeding after
sex intercourse. But I gave cervical ectropion as my Dx and also gave
fibroids, cervical or intrauterine polips, bleeding disorder or medication
induced. I forgot to ask more about mirena, when she started using that. I
think this case the Dx might be mirena induced bleeding or break through
bleeding. Please refer other feedback.

Station 9: Dysuria
 Station 9: 40 male, comes with history of urinary pain, frequency. UDS showing
blood, protein, nitrates, leucocytes; Give Dx, and Ix needed
This is handbook case of UTI in male.

Station 10: Irritable baby

Station 10: baby 6 weeks, crying a lot. PE given showing normal; history + DDX
I failed this one. I approached as colic infantile. Asked all the questions about
crying baby. I maybe misinterpreted the PE finding so that leads to fail. Sorry
not hepful in this case.

Station 11: Facial lesion

Station 11: SCC results given from biopsy, tell DX and

management SCC couselling case.
Patient asked me is it same as melanoma. My explanation may be not very
organized. Probably that is why I failed. I tried to be sympathetic to the
patient and start as breaking bad news approach. But the roleplayer seemed
not very upset. So I did not spend too much time to calm her down. She
justed me what I need to know about this condition. So I explained what is
SCC and it is a slow growing skin cancer, very common but could spread
from lymphatic system. I referred her back to surgeon for reinscision.
Referred for further investigation including blood test, CT scans ,PET scans. I
talked about sun protection methods as well.
Station 12: ANC

Station 12: women LMP 9 weeks ago, irregular period; drinks ocassionally need
to discuss about antenatal check up and preventive measures during
pregnancy
My approach: I asked just a few questions including past obstetric history,
whether it is a planned pregnancy or not. How did she find out the pregnancy.
I also asked whether she has enough support at home. I briefly ask about her
drinking pattern, she said she only drinks occasionally.
st
I talked everything about the antennal checkup, 1 trimester, seen the GP every
4 weeks, after
rd
that every 2 weeks, 3 trimester every week. I mentioned blood test including
Hb each visit and urine test to rule out UTI and measure blood pressure. I
talked about TORCH screening, vaccination if she is not immunized. Blood
group and cross matching. As the period is not regular, I offered dating scan.
Followed up by 18 weeks morphology US scan, and 32 weeks repeat US
scan. I talked about 24-28 weeks sweet drink test and GBS at 36 weeks.
I also talked briefly about Down screening. I told her that she needs to stop
drinking, as this could leads to birth defect to the baby. I also mentioned about
lifestyle modification, exercises, balanced food. I also offered help whenever
she needs and mentioned that she will be seen by specialist as well during
the pregnancy.
Station 14: Disturbed behavior

Station 14 case 1: Man brought by Police because wondering on the street, Past
history of schizophrenia; History + MSE Or
Case 2: Postoperative patient sees crocoraches everywhere, delirum case,
History + present MSE
I am not sure which one is scored between these two cases. Roleplayer was
quite good at acting.
Case 1:patient keeps asking me “ Can I go home? I don’t know why
they brought me here.”He has auditory hallucination. He was diagnosed as
schizophrenia a few years ago, he is not taking the medication now. He is
homeless and drinks as well. He is oriented but insight and judgement is
impaired. I mentioned patient is at high risk of harm himself and others
due to the past mental history and auditory hallucination.

Case 2: Famous delirium cases that patient saying that he can see cockroaches
everywhere. He is disoriented, no other hallucinations. He had shoulder
surgery 2 days ago. Need to present MSE to invisible examiner.

Station 15: Eye exam

 Station 15: Eye redness and conjuctive swelling; Tell patient
about Eye PE My approach:
This station 8 mins only one task, explain to the patient how you are going to
exam the eyes. Roleplayer was wearing sunglasses.
I explained that I am going to exam the eyes and I will need him to take off
sunglasses. I followed the look and feel approach. Explained what I signs I
will be looking for. I explained how I am going to do the pupil reflex test. I also
explained the visual acuity, visual field and eye moment. At last, I said I will
need to dilate the pupil and dim the light for ophtamoloscope. I said I would
assemble the scope and check the filter and light size first before
approaching to the patient. I would check the red reflex and funds using the
fundoscope.

Station 16: Rash

Station 16: Kids have rash after diagnosed as tonsillitis; comes with rash 2 days
after taking amoxicillin. Need to explain about PE of rash and other relevant PE;
My Approch:
PE I mentioned ENT examination (look and check the through) for the Rash PE,
I explained that I would start with look the site, size,distribution, color of the
rash, elevation, blanchable, and whether any ulceration or discharge. I will do
palpation of the rash as well.
Then I mentioned about check lymph nodes and ENT examination. I also
mentioned abdominal PE for hepatomegaly or spleenmegaly. Lower lims and
upper limbs checking any bruise or peteques.

PE finding given after explanied about the rash PE:

Finding showing generalized rash and cervical lyph nodes (+); speen enlarged,
tonsil enlarged with exudate.
I gave Dx as infectious mononucleosis, others could be reaction to the
antibiotics, streptococus infection, other viral infection; or lymphoma, leukymia
or bleeding disorder.
Station 19: Vomiting

Station 19: 18 months baby vomiting + diarrhea; most likely acute gastroenteritis;
PE given showing dehydration; take history+ DDx
My approach:
Baby started vomiting since yesterday, vomited twice, not projectile. Watery
diarrhea about 6 times since yesterday. Baby had fever as well. No
respiratory symptoms. Baby is crying a lot and not breastfeeding well.
No lumps or bumps on the abdomen. First episode. No contact history, No travel
history.BINDS normal.
PE showing that baby is having moderate
dehydration. Dx: Viral gastroenteritis with
moderate dehydration.
DDx: Gastroenteritis by bacteria, UTI, meningitis, hernia strangulation,
intersussception, testicular torsion, Giardiasis, food poisoning.

Station 20: Abdominal pain

Station 20:Left lower abdomen pain, tell medical student about Abdomen PE;
I do not know how did I failed this case, only need to explain abdominal PE. I
followed the inspection, palpation (superficial and profund), percussion and
auscultation.
 I checked rebound tenderness and liver and spleen enlargement. I mentioned about
bellot kidneys.
I am quite confused what they expect in this case for online platform.
Please refer to others.

Not scored:
70 male chest pain + SOB+ ankle swelling; history+ Ix+
DDx History:
Patient has chest pain in the central chest, heaviness feeling. No change when
changing position. He also has SOB on excertion which has been for a while,no
need extra pillow when sleep. No trauma history. Past history of hypertension. He
has ankle swelling as well. He smokes.
PE given showing murmur, tachycardia, ankle swelling. Others cannot
remember. Ix: ECG, echocardiogram, chest Xray, blood test including cardia
enzyme.
When I mentioned ECG, patient asked me what is ECG?
Dx: congestive heart failure.
DDx: Chest pain DDX: heart attach, angina, pericarditis, cardiac valve defect, chest
trauma, or lung problem such as pneumothorax, pleural effusion, lung cancer.
Or could due to GI system: GORD, peptic ulcer,

Another feedback: 27th April 21

1) down syndrome (adjustment disorder)
2) IBS with gastroenteritis not sure
3) SCC
In marwan PE is there but counselling not sure, may be same way as BCC
4) Rash PE
5) Acute abdomen PE
6) UTI male
7) Temporal arteritis
8) vaginal bleeding
could be atrophic, cancer, ectropion
9) Delirium-
depends on history but maybe hyponatremia
10) ankle pain- don’t no
11) ANC counselling with alcohol counselling
12) Red eye PE
13) Infantile colic-
but have to rule out depression.

28th April 21
Tips from candidate
I sat the online exam on 28th April 2021. It was my first attempt. I had booked the exam for June
2020, but it got cancelled. I had also signed up for Alan Roberts course for April/May 2020, but
when the exam got cancelled and the course moved online, I decided to withdraw from it as I
didn’t see the value in preparing for a clinical skills course online. (which is ironic now,
considering I took the entire exam online.)
Without any course, I learned a lot from just this group and different wonderful people giving
wonderful suggestions and advice. It was also a protracted and unending year of studying
on/off, so I have no idea how much of what I will say will be useful, but here’s how I prepared.
I read through the handbook by myself first. It helped familiarize me with what the AMC was
expecting.
I then started insane roleplay schedules for Marwan Notes. I was doing Gynae 8-9am with one
person, Psychiatry 10am-12pm with another, Pediatrics 3pm to 5pm with someone else and
Medicine/Surgery 7pm to 9pm with another. The 4 study partners helped me kickstart my study
and really really pushed me to understand all of these different topics and how they
intermingled. I am forever grateful to them.
I did that for little over a month before realizing that is unsustainable. Then, gradually as I
started finishing each subject, I started reducing the number of study partners until I was doing
Medicine/Surgery with just one partner from 10am to 12pm every day. I did that for a few
months, stopped when exam looked endlessly away, started again, stopped again, and then
from February onwards, I have been regularly doing 2 hours roleplay with the same partner 4 to
5 days a week. It really helped me fine tune the roleplays, develop time management, also get
used to saying the difficult medical terms in lay man words. After a while, I roleplay sessions
became more about the new things we learned, the interesting topics we come across, and we
modified and challenged each other with that.
We did the Marwan notes once in detail, then we did random roleplays from 2019 recalls and
some even from Karen notes. It was actually fun. I somehow miss those hours of the morning
now.
About the physical examination… that was a new format and I still have no idea what was really
expected of us. But once we came to know of the format, we started practicing saying all the
examination steps to each other, and correcting each other when we didn’t explain it well. I think
that helped a lot. We did very simple system specific examinations first, and then did Marwan
notes PE file.
That’s about all for how I prepared. I was initially planning to prepare quickly in a couple of
months, but due to covid… it was a long year of preparation. But I think that eventually helped
me in passing it in first attempt.
Oh I also did a mock online exam with Alan Roberts 1 month before my exam and that was
immensely helpful. I failed that with 9/14 stations, but it taught me a lot about how to better
prepare and approach scenarios.
I think enough have been said about the online examination format by now. It is well co-
ordinated and you get plenty of breaks. The physical examination is easier like this than it
would’ve been face to face. If anyone has any specific question, you can ask in the comments
and I will try and explain as best as I can.

