NAFJA 2022 RECALLS

15th February f2f .................................................................................................................. 3

16th February: f2f ................................................................................................................. 4
22nd February: f2f ................................................................................................................ 8
23rd February: f2f ................................................................................................................. 8
24th February: f2f ................................................................................................................. 9
28th February Clinical Exam ................................................................................................. 9
1st march: .......................................................................................................................... 13
2nd March: ......................................................................................................................... 13
3rd March: ......................................................................................................................... 13
8th March: ......................................................................................................................... 14
9Th march: ......................................................................................................................... 16
16th march: ........................................................................................................................ 19
17th March online .............................................................................................................. 20
18th March f2f .................................................................................................................. 42
22nd march online .............................................................................................................. 43
23rd MARCH - ONLINE EXAM ............................................................................................. 45
29th march f2f .................................................................................................................... 45
30th march f2f ................................................................................................................... 47
31st march f2f .................................................................................................................... 57
5th April: online.................................................................................................................. 58
6th April 2022 online .......................................................................................................... 59
12th April: f2f ..................................................................................................................... 63
13th April f2f ...................................................................................................................... 64
14/04/2022 (Face to face) ................................................................................................. 65
20th April: online ................................................................................................................ 66
21st April: online ................................................................................................................ 68
28th april Recalls f2f .......................................................................................................... 71
29th April f2f ...................................................................................................................... 72
3rd May online ................................................................................................................... 73
4th May 2022. Online ......................................................................................................... 75
10/05/2022 f2f .................................................................................................................. 76
11th May: f2f ...................................................................................................................... 77
12Th May 2022 f2f .............................................................................................................. 77
17th May 2022 (online) ....................................................................................................... 78
18/05/2022 (online) .......................................................................................................... 82
24/5/2022- online =.......................................................................................................... 84
25/5/22 (Online recalls) ..................................................................................................... 85
26th May 2022 online ......................................................................................................... 87
1st June 2022 online exam: ................................................................................................. 89
2nd June: online ................................................................................................................. 91
3rd June: ===== .................................................................................................................. 91
7th june 2022 f2f ................................................................................................................ 92
8th June. F2f .....................................................................................................................107
9th June 2022 f2f ...............................................................................................................108
15th June 2022 Online .......................................................................................................124
16th June (online) ..............................................................................................................125
17th June (online) ..............................................................................................................126
21st June f2f .....................................................................................................................126
22/06/2022 f2f .................................................................................................................127
23rd june 2022 f2f .............................................................................................................128
28th june online ................................................................................................................128
29th June online exam ......................................................................................................129
30th JUNE ..........................................................................................................................139
5th July 2022 .....................................................................................................................144
6th July 2022 online ...........................................................................................................148
12th July face to face ........................................................................................................159
20th July recall 2022 FTF ....................................................................................................160
21st July: ..........................................................................................................................162
26th July online .................................................................................................................163
3 August 2022 f2f .............................................................................................................175
4th August 2022 f2f ...........................................................................................................176
09th August 2022 ..............................................................................................................178
10th August, 2022 - online .................................................................................................184
16th August 2022 F2F Passed feedback ..............................................................................184
17th Aug, 2022 recalls........................................................................................................196
23rd august 2022 PASSED FEEDBACK .................................................................................197
24th August 2022 Melbourne NTC ( Face to face ) passed feedback.......................................205
 31st Aug 2022 Online Exam ...............................................................................................220
6th September 2022 ftf ......................................................................................................220
7th Sept 2022 FTF pm session ...........................................................................................227
8th sept 2022 FTF ..............................................................................................................227
13th sept 2022 online ........................................................................................................249
14th Sept 2022 online ........................................................................................................249
20th SEPT 2022 f2f ............................................................................................................252
21st Sept 2022, F2F ............................................................................................................265
27th Sept 2022 F2F ............................................................................................................277
28th sept F2F .....................................................................................................................278
29th sept 2022 F2F ............................................................................................................278
5th October online ............................................................................................................278
6th October online ............................................................................................................279
18th October online...........................................................................................................282
25th Oct 2022 f2F .............................................................................................................286
26TH OCTOBER 2022 F2F ....................................................................................................287
27th October F2F ...............................................................................................................288
28th Oct 2022 Ftf ...............................................................................................................289
8th November online .........................................................................................................289
9th November 2022 Online ...............................................................................................290
15th November 2022 online ..............................................................................................293
16th nov 22 online .............................................................................................................293
22nd nov 2022, f2f .............................................................................................................295
23rd nov 2022 f2f ..............................................................................................................295
24th november 2022 f2f ....................................................................................................303
29/11/2022 f2f .................................................................................................................303
30.11.22 f2f ......................................................................................................................304

February
15th February f2f
1. Fussy eater hx Pefe management Marwan 256
2. Hernia examination to medical student feedback
3. Iron deficiency anemia explain report to lady in her 50’s tell causes and investigation management Marwan case 144,
4. Tremors hx diag ddx karen 34, Marwan case153
5. Child with sleep problems take hx Pefe and dignosis bilateral tonsillitis osa case karen
6. Pregnant lady with bleeding at 7week ultrasound shows retroplacental clot hx Pefe arrange investigations management
she takes marijuana
7. Respiratory examination to medical student long stem can’t remember
8. Bartholinitis/abscess?? Hx Pefe pic diag management allergic to penicillin
9. Repeat script tamazepan sleep issues hx tell reasons for insomnia depression symptoms present
10. Relapse of schizophrenia hx and mse and tell diagnosis
11. Nose bleed immediate management take hx and tell diagnosis use nasal spray steroids
12. Pregnant 20wks wants to discuss delivery wants to deliver in rural hosp with kids along music in room etc hx and
management she had bad obstetric history
13. 7days old not feeding well hx Pefe diagnosis with reason mother was positive with gbs swab at 36wks
14. Cough in middle age lady dry cough hx diagnosis
15. Acquired brain injury Mmse
16. Back pain hx Pefe diagnosis
(7. DELIVERY COUNSELLING IN A RURAL HOSPITAL- PILOT CASE october
A 35-Year-old female at 20 weeks pregnancy comes to the rural hospital where you work. She has come for discussing her
delivery plan. The rural hospital you are at is low risk and has low facilities of maternal care (written in stem)
A list was given of what she wants during her delivery:
1. She wants her partner and her children near her during delivery
2. She wants soothing music
3. She wants a midwife only, no doctors or nurses
4. She wat the placenta to be delivered by itself with no intervention
5. No unnecessary intervention
TASKS:
1. Take history for 4 minutes
2. Counsel her about her delivery plan and address her concerns

16th February: f2f

4- Marwan 193
7. Marwan 89, Handbook-
9. Smoking counselling 104, karen 8, handbook- 115
10. egg allergy- Marwan-
22nd February: f2f
1. AAA. Middle aged man had abdominal pain, smoker, on atenolol. HTN controlled. US given. explain report to the patient. Mx to
the patient.
2. COPD smoker with spirometry. Explain report. Hx. Dx with reasons
3. HSIL: 27 year old lady was LSIL 12 months ago. Now it is HSIL. HPV 16 +ve and 18 -ve. Explain results. Hx. Mx plan to the
patient.
4. Child 5 years Dad bib due to lethargy for 1min! vague Hx. No neurological findings. Loss of weight positive. Hx, PEFE, Dx with
reasons
5. IBS, lady irittaed. Psychosocial Hx, MSE, management. Conditions related to them.
6. Elbow examination in a male who used to be a basketball player when he was young.
7. Sensory PE in UL and LL
8. PE CVS in 5-year-old child unwell. Acute heart failure
9. Postpartum psychosis with depression? 3 page stem. All MSE findings were given. Explain Dx to the patient. Immediate and
long term Mx.
10. 92 year old lady with respiratory failure and pneumonia. DNR +ve. POA present. Explain to next of kin the patient condition
and palliative care as told by the specialist she will be referred to palliative care.
11. 9 month old baby, fever for 2 days, vomiting for 2 days. H/S PEFE, Dx with reasons. Ix. PEFE urine bag collected
12. Exercise induced amenorrhea. Hx, PEFE, Dx with reasons, Complications in her life.
13. 36-week PROM. Explain to med student what exam you would do. Explain CTG to med student.
14. 42-year-old with hx of 12 months of cyclical mastalgia. Hx, Dx, DDx. No US done.
15. Fell into sewage. Feeling unwell, N/V, upper tummy pain. +ve urobilinogen and tender hepatomegaly.
16. Limb weakness in a lady on apixaban for DVT. PEFE deranged ??? weakness UL and LL

23rd February: f2f

1. HSV Rash PE
2. Chest Pain PE
3. RUQ pain, PE med student
4. MSE- OCD
5. CST screening explain med student
6. COPS- spirometry
7. HT noncompliance
8. Headache – child
9. Delirium- UTI
10. Neonatal sepsis
11. Male UTI
12. Back pain
13. Depression Hx Dx
14. Post op day 3 discharge request Hx, PEFE, MX
15. Acute psychosis, pt is daughter, hx from father
16. Type 1 DM, request for home delivery

24th February: f2f

1. Hyperemesis gravidarum,,women with history of nausea and vomiting. Urine positive for ketones. And was asking to to do
further instigations and tell the pt diagnosis with reason
2. Young man with penile rash. Take history and tell diagnosis. Possibly HPV
3. Man with rotator cuff tear. Explain USG to pt and take further history
4. Recently diagnosed DM2. Tell her about dietary control and how to used glucometer. Picture given.
5. 16-year-old with abdominal pain. Take history and pefe given. Tell diagnosis. Most likely Non-organic abdominal pain
6. Pt with bilateral lower leg swelling getting worst for 6 months. History of varicose vein. Describe picture and tell student how
to to examination of lower limb. PVD examination.
7. Pt with dizziness and palpitations. Take history and explain ecg to examiner and tell pt about diagnosis. AF possibly due to IHD.
8. Child with rash on face. Looked infected, and with history of eczema. Describe picture and what examination you will do.
9. Heroin addiction. Take history and counsel patient.
10. Pt with dysmenorrhea, usg shows ovarian cyst. Take history and diagnosis with reason for her symptoms.
11. Child with seizure. Concerned and anxious mother, take history and tell her diagnosis.
12. OCD, take history and tell patient his diagnosis with reason. ( king)
13. Hand examination. Items like coin, pen, key and a small container was given. Exam hand using the items provided and tell
what you are looking for and then do remaining hand examination.
14. Facial trauma, tell medical student how you examine with relevant reasons.
15. Elderly women with increased frequency of micturition. Take history and tell patient diagnosis with reason. Physical exam
unremarkable,,most likely urge incontinence bt I said pelvic floor muscle weakness.
16. Women in 60s with history of calf pain on walking for 6 or 18 months, take history and tell diagnosis and other possible
causes. Most likely PVD.

28th February Clinical Exam

Station 1 (pass)
• Your next patient is a 55 year old (not sure if this was exactly the age but it was around this) man that comes here to do a
health check up. He has no complains but in his previous visit he did some blood work that he brought for you to discuss.
• ALT, AST, alcaline phosphatase, albumin, bilirubin were all normal
• GGT is elevated
• You also get the information that he drinks 1 bottle of wine everyday
Tasks:
• Explain lab results to pt
• Perform abdominal examination
• Diagnosis and differentials
There were no changes in PE of patient.

Station 2 (pass)
• Your next patient is a 68 year old lady that comes with complain of leg pain on her right leg for the past 2 months and it is
increasing. The pain is worse when she walks uphill. She has history of DVT on this same leg 10 years ago. Patient is
hypertensive and she takes propranolol to control her blood pressure. She is a chronic smoker she smokes 20 cigarettes
per day for the past 35 years. ABI is 0.7 on the right side.
• Tasks:
• - Explain her diagnosis
• - Differential diagnosis
• - Investigations
• - Management
PVD case she was also taking B blocker for Hypertension.
• Investigations:
• FBE, ESR, CRP, BSL, LFT, RFT, lipid profile.
• Duplex us
• CTA or MRA
Counsel:
• Lifestyle changes
• Medications
• Referal
• Surgery?
Station 4 (fail)
• Your next patient comes because he is has a inguinal hernia repair scheduled 10 days from today he takes thiazide for his
high blood pressure that is controlled. He did some investigations that he would like to discuss.
• Tasks
• -Interpretation of investigations
• - History
• -Diagnosis and DDs
Lab results (there were more but I cant remember)
• Potassium and Sodium just below the normal range
• Serum creatinine normal
• Blood urea nitrogen normal
• Estimated GFR normal
DDs of hypokalemia:
• Medication side effect
• Vomiting
• Diarrhea
• Dialysis
• Diabetes
• Hyperaldosteronism
• Diet
Station 5 (pass)
• Your next patient is a 9 year old girl that comes with complain of headache for the past 3 months.
• Task: history
• Diagnosis and DDs
Positive points in history:
• Patient has pain on back of the head
• Patient has pain almost every other day
• She is missing school
• Nausea/vomiting
• Photofobia
• Family history
• Parents just got divorced
Case of migraine.
Station 6 (pass)
• Your next patient comes with a lump and a rash.
• Task:
• History
• PEFE on card
• Diag and DDs
Positives in history:
• Patient comes and says she has a bulge from down below and a rash over the same area for the past 1 year.
• It is getting worse
• Patient is 58 years old menopause was 5 years ago and she takes cream for HRT
• Patient says she had 3 babies and they were all big babies and forceps was used 2 times
• Rash is very itchy
• NO LOSS of urine
• NO DISCHARGE
PEFE on card
• Red rash over labia
• Prolapse at level of introitus
• No loss of urine
• BSL 12
Diagnosis and DDs
• Uterine prolapse + candidiasis
• Tumor, fibroids, polyps, other types of prolapses
• DDs for the rash

Station 7 (pass)
• Your next patient is a 30 year old woman she Works at na office for the past 3 years and for the last 5 months she has
been feeling very anxious and she comes to discuss this with you.
• Task:
• History
• Diagnosis and DDs

Case of GAD
Station 9 (pass)
• Your next patient is a mother of a newborn that was delivered 4 hours ago at 35 weeks of pregnancy via normal vaginal
delivery. The baby had to receive oxygen via mask to maintain his O2 saturation and at this moment is stable.
• Tasks:
• -History
• -Diag + DD
• - Management
Case of RDS.
Station 10 (pass)
Your next patient is coming with complain of dark urine.
Task:
History
PEFE on card
Diagnosis and DDs

Case of Post cholecystectomy sd. Patient had surgery done 5 years ago. She also had pale stools, Loss of weight. She is a heavy
chronic smoker.
She asked what could be the malignancy related to her condition and I said cholangiocarcinoma.
Station 11 (pass)
• Your next patient is a 30 year old school teacher that comes because she is worried she had contact with a student
diagnosed with Rubella.
• She thinks she might be pregnant.
• Task:
• History
• Investigations
• Counseling
Rubella in pregnancy recall. She did not confirm her pregnancy yet.
Station 12 (pass)
• Your next patient is a 65 year old man complaining of blood in the urine
Task:
History
PEFE
Diagnosis and DDs
This patient had symptoms of painless bleeding in the urine towards the end of stream for the past 10 days. He also had
symptoms related to BPH for the past year (straining, dribbling, weak stream). He smokes heavily for a long period of time.
He has previous history of renal stone. On PEFE there is a mass in the abdomen (painless), DRE shows findings of BPH.
Diagnosis is combination of possible Bladder ca and BPH.

Station 14 (failed)
• Your next patient is a 35 year old woman coming with no complains. She is 37 weeks pregnant and all visits have been fine
so far. This is her third pregnancy.
• Task:
• Perform obstetric exam
• Diagnosis and DDs
I think this was normal pregnancy exam I did not find anything that pointed to any pathology, but I failed this case.

Station 15 *pilot
• Your next patient is a mother of a 17 year old girl who was admited to the hospital 7 days ago after an episode of
psychosis.
• Task
• History
• Diagnosis
• Management
Mom is showing symptoms of anxiety and can’t go to work. She also has trouble taking care of her other child.

Station 16 *pilot
Your next patient comes with complain of thirst (30 year old woman)
Give dds
This case patient said she started feeling increase in thirst for the past 10 days and also noticed increase in urinary frequency. No
complains of UTI. No discharge. She mentioned she put on some weight. No recent change in diet or exercise. No
excessive sweating. She started taking vitamin D tablets (3 or 4 per day because her mom got diagnosed with
osteoporosis). Her dad has DM. No other relevant findings.
Most likely vitamin D side effect
I put some information of this case in the clinical exclusive group already.
Station 17
• Your next patient is a 58 year old woman that comes with complain of joint pain over the hands and fingers and stiffness
• Task:
• Perform PE
• Diagnosis and DDs
OA physical exam

Station 19 (failed)
• MSE video for mania.

Station 20 (pass)
• Your next patient is a 17 yo teenager that has come because of complain of tiredness. He Works at his parents farm and
recently he has not been able to perform well. He has no known previous medical conditions.
• Tasks:
• -Take history
• - PEFE
• - Diagnosis and differentials With reasons
Famous recall of DKA

March
1st march:

1. DVT, h/o long flight, US given with DVT. Explain with reason,
2. Acute post partum psychosis,
3. UTI in pregnancy, 15 weeks, fever, vomiting, loin pain
4. Breast lump, 6 weeks post delivery, breast feeding, no signs of infection
5. Vomiting, Diarrhoea, 6 weeks baby, 1+ Ketone present, brother had gastro recently
6. CST, explain to Med St, pelvic US showed ovarian cyst
7. Paed CVS, PE, X-ray given
8. H/O seizure, Rt side weakness, UL & LL motor system exam
9. 4 yrs injury outstretch hand, PE to father, X-ray given afterwards, explain to father
10. 22 yrs male, urinary symptoms, penile d/c, h/o multiple sexual partner 6 months ago
11. Feeling “nerves” these days. No other findings, feeling hot, fanning herself, ? Thyroid disorder
12. Non compliant HTN medication case
13. SCC— BBN case
14. CXR given, 72 yrs female, wt loss, smoking history for 45 yrs, haemoptysis, yellow phlegm.
15. Painful Ulcer: PE to med St
16. 36 wks pregnant, itchiness whole body, raised LFT; ? Obstructive jaundice in pregnancy.
2nd March:
1. Obs exam (recent recall with chart provided) [Link]
2. Elbow PE
[Link]
3. Paediatric resp PE
4. Cvs pe
5. Down syndrome counselling
6. Ureteric stone CT??
7. UC counselling
8. Adrenal crisis tiredness – stopped medication
9. Secondary amenorrhoea- ovarian cyst?
10. Urge incontinence
11. Serotonine syndrome
12. Mania Hx, Dx, DDx
13. Neck lump, rt side, dry cough, no LOW, LOA, solid food swallowing problem??
14. Vasovagal symptom, examination to the mother, dx
15. Chronic liver disease due to alcohol
Stem is about a male patient diagnosed to have chronic liver disease, he stopped drinking alcohol when told he has liver cirrhosis.
Inv showed: deranged LFT, decreased hemoglobin, decreased albumin, decreased platelet.
Tasks:
-History taking
-PE findings will appear I think after 5 or 6 mins: (+) Fever, (+)jaundice, (+) ascites (+) hepatomegaly (+)parotid enlargement
-Explain the investigation results to patient
-Dx and ddx

16. Gential herpes, male

Acyclovir 200 mg 5/day PO for 5-10 days
3rd March:
1. Heart failure-breathing difficulty for 1 month
2. Fall- peripheral neuropathy- Alcoholic
3. PROM
4. Bartholin abscess
5. Osteopenia- Tscore, z score
Old aged male+ COPD and taking steroids+Osteopenia on bone scan,FHx +ve for [Link] results, history , causes and
management
6. Back pain at T10 region- weight loss-cancer