Here’s the feedback of each station.

Station 1: Health Review

A 72 year old man had had an episode of unconsciousness and fall. This is the second time it
has happened. He is otherwise well, but he comes to the ER because he is concerned why it is
happening.
Tasks: History. (you get PE after 5 minutes)
Diagnosis/differentials.
The roleplayer in this case was not the most cooperative. He had some papers in front of him
and he was reading the scenario from that. If you asked the right question, he read the
response.
I asked him about how he was feeling now. If he hurt himself when he fell. He said he was
alright and just concerned. The stem said something about hurting his leg and I asked if that
was okay and he said yeah no worries.

When I asked him to tell me about his fall, he said he had gotten out of bed and was just
standing when all of a sudden he fell down. I asked if it’s the first time and he said it has
happened once before. I don’t remember how that one was. I asked if someone saw him and he
said his daughter did and she said he looked very pale. I asked about any triggering factors, any
aura, any voiding of urine or stool, any tongue bite. Nothing positive. He was unconscious for
about 30 seconds or so.
I asked history of any chest pain or palpitations, he told me that he sometimes feels a thump in
his heart. I asked details but he didn’t give me any.

Past history didn’t have anything.

His father had a sudden death at age of 70 of some cardiac cause.
PE findings were all normal except heart rate of 42 beats per minute. Regular.
I explained bradycardia that your heart is running slower and that can sometimes get less blood
to your brain. It can also sometimes cause heartblock, and I will need to do an ECG to know
what is going on. Also explained the other causes of falls why it wasn’t hypoglycemia, postural
drop, or seizures.
I guess it could’ve been long qt syndrome, but I didn’t think of that at the time.
Station 2: Behavioural change

Young lady, feeling out of sorts for the last month.

Tasks: Take psychiatric history.
Most likely diagnosis.
I seem to have barely passed all the psychiatry stations so I don’t know if my feedback is very
helpful. I am so glad to have passed this though. Phew.
She was a depressed woman. No interest in things. She spoke really slowly and was very
obvious it as depression. She felt Guilt for making a mistake a month ago. Disturbed appetite.
Increased sleep. She wasn’t suicidal but when I asked have you ever felt like life is not worth
living, she said when she wakes up sometimes, she does wonder what is the point. Increased
alcohol intake since she started feeling bad. Supportive partner and home situation.
I probably should’ve taken the proper ASPECTICRRR history, but I didn’t. I didn’t rule out any
organic causes either as the task was psychiatric history.
Diagnosed it as Depressive episode of moderate to severe depression. As it hadn’t been there
for very long, I didn’t want to call it severe depression? Just explained what depression is.

Station 4: Health Review

 1- Young man. Had heroin a month ago. Now feeling sick.
Tasks: History.
Get PE findings in 5 minutes.
Explain diagnosis/differentials.

I have read this as recall before. There was a young man, he looked healthy enough and he
was just complaining of feeling bad right now. When I asked since when, he readily told me that
he went to a party a few weeks ago, and had some heroin there. I reassured him of
confidentiality and appreciated him for coming for help. When I asked what route, he said
needle. I asked if the needles were shared, he told me the story that they partied hard the night,
he was having hangover in the morning and his friend said here, take this. You will feel better.
And injected the heroin in his arm. He thought there were only a few needles around and they
might have been shared.
He has never done drugs before this, and never wants to do this again.
I asked about how he felt later, and he told me that he had some fever and rash a couple of
weeks ago but those got better. Now he just feels lethargic and out of sort. I asked all the
questions about change of skin color, tummy pain, problems with urination. Got no signs and
symptoms of current feeling bad, other than the lethargy.
After 5 minutes, got the PE findings which showed tender hepatomegaly and bilirubin in urine.
So I told him he had hepatitis, could be many causes but its most likely viral from Hepatitis B,
and also talked about how we should rule out HIV too because of seroconversion rash 2 weeks
ago maybe. Discussed needle sharing being the cause of this, and that the rest of the friends of
his from the party should get tested too.

Station 5: Leg pain

60 something woman complaining of leg pain when walking.

Tasks: History.
Most Likely diagnosis.
I got a higher score in this than I really expected as she didn’t really give me a lot of history. She
just said she has pain in the legs. I asked the details and she told me it happened when she
walked. It was sort of crampy, and only in one leg. Got better when she rested. It started
gradually and now got worse.
Asked about any skin color changes, any swelling, any ulcers any cold feet, nothing. The other
leg was absolutely not affected.
Asked about any back pain, any injury, any shooting nerve pain. Nothing was positive.
in SADMA she was an ex smoker. She was taking beta agonists for asthma I think, because I
remember telling her that it’s the beta blockers that can increase the claudications, not the
agonists so she is alright.
I told her this sounded like intermittent claudication, and most likely is happening due to
atherosclerosis which is fat depositing in arteries and making them smaller. So when you walk,
oxygen demand increases, and the vessels cant dilate to let in more blood. So you have pain.
When you stop walking that gets better. The smoking history can increase the chances of it.
Also explained to her why it wasn’t sciatica or muscle cramps due to some deficiency.

Station 6: Immunization counselling

Mum to a 4 year old here to talk about influenza vaccination for her daughter.
Task: History.
Explain Influenza vaccination guidelines.
I thought I did this one fairly well. But well, apparently not. I did this one TERRIBLY, and I have
very little idea why. There is a passed feedback for this one, so refer to that.
I think what I didn’t talk about was like… egg allergies. She had them. I didn’t ask. She also
used epi pen, I didn’t ask about that too.
It was just a fairly sweet mum asking why her daughter was asked to get flu shot. Her daughter
was asthmatic and had recently had steroid course for her exacerbation of asthma.
Station 7: OCP Counselling

OCP counselling.
22 year old, wanting to get the pill.
Tasks: History.
Counsel her accordingly.

This one was very simple and you can refer to many Marwan notes cases for this. This was a
young girl, sexually active rn, asking for OCP prescription. The points that were different than
normal in this were the fact that she had not had pap smear, she was a smoker, and she was
also taking some antiepileptic drugs. So I mentioned all of these points in the counselling too.
Station 9: Headache

Lady with Headache. Past histories of abdominal pain-undiagnosed, urinary tract infections-
undiagnosed etc. Multiple visits to the practice.
Tasks: History of the current complaint.
Most likely diagnosis and other diagnosis.
Another Psych one, that I am SO grateful to have passed even if just on the margin. So I started
talking to her and she said doctor I have severe headache. Please help. I offered her painkillers
that she refused. When asking her to describe her headache she said it was tension headache,
she gets them often. On a scale it was 9/10. I asked all the headache questions, ruling out any
sinister cause. I asked her if something was going on in her life to make her stressed out and
she said well… nothing specific. I stopped and reassured her confidentiality and told her I am a
safe space to discuss things. Then she opened up about stress at work and recent separation
from partner.
I showed lots of empathy. I asked SADMA. (I think she was having alcohol but normal amount,
nothing else). By the time I reached that, the history time was over so I didn’t take much history
of the other symptoms she had. The task was history of current complaint anyway.
I quickly asked that for all the other symptoms, if there was any organic cause found, and she
said no.

I then explained to her what somatization was, what was mind body axis and how the stress of
mind can cause pain in the body. Told her all of her other problems were probably linked to that
too, and said she probably has somatization disorder. She didn’t fit the exact criteria but like… I
had no time to ask all that detail. That’s why I barely passed this station.

Station 10: Pallor

18 month old child. Had URTI a week ago, seemed pale to the doctor so he ordered some labs.
Labs had anemia, microcytic hypochromic. Platelets, wbs normal. Low Fe and Ferritin
Tasks : History
Explain the investigations with diagnosis.
Advice management plan.

This was a lovely mother I was talking to. She said she is just here because of the labs. Her son
had a flu a few days ago and the GP has said he looked pale and she had gotten some tests. I
told her I have the results, but is it okay if I just ask a few questions first. She was like, yes, sure.

I asked him how was the her son. (always take the name. They didn’t give us any name in
stems so I always asked for the name of the son as well as the person I was talking to, and
wrote it on a page, so I would remember). She said he was fine. I asked if he had recovered
from the flu, he had. I then asked about his diet, and she said he likes his milk. I said is he still
breastfed, and she said no. he was breast fed until he was 6 months, and then they put him on
formula feed for the other 6 months. And now for the last 6 months he drinks cows milk. I asked
if he eats any solids and the mum was like, he just doesn’t like them. He would eat biscuits and
chips sometimes, but no fruits, nothing. He just enjoys milk. After taking a detailed nutrition
history, I asked about any brusies, any blood in stool, any dark colored stools, any bleeding, any
chronic infections. Nothing.
Asked developmental history and that was normal. Asked about parents ethnicity or family
history of thalassemia, but the parents were both Australian and nothing in family.
I explained to the mum that her son had low blood hb, explained that was the oxygen carrying
substance, and told her iron is important for its formation. As the son also has low iron, he has
iron deficiency anemia. Told her cow’s milk doesn’t have enough iron and it can cause this
problem. Told her other reasons for it are chronic disease or blood loss or thalassemia and
explained that’s unlikely.

Discussed with her plan of introducing solid food, decreasing cows milk. If not, at least
supplementing it with formula with enough iron at least. Referring to dietitian for meal planning.
Told her if nothing is helping we could give iron supplements but he needs better nutrition
anyway. Told her I would see her in 1 month, and told her redflags.