57 yr old man presented with lower back pain

Hx for 6 min
Pefe card will appear at 6 min
Dx ddx with reasoning
+from last 2 months maybe
Started gradually
No neurological prob along with it
No heavy lifting
Healthy balanced diet
Low almost 5 kgs in 2 months
Happy that he has reduced
No fhx of bone problems
Rest all negative
Pefe card
Pale
Tenderness positive in lower back
SLR positive bilaterally
No sensory motor reflexes deficit
No problem of loss of sensation around anus
7. Unprovoked seizure
8. Child lathergy- DM
9. Right sided facial swelling- pE
10. Hand PE- osteoarthritis + functional test(which test signify what)
11. Cockroach case- MSE
12. Live with boy friend, due to fight took sleeping pill, attempt several time previously, not intention to suicide- Borderline
personality
13. 58 yr old urinary pain... UTI due to prostate
14. Hyperemesis gravidarum
15. Abdominal examination- left lower abdominal pain- Man

8th March:
1.42 year lady with flu like symptoms for 3 [Link] negative
HX
PE card:flank [Link] rbc+.wbc+.protein1+.
Diagnosis with reason and differentials
2. school teacher with exposure to child with rubella.
Hx.
Counsel
Alan page 14
[Link] comes with 15 month old child and noticed she is not using left [Link] ho instrumental delivery and resuscitation was
required at birth.
Hx
PE card:left upper limb and ll weakness with increased reflexes
DD and DDX
Marwan - 73
[Link] with 6 weeks post deliver experiencing chest pain and palpitation at post natal class repeatedly. TFT [Link] shows
sinus tachycardia
HX
DX
Explain pathophysiology of the condition
[Link] 2 of laparoscopic appendix removal following ruptured [Link] wants to go home to take care of [Link]
has suggested to stay 72 [Link] SC heparin and IV antibiotics
Hx
PE card
Counsel(no management was instructed in question)
Hx PE card:all normal
[Link] use in woman whose husbands has threatened to leave her.
HX for 4 mins
Ix u will do and management
[Link] at 36 [Link] medical student the PE for 5 mins and interpret CTG.
[Link] pallor in a child since six months of age.
HX
PE card: hb;[Link] and platelet normal.s bil raised. Indirect:[Link] alt normal. Reticulocytes [Link] size
[Link]
DX

2yr old girl was brought to the ED due to lethargy. She has being having lethargy, on & off yellow skin for the past 6M. On Ex,
there was jaundice, pallor, splenomegaly, no hepatomegaly, no lymphadenopathy.
Ix were given on a separate sheet, all the reference ranges were provided.
FBE: this was a full report. I'll be mentioning only the stuff I can remember.
WBC- NL
Hb- 6
MCHC- high
Plt- 250
Retic count-12(<2)
Spherocytes- +++
Billirubin- total 200+
Unconjugated & conjugated- cant recall
Task:1) explain blood results to mother
2) Inform Dx to mother
3) Inform Ix to confirm
4) Inform Mx to mother
Do not take further Hx, come to a Dx with the given inf.

9. rt groin pain in a 67 year old man for 2 days with fever.

Hx for 6 mins
DD and DX
No trauma,no loa,low,no pain on lateral hip, no steroid, no twisting, no pain on sitying, diet good. No past history of trauma. No
other jts involved. No shoulder pain
10. herpes on lips with fever and irritibality
.explain rash to mom
outline how you are going to perform pE to mom
PE to examiner
[Link] stem of 50 pack years smker with SOB with recent flu like illness brought to ED.
Tell examiner about PE and investigation you are going to do for 4 mins.
PE appers: CXR: hyperinflated
ABG:CO2 high
PO2 low
Ph-7.33
Spirometry awaited
12. Pt came to ED with chest pain and sob.
Take history
PE card
Dd and DX and investigations you are going to order.
Sharp pain on [Link] on [Link] [Link] pain .said no swelling or [Link] by long journey by bus but did move
arund in the bus.
PE card:ll lobe lung [Link] [Link] parasternal murmur.
13. knee [Link] player asked how to do extension flexion nd some details of patellar tests
[Link] came to ed with abdomen pain relived with passing [Link] bronchitis and treated with [Link] still on
course. Tenderness in [Link] blood.
Drinking fluids but mouth is dry.
explain condition and diagnosis and ddx
investigations you will do
outline management plan
[Link] nerve [Link] 7 ,9,10,11 nerves to medical student.
16. 23 year old girl wants OCP.
Hx and counsel
Was told not to do management.
Was on topiramate.
Na valproate has no interaction with OCP, Topiramate interact with OCP, so need to give higher dose of OCP.

9Th march:
1. 37 yr old 36 weeks pregnant
Bmi 32
With c/o burning in epigastrium

On pefe-
Normal bp Soft mid systolic murmur A lot of other findings also. GERD??
2)OCD- king case
Mse hx 6min Present mse
3)Bronchiolitis paeds case May b 4 months old Dehydrated
Tell parent what examination to do
Examiner the physical exam
What to ask in hx
Dx n dds
4)Seborrheic dermatitis
Picture with back of ear 67 yr male
Pe and relevant head and neck exam
5)Teenager with drug overdosage
Ectasy n 1 more
Breakup with gf
Parents concerned
Gcs 3 initially
Then 14/15
Thn 13/15
3 min hx
Tell parents condition and management
6)Old age woman
History of fall
4th time in a month may b
On meds for hypertntn and polymyalgia rheumatica since 7 weeks

Hx for 5min
Tapered to 10 on drs advice
Pefe at 6min showed glucose in urinalysis
Tell one office test to do
7)Breastfeeding woman with breast lump
Hx for 6min (Feverish,6 week postpartum,Mother had breast cancer)
Dx and dds
8)Genital herpes in 8weeks pregnant
9)Ecg given of MI of a pt in a metropolitan hosp
Chest pain and sob for 1 hr
Was chopping woods
No bleeding hx
135/85 bp given
Explain in 3 min the ecg
Tell management
No hx should b taken

10)7month baby, Umblical hernia,Undescended testes,Inguinal hernia

Explain result
Mother says wants to travel

11)Heroin I month ago, Feeling unwell

Hx for 5min
Dx and dds
(Right upper quadrant pain)

12)Rectal bleeding pt
Do rectal exam
Expain to med student

13)50yr female, Hot flushes

Hx for 3min
Tell diagnosis
Management with risks and benefits

14)17 yr boy,Abd pain for 3 weeks

Take hx for 6 min
Explain dx with reasons
On pefe at 6min
No pallor,No jaundice
Red nodules on shin
No arthritis
In hx he said he has some pain in knee
sloppy stools,No blood
Sharp pain
No stress

15)Knee pain,Playing volleyball

Hx for 5min (In hx she said there was swelling after half and hr)
On pefe-A lot of movements told at different angles, don’t remember
Patella tap test positive
Dx with reasons

16)female with headache

Hx for 6 min
Dx and dds
In hx-Has pain since teenager, Right side Vomiting sometimes

16th march:
Gout handbook case
Epilepsy driving license

17th March online

vsd
11. Raily p-74
12.
[Link]- P 6
Case 12- HB case no 20, P- 67
Case 15-
Results: We identified 211 patients with biopsy-proven lichen sclerosus, 63 (29.9%) of whom had thyroid disease. In women <55
years old, 25 of 74 (33.8%) had thyroid disease; in women > or = 55 years old, 38 of 137 (27.7%) had thyroid disease.
Conclusion: The prevalence of thyroid disease in our patients with biopsy-proven lichen sclerosus is almost 30% and is not
dependent upon age. This prevalence is 5- to 30-fold greater than in the general population.
 feedback
Thank you AMC clinical exclusive. This group has helped a lot in my preparation. I started preparing in June 2021 with Hand book
and then Marwan. I have done these twice. I also enrolled in Dr Shahriar’s clinical course. The tutors were very helpful in giving
genuine feedback and encouraging to do roleplays.
After this, as my exam was nearing I attended Dr Amir Workshops and just before my exam I attended Dr Amir’s medicine 5 day
workshop. I revised his topics in the last few days of my exam.
My study partners were very helpful and I could not have done this without their support. I studied in a group of 4-5 so that there
was always someone to do roleplays. But all of them were very regular and I thank them for that.
I did focus on MSE, rash practiced PE with my study partner.
I also did a online trial exam and I could pass only 9 stations.
Just before exam I could not study much nor do roleplays so just revised my notes.

My aim was
1. To complete all the tasks on time (even if I missed few things)
2. To tell DDs for every case
3. Talk till the 8th minute in every case
4. Study cluster wise rather than recall based.
5. There was prompt timer in almost all the cases.

Q) A father had come for Asthma review of his child. Asthma was well controlled but his weight was high , he did not do much
physical activity and was always watching TV. There is finding of his height and weight.
Task: Plot the graph and explain for four minutes
Counselling and management
PREDOMINANT ASSESSMENT AREA - MANAGEMENT/COUNSELLING/EDUCATION STATION 1

Scenario: Obesity Grade: Pass

Assessment Domain Domain Score (see key below*)

Performance of procedure 2
Diagnosis/ Differential diagnoses 4
Patient Counselling 4

I started off with telling him though the asthma is under control, nurse had noted some changes in weight and height. Is it ok to
discus now. He said yes. ( there was a coke tin on the table) I tried to plot the graph and it was above 95 percentile and then
explained him the graph ( I got 2 for this though). I spoke about management – again emphasized that Asthma is under
control which is good. I also spoke about diet, dietician, Exercise physiologist, Program by UNSW for obese kids and how to
manage. Parents counselling and try to eat meals like a family and include fresh fruits and veggies. Limit the use of coke and
carbonated drinks, fast food. Engage child in sports.
NOTE: Spoke to one of the tutor and he has told it is better to mention like in running commentary when you plot the graph. I did
not do running commentary. Talk bout how it copares patient weight/height with normal person same age.

Q) There is man who worked as a strawberry picker and noticed tingling numbness in the lower limb.
Task : do relevant PE
DD and diagnosis.

PREDOMINANT ASSESSMENT AREA - EXAMINATION STATION 2

Scenario: Walking difficulty Grade: Fail
Assessment Domain Domain Score (see key below*)
Approach to patient/relative 2
Choice & Technique of examination, organisation and sequence 2
Accuracy of Examination 1
Diagnosis/ Differential diagnoses 1
I don’t know what happened I did very bad in this case please see passed feedback of foot drop.
Even after seeing strawberry picker I dint think and roleplayer told me that my PE was fast and he cant answer.