Station 11: Spirometry results

Spirometry.
COPD values in a spirometry given. Middle aged guy, ex smoker, now having breathlessness
with exertion, sats 93% and wheeze.
Tasks: Explain the results to the patient . Explain diagnosis. Outline management plan.
The stem was long and already had a lot of information. I introduced myself to the patient and
asked him how I could help. He said he just wanted to get the reports of his test. Asked him if he
knows why it was done, and he said it was because he was having breathlessness recently.
I then asked him if he could see the charts. He could. I explained every value separately. Like,
told him FEV1 is, you remember you had to blow out really fast in the beginning , that’s what we
were checking, the air you breathe out in 1st second. It is supposed to be this much, but as you
can see, yours is low. Then FVC is the total air you blow out forcefully, yours is decreased too.
And then we look at the ratio, that’s the most important in diagnosing obstruction, and yours is
reduced. It means you have obstructive lung disease. Now we want to know if this is asthma, so
we gave you some puffers, and repeated the test. In asthma, the values should improve. It
didn’t in your case. So this shows you have COPD. Some other values of residual volume and
Total lung capacity was given too, so I explained that as there is resistance and obstruction to
air moving out, there is some air remaining in the lung, residual volume, and total lung capacity
has increased, because the air doesn’t all go out, and it has increased the lung size. All that
happens in COPD.

Then I explained what COPD means, told him its because he smoked for that many years, that
can cause COPD. Told him why its not asthma.

In management plan, I wanted to rule out heart disease and any sinister lung cancer, so I said I
would screen you for those first. So chest x ray and ECG and exercise tolerance test. Then I
would refer you to physio, for exercises. I would also refer you to pulmonologist for proper
management of COPD, and he will prescribe you inhalers, which will help. If your oxygen
saturation falls, you might need ambulatory oxygen. Unfortunately there is no reversing what
damage has happened, but we will stop it from worsening.
He asked me “doctor, would any of it make me feel any better” and I was like “absolutely, the
whole point is we want to make you feel better, and all this would help.”
I started on lifestyle modifications at the end, and that’s when my time ran out.
Station 12: HTN Counselling

Hypertension in 42 year old. Ambulatory BP was high about 150/100. Office readings high
170/100 something. Copper wiring and tortuosities in the retina.
Tasks: Explain the significance of exam findings and the BP to the patient.
Explain the most likely diagnosis and risks and consequences of it.
Order investigations

This roleplayer was a little annoying, as he kept interrupting me to ask me to explain many
many terms.

I started by introduction, asking him his name, and asking how I can help him. He said he just
wants to know what the readings mean.
I told him that he had high BP in the office, but we wanted to rule out white coat hypertension
and did it again a separate time, it was still high. To confirm we also did the ambulatory
monitoring and its still high, and with that we can say that he has hypertension. Also told him
that we looked at his retina and it has signs of hypertension. He asked me what retina is, I
explained it’s the back of the eye.

I asked him if he knows what hypertension is, and he said a little bit. His dad also had it. So I
explained it means high BP, and told him that it might not sound dangerous, because what does
it matter if blood is flowing with more pressure, but explained how in the end organs in the tiny
capillaries, that increased pressure can cause damage. Like in eyes it already had. It could also
cause blood vessels to rupture in brain. Could damage kidneys etc. Also told him that along with
that, sometimes high BP can also be linked with atherosclerotic plaques in arteries, which is just
fat clogging up arteries, so now even if the blood is flowing with more pressure, because the
vessels are narrow, not enough blood is flowing to the organs, and it can cause ischemia.
(again he asked me what does ischemia mean). Explained that not enough blood oxygen or
nutrients reach that area and that can cause that area to die. Can happen in heart, brain or
kidneys.

Also told him most likely its essential hypertension. (I think he was ex smoker too and family
history, it was given in stem). But he is still young so it can be secondary hypertension as well,
which is high BP because of some cause in the body, like pheochromocytoma, or renal artery
stenosis etc. explained what they were.
Told him if blood pressure is not controlled, he could have a stroke, could lead to low vision or
blindness, could cause kidney damage, and also cause decreased blood supply to hands and
legs.
Arranged investigations. I was a little short on time, so told him firstly I want to arrange
investigations to rule out any secondary causes. So arterial dopplers for kidneys, urine for
VMAs, and thyroid hormones for hyperthyroidism. Then I would like to check for end organ
damange, so I want to do ECGs, liver function tests, kidney function tests, eye exam is already
done. I didn’t get to mention urine for proteins and like, cholesterol and stuff. So yeah, less
score in that one.
Station 14: Obstetric exam

Pre-eclampsia.
36 weeks pregnant lady with hypertension and proteinuria. Obstetric exam and fetal heartrate
already done.
Tasks: What further examinations you would do. Explain the instruments you would use.
What investigations would you order.
Tell the patient of the most likely diagnosis.
I messed up this one pretty terribly. I didn’t even know we had to take history. I just explained to
her how I would do fundoscopy and reflexes, and then told her I would do CTG and swab for
GBS and forgot to do any lfts or rfts. I totally blanked in this one. I did explain what pre
eclampsia and eclampsia was and explained some management. I am really not surprised by
this score. This was a terrible station.
Station 15: Weakness

72 old man, had a TIA. Now okay. Teach a medical student how to do motor examination of
upper and lower limbs.
This was a student who was just not willing to actually participate in any discussions. Everytime
I asked him, “do you know what upper motor neurons signs are” or “have you ever done this
before” he would just say “it would be good if you would just explain that to me”.

So yeah, that was frustrating. He wasn’t willing to be involved.

I started with explaining we wash our hands, take consent, and then expose. And then like, from
gait, and the ITPRC of the motor exam of upper and motor limb simultaneousy. It was SO
LONG though, and I ran out of time when I started co-ordination. Definitely glad I still passed
this one. I suppose they liked my explanations.
Station 16: Post-op delirium

Post-Op Delirium.
Middle aged man. Came for knee replacement. Confused and agitated 2 days later.
Tasks: Explain to the sister the pre-and post-op assessment.
Explain the probable causes of patients condition.

This one had A LOOONNGG stem. No matter how much I read it, I couldn’t absorb all the
information. All I can remember is there was a page of pre-op assessment which had mostly
normal everything, except he consumed 25 Standard drinks/week. There was Anemia.
Macrocytosis. Liver labs looked normal to me, but I am not completely sure. Well, ALT and AST
were in 40’s but I am not so sure about alkphos. There was a LOT of info on that page. Other
labs and examinations were normal.
2 days post op assessment, the patient was angry and agitated and confused now. In
examination, there weren’t any findings per se, except Temp: 37.8 Pulse 120. And confusion. It
said stuff like “you didn’t find any cannula site inflammation, but because patient was
uncooperative, the examination could not be performed to your satisfaction.” And “abdomen
seemed soft and non tender with no visceromegaly, but because patient was uncooperative, the
examination could not be performed to your satisfaction.” I remember there were some spider
nevi present though.
I introduced myself to the sister, told her I am sorry she must be stressed out about her brother.
She just wanted to know what was going on with him. So I explained both the pre-op
assessment and the post op one to her in lay man terms.

Then I told her I think what he most likely is suffering from is alcohol withdrawl. The acute form
of it is called delirium tremens. Explained that to her. Told her this is post op delirium, it is fairly
common and has lots of causes, but in his cause I am considering alcohol withdrawl as most
likely because he also has excessive alcohol consumption signs. The anemia and the
macrocytosis and the spider nevi. I told her it could also be werinke’s korsakoff, explained that.
Told her it could also be some infection, but even though his pulse is high, his temperature is
very slightly raised. But I will investigate for all possible signs of infection anyway.
Mentioned quitting alcohol as it already seems to be affecting his liver.

Station 17: Breathing difficulty

4 year old child. Fever, cough for a few days. Now not eating food.
Tasks: Brief outline of examination to parent.
Explain to examiner the examination and what you will be looking for.
Interpret the examination findings and give likely diagnosis/differentials.

I approached the cases that had the whole “explain to the parent and explain to the examiner” in
a way that I did the part to the parent as consent taking. So I told the dad that I am going to
examine your child. I will be taking a look at him, checking his vitals, looking at his chest,
tapping on it, touching it and then listen with a stethoscope. I might also listen to his heart and
feel for glands in different parts.

Then went to the examiner and started with, I will wash my hands, and I have already taken
consent from parent. I will start with general inspection…. And continue the examination
description as in any of the videos/pages. After I went through all the respiratory examination,
the findings were given.
The exam findings were of dehydration, sick child, and consolidation in lower zone.
I explained how it wasn’t upper respiratory tract infection or a flu because there is a dense area
in his lower zone. He also is dehydrated and has high fever and is sick, so it’s a great thing you
brought him here. I think he has infection in his lung…..

And… time ran out. I didn’t get to give the diagnosis of lobar pneumonia that it was.

PILOT 1 – Total hip replacement counselling

60 year old man, with arthritis of right hip. Wants to get total hip replacement. Wanted it last
year but the GP said the symptoms weren’t bad enough.
Tasks: Take history.
Explain in general terms the process of total hip replacement, its risks and benefits.
Otherwise healthy man with painful hip. Getting worse. Disturbing his lifestyle.
Even though I didn’t really know much about total hip replacement, this one was somehow an
easy one to explain. I didn’t know the prosthesis was made of metal, but I explained about how
we remove both the ball and the socket and use artificial ones instead. Risks of anesthesia,
surgery, post-op. Benefits of better mobility.
PILOT 2 – Rash around lips - PE
A little boy with rash around the lips. It looked like Herpes. Looked something like this

Child had sore mouth and tongue.

Tasks: explain rash to mother.
Briefly outline how you will examine the child to the mother.
Explain in detail the examination to the examiner with landmarks.
 Explain what you would be looking for in history and examination given the condition of
the child.
I didn’t do very good in this one. It looked like herpes labialis to me. I did rash exam, then
checked for general sick baby signs, dehydration, lymphadenopathies, did ENT exam, and a
mix-match of hematological and neurological because the child was febrile too.
Read up on Herpes gingivostomatitis. That is what it is I think, and we should’ve done
neurological exam to rule out encephalitis and keratitis?

SO GLAD this one was a pilot :D.

28th April 2021 – Another feedback
Tips from candidate
Thank you for this amazing group which helped me immensely as I learnt the most from both
passed and failed feedbacks.
I did not do any PE courses for the online format, luckily, I had an amazing study group and we
practiced PE daily 2 hrs for 4 weeks as we booked in end March and had an exam in end April.
Followed CitiMed 3 days PE course, GEEKY, physio tutor, oxford medical education, and
MRCPCH websites and googling randomly for anatomical landmarks. We were always
encouraging and gave positive criticism which helped us all. Please allow your study partners to
trick you and give you a twist during the role play. Don’t blindly give findings as stated in recalls
as it will help you train yourself for anything unpredicted that comes your way. In the mornings,
we did role play some recent recalls but I wasn’t so regular as I had to revise my Marwan and
my kay t files that were already printed and marked.
I think if you can use layman terms and simple language while explaining PE to
patient/carer/parent you can easily crack those stations provided you complete your tasks.
JUST PRACTICE, PRACTICE AND PRACTICE!
Role plays are imp but self study is also IMP!

PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION STATION 1

Scenario: Health review Grade: Pass
Assessment Domain Domain Score (see key below*)
Approach to patient/relative 6 6
History 5 5
Diagnosis/ Differential diagnoses 5
5
Global Score 6
In this case, the role player was a 72 yr old man who kept on glancing at the script as I was
asking questions.
I asked the pre, during post syncope details. It was his second syncope, first one happened at
night when he got up to wee and fell (I thought it could be postural hypotension due to alpha
blockers or BPH as its at night)
Second episode details: Daughter has witnessed it, he turned pale and nothing else was
positive.
Nil SOB, cheat pain, palpitations, light headedness
Nil shakes/seizures
Nil Weakness, blurry vision or CNS symptoms
Nil endocrine, Diabetic Neuropathy
Nil polypharmacy
Nil N/V/D or dehydration
Nil vertigo
Nil missed meal
Nil signs anaemia
Exhausted all my ddx
Father had a heart problem and died of heart attack he didn’t know (he glanced at script again
to see if there was any ans lol)
I was clueless and started summarising it to him and the PEFE card appeared after 6 min, only
positive finding was Bradycardia, BSL was 5.8
I asked if he feels anything new or unusual in his chest, and he finally gave me a positive finding
that he has a thump which is resolved by itself and he cant diff whether its regular or irregular or
tap it on the table
I said based on your history, most likely it could be cardiogenic syncope due to slow heart rate
called as sinus bradycardia or something similar called as a heart block or any abnormal
beating called as arythemia or any waveform problems like Prolonged QT syndrome *time up

PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION STATION 2

Scenario Grade
Behavioural change Pass
: :
Assessment Domain Domain Score (see key below*)
Approach to patient/relative 4 4
History 4 4
Diagnosis/ Differential diagnoses 4
Global score 4 4

Young lady, feeling out of sorts for the last month.

Tasks: Take psychiatric history.
Most likely diagnosis.

This role player was not giving findings easily

She was looking down and not making eye contact, typical depression
Mood I had to ask twice, first time the ans was I dont know, second time she said it was
negative
I asked all the psychosocial hx in detail
Sleep was disturbed, wakes up at 4am
Anhedonia present as she doesn’t want to go out with her office friends gathering
Fought with BF and cranky
Works in a stressful job environment as a lawyer as feels guilty as they lost a project/contract
because of her
Nil psychotic features but increased alcohol
Everything started a month ago hence I ruled out adjustment disorder but she was working in
the same firm since a long time
Nil symptoms of GAD, PTSD, head injury, thyroid or any recreational drugs
LOW 2kgs and she didn’t feel like doing anything basically
After asking suicidal ideation twice (we all are humans and sometimes we tend to think that life
is not worth living or whats the point, is it applicable to you?) she finally gave me something, doc
when I wake up at 4am I feel like whats the point
Nil plans or intent or any previous attempts of suicide
FHX of mom post natal depression when she was born
Most likely based on this info, you have melancholic depression, it could be due to adjustment
disorder, GAD, thyroid etc (time up)

PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION STATION 4

Scenario Grade
Health review Pass
: :
Assessment Domain
Approach to patient/relative 4
History 4
Diagnosis/ Differential diagnoses 5
Global Score 5

Young man. Had heroin a month ago. Now feeling sick.

Tasks: History.
Get PE findings in 5 minutes.
Explain diagnosis/differentials.

This guy had used Heroin a month ago and was feeling unwell since then
I gave confidentiality and asked about heroin usage, other drugs, mode and if he is a habitual user
He went partying to a hill with 10 friends, didn’t take his GF along
They had limited needles so shared and had developed some fever
He had never done heroin before and didn’t even want to try again as it made him feel sick
I ruled out Hepatitis, HIV, Infective Endocarditis (as IV drug use was priority)
They didn’t eat outside food, nor water
No vomiting or diarrhoea but felt nauseous
Nil LOW or lumps bumps or flu like illness
Nil tummy pain
Nil SOB, dental inf, SOB, palpitations
He has a rash that disappeared after three days (I thought could be HIVVVVVVV)
Anyways he didn’t have any sexual encounters as his GF was at home and always used condoms,
no symptoms of uti, discharge or rash in genitals
Nil meds or steroids

PEFE card only shows hepatomegaly and bilirubin in urine

My ddx were Hep B/C and HIV

Rest I said could be Infective Endocarditis as IV drug use can affect structures in heart
Could be due to other STIs
PREDOMINANT ASSESSMENT AREA - HISTORY TAKING STATION 5
Scenario: Leg pain Grade: Pass
Assessment Domain Domain Score (see key below*)
Approach to patient/relative 6 6
History 6 6
Diagnosis/ Differential diagnoses 5 5
Global Score 6

60 something woman complaining of leg pain when walking.

Tasks: History.
Most Likely diagnosis.

I started by asking leg pain SOCRATES and offered painkiller

It was typical PVD pain, intermittent claudication hx since 3 months in one leg, distance dec from 100m to
50m

Ex smoker and had COPD but didn’t take any steroids that could cause back pain
Has Osteoarthritis of back
I asked for meds (for HTN and beta blocker) but she said Im using Tiotropium Bromide and Panadol osteo
for
my OA

I asked ABCDEFSSS (salt smoking stress) all good

She had just just some check up and her bloods were fine in terms of cholesterol etc
My dx was PVD and gave ddx as sciatica, dvt, back injury or insect bug bite

PREDOMINANT ASSESSMENT AREA - HISTORY TAKING STATION 6

Scenario: Immunisation Grade: Pass
Assessment Domain
Approach to patient/relative 5
History 4
Patient Counselling/ Education 4
Global Score 5
Mum to a 4 year old here to talk about influenza vaccination for her daughter.
History (5min)
Counsel and mx
I asked history and was done very quickly with history
Ruled out all contraindications of immunizations mentioned in HB
Positives: Egg allergy as mom fed her scrambled eggs once and her lips got swollen developed
a rash and was taken to the hosp, dust mite allergy when GP did skin test, Epipen already in
place and mom knows all about it, child has asthma and recently had a flare up which resolved
with steroids, all other jabs up to date, mom is anxious why is it imp to give flu shot as daycare
mom group had some apprehensions about it
I explained her in layman terms about fighter cells and memory cells being produced once the
shot is taken, the shot has dead bugs, so the body gets prepared well for another hit later on
and the future hit is less severe as the body is more prepared or immune.
She had no other concerns surprisingly.
I explained to her about the imp of influenza vaccination in children with Asthma as it will
prevent flare ups and exacerbations hence its highly recommended to take the jab.
Two shots in the first go, yearly shot thereafter as the virus changes its shape
Contains trace of egg hence no need to worry n its safe to administer in egg allergy
Will give the jab in our clinic and observe her for 4 hrs as she has had anaphylaxis before,
reassured her we have all equipment available if things go south. Minor fever or pain in the arm
is expected for which u can give Panadol
Herd immunity is good
Mom was happy overall but I was shaking as it’s a highly failed case and I didn’t go into details
of active passive immunity :P

PREDOMINANT ASSESSMENT AREA - HISTORY TAKING STATION 7

Scenario: Health review Grade: Pass

Assessment Domain
Approach to patient/relative 5
History 6
Patient Counselling/ Education 3
Global Score 4

OCP counselling.
22 year old, wanting to get the pill.
Tasks: History for 6min
Counsel her accordingly and you are not required to manage her
I HAD MARKED IT AS A DIRECT FAIL AS I DIDN’T COUNCEL HER ABOUT OCP TIMINGS, MISSED PILL
which are critical errors acc to HB

(I didn’t have any passed feedback for this as my exam was in April so got carried away with Hx)

I asked all 5Ps from Victoria (her name lol)

She had her Gardasil in high school but didn’t start her Cervical screening and was using condoms
I asked all contraindications to OCP
I got Epilepsy and smoking positive
She was non complaint to her anti epileptic med Topiramate before but now is compliant, hasn’t seen
any specialist for 8 years, last attack 3 yrs ago
Smokes 4 to 5 cig
I counselled her look you are a good candidate for OCP, however, I am a bit concerned as
you haven’t seen any specialist for 8 yrs and OCP have interactions with epileptic doses
We need to give u a higher dose of OCP
I would like to refer back to ur specialist for a proper check up and dosing regimen
You need to be compliant as this is a dose sensitive process and one might fall pregnant otherwise
Please keep using condoms as they protect against Sti
Would like to offer you another appointment for smoking cessation as it’s a relative
contraindication in women over 35 yrs but still its better to avoid smoking
Once the specialist gives u a go ahead, then ill start u on OCPs
PREDOMINANT ASSESSMENT AREA - HISTORY TAKING STATION 9
Scenario: Headache Grade: Pass
Assessment Domain Domain Score (see key below*)
Approach to patient/relative 4 4
History 4 4
Patient Counselling/ Education 3 3
Global score 4

Lady with Headache. Past histories of abdominal pain-undiagnosed, urinary tract infections-undiagnosed etc
Multiple visits to the practice.
Tasks: History of the current complaint.
Most likely diagnosis and other diagnosis.