Q) This was a menorrhagia case in a perimenopausal lady . History , diagnosis and dd

PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION STATION 4

Scenario: Health review Grade: Pass
Assessment Domain Domain Score (see key below*)
Approach to patient/relative 4
History 4
Choice & Technique of examination, organisation and sequence 5
Diagnosis/ Differential diagnoses 5

IN this case I don’t remember much but she was a perimenopausal so I stated with HPOI , 5 ps and then LOW,LOA ,lumps/bumps
Then asked family history of cancer Sadma.
Gave DD as DUB, Endometrial hyperplasia, Uterine cancer, endometrial cancer, perimenopausal symptom.

Q) This was a 60 year old female with sob. She lives in a rural town and husband is a farmer.
History , diagnosis and dd
PREDOMINANT ASSESSMENT AREA - HISTORY TAKING STATION 6

Scenario: Shortness of breath Grade: Fail

Assessment Domain Domain Score (see key below*)
Approach to patient/relative 4
History 3
Diagnosis/ Differential diagnoses 4

I thought I did this well but failed.

Please refer passed feebback. Cant remember what I missed. Positive findings were – she has SOB on exertion, wsa using 2/3
pillows, no fever no infections
Told about farmers lung, heart failure, asthma , COPD, PE( no travel history)

Q)Patient with depression was on temazepam. Still had sleep issued so another GP prescribed her Mirtazapine. Now she feels
headache and unwell. This is at Gp setting if I remember.
Task : history, diagnosis and management.

PREDOMINANT ASSESSMENT AREA - MANAGEMENT/COUNSELLING/EDUCATION STATION 7

Scenario: Fever Grade: Pass
Assessment Domain Domain Score (see key below*)
Approach to patient/relative 7
History 5
Patient Counselling/ Education 5
Management plan 6
This case I followed the serotonin approach by Amir. Started with hemodynamic stability and reassured the patient.
Confidentiality. Asked her about the meds, if she increased doses .any other medication, similar symptom in the past.
Talked about her mood and sleep and appetite.
Management told her we need to admit and stop both medications and once she is better will start with medication gradually.
She asked if admission was necessary – I told I highly recommend as you have depression and being off medication is not safe.
She was happy.

PREDOMINANT ASSESSMENT AREA - EXAMINATION STATION 9

Scenario: Health Review Grade: Pass
Assessment Domain Domain Score (see key below*)
Approach to patient/relative 4
Choice & Technique of examination, organisation and sequence 4
Accuracy of Examination 5
Diagnosis/ Differential diagnoses 4

Station 9:Thyroid PE
My first station was Thyroid PE. Stem was clear that it was Hypothyroidism and I had to perform PE and diagnosis and DD
I went in and saw a 50 ish old lady on the chair. She had a lump on the right side of the neck that was clearly visible. I was tensed
and although I knew Thyroid exam very well I could not do it in a sequence. I thought I would fail this case but thank god I
passed. Please make your own notes and if your exam is F2f practice on your study partner.

*
Station 10: Vaginal Discharge
50-60 yr old lady has come with vaginal discharge.
1) History 2) PEFE 3) Diagnosis and DD

Scenario: Vaginal discharge Grade: Pass

Assessment Domain Domain Score (see key below*)
Approach to patient/relative 5
History 5
Choice & Technique of examination, organisation and sequence 4
Diagnosis/ Differential diagnoses 5

In this with the age I did expect it to be atrophic vaginitis and thankfully my diagnosis was correct. She was menopausal with
brownish bleed dry vagina, problem with intercourse. No LOW LOA, no lumps and bumps.
Here I had to ask PEFE from examiner and I did ask about GA, Cvs and resp briefly, Abdomen for lumps and bumps, BMI, Pelvic in
the presence of chaperone and consent of the patient- She gave brownish discharge , dry vagina and UDT – negative for
leucocytes, nitrates
I gave diagnosis as atrophic vaginitis and dds endometrial hyperplasia, cancer, lichen sclerosis, HPV warts, Herpes (though she did
not have any risk) I did try to add and explain in one sentence why it couldn’t be.

Q)It was given in the stem that patient was worried about recent use of heroin and has come to the GP clinic.
Task
1. History
2. PEFE
3. Diagnosis and DD

PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION STATION 11

Scenario: Health review Grade: Pass
Assessment Domain Domain Score (see key below*)
Approach to patient/relative 4
History 4
Choice & Technique of examination, organisation and sequence 4
Diagnosis/ Differential diagnoses 5
This case I started off normally and the RP did not tell anything. Then I mentioned confidentiality and he started talking. I directly
asked about heroin history ,any other drugs, how did he take, any needle sharing, ( which was positive). He had pain in the
RUQ, no yellowish discoloration of skin , dark urine was positive.
He had no travel history

PEFE again I asked specifically for rash and jaundice .no rash. UDT I just asked nitrates ketones, leucocytes. Then the examiner
asked what else u want to know I forgot bilirubin ( did not remember) just moved on
Told my diagnosis as hepatitis C, Hep B ruled out hep A other DDs hiv seroconversion Liver cancer.
Q)There was a 60 ish man with complaints of Bleed per rectu.
History
DD and diagnosis

PREDOMINANT ASSESSMENT AREA - HISTORY TAKING STATION 12

Scenario: PR Bleeding Grade: Pass
Assessment Domain Domain Score (see key below*)
Approach to patient/relative 4
History 4
Diagnosis/ Differential diagnoses 5

This patient I started with confidentiality and asked the onset progression, duration, better or worse.
He said intilially was on tissue paper and now in the poo. No pain , no infection(fever /rash), something protrudes while he strains
for the bowel movement ( this finding he told me at the end when I asked is there anything else u want to add) – No
LOW,LOA,L and B. Again diet was off here.
I told u might have hemorrhoids -explained, external and internal, anal fissure (no pain) Pilonidal sinis(no dischare) bowel cancer I
have to rule out coz of age ( he told he has not done FOBT also) diverticulosis, angiodysplasia.

There is a mother of a 18 or so month old baby who was brought with fever.
History
PEFE
Diagnosis and dd
Management
 PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION STATION 14
Scenario: Fever Grade: Pass
Assessment Domain Domain Score (see key below*)
History 4
Choice & Technique of examination, organisation and sequence 4
Diagnosis/ Differential diagnoses 4
Management plan 4

This station there was a mother sitting and very worried. I started off with hemodynamic stability ( I think moderate dehydration-
so I said move to the resus cubicle and 2 large bore IV needles and start fluids while I take history.
Reassured the mother we will take good care of her son.
Asked her about fever since 3-4 days, no rash, vomiting, decreased nappies, no UTI, no git no one sick at home.
Then asked about PEFE – No lad ,sick child, dehydration +ve= moderate.
Told her that her son is in the best hands but needs admission and we will run some blood tests first( Blood culture, FBE,
electrolytes. And start on antibiotics

I told the diagnosis that can be meningitis, Otits media, UTI, GE

Q)This was a female patient truck driver and had come with behavior issues.
History for 6 min
DD

PREDOMINANT ASSESSMENT AREA - HISTORY TAKING STATION 15

Scenario: Behavioural complaint Grade: Fail

Assessment Domain Domain Score (see key below*)

Approach to patient/relative 4
History 3
Diagnosis/ Differential diagnoses 4

This lady was a truck driver and when I asked open ended Q she told that she had met with accident 1 month back where the
person she hit had died thought it was not her fault. Since then she had nightmares of the incident and today while she was
back to work ( her boss had given her 1 month off) she could not drive and had memories of the incident. So she came to see
you.
I told confidentiality and started with MSIGECPAS, her husband was supportive , they had recently gone on hiloday where she did
not have to drive. I did ask sadma and social history most questions, did not think I would fail this case. Please check passed
feedback.
 There was a gastroscopy result which stated hiatus hernia and Hpylori was negative and few other normal findings. Patient was
presenting with heartburn and tasks were to
Interpret the result
History
Counselling
Management (specifically said referral alone would not be enough)

PREDOMINANT ASSESSMENT AREA -MANAGEMENT/COUNSELLING/EDUCATION STATION 17

Scenario: Heartburn Grade: Pass

Assessment Domain Domain Score (see key
below*)
Approach to patient/relative 5
History 4

Interpretation of investigation 5
Patient Counselling/ Education 4
Management plan 4

For this station I started off by asking do you know why the investigation has been done??
How have you been since, how is the heartburn.
Then I told the report and explained positive and negative findings, drew diagram. Asked If I could ask a few questions and asked
onset duration, on/off any thing makes it better or worse, his diet , family history and SADMA coffee
There was positive in diet ( I don’t rememeber what he told)
I explained his condition again with diagram and said his symptoms are due to hernia
We will start with lifestyle modifications, PPI and if it does not get better will refer to gastero who could do a surgery and this
would be the last option if nothing else works.

Q)There was a father holding a doll on his shoulder. Outside in the stem there was baby who was crying,
Task was History, Diagnosis and DD
In this I started with reassuring the father and hemodynamic stability.
Asked about onset duration and there was vomiting 2 episodes and
I asked birth history in detail and asked other dd like infection, GI ,any other sick person at home, otitis media, UTI symptoms
 PREDOMINANT ASSESSMENT AREA - HISTORY TAKING STATION 19
Scenario: Crying Grade: Pass
Assessment Domain Domain Score (see key below*)
Approach to patient/relative 4
History 4
Diagnosis/ Differential diagnoses 4

In this case there was a long stem with 30 weeks gestation 3+ proteinuria and 150/85 or so BP. Tasks were to ask history and do
relevant PE ,diagnosis and diagnosis and DD

After my exam I did speak to a few candidates and they had mentioned that the BP apparatus was hidden and we had to
measure BP. Otherwise there was an ophthalmoscope and knee hammer on the table . Ophthalmoscope – I did till red reflex
but forgot to mention about dimming light and drops. Hyperreflexia was positive here. I forgot to do clonus. In PE when I asked
her to lie and wanted to check fundal height the examiner asked me what do u want to know and gave me the finding for
abdomen as well as the per speculum and everything was normal.
Otherwise in history I asked 5 P, folic acid use, 18-week scans, downs testing seizure medications sweet drink test, support
DD I gave preeclampsia, eclampsia, PIH

PREDOMINANT ASSESSMENT AREA - EXAMINATION STATION 20

Scenario: Late pregnancy complications Grade: Fail

Assessment Domain Domain Score (see key below*)
History 5
Choice & Technique of examination, organisation and sequence 3
Familiarity with test equipment 3
Diagnosis/ Differential diagnoses 4
In the end my pilot stations were ear examination: Conductive hearing loss, otoscopy on mannequin, and inspection and tuning
fork on patient. There was ruptured tympanic membrane on the mannequin

The other one was hematuria case with BPH findings . Dribbling, frequency, low stream ,hesitancy ,blood at the end of urination,
no burning/stinging sensation, no abdominal pain .