She was a difficult role player to begin with she started crying
Doctor please do something my head is bursting with headache omg n dramatic
I gave painkillers and asked SOCRATES of headache
She had a previous dx of tension headache and MRI was normal acc to the stem
I ruled out migraine and asked her if her headache is similar to the one she has always had before or has it cha
Nothing new or changed in terms of headache but too much drama / acting
I started with somatization pain and she had some dysuria previously that has resolved, some tummy pain
The 8 pain criteria wasn’t met so somatization was ruled out for me
She didn’t think there was an underlying hidden dx that wasn’t being ruled out so Hypochondriasis out
Asked psychosocial hx: Mood was low, sleep was disturbed, no anhedonia, no psychotic features
Nil BDD, GAD, OCD, PTSD or anxiety features but she looked anxious
Nil diarrhoea
Stressed about her job as she works in a bookstore and the owner has hired new and pretty young girls n she th
He will fire her
Had breakup with BF sometime ago but there was no dysparunea ever
In this case, as usual I did detailed history and said most likely it is Somatoform Disorder, didn’t give any ddx
(time was up, didn’t explain anything)

PREDOMINANT ASSESSMENT AREA - MANAGEMENT/COUNSELLING/EDUCATION STATION

 10
Scenario: Pallor Grade: Fail
Assessment Domain
Approach to patient/relative 6
History 3
Diagnosis/ Differential diagnoses 6
Management plan 2
Global Score 2 FAIL
I failed this case
18 month old child. Had URTI a week ago, seemed pale to the doctor so he ordered some labs.
Labs had anemia, microcytic hypochromic. Platelets, wbs normal. Low Fe and Ferritin
Tasks : History
Explain the investigations with diagnosis.
Advice management plan.

Iron def anemia labs were already give in the stem and growth chart was 50 centile
I took history and got cow milk overfeeding and picky eating positive
Mom was happy
Home situation ok
No FFT ddx were positive
Nil diarrhoea or lactose intolerance
She had BF baby till 9 months, no celiac of fhx of special diet
I told the mom that the most likely reason could be cow milk as its deficient in iron and picky eating
Mom was very happy with me as I explained her that the growth chart looks good so not need to worry and
we can chalk out a plan
Dietician for cow milk switch to another milk and proper diet plan as child is eating junk food mostly chips biscui
Iron supplements available in diff flavours n pick what flavour he likes
Will have another check up after a few weeks time to plot growth chart
The only thing I think I missed saying was to repeat Iron after 2/3 months
(Failed feedbacks helped me improve hence I wrote this)

PREDOMINANT ASSESSMENT AREA - MANAGEMENT/COUNSELLING/EDUCATION

Scenario: Cough

Assessment Domain
Approach to patient/relative 5
Interpretation of investigation 5
Diagnosis/ Differential diagnoses 6
Management plan 6
Global Score 6
COPD values in a spirometry given. Middle aged guy, ex smoker, now having breathlessness with exert
sats 93% and wheeze.
Tasks: Explain the results to the patient . Explain diagnosis. Outline management plan.

The stem had lots of info

COPD scenario with ex smoker, hyperinflated lung fields and exp wheezes BL
Spiro shows 6% increase

I explained spirometry fev1 and fvc in layman terms

We compare these ratios with a healthy persons lung functions ratios to compare how ur lungs are doing
Checked understanding and he was happy with my explanation n quite frankly it was my 2nd last station
was too tired hence used some hand gestures to explain 6% means irreversible and more than 12%
is revsersible which is asthma
Both these come under the umbrella term OBSTRUCTIVE diseases in which there is an obstruction
like phlegm or air trapped inside in ur case
I gave ddx as occupational exposure, chest wall abnormalities that can also give abnormal lung tests
I didnt talk about TLC DLC as I had 3 tasks

Quickly moved this time, hence, I would like you to follow a management plan we call as COPDx and
explained each component in detail
Appreciated him for quitting smoking, asked to avoid passive smoking, covid hotspots and get covid jab
Inaddition to other vaccinations
He said I don’t smoke anymore, I explained smoking causes irreversible damage but its good that u stopped an
Reassured

PREDOMINANT ASSESSMENT AREA - MANAGEMENT/COUNSELLING/EDUCATION

Scenario: Health review

Assessment Domain
Approach to patient/relative 6
Diagnosis/ Differential diagnoses 5
Patient Counselling/ Education 4
Choice of investigations 5
Global Score 5

Hypertension in 42 year old. Ambulatory BP was high about 150/100. Office readings high 170/100 something.
Copper wiring and tortuosities in the retina.
Tasks: Explain the significance of ambulatory BP monitoring and exam findings to the patient.
Explain the most likely diagnosis and risks and consequences of it.
Order investigations

It was big stem with ambulatory BP as 155 Systolic and in ur clinic its 170 175 something systolic

I explained white coat HTN and said when you see a doc its normal to feel a bit nervous and hence ur B
Rises, thats why we do ambulatory BP monitoring so that u can check ur BP at home when u are relaxe
and
It gives us a fair idea about the range

I explained that there are already some changes happening in the back of your eyes we call as copper w
Which means that these blood pipes are small n sensitive to high BP tend to overlap and dilate

As the stem had nothing positive in him, he was a young guy with positive FHX in both parents for IHD a
HTN, I said most likely you have something we call as Essential HTN as you have a strong FHX

Consequences > damage to back of eyes, kidney blood pipes, leg blood pipes become hard and give le
Heart becomes weak in the long run and brain blood pipes also become tensed and give headaches

INV: I told acc to TRACKPADS

Bloods for kidney function tests, thyroid, lipid, hormones cortisol etc in blood, urine hormones and protei
ECG, kidney ultrasound and will regularly check ur eyes for new changes and may need
an ultrasound of heart and leg pipes later on if any complications arise
PREDOMINANT ASSESSMENT AREA - EXAMINATION

Scenario: Obstetric examination

Assessment Domain
Approach to patient/relative 5
History 3
Choice & Technique of examination, organisation and sequence 4
Choice of investigations 4
Diagnosis/ Differential diagnoses 4
Global score 4

36 weeks pregnant lady with hypertension and proteinuria. Obstetric exam and fetal heartrate
already done.

Tasks:
Take history for 3 min
Explain to the patient what examinations you would do. Explain the instruments you would use.
What investigations would you order.
Tell the patient of the most likely diagnosis.

In the stem they had already performed a full obs exam, FHR and fundal height was normal
BP was 155 systolic
Urine protein was two plus
All this was given in stem already

I asked history about pre eclampsia headaches, blurry vision, leg swelling, fits, confusion, shakes,
altered consciousness, any bleeding or bruising, yellow discoloration of skin
I didn’t do whole obs history as prompt timer already appeared 3min over

I told her I need to check the back of your eyes with the help of a fundoscope and will use some drops to
Dilate the eyes u may feel blurred vision but it will be fine, this is to rule out any swelling in the nerve
supplying the eye, reassured

Next, would also like to check some reflexes using a hammer, it wont hurt, and some abnormal repetitive
 movements called clonus in your foot

I will also check for any signs of bruising bleeding and yellow dislcoration of skin
Your right upper tummy for any pain (HELLP)

Inv: Bloods for platelets and kidney function tests esp, LFTS, urine proteins, CTG, USG of baby

PREDOMINANT ASSESSMENT AREA - EXAMINATION

Scenario: Weakness

Assessment Domain

Approach to patient/relative 4
Choice & Technique of examination, organisation and sequence 4
Explanation of procedure 4
Global Score 4

72 old man, had a TIA. Now okay. Teach a medical student how to do motor examination of upper and
lower limbs.

I was so happy finally got an intern to use as much medical jargon I wanted

I started with WIPE, vitals, inspection for stroke features: ptosis, loss of wrinkles, deviation of face,
Loss of nasolabial fold etc
Then talked about GAIT: antalgic, rhomberg test for cereballer, both closed n open eye n why,
Tandem gait

Motor exam involves ITPRC

Inspection SWIFT (geeky)
Tone I showed on my elbow n wrist for UMN n LMN lesions we check
Power I told all dermatomes wise for upper limb C5 for shoulder abduction etc
Reflexes ill check biceps, n he asked me how do we check biceps reflex
I said youll have to paplate the tendon in the cubital fossa lateral to the artery, place ur thumb n tap hammer
on ur thumb
I told triceps, knee, ankle a lil details as I didn’t want to waste time by letting him ask me

Explained ill check clonus by repetitively dorsiflexing the ankle

Coordination u can check dysdiokineisia I showed with my hands and heel shin on legs as per geeky

I told ill finish with all cranial nerves, fundoscopy, carotid bruits n cvs auscultation

PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION

Scenario: Post-surgery delirium

Assessment Domain
Approach to patient/relative 4
Interpretation of investigation 5
Accuracy of Examination 3
Diagnosis/ Differential diagnoses 3

FAILED DON’T KNOW WHY

Stem was v long
Normal lab values were not given
Megaloblastic anemia and GGT were high

I did as per previous feedbacks and said it is Delirium tremens or Wernicke Encepahlopathy

Role player was v naggy and it was my 2nd station, as I had a rest station to being the exam with!!!!!!!
She asked me too many questions what is GGT , what is enzyme, what is megaloblastic, though I kept my
Cool but maybe I was so nervous after the v first station begin a rest station maybe I missed a critical point
PREDOMINANT ASSESSMENT AREA - EXAMINATION

Scenario: Breathing difficulty

Assessment Domain
Approach to patient/relative 5
Choice & Technique of examination, organisation and sequence 5
Explanation of procedure 5
Diagnosis/ Differential diagnoses 5
Global Score 5

4 year old child. Fever 39 degrees, cough for a few days. Now not eating food.
COVID swab negative 3 days back

Tasks: Brief outline of examination to parent.

Explain to examiner the examination and what you will be looking for.
Interpret the examination findings and give likely diagnosis/differentials.

I greeted the father, and asked permission for examining the child, and told about insturments
Like torch to see inside the mouth, otoscope to see inside ear, steth to listen to chest, tongue depressor

I didn’t have any PE approaches for online exam or any tutor or any feedback so I followed my own insti

I told the dad ill check your childs hands, face for bluish discoloration, dehydration signs like
sunken eyes, dry mouth dry skin
then his ear for any infection discharge and ear drum using that instrument, will check nose for any swelling red
or small
harmless growth called polyp, mouth for coated tongue, any spots in molars (kolpik spots), glands called tonsils
which can be big, infected or red and a central structure called uvula
checked understanding, dad was chill and happy
I said Work of breathing in layman terms like any abnormal noises and retractions of chest wall to dad
I will also CHEST, I will have a look for any abnormal movements, any noises I can hear
and if there is any bony deformity in chest wall in front or the back,
Will feel for wind pipe (tracheal tug) in middle of neck it wont be painful,
ill tap on the back of the chest and will also listen the chest for air entry n any abnormal sounds
I told we can play a game who stays silent for a longer time
(so that the child doesn’t move n stays quite for a good auscultation which my GP did for my child lol)
Dad was quite happy and understood well

Then I spoke really fast to the examiner n used a lot of jargon for the examiner who was thankfully mute as
my PEFE card had already pooped up n I was running out of time
PEFE card popped up after 5 min > RR-24, Hr=120, T-39
PEFE-R side fremitus, resonant-increase, dullness on percussion, decrease breath sound
DDX: Infection in lungs by a bug called Pneumonia and collection of fluid around lungs called Para pneumonic
Effusion (time up)

PILOTS

HIP REPLACEMENT
60 year old man, with arthritis of right hip. Wants to get total hip replacement.
Wanted it last year but the GP said the symptoms weren’t bad enough.
Tasks: Take history.
Explain in general terms the process of total hip replacement, its risks and benefits.

, PEFE card-gait antalgic, restricted movement all direction

Has some problem taking the dog to the park for a walk
Daily life is affected
Limps
Pain since 1 year
Lives with wife
[don’t need to tell technical part of hip replacement]
smoking, alcohol positive
I told him we use implants and replace the joint , it is a long procedure that requires
hospitalisation for prolonged period of time, has infection risk, bleeding, blood clot formation,
and longer time for recovery
Pros are you will be good to go for ten twenty yrs and will be followed up

LIP RASH
Tasks: explain rash to mother.
Briefly outline how you will examine the child to the mother.
Explain in detail the examination to the examiner with landmarks.
Explain what you would be looking for in history and examination given the condition of the child.
May 2021 Recalls
4th May 2021
1. Bulimia Hx Dx
2. Binge drinking hx including substance abuse hx and MSE, present MSE
3. Cough and fever with x-ray consolidation on R lung field 5 year old, hx ddx
4. Elbow PE lateral epicondylitis
5. Rash PE mental disability 20 yr on right knee and thigh. Describe rash to medical
student then PE ?maculo papular rash vs petechiae
6. Headache PE, paediatric ?5 years old generalised headache, some vomiting but no
specific timing
7. R Ankle pain, with skin changes and increase temp, no deformity +ve gardening hx, ddx
(? Cellulitis)
8. 34 weeks had APH, did usg, usg report low lying placenta completely covering is. Hx
explain report to patient, mx
9. - 56 year old woman, came in for new script for HRT, and routine checkup BMI 28
Counsel (basically on HRT for 6 years now, climacteric symptoms resolved, also didn’t
have mammogram or bone scan or recent HPV test, also gave advice for weight
reduction SNAP)
10. - ?pilot man with strange behaviour found in neighbour’s garden can’t remember much
from this case
11. - ?pilot mum came in suspecting ex husband sexually abused her daughter. Hx Ix and
mx (recently divorced, some weekends with husband, PE nonspecific erythema in vuvla
no other signs of NAI, but on hx she also said she has a new boyfriend who stays at
home, so important to ask about other adult carers as suspects and organic causes of
rash in vulva)
12. - Adult, cough, blocked nose, hx of asthma, wheeze hx ddx ? Acute Exacerbation of
asthma due to URTI
13. - Microcytic microchromic anemia in pregnancy, no iron studies provided, hx ddx Ix
14. - HT medication non compliance, came in for varicella zoster vaccine, forgets to take
med and recently moved away, hx mx

5th May 2021

STATION NO 1: ASSESED, NOT SCORED NEONATAL PE TO MOTHER
I tried to explain the whole neonatal pe to mother in layman terms including how we will check
neonatal exams. During the prep time could not prepare any PEs in lay man terms to explain to
pt or relative. Got lucky as this was not scored.

STATION NO 2: PAINFUL LEG PE (PASS)

LEG COMPARTMENT SYND< EXPLAIN PE TO MED STUDENT.
Good morning! My name is… , one of the drs today. How are you doing? How can I address
you? ( my opening statement for all).
(Mostly in pe stations the students themselves start to speak that I need to know regarding this
examination.)
So, our todays task is to do pe of a pt coming with complains of pain in leg. At any point if you
do not understand anything please let me know or feel free to ask me. First we will introduce
ourselves to the pt., briefly explain that we will be having a look, feel over their leg, asking them
to some movements only if hes able to do. As pt is in lot of pain offer him some painkillers after
ruling out any allergies. Then check the vitals of the patient to check if he is doing vitally well.
We will start our examination with inspection on inspection we are looking for any scar any
swelling any redness specially any color change of the foot. (SSRBMD) and if the bandage is
fully soaked, dry any open wound.
Then feel, ie palpation we will check temp changes, I added that we always check temp with
dorsum of hand and compare bith the sides. Check crt and pulse aim is to rule out any vascular
compromise. Check tenderness above n below the injury, avoid if very painful.
In this case, it might be very painful for the pt to do movements so we can ask him to wiggle
the toes. But for the purpose of explanation, we will discuss the movements. Then told him
movements and nerve supply of all 3 compartments, along with the name of muscles and nerve
its innervated by. Because task was to mention anatomical landmarks. I thougt it would be
appropriate to do so. Kept checking understanding in b/w.

Sensation Compartment wise.

Then explained compartment wise that if ant compt is involved then this movements n sensation
will be lost. Similarly, for other compartments too.
STATION NO 3 MENTAL HEALTH ASSESMENT PASS
University counsellor had referred a student because he was feeling lost his way and
depressed.  Task: hx, dx, dds

It was the same recall, mother was dx with pancreatic ca I think 2 years ago. He was having
dreams of her mother with the condition. And sleep was disturbed.
He also gave hx that father soon got married again n he's not getting along with his wife that is
why he is disturbed. Upon asking he said yes the mother's death happened around the same
time of year but that was just to confuse I guess.
There was no tearfulness, crying or low mood. But sleep disturbed because of dreams.
I gave dx as delayed ptsd n explained.
Dds: depression, anniversary grief, adjustment, subs abuse.

STATION NO 4: DIFFICULT BREATHING, PASS

Child(under 1 year)  is having breathlessness which started 2 days ago. He also had some
cough and mild fever.
TASK: Hx, dx, explain mx.

History same, hopc, assoc, d/ds..

Pefe card was given; I think stridor n fever was there, I don't remember it clearly.
Gave dx as bronchiolitis n child was having severe breathing difficult n dehydration.
As mx: told admission; O2 n fluids.. consult with specialist n once child is little stable so d/c after
consultation with specialist.

STATION NO 5: BEHAVIOURAL CHANGE: FAIL

It was clear cut mania case, Task: hx, dx, dds.

I got low score in pt counselling n education and that was a predominant assesment area. I
think thats why I failed.

STATION NO 6: PREGNANCY COMPLICATION; PASS

Preg lady in 2nd trimester, blood reports were given showing IDA. ( All other antenatal inves
done n normal, it was mentioned) Tasks: explain reports, Relevant hx, explain dx no mx.
Gave opening statement, explained the reports, asked ques regarding IDA explored reasons.
She was a vegetarian, less gap in 2 pregnancies, n also hx of heavy menstrual cycle.

STATION NO 7:NECK EXAMINATION : PASS

Explain thyroid Pe to med student.

Started the similar way. Started from hand, face( while explaining told this will be in hypo n this
in hyper) thyroid inspection, palpation explained, auscultation, percussion.
Explained how to check reflexes.

STATION NO 8. FAILURE TO THRIVE; FAIL.

I failed this one, growth chart was given outside showing decline in wt, ht was normal, I took all
hx as usual.. mother was least interested in talking even after knowing that the son is not
gaining wt.
She was single had financial issues, was not sure of his eating n pooping habits.

It seemed that of ftt because of neglect. But don't know why. I didn't say it.
Check the passed one.

STATION NO9. LATE PREG COMPLICATION: PASS

This was similar placenta previa case that has been coming with U/S report, tasks; explain n
mx.
Followed the same approach.

STATION NO 10. HEADACHE PASS

Typical migraine case.
Hx, dx,dds

STATION NO 11; HEALTH REVIEW PASS

HERION CASE..
same used it once, hx of travel and needle sharing..
Feeling fatigue..
I asked all tiredness ques..
Only tummy pain was there..
On pefe: tenderness over rt hypochondrium, udt: bilirubin +ve.

Gave dx as hepatitis; A,B, C n all other ddx of tiredness

STATION NO 12. ABDOMINAL PAIN: PASS

It was the same CT scan case; gall stones present but no thickening, diverticular diaease
present but no signs of inflammation, no comment on pancreas, hypodense lesion present in
liver.

First asked if hes doing fine, offered pain killers.  Explained all the findings of Ct scan
I did not say a firm dx...
I mentioned all dds of abd pain.
And in dx I said main thing I think that is causing tummy pain is the lesion in liver.
It could be hemangioma, hydatid cyst, abscess, primary ca, sec ca(though unlikely). Mx will be
decided by the specialist.

Will  see what blood inves have been sent Or will add fbe, uce, lft, amylas, lipase
U/s and might be biospy of the lesion.
Depending on the specialist.

STATION NO 13: VULVAR DISORDERS; PASS

Typical lichen sclerosus case.
Hx, dx, dds, Mx

STATION NO 14 SHORTNESS OF BREATH: PASS

Pt had difficulty breathing, hx of smoking +ve.
Explain resp pe to examiner n dx n dds to pt.
I explained the examination to examiner all details like how to do inspection, palpation( where to
keep hands) , percussion( how to do percussion, using the phalanx of middle finger)
auscultation.

In this station after explaining the examination to examiner there came a pefe card.
Findings were that of copd; hyper resonant node, wheeze.
I said dx as copd n told all the ddx of sob.