2nd feedback
17 May, 2022

Alhamdolillah I have passed my clinical examinations. May you succeed in your journey too. I think there multiple ways to achieve
this, you can take suggestions from everyone but have your own way of dealing with this exams. I chose a course for myself and
did Handbook and Marwan files along with it. Also tried to be regular with my role play practise. Physical examinations were my
weak point so did that more often. Also took one mock test a month before the exams. The online exam is pretty long and
tiresome so try to move infront of the camera in the rest stations. Also keep having some snacks in the rest stations so you feel
alert. The last 7-10 days should be dedicated to revision of things you have done till now. I had done only 6 months recalls. I was
also working full time and had taken 2 weeks off before the exam. I got a score of 12/14 stations Alhamdolillah. Hope the
following feedback helps you.

STATION 1 - PILOT
58 YEAR OLD PATIENT WAS DIAGNOSED WITH ALZEIHMER DISEASE 2 WEEKS BACK. HIS SON HAS COME TO YOU TO DISCUSS
ABOUT FATHERS CONDITION.
TASKS :-
- ADDRESS SONS CONCERN FOR 4 MINS
- DISCUSS ABOUT DIAGNOSIS AND COMPLICATIONS
- MANAGEMENT

Introduced and asked sons concern. He said he wanted to know more about the disease so told him it is a condition with loss of
memory and might get personality changes as well in the long run. He also said he was not in good terms with his father so wants
to know how we can help him in this. I told him we can arrange for social worker as well as nurse to be with him and help him.
Elaborated more on these points. Told him that complications are that prone to accidents(kitchen gas left on/forget car or house
keys), poor personal hygiene and impairs decision making.
In management I said needs to be supervised. Can arrange social worker and nurse. Also about meals on wheels. Also son asked
that he could go into depression, I said it is common in their age group. We could arrange activities for him to keep him engaged.
If not helping then can arrange psychologist and even medications if recquired.

STATION 2 - GLOBAL SCORE 4

40 YEAR OLD CAME WITH SHORTNESS OF BREATH AND TIREDNESS. BLOOD REPORTS GIVEN SHOW LOW HB, LOW MCV AND
MCHC.
TASK :-
- TAKE HISTORY AND INTERPRET THE RESULTS TO THE PATIENT IN 6 MINS
- GIVE DIAGNOSIS AND DDX TO PATIENT

Introduced myself to the patient and asked if I can ask questions before discussing the results. So asked all Qs of microcytic
hypochromic anemia ie. to rule out thalessemia (genetic origin), chronic diseases, infections(parisitic infestation), excess
bleeding(periods,post partum haemorrhage) decreased gap betweeen pregnancies, prev history of anemia, diet. I got only
positive history of PPH after the last chils but that was also 8 years back. Since I dint get anything else positive I said Iron
deficiency anemia and gave all the differentials. Also interpret the investigations by explaining that Hb carries oxygen and that is
reduced so you have SOB and tiredness.

STATION 3 - REST

STATION 4 - GLOBAL SCORE 6

YOUNG MAN CAME WITH INJURY TO RIGHT WRIST (VOLAR ASPECT) BY GLASS. BLEEDING HAS BEEN STOPPED BY COMPRESSION.
YOU HAVE A MEDICAL STUDENT WITH YOU NOW.
TASK :-
- EXPLAIN PE TO MEDICAL STUDENT
- MENTION ANATOMICAL LANDMARKS AND WHAT YOU ARE LOOKING FOR.

Introduced myself to the medical student. Explained WIPE approach. Vitals are stable was given in the stem. Said we are looking
for any injury to nerve, tendons or artery. Started with inspection by placing hands over pillow. All insoection findings scar,
swelling, rash etc. Also the semi flexed posture of fingers was lost. On palpation mentioned about CRT, pulse and sensation across
distribution of ulnar, median and radial nerve. Power assessment at all joints distal to the injury and also how to differentiate
movement of FDS and FDP. Special test ie. Pen touch test for Median nerve and Card test for Ulnar nerve. Also asked in between if
student was following.

STATION 5 - GLOBAL SCORE 7

MOTHER BROUGHT HER 13 MONTH OLD BABY WHO HAS FEVER.
TASK :-
- HISTORY FOR 4 MINS
- DESCRIBE WHAT PE YOU WILL DO TO THE EXAMINER TILL 6 MINS
- PEFE APPEARS AT 6 MINS
- DISCUSS DIAGNOSIS AND DDX TO THE MOTHER
Introduced myself to the mother and assured her that I would help her baby. Asked all fever source Qs ie. Meningitis, Otitis Media,
URTI, LRTI, AGE, UTI, Meningococcus Meningitis. Asked for rash anywhere over the body. Nothing was positive apart from fever.
On PE said will check vitals, dehydration status and if rash then what all would see. Dint mention Neck stiffness as small child.
Fundoscopy and otoscopy with examination. Mouth examination and quick RS and CVS exam(auscultation). Looking for rash and
LN all over body.
At 6 mins PEFE appeared showing fever 39 and right knee pain, redness, effusion +
I mentioned diagnosis as Septic arthritis and described a little. DDX osteomyelitis, septicemia, UTI, RTI etc

STATION 6 - FAIL
YOUND FEMALE WITH PAST HISTORY OF SCHIZOPHRENIFORM DISORDER, NOT REGULAR WITH MEDICATIONS.
TASK :-
- TAKE PSYCHOSOCIAL HISTORY FOR 4 MINS
- PRESENT MSE TO EXAMINER
- DISCUSS DX, DDX
So this was a case with a young female wearing a cap throughout, I couldnt see her eyes anytime. She kept looking behind and
spoke something weird about Harry Potter. I think I took the history in the normal format but did not present the MSE well.
ASETICJ3Rs, make sure you ask everything in the history of this. Also I said diagnosis as relapse of schizophreniform and DDX as
schizophrenia, psychosis and substance abuse. Thats when I remembered that I dint ask SADMA, asked then and Marijuana intake
was positive. I think I had to be more organised and also dint ask HEADSS Qs.

STATION 7 - GLOBAL SCORE 6

42 YEAR OLD FEMALE COME WITH COMPLAINTS OF IRREGULAR PERIODS AND HOT FLUSHES.
TASK :-
- HISTORY FOR 4 MINS
- DX WITH REASONS
- COUNSEL REGARDING MNX WITH RISKS AND BENFITS
Introduced and asked the HOPC first, then asked other symptoms (vasomotor, Somatic, Psychological, Urinary and Genital). Only
hot flushes and irregular periods. Also asked Qs to r/o thyroid d/o and phaechromocytoma.
Gave DX of Perimenopause and explained about it. Mnx HRT, risks of cancer, DVT, MI and stroke. Benefits relief of symptoms,
bowel cancer, Alziehmer ds.

STATION 8 - REST

STATION 9 - GLOBAL SCORE 4

PATIENT IS A CHRONIC ALCOHOLIC BUT RECENTLY STOPPED TAKING IT. HE IS COMPLAINING OF TINGLING AND NUMBNESS IN
LEFT LOWER LIMB.
PEFE GIVEN –
SENSATION LOST UPTIL ANKLE IN BOTH LOWER LIMBS. INVESTIGATION RESULTS WERE ALSO GIVEN, VIT B12, LFT NAD
TASK :-
- DISCUSS DX WITH PATIENT WITH REASONS
- EXPLAIN IMMEDIATE AND LONG TERM MNX
Introduced myself to the patient. Appreciated him for stopping alcohol intake, also confirmed if he started it by any chance. Told
him alcohol has an impact on various organs in our body affecting the brain (thinking, memory, decision making), heart, liver and
nerves. In your case they have affected your nerves and that’s why there is decreased sensation in your legs. This is called as Loss
of Protective Sensations (LOPS). This can lead to trauma to legs and frequent falls.
Mnx – supplemental vit b complex, Fall prevention clinic, healthy balanced diet, avoid smoking, regular physical activity, if ever
think of starting alcohol then come back asap, CBT and motivational therapy to prevent it.

STATION 10 – GLOBAL SCORE 4

4 WEEKS OLD BABY BOY BROUGHT BY MOTHER DUE TO RASH. PICTURE OF RASH GIVEN IN THE STEM.
TASK :-
- EXPLAIN DX TO MOTHER
- WHAT PE OU WILL DO, EXPLAIN TO MOTHER
- EXPLAIN WHAT PE YOU WILL DO TO EXAMINER, WHAT YOU ARE LOOKING FOR
So picture was given of Nappy rash(please check it on google). Explained mother the condition and could be due to increased
moisture (freq stools or wet nappy for a long time) or change in nappy recently. PE of the rash and hemat exam of baby in brief.
To examiner mentioned could be due to Seborrheic dermatitis but seen in creases of arms and groin or Psoriasis but seen on
extensor aspect of hands and legs with eyes changes or Atopic dermatitis but is on flexor aspect and dry and itchy skin with family
history. Hemat exam head to toe to the examiner to r/o seborrheic, atopic, psoriasis, viral infections, meningococcemia,
malignancy unlikely.