STATION NO 15; PRE OP MX; PASS

Pt was to be operated for sigmoid ca, was taking warfarin, anti htn, statin.

Hx and pre op counselling.

I mentioned the same approach as previous.

STATION NO 16; DELERIUM CASE, NOT SCORED.

Same greek lady case

5th May 2021

1– Pre-op counselling for a patient awaiting colectomy. On Warfarin, Ramipril,
Atorvastatin
2 – Compartment syndrome – PE to med student with landmarks
3 – Anniversary grief reaction. Mom passed away 2yrs ago at the same time.
4 – Mania – Known case of Uni student – history and diagnosis, ddx
5 – Bronchiolitis in a 4-month old child – Immediate mx, explain dx
6 – Delirium – Known greek lady case. Admitted to hospital with pneumonia & heart
failure. O2 sat 93%.
7 – IDA in 15/52 preganant lady – vegetarian, small gap between pregnancies;
menorrhagia before pregnancy.
8 – RS examination in 5 minutes to a medical student. PEFE & explain DDx
9 – PE of thyroid in a case who has difficulty in swallowing. What other findings you
want to examine. Explain it to a medical student.
10 – 18 months old child – FTT (tall & thin child, height was WNL & weight was
<3percentile). He was a fussy eater. Mom was depressed as well. Hx; PEFE; Mx. I
think... mom low mood – discuss baby history assessment findings with mom
11 – Placenta previa – known case, explain USS, management
12 – Migraine – known case. Hx & DDx
13 – Examination of a 10-days old neonate to mom. She has asked how to measure
head circumference.
14 – Guy took heroin two times a month ago. Feeling unwell, saying he is tired & has
tummy pain. PEFE: enlarged & tender liver.
Hepatitis C – Heroin IV use a month ago, feeling tired – PE findings given with
hepatomegaly and RUQ pain
15 – CT findings – known case with hypodense liver lesion, diverticulosis and gall
stones.
Another feedback: Explain US report to a patient – Large diverticula, calcified GB
stones, 2*7*12 mm hypodense lesion in liver. Explain to patient. Further Ix to order.
16 – 77yrs old lady with itching down below ?Lichen sclerosis

11th May 2021

1.PE Rash picture given task:describe the picture to the student do pe dx and dd (rash present
in the back of leg but not extended to buttock positive h/o flu 10 days back)
2. CHILD WiTH COUGH PE to parents resp
3. One more PE
4. Depression psych h/o and PE
5. Famous coackroach case
6. Boarderline personality disorder with wrist cut
7. Vaginal bleeding for 3 mths on mirena for 3 yrs h/o pefe d/dx
8. Antenatal visit task Ix till gp setting hospital from 16 wks and precautions to be taken in
pregnancy
9. Pregnant 36 wks comes for f/u BP high protein +++ abd exam given all Discuss about finding
focused PE you would look for PEFE after 6 mins dx with reason
10. Iron deficiency anaemia case similar to HB describe ix hb mcv mchc low wcc and plt normal
task describe the ix h/o dx/d with reason
11. Dark coloured urine post cholecystectomy h/o pe dx/dd
12.child with fever 39 degree h/o what pe will you look for PEFE card d/dx (positive finding in
pefe card painful knee hip alright)
13.cough in child h/o pefe dx/dd
14.diarrhoea for 3 mths adult h/o 6 mins d/dx (postive h/o Ab use and slimy poo)
15.ECG MI HMO in rural area describe ECG 3 mins Mx to the patient *note no option to transfer
the patient to tertiary
16. Knee pain giveaway during game H/o 5 mins PEFEcard d/dx (positive finding lachmantest
+ve patellar apprehension test couldn't be performed)

11th May 2021 – Another feedback

1. PE Rash picture given task:describe the picture to the student do pe dx and dd (rash present
in the back of leg but not extended to buttock positive h/ o flu 10 days back)
2. CHILD WiTH COUGH PE to parents resp
3. PE
4. Depression psych h/ o and PE
5. Famous coackroach case
6. Boarderline personality disorder with wrist cut
7. Vaginal bleeding for 3 mths on mirena for 3 yrs h/ o pefe d/ dx
8. Antenatal visit task Ix till gp setting hospital from 16 wks and precautions to be taken in
pregnancy
9. Pregnant 36 wks comes for f/u BP high protein +++ abd exam given all Discuss about finding
focused PE you would look for PEFE after 6 mins dx with reason
10. Iron deficiency anaemia case similar to HB describe ix hb mcv mchc low wee and plt normal
task describe the ix h/ o dx/ d with reason
11. Dark coloured urine post cholecystectomy h/ o pe dx/ dd 12.child with fever 39 degree h/ o
what pe will you look for PEFE card d/dx (positive finding in pefe card painful knee hip alright)
13.cough in child h/ o pefe dx/ dd
14.diarrhoea for 3 mths adult h/ o 6 mins d/ dx (postive h/ o Ab use and slimy poo)
15.ECG MI HMO in rural area describe ECG 3 mins Mx to the patient *note no option to transfer
the patient to tertiary
16. Knee pain giveaway during game H/o 5 mins PEFEcard d/ dx (positive finding lachmantest
+ve patellar apprehension test couldn't be performed

12th May 2021

1. breast lump exam to med student
2. two years old child had flu like symptoms 3 weeks back, PE - ESM with grade 3/6, x
ray showed boot shaped heart, perform PE talk to your med student
3. 50 years old lady with hot flush, menopausal counselling
4. taking temazepam 10 mg daily for a year, now here to refill the script - history, explain
the cause for insomnia
5. 42 years old lady with 6 weeks preg, BMI 32 - history and counsel management
6. 18 years old, having tightness of chest, dizziness and palpitation, take history and
counsel dx and ddx
7. 27 years old lady with 34 weeks preg, having posterior placenta previa covering the
os in USG, u re in the rural area where it is 250 km away from the level 4 hospital -
explain USG, explain about further investigation u would like to do, furthere
management
8. 62 years old, having chest pain - take history (it is leading to pericarditis), when they
provided the PEFE (seems like pneumonia), explain likely diagnosis and ddx
9. serotonin syndrome
10. periorbital cellulitis examination to med student
11. TIA exam (slurred speech and left sided weakness) - i forgot to check fundoscopy

12. 72 years old man having back pain, PEFE card - moderate tenderness at T 10 level,
SLR is positive at 30degree, no sensation loss, no urinary and bowel problem
13. two years old girl is having intermittent pallor, since 6 months of age, history(only
tiredness was positive, no family history of blood disorder, had jaundice after the
delivery), PEFE card - jaundice, pallor, invx showed spherocytes +++, Dx - hereditary
spherocytosis
14. wife concerned about her husband drinking, 3-4 SD of wiskey with soda, never try to
stop it, not feeling guilty abt his drinking, not eye opener, only drink at the midday and in
the evening, driving license was suspended due to drink driving 6 months back task -
history, explain it potential consequences to the patient
15. 60+ old lady had a fall(second time) this morning, she also had a fall in the couple of
weeks back. concerned about it. task history, PEFE card - nonfasting blood sugar level
is 5.8 mmol/dl. no postural drop. in the history, i didn't get any positive findings, no
skipped meal, generally healthy, nothing was postive. no medication, no trauma,
16.osteopenia result explanation. femur -1.4, AP spine value was 0.3. vit D level was
37(normal more than 50), COPD patient taking oral steroid 30 mg for 8 days whenever
there is an attack, currently on budisonide and another puffer medication, smoking a lot,
3 glasses of red wine,... task explain result, talk about the contributory factors and
management.

12th May 2021 – Another feedback

1. 62yo recurrent falls – 2 falls in 1 month
Task: Hx; DDx
2. Depression – Temazepam script request
Psychosocial Hx; Causes for insomnia
3.Advanced age pregnancy – ANC counselling
4. Watches a movie – after chest tightness & SOB. Hx of parental divorce. Sx resolved.
Hx; Dx; DDx
5.Placenta previa Grade IV 34 weeks 240 km away
Explain U/S; Mx; Ix
6.Pneumothorax – Lt sided chest pain sharp/stabbing/pleuritic
Hx; Dx; DDx
7.Serotonin syndrome – known depression on escitalopram 10mg - increased to 20mg few
weeks back. Abdominal pain; dizziness; sweats; Temp 38
Hx; Dx; DDx; Mx
8.facila swelling in a child
PE explain to medical student
9.UL, LL motor exam
10.Back pain on increased movement at T1 level
PEFE T1 tenderness. Increased pain on all movements of Thorax & lumbar
SLR 30o
Hx; DDx
11. Hereditary spherocytosis – 2yo intermittent pallor for 6/12 splenomegaly
Hx; Dx
12.Patient with COPD for 20yrs – Chronic smoker on intermittent steroids
Bone density scan Femur -2.7 Lumbar spine -0.7 Vit D levels low
Ix findings with predisposing factors
Explain. Mx
13. Alcohol addiction: 3-4 drinks after work; 12 drinks ever Saturday. Wife brought as
concerned.
Hx; Consequence of alcohol use (physical, mental, psychosocial)
14.Breast exam. Lump in the Lt quadrant. Explain PE to med student
15.CVS exam 2yo – explain to medical student
PEFE Bilateral basal crackle; pitting oedema; sacral oedema
Mild diastolic murmur
CXRL Large heart; nil effusion
16.HRT counselling

18th May 2021

1.Hindfoot examination 
66 yr old used to play sports now coming with pain getting worse from sometime
Explain PE to student with anatomical landmark 

2. 60 yrs old man admitted for 5 days with sob, orthopnea swelling in legs
explain PE to student with the reasons what will you find in examination regarding history.

3. redness and watery Eye

Explain PE to Patient
what instrument will you use. Tell in detail

4.Rubella in pregnacy

5.Lichen sclerosis

6.Relpase of schizophrenia
Psychosocial history
risk assessment to patient
7.Sore throat rash fever ( ebv)
history
Pefe card after 5 mins
diagnosis
management

8.Warfarin counselling( inguinal hernia operation to be done, warfarin for afib, atenolol,
metformin)
Take History regarding medication and explain what to do just regarding medication

9.Bcc counscelling

10.All iron deficiency anemia lab result

Hb low 
mcv low
ferritin low
hb electrophoresis normal
wbc normal plts normal
explain investigations to mom
what findings will you find related to result
explain examine you examination

11. child with seizure for 8 mins  previous two history of febrile convulsion brought in ed
now stable but drowsy
bsl 4.6
temp 37.1
task history
diagnosis with reason

12.GAD (already diagnosed)

 Explain
Management
13.Short term memory problem long scenerio.she has injury to her elbow. Now fine. Has history
of high bp but never thought of taking medication. Now with ulcer on medial malleolus.
Take psychosocial history.
Tell your management. Role player was not easy to convince

14. Postop delirium alcohol withdrawal

Long scenario with preop assessment long list given with alcohol intake all preop investigations,
post op assesment done 
Tell brother preop findings
Postop findings
Diagnosis ,dds

15. Gout in knee (all findings given in scenario)

explain, investigations and shot term management

16.runny nose and blocked nose( Allergic Rhinitis) 

History
diagnosis with reasons
Mechanism of action

19th May 2021

1. Ocp with epilepsy. Same recall
2. Head injury paeds. Boy was playing had a head collision hx, pefe on card, Mx
3. Acute abdomen. Lt lower abdomen, PE to student. No dx
4.PE.. Pneumothorax xray given outside with chest pain, increasing with breathing, explain xray
to student, PE steps to student
5. Serotonin syn.. hx 3 min, Mx
All symptoms to dx given outside
6. Knee pain. Recent recall. Acl injury. Playing and done sudden twisting and effusion positive.
Lachman test not given on pefe card
7. Pleural effusion.. with sob . Cough with sputum. No Low.
Pefe card..lower lobe dullness on percussion. Hx pefe card. ddx
8. Ambulatory Bp.
Fundoscopy findings given..
Copper wiring, tortuous vessels etc high bp on 2 occassions
Hx, sigificance of findings, further Ix
9. Bruise on cheek. Mother father young working financial stress.. Hx, Mx
10. Anemia in pregnancy. Same recall. Positive Italian parents
11. Burning in urine.. male uti. Hx. Dx ddx
12. Pt feeling anxious.
Positive.. feeling scared of crowded placed. Hx. D.ddx
13. Nappy rash PE to examiner and explain rash
14. Neck pain with cervical spondylosis. Hx. Dx ddx
15. Alcoholic pt. Take hx of abuse and Present MSE. Alcohol level 0. 17

25th May 2021

 Increased thirst
2. Placenta Previa
3. Preeclampsia
4. EBV rash
5. Antibiotic induced diarrhoea
6. Apixaban
7. MDD with psychotic features
8. 6 MTH child with diffuse rash, vitals stable- temp 38.5,
9. Tension headache
10. COPD
11. Heel pain 1 yr
12.Unsteadiness
13. Missing mirena- bleeding
14. Downs baby- counsel mother.
15. Perimenopause
16. Vague lower abdominal pain

26th May 2021

1) Temporal arthritis .. steroids tappered..
Low mode , loss of appetite, loss oy weight, early morning awakening
H/o 6 min
Dx with reasons
( depression)
2) mom came daughter admitted to hospital with psychosis daughter improved with medication
H/ o
Dx and counseling (adjustment)
2) respi pe adult
3 months cough and sob
Dx : copd
Task: pe to student
Pefe card 6 min
Dx /dd
5) TIA..pe to student
Motor uper and lower limb..
6) prostate cancer counseling
Test explain
Marwan one
7)headache migraine with tension headache stresss
8) rash.. in chid in the popleteal fossa and back of leg for 3 month pe
Explain to mom and examiner..
9) toddler dia due to fruit juice h/ o, Dx
10)lif abd pain pe
Explain to student
11) family return from malaysia
7 yrs with fever, dry cough, sore throat for 24 hrs
H/o, Dx/ dd( pilot)
12) hrt for 6 yrs
Cervical screen and breast screen..
13) leg pain pvd
14) rt ankle pain gout
15)ida in pg
2 Nd pregnancy
Bleeding in 2nd pregnancy
Vegetarian
16) 27 yrs with dryness and itcy for 2 years lichen sclerosis (+_)
H/o , pic came, Dx with causes, mx

1st June 2021

MSE
A 27-year-old man intruded to neighbor’s house, abusive and shouting brought by the police in
ED, pt was having unsteady gait with blood alcohol level 0.17 mmmol/l. Take history to assess
his substance abuse, present MSE to examiner and tell the risk he is having.
Include alcohol tolerance, dependence and tolerance
Sudden onset pain-4 hrs,constipation 1 day, flatus less passed, decreased feeding, non biouls
vomiting(4 hrs abdominal pain)
Brother had gastro last week
h/s .d/d
5. Hypertension -noncompliant with medications
1.PE-COMA pt unresponsive Has DNR? Talk to wife then Perform an examination to the
student How do you break news of death? Or come to spouse
3. CT-Scan Renal Calculi right side Expl CT Scan Diagnosis and Management
6. Resp Exam Adult – pt has acute SOB had a Knee replacement 1 week ago is a smoker Do
the relevant exam (Resp) and give the diff diagnosis Student ask what is the diagnosis doctor
before I started my examination
Truck driver, with pleuritic chest pain, sob, stopped taking aspirin, alcoholic and smoker
d/d,
PE,MI,PERICARDITIS—PULSES PARADOXUS- Pulsus paradoxus is traditionally measured
using a sphygmomanometer. The brachial cuff must be inflated above the presumed value of
systolic arterial pressure and then deflated slowly to find the highest pressure at which the first
Korotkoff sound is heard, normally during expiration.
7. Obs Gynae C Section Request
8. Obs Gynae Mid Cycle Pain – USD shows ruptured ovarian follicle /free fluid in pouch of
douglas /Corpeus luteum rupture and ovarian follicle rupture Appendix not visualised
/gallbladder 1.5mm , WITH 3 STONESExplain USD findings Diagnosis FUTURE,Management
10- 4-5 EPISODES PER YEAR
PEFE-T/M OPAQUE, BULGING,TONSILLS ENLARGED NO EXUDATES, ANTERRIOR
GLAND SWELLING ,WT 25TH PERCENTILE, HT 50TH CENTILE--- IF IN STEM ONLY THIS
GIVEN THEN CHILD IS FINE THEN HE IS NOT FTT
BUT IF DECLINE IN 2 CONSECUTIVE STEEPS--FTT
3 yr old with Adenoids Snoring at night OSA with tonsillar enlargement – Hx and management
11. Obs gynae Fe Def anemia Explain Results what other results would you order (fe studies
with ferriten) Differential diagnosis with reasons
12.Police brought in a man found jumping over neighbors fence no delusions no hallucinations
Present MSE + substance abuse marijuana use and etoh Management Include risk assessment
13.Case of Depression with low mood with low tone, anhedonia ,typical depression case
Task
h/s, d/d
14.Child 3 years CHRONIC RUNNY NOSE,FLU LIKE SYMPTOMS,FOR 3 DAYS AND FEVER
38.5WHEESING ,F/HISTORY OF ATOPY, HAY FEVER, ASTHMA , PETS ,MUM SMOKER +
FH of atopy eczema PH bronchiolitis at 6 months PEFE given Temp 38.5 Give Diagnosis and
diff diagnosis, CHILD HOOD H/O BRONCHIOLITIS IN CHILD
PEFE-expiratory wheeze ,no crepts
Tasks
h/s.
d/d
15.Heel Pain Hx History 6 min Diagnosis /Differential Diagnosis
Lady 48 yrs old,had fracture 10 yrs ago, pain getting aggravated on walking , pain especially in
back of foot.ocp taking
Pefe
heel was compressed, widened.
Pain on inversion
Taskh/s.d/d
She had delusions of people putting pain in her chest , non-compliant with drugs

2nd June 2021

1- CVS examination explain to student. 34/M admitted with orthopnea/SOB since four days. Had
CABG 12 months ago.
2- 6 week baby bib mom about baby crying 3-4hours on evening. Take history. Pe card at 5
minutes. Counsel mom.
3- ADHD- 8 year old bib mom after a parent teacher meet with complaints of poor performance
at school. Take history. Pe card at 5 minutes. Explain diagnosis to mom with reasons
4- 6 year old with headache bib mom. Take history. Pe card at 5 minutes. Explain condition to
mom with reasons.
5- Antenatal 20 weeks pregnant presents to a rural hospital 400 km away from tertiary hospital.
To discuss delivery. Has specific conditions for delivery. She wants her whole family to be with
her during labour. Wants to have music and candles. Does not want any doctor or nurse to
assist. Does not want to take any medication or injections. Wants the placenta to be delivered
by itself. Doesn’t want it to be handled by medical staff.
Task is to take further history. Counsel the patient.
She has a normal antenatal history till now but complicated previous pregnancies and one
miscarriage. One c section previously.
6- 36 weeks pregnant presents with BP 150/100, protein 2+. Head engaged. Task is to explain
further examination and speculum examination. Counsel patient and tell findings to patient.
7- 58 year old on hrt. Wants a repeat script. Take history, investigations you would like to do
and management plan.
8- xray of an in-patient given. Patient is short of breath. Has grey coloured sputum. Reduced
breath sounds on right side with bilateral wheeze. Task is to explain xray to patient. Give dx and
ddx
9- 57/m pain in right abdomen. Radiation to flanks and groin. Take history. Pe card given. Talk
about investigations and counsel patient.
10- 60/m with right ankle pain. Pe on card. Examination/ explain diagnosis with reason/
investigations to arrange (not sure of tasks)
11- OCD- 22/f not completing assignments.
12- IBS with GAD/ somatiform disorder (not sure)
13- 62/f with trigeminal neuralgia. Pain around mandibular area. Take history. Diagnosis.
Differentials. All with reasons.
14- lady with cervical spondylosis and radiculopathy.
15- The rash on neck picture. Erythematous base with scaly rash. Picture given. Task is to
explain rash to examiner. Explain further systemic exam you would like to do to refute or
support your diagnosis. Further investigations to do
16- Facial trauma- PE to medical student.