STATION 11 – GLOBAL SCORE 4

PT COMES WITH INCIDENTAL HIGH BP ON 2 OCCASIONS. KNOWN CASE OF HYPERTENSION ON TELMISARTAN BUT STOPPED
TAKING THE MEDICATION.
TASK :-
- TAKE HX REGARDING HTN MEDICATION
- COUNSEL PT ABOUT NON – COMPLIANCE
Asked about symptoms (headache, blurring of vision, chest pain, decreased urination) then asked about non – compliance, pt
factors (cost of medicine, alternative treatment, belief it helps), medicine factor (side effects) and doctor factors ( prescription
understandable, dx explained properly to the pt). Here she did not feel she should take the medicine since she feels fine also she
does not remember what her prev doctor told her about htn.
Counselled her about the complications on heart, brain, kidney. Also that symptoms might not occur unless it is very high and life
threatening at that stage.

STATION 12 – GLOBAL SCORE 7

FATHER BROUGHT 4 YEAR OLD SON COMPLAINING OF PAIN IN GROIN AREA SINCE 2 HOURS.
TASK :-
- TAKE HX FOR 3 MINS
- PEFE APPEARS AT 3 MINS
- EXPLAIN DX WITH REASONS
- ADV INVESTIGATIONS TO CONFIRM THE DX
So in history asked HOPC and tried to rule out Testicular torsion, strangulated inguinal hernia, pyelonephritis. Vomiting was also
positive.
Pefe showed left testis horizontal with no relief of pain when elevated and was also able to get above the swelling. Hence ruled
out hernia and epididymoorchitis(unlikely at this age).
Kept re-assuring in between and told him that he is within the golden period so can be managed accordingly. At this stage no
investigations are required as this is a clinical dx. Investigations would only waste the time. Specialist will take the child to the
operation threatre and untwist the testis, if damaged will ask your permission before removing it. Fertility preserved as other
testis is functional and also would fix other testis to the wall so that it does not repeat.

STATION 13 – REST

STATION 14 – GLOBAL SCORE 4

34 WKS PREGNANT LADY CAME FOR ROUTINE ANTENATAL CHECK UP. EXAMINATION WAS DONE AND SHOWED SFH 30 CM AND
SMOKIN + IN MOHTHER.
TASK :-
- HISTORY AND WHAT INVESTIGATIONS YOU WANT IN 6 MINS
- DX, DDX WITH REASONS
Asked any concern and all ANC Qs, ABCD FST ( ANC blood test, Blood group, Contractions, Downs screening and Discharge, Folic
acid and Fetal kick, Sweet drink test, Toxemia (headache and blurring of vision))
Bowel and bladder, past medical and surgical history, SADMA
Investigations, Ultrasound results appeared in the form of charts, showed liquor, Abdominal circumference, Crown rump length,
all in the normal range.
Told the diagnosis as IUGR, DDX as Oligohydramnios, genetic abnormality, infections, smoking/alcohol intake in pregnancy. I got
a 3 in diagnosis and ddx so I think you should look into this a little more.

STATION 15 – FAIL
23 YEAR OLD FEMALE CAME TO A SUPERMARKET WHERE SHE WAAS CAUGHT SHOP LIFTING. SHE DEVELOPED A FIT FOR LESS
THAN ONE MIN.
TASK :-
- HX FOR 6 MINS
- PEFE APPEARS AT 6 MINS
- DISCUSS DX, DDX
Asked all syncope cluster Qs in this ruling out CVS (MI, Arrythmia,AS,HOCM), CNS (stroke, epilepsy, trauam, tumor), Postural
hypotension, Vasovagal syncope, Pregnancy, Alcohol. Childhood history of epilepsy was positive but not taking medicine. Last
seizure was 10 years ago. So when I read the stem it felt like a Psych case but I dint ask psych Qs, SO belief in your first instinct. I
said the dx as epilepsy and all the ddx mentioned. It would have been Conversion d/o. Please check other feedback for this case.

STATION 16 – PILOT
32 YEAR OLD FEMALE COMES WITH LUMP IN BREAST.
TASK :-
- HISTORY FOR 5 MINS
- PEFE APPEARS AT 5 MINS
- DX, DDX WITH REASONS
First asked about HOPC Qs, Patient was post partum 2 wks and had cracked nipple positive so asked post partum Qs about Bowel,
bladder, breastfeeding, post partum blues and birth canal (episiotomy/dischare/bleeding).
PEFE showed painful lump but no redness and not fluctuant ( Im not sure) Told dx as mastitis and ddx as abcess,fibroadenoma,
adenosis, trauma, cancer.

STATION 17 – GLOBAL SCORE 5

FATHER COMES WITH 8 YEAR OLD DAUGHTER WHO IS COMPLAINING OF HEADACHE.
TASK :-
- HX FOR 5 MINS
- PEFE APPEARS AT 5 MINS
- DX WITH REASONS
Asked all headache Qs (Tension headache, Cluster headache, Sinusitis, Meningitis, Trauma, tumor, Migraine, Resp tract infections,
Refractive error). Family history of migraine was positive.
Pefe was Normal
Gave dx of Migraine and why others unlikely.

STATION 18 – REST
STATION 19 – GLOBAL SCORE 4
PT COMES WITH SUDDEN SHORTNESS OF BREATH SINCE YST.
TASK :-
- EXPLAIN PE TO MEDICAL STUDENT
- WHAT YOUR LOOKING FOR WITH ANATOMICAL LANDMARKS
In this stem vitals were given as normal but in that SPO2 was not mentioned so I mentioned that I would also check the
saturation. Then the medical student asked me how would we check that then I said with the help of an instrument called pulse
oximeter which helps measuring oxygen level in the body and should be more than 94 %. Then described the PE of respiratory
system as Geeky medics. Also mentioned about the CVS exam(JVP, carotid bruit and auscultation)

STATION 20 – GLOBAL SCORE 4

38 YEAR OLD MAN COMPLAINTS OF BURNING IN CHEST AND BITTER TASTE IN MOUTH. ENDOSCOPY WAS DONE AND SHOWS
SMALL SLIDING HIATUS HERNIA, INFLAMMATION OF LOWER ESOPHAGUS, NO ULCER, [Link] NEGATIVE, NO CANCER.
TASK :-
- HX FOR 3 MINS
- DIAGNOSIS WITH REASONS
- MNX
So stem looked like GERD so asked focussed history for it, causes ie. Spicy,oily/ take away food, NSAID intake, long gap between
meals, Coffee intake, stress,smoking. I had asked him to describe his diet for me so it gave almost all the findings. Positive was
take away food, long gaps,smoking and coffee intake.
Explained what the endoscopy findings were and gave the diagnosis as GERD responsible for his symptoms. Mnx I said PPI will be
given now and LSM required, healthy balanced diet, avoid smoking and alcohol, physical activity (SNAP).

18th March f2f

1. Jaundice & liver enzyme increased, WBC increased → Result+Hx+ PEFE,Dx,Ddx
JM- 657( Viral hepatitis?)

2. lower tommy ache, contipation, Hx, Dx,Ddx

47 year old with intermittent abdo pain(lower tummy) for 6months,,history of constipation,,blood on toilet paper,,no pain on
passing stool,,weight loss history.
No other finding positive,no family history of cancer.

3. rash whole body PE online pe exam,

4. Respiratory PE( hx of knee hx, 2 weeks back)

5. Displaced mirena, hx, ddx,

6. Daughter acute psychosis
Hx, Dx, immediate Mx.
7. allergic rhinitis, hx, ddx
8. [Link] previa.
Usg, inv, Mx.
9. [Link], ankle pain, after injury.
Tell pt how to do examination,
10. Pic of foot, swelling on 5th metatarsal ! Xray needed or not, why Ottowa rule
11. [Link] gravidarum. Hx, inv & why. Dx,DDx.
12. Developmental delay 9 month hx, ddx
13. 12. Bullimia nervosa, hx,Dx, mx(Marwan-42)
14. 13. Hernia, warfarin, inr 2.5, metformin, atenolol, hx, management (shiri surgery recalls case-3)
15. 14. Ct liver metastasis, anemia (Marwan- case 248) karen- oncology Explain, Dx, further inv.

Most likely its cecal/right sided colon's ca (dyspepsia with anemia) or stomach ca with mets to liver and back bone. After
explaining results (Follow SPIKES protocol for Breaking Bad news), tell the patient that these nasty growths in his liver
most likely seem to be coming from his bowel or stomach, so in order to locate the primary source of metastasis, he
need to have colonoscopy and gastroscopy (also take the opportunity to ask about any s/s of bowel ca and stomach ca).
 So refer him to gastroenterologist and oncologist immediately. Further tests to be done would UCE, LFT's, CEA, CXR, CT
abdomen and pelvis. Let the patient know of poor prognosis of metastatic ca. Tell him about Palliative care tram and its
goals in giving him better quality of life by keeping him pain free, symptoms free and to address the emotional issues.
Also tell about hospice care and pastoral care. As it can be a lot to sink in in first consultation, so you can offer him
follow up discussion and family meeting with his consent. Finish the discussion by ensuring him all the support you and
lots of other health professionals can offer. Also tell about different support groups and lifeline. Empathy is the key!
Also tell about pain management thats given in step ladder pattern n role of RT in relieving back pain. Treatment options
can be discussed in detail with specialist or in FU visit.

16. [Link] gait,alcohol (Marwan cerebellar ataxia- 26)

17. Egg allergy, History, Dx, management ( peanut butter allergy marwan)

22nd march online

1. Uti in male with discharge
[Link]- alcoholic- Marwan delirium case 203
3. Facial trauma PE Marwan P- 989
4. PE Death confirmation- Marwan P- 1148
5. PE- infectious mononucleosis Rash- Marwan- case 21
6. GDM in rural wants to deliver at home
7. C sec counseling wants becoz of pain

8- cough form shiri pulm-1

9- diverticulosis dt finding explain GB STONE LIVER MASS HYPODENNSE
10. Leg swelling varicose vein hx red in colour tell mx
11neck lump dx n ddx

12.. Primary amenorrhea exercise induced hormone Level given 18 yr karen, Marwan case 94, p-150

13. karen PPD with depression n psychosis explain n mx

14. karen 60, hB 363 page Marwan Pt with nervousness n palpitations explain ecg atrial fibrillation hx

15. Marwan 666 Headache in adult hx n dds

23rd MARCH - ONLINE EXAM

1. 42 year old female, home pregnancy test positive. BMI 32 and BP 130/80 - Hx and counsel about further management of
pregnancy. Marwan – advanced preg- 96
2. 52 year old male with SOB for months. Brings spirometry. Interpret Spirometry, Dx and ddx. Shiri pulmonology adult
3. Child 5 years old, presents with cheek rash and 40 degrees fever. Drowsy and hard to arouse. Explain rash to examiner and
describe PE you would do.
4. Neck lump in 42 year old male. Tooth ache associated and smoker. Hx Dx and ddx
5. Young male, had sudden chest tightness and SOB while watching a movie at home. Long history, parents separation when
he was 8 years old. Not the first episode, happened a couple of times before. Hx dx and counselling about triggers. ( Post
November recalls page 49)
6. Newly diagnosed diabetic. Counsel about diet and explain how to use [Link] P{78}
7. 27 year old comes with CST results. 1 year before results showed LSIL and results today show HSIL. Hx, explain results and
further management Marwan case 102
8. 33 year old male presents with sudden SOB and chest pain. Pneumothorax x ray. Explain x ray to med student and
Respiratory PE (what findings you would be looking for) online physical exam file
9. PHD mathematics student referred by counsellor because he changed the name of his thesis from ‘’A formula for
weather’’ to ‘’The formula to orgasms’’ - Hx Dx and Mx (Mania) Marwan case 202 MSE
10. Call by nurse about snapped cord, not able to deliver placenta. Mother is stable. Explain dx to mother and further
management Marwan snapped cord case
11. Hemosiderin rash legs PE like PVD exam
12. Diarrhoea for 2 months in a 2 years old. Hx Dx and ddx
13. Knee injury (ACL rupture) Hx Dx and Mx
14. Weakness in left leg and arm in 82 year old since last night. On apixaban multiple thrombosis in the past. hx ddx dx (Riley
p-82)
15. Complete abdominal exam to med student
16. 18 month had a cold, went to GP who noticed pallor. Ordered labs which show IDA. Hx Dx and Mx - Explain results to
father. Marwan case 199
Fe supplement

29th march f2f

1. Ocp counselling 18yr
- relevant hx,
-PEFE from examiner
- counselling
2. Fall on r shoulder 3 days ago.
-Shoulder PE
- most likely diagnosis.
No need for further hx or management.
(Likely rotator cuff injury )
[Link] stem of post op SOB.
Hemicolectomy 7 days ago.
You are surgical intern.
The stem had hx of sugery, his past medical hx, medication (ace i, frusemide, aspirin) stopped for two days before surgery
and restarted. post op clexane started.
 Charts of saturation, RR, PR, BP, temp given.
- PEFE from examiner
- explain to examiner the vital charts.
- explain to patient possible cause of SOB (no management)
likely fluid overload, but other differentials
4. MSE - depression in a 16yr old with acne vulgaris, with ?body dysmorphic disorder secondary to acne
5. 22yr old sent in by school counseller due to aggressive outbursts, talking back in uni.
- psych hx
- explain to patient likely diagnosis.
(possible manic phase of Bipolar )
6. 7 month old with vomiting - hx, PEFE, diagnosis and diff
Likely intessuseption
7. Chronic cough
- hx and explain to patient likely diagnosis.
ACE inhibitors induced.
8. Child tired and not concentrating at school - hx, PEFE AND Dx to dad.
Likely OSA secondary to adenoids and tonsils.
9. 22yr old bought to Ed, long stem post seizure 4hrs ago with visual hallucinations.
Bloods, LP done (which has protiens+, WBC+) hx and PEFE all on stem.
- Explain investigations to mom
- explain findings to mom and explain diagnosis.
(Meningitis)
10. Woman with pneumonia in Gp office - confused, aggressive. Large stem with hx, and vitals.
Explain to son
- condition and management
likely delirium.
11. a 3yr old in ED with 3 day hx of cough and fever, now lethargic.
CXR given
Focused history, PEFE, explain CXR and diagnosis
Likely paranpneumonic effusion.
[Link] patient came 2 days ago with tiredness to you. Bloods sent.
Blood picture normal, RFT normal, LFT raised GGT, rest of lft normal.
Hx shows increased alcohol intake. He has come back now.
Abdominal examination with findings you would expect, and explain to patient his diagnosis. No management or further
history.
13. Lady on diazepam 15mg daily for 6 months wants to stop. Quite a long stem with medical hx, psychosocial hx given,
mentioned not depressed. Was on diazepam as her son was sick and she was anxious as carer, but wants to stop now.
- focused hx, and plan
14. Post natal six weeks.
NVD , prolonged labourwith 4kg and episiotomy that extended to perineum repaired in OT.
Now coming for first post natal check. Bub well, feeding well. Had sex first time yde and had superficial pain. Also pees on
coughing and sneezing.
- PE
- explain to patient findings.
15. PV BLEEDING at ED
- hx
-PEFE
explain to patient most likely diagnosis
(Hx elicited pregnant 8 weeks
On pefe was unstable (HR 40/ Bp systolic 70) however when mentioned that I would like to move to resus was asked to
focus on task.
Abd tender
Os open with products coming out
(Miscarriage with cervical shock )
16. Neck pain for 1 week
- hx
- pefe card given
- diagnosis and differentials
 NO management.
(Hx and pefe of a cervical radiculopathy - numbness L arm)

30th march f2f

1) Stem of a lady with multiple symptoms of hypothyroidism (cold weather intolerance, constipation, tiredness) - examine lady
telling your findings as you proceed - tell possible causes or differentials
2) strawberries picking lady case Had numbness and tingling in her leg examine her and tell your differentials (Foot drop case)
3) patient feeling something in her ear - examine her hearing - examine mannequin with otoscope -mention likely cause and
differentials (Conductive hearing loss, cholesteatoma)
4) 30 week pregnant lady, headache and proteins in urine - examine her - diagnosis with differentials
5) 8 month old with excessive cring -Hx - Diagnosis and differentials (Nothing positive in hx I don't know what's this case is about..
he started crying suddenly before 4 hours)
6) a young man started feeling unwell and concerned this can be due to heroin - hx - PEFE - Dx and differentials (Went to a party
2 weeks ago and tried heroin with some friends sharing needles, had a rash 3 weeks ago, now feeling unwell with a
headache and tired.. positive urobilinogen in urine dipstick)
7) 14 months old brought by his father because his child is lethargic, quiet and have high fever - hx - PEFE - Dx and D.D -
Immediate management (Sore throat on exam and delayed capillary refill time)
8)62 year old man with blood in his urine - hx -PEFE - dx with d.d (Blood at the end of stream, urinary obstruction symptoms,
Bladder fullness in PEFE and prostate is smooth and enlarged, takes aspirin)
9) 58 man with blood in his stools. - hx -Dx and D.D (Blood on top of stool not mixed, taking aspirin)
10) 45 yr man with burning chest pain, endoscopy done with biopsies showing sliding hernia with considerable inflammation of
the esophagus but no barret esophagus or malignancy. No halicobacter -hx -explain endoscopy findings -mx (Pt stopped
exercising bcuz of his symptoms, put on weight, excessive alcohol drinking hx)
11) parent of asthmatic child came (long stem) child stopped exercising, mostly seated in front of the TV - plot his height and
weight on a growth chart (4 readings given at 4 ages) - explain to parent the child's growth - give advice
12) truck driver feeling his head going to explode when her gets into his truck - hx - Dx with D.D (Had accident 2 weeks ago,
flashbacks, nightmares, SOB, palpitations, head is going to explode when he rides his truck.. PTSD)
13) Serotonin syndrome case
14) 65 lady came with SOB. - hx - dx with d.d (Palpitations irregular, had DM and HTN for 10 yrs, sleeps on 3 pillows at night and
wakes up because she's SOB)
15) 62 yr with vaginal discharge - hx - PEFE - Dx and differentials (Watery yellowish discharge, had atrophic vaginal
on PE)

Thank you AMC clinical exclusive. This group has helped a lot in my preparation. I started preparing in June 2021 with Hand book
and then Marwan. I have done these twice. I also enrolled in Dr Shahriar’s clinical course. The tutors were very helpful in giving
genuine feedback and encouraging to do roleplays.
After this, as my exam was nearing I attended Dr Amir Workshops and just before my exam I attended Dr Amir’s medicine 5 day
workshop. I revised his topics in the last few days of my exam.
My study partners were very helpful and I could not have done this without their support. I studied in a group of 4-5 so that there
was always someone to do roleplays. But all of them were very regular and I thank them for that.
I did focus on MSE, rash practiced PE with my study partner.
I also did a online trial exam and I could pass only 9 stations.
Just before exam I could not study much nor do roleplays so just revised my notes.

My aim was
6. To complete all the tasks on time (even if I missed few things)
7. To tell DDs for every case
8. Talk till the 8th minute in every case
9. Study cluster wise rather than recall based.
10. There was prompt timer in almost all the cases.

Q) A father had come for Asthma review of his child. Asthma was well controlled but his weight was high , he did not do much
physical activity and was always watching TV. There is finding of his height and weight.
 Task: Plot the graph and explain for four minutes
PREDOMINANTCounselling
ASSESSMENTand
AREAmanagement
- MANAGEMENT/COUNSELLING/EDUCATION STATION 1

Scenario: Obesity Grade: Pass

Assessment Domain Domain Score (see key below*)

Performance of procedure 2
Diagnosis/ Differential diagnoses 4
Patient Counselling 4

I started off with telling him though the asthma is under control, nurse had noted some changes in weight and height. Is it ok
to discus now. He said yes. ( there was a coke tin on the table) I tried to plot the graph and it was above 95 percentile and then
explained him the graph ( I got 2 for this though). I spoke about management – again emphasized that Asthma is under
control which is good. I also spoke about diet, dietician, Exercise physiologist, Program by UNSW for obese kids and how to
manage. Parents counselling and try to eat meals like a family and include fresh fruits and veggies. Limit the use of coke and
carbonated drinks, fast food. Engage child in sports.
NOTE: Spoke to one of the tutor and he has told it is better to mention like in running commentary when you plot the graph. I
did not do running commentary. Talk bout how it copares patient weight/height with normal person same age.

Q) There is man who worked as a strawberry picker and noticed tingling numbness in the lower limb.
Task : do relevant PE
DD and diagnosis.

PREDOMINANT ASSESSMENT AREA - EXAMINATION STATION 2

Scenario: Walking difficulty Grade: Fail
Assessment Domain Domain Score (see key below*)
Approach to patient/relative 2
Choice & Technique of examination, organisation and sequence 2
Accuracy of Examination 1
Diagnosis/ Differential diagnoses 1
 I don’t know what happened I did very bad in this case please see passed feedback of foot drop.
Even after seeing strawberry picker I dint think and roleplayer told me that my PE was fast and he cant answer.

Q) This was a menorrhagia case in a perimenopausal lady . History , diagnosis and dd

PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION STATION 4

Scenario: Health review Grade: Pass
Assessment Domain Domain Score (see key below*)
Approach to patient/relative 4
History 4
Choice & Technique of examination, organisation and sequence 5
Diagnosis/ Differential diagnoses 5

IN this case I don’t remember much but she was a perimenopausal so I stated with HPOI , 5 ps and then LOW,LOA
,lumps/bumps
Then asked family history of cancer Sadma.
Gave DD as DUB, Endometrial hyperplasia, Uterine cancer, endometrial cancer, perimenopausal symptom.

Q) This was a 60 year old female with sob. She lives in a rural town and husband is a farmer.
History , diagnosis and dd
 PREDOMINANT ASSESSMENT AREA - HISTORY STATIO
TAKING N6

Scenario: Shortness of breath Grade: Fail

Assessment Domain Domain Score (see key
below*)
Approach to patient/relative 4
History 3
Diagnosis/ Differential diagnoses 4

I thought I did this well but failed.

Please refer passed feebback. Cant remember what I missed. Positive findings were – she has SOB on exertion, wsa using 2/3
pillows, no fever no infections
Told about farmers lung, heart failure, asthma , COPD, PE( no travel history)

Q)Patient with depression was on temazepam. Still had sleep issued so another GP prescribed her Mirtazapine. Now she feels
headache and unwell. This is at Gp setting if I remember.
Task : history, diagnosis and management.

PREDOMINANT ASSESSMENT AREA - MANAGEMENT/COUNSELLING/EDUCATION STATION 7

Scenario: Fever Grade: Pass
Assessment Domain Domain Score (see key below*)
Approach to patient/relative 7
History 5
Patient Counselling/ Education 5
Management plan 6
This case I followed the serotonin approach by Amir. Started with hemodynamic stability and reassured the patient.
Confidentiality. Asked her about the meds, if she increased doses .any other medication, similar symptom in the past.
Talked about her mood and sleep and appetite.
Management told her we need to admit and stop both medications and once she is better will start with medication gradually.
She asked if admission was necessary – I told I highly recommend as you have depression and being off medication is not safe.
She was happy.

PREDOMINANT ASSESSMENT AREA - EXAMINATION STATION 9

Scenario: Health Review Grade: Pass
Assessment Domain Domain Score (see key below*)
Approach to patient/relative 4
Choice & Technique of examination, organisation and sequence 4
Accuracy of Examination 5
Diagnosis/ Differential diagnoses 4

Station 9:Thyroid PE
My first station was Thyroid PE. Stem was clear that it was Hypothyroidism and I had to perform PE and diagnosis and DD
I went in and saw a 50 ish old lady on the chair. She had a lump on the right side of the neck that was clearly visible. I was
tensed and although I knew Thyroid exam very well I could not do it in a sequence. I thought I would fail this case but thank
god I passed. Please make your own notes and if your exam is F2f practice on your study partner.

*
Station 10: Vaginal Discharge
50-60 yr old lady has come with vaginal discharge.
2) History 2) PEFE 3) Diagnosis and DD

Scenario: Vaginal discharge Grade: Pass

Assessment Domain Domain Score (see key below*)
Approach to patient/relative 5
History 5
Choice & Technique of examination, organisation and sequence 4
Diagnosis/ Differential diagnoses 5

In this with the age I did expect it to be atrophic vaginitis and thankfully my diagnosis was correct. She was menopausal with
brownish bleed dry vagina, problem with intercourse. No LOW LOA, no lumps and bumps.
Here I had to ask PEFE from examiner and I did ask about GA, Cvs and resp briefly, Abdomen for lumps and bumps, BMI, Pelvic
in the presence of chaperone and consent of the patient- She gave brownish discharge , dry vagina and UDT – negative for
leucocytes, nitrates
I gave diagnosis as atrophic vaginitis and dds endometrial hyperplasia, cancer, lichen sclerosis, HPV warts, Herpes (though she
did not have any risk) I did try to add and explain in one sentence why it couldn’t be.

Q)It was given in the stem that patient was worried about recent use of heroin and has come to the GP clinic.
Task
4. History
5. PEFE
6. Diagnosis and DD

PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION STATION 11

Scenario: Health review Grade: Pass
Assessment Domain Domain Score (see key below*)
Approach to patient/relative 4
History 4
Choice & Technique of examination, organisation and sequence 4
Diagnosis/ Differential diagnoses 5
This case I started off normally and the RP did not tell anything. Then I mentioned confidentiality and he started talking. I
directly asked about heroin history ,any other drugs, how did he take, any needle sharing, ( which was positive). He had pain in
the RUQ, no yellowish discoloration of skin , dark urine was positive.
He had no travel history

PEFE again I asked specifically for rash and jaundice .no rash. UDT I just asked nitrates ketones, leucocytes. Then the examiner
asked what else u want to know I forgot bilirubin ( did not remember) just moved on
Told my diagnosis as hepatitis C, Hep B ruled out hep A other DDs hiv seroconversion Liver cancer.
Q)There was a 60 ish man with complaints of Bleed per rectu.
History
DD and diagnosis

PREDOMINANT ASSESSMENT AREA - HISTORY TAKING STATION 12

Scenario: PR Bleeding Grade: Pass
Assessment Domain Domain Score (see key below*)
Approach to patient/relative 4
History 4
Diagnosis/ Differential diagnoses 5

This patient I started with confidentiality and asked the onset progression, duration, better or worse.
He said intilially was on tissue paper and now in the poo. No pain , no infection(fever /rash), something protrudes while he
strains for the bowel movement ( this finding he told me at the end when I asked is there anything else u want to add) – No
LOW,LOA,L and B. Again diet was off here.
I told u might have hemorrhoids -explained, external and internal, anal fissure (no pain) Pilonidal sinis(no dischare) bowel
cancer I have to rule out coz of age ( he told he has not done FOBT also) diverticulosis, angiodysplasia.

There is a mother of a 18 or so month old baby who was brought with fever.
History
PEFE
Diagnosis and dd
Management
 PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION STATION 14
Scenario: Fever Grade: Pass
Assessment Domain Domain Score (see key below*)
History 4
Choice & Technique of examination, organisation and sequence 4
Diagnosis/ Differential diagnoses 4
Management plan 4

This station there was a mother sitting and very worried. I started off with hemodynamic stability ( I think moderate
dehydration- so I said move to the resus cubicle and 2 large bore IV needles and start fluids while I take history.
Reassured the mother we will take good care of her son.
Asked her about fever since 3-4 days, no rash, vomiting, decreased nappies, no UTI, no git no one sick at home.
Then asked about PEFE – No lad ,sick child, dehydration +ve= moderate.
Told her that her son is in the best hands but needs admission and we will run some blood tests first( Blood culture, FBE,
electrolytes. And start on antibiotics

I told the diagnosis that can be meningitis, Otits media, UTI, GE

Q)This was a female patient truck driver and had come with behavior issues.
History for 6 min
DD

PREDOMINANT ASSESSMENT AREA - HISTORY TAKING STATION

15
Scenario: Behavioural complaint
Grade: Fail
Assessment Domain Domain Score (see key below*)
Approach to patient/relative 4
History 3
Diagnosis/ Differential diagnoses 4

This lady was a truck driver and when I asked open ended Q she told that she had met with accident 1 month back where the
person she hit had died thought it was not her fault. Since then she had nightmares of the incident and today while she was
back to work ( her boss had given her 1 month off) she could not drive and had memories of the incident. So she came to see
you.
I told confidentiality and started with MSIGECPAS, her husband was supportive , they had recently gone on hiloday where she
did not have to drive. I did ask sadma and social history most questions, did not think I would fail this case. Please check
passed feedback.
There was a gastroscopy result which stated hiatus hernia and Hpylori was negative and few other normal findings. Patient
was presenting with heartburn and tasks were to
Interpret the result
History
Counselling
Management (specifically said referral alone would not be enough)

PREDOMINANT ASSESSMENT AREA -MANAGEMENT/COUNSELLING/EDUCATION STATION

17
Scenario: Heartburn
Grade: Pass
Assessment Domain Domain Score (see key
below*)
Approach to patient/relative 5
History 4

Interpretation of investigation 5
Patient Counselling/ Education 4
Management plan 4

For this station I started off by asking do you know why the investigation has been done??
How have you been since, how is the heartburn.
Then I told the report and explained positive and negative findings, drew diagram. Asked If I could ask a few questions and
asked onset duration, on/off any thing makes it better or worse, his diet , family history and SADMA coffee
There was positive in diet ( I don’t rememeber what he told)
I explained his condition again with diagram and said his symptoms are due to hernia
We will start with lifestyle modifications, PPI and if it does not get better will refer to gastero who could do a surgery and this
would be the last option if nothing else works.

Q)There was a father holding a doll on his shoulder. Outside in the stem there was baby who was crying,
Task was History, Diagnosis and DD
In this I started with reassuring the father and hemodynamic stability.
Asked about onset duration and there was vomiting 2 episodes and
I asked birth history in detail and asked other dd like infection, GI ,any other sick person at home, otitis media, UTI symptoms
 PREDOMINANT ASSESSMENT AREA - HISTORY TAKING STATION 19
Scenario: Crying Grade: Pass
Assessment Domain Domain Score (see key below*)
Approach to patient/relative 4
History 4
Diagnosis/ Differential diagnoses 4

In this case there was a long stem with 30 weeks gestation 3+ proteinuria and 150/85 or so BP. Tasks were to ask history and
do relevant PE ,diagnosis and diagnosis and DD

After my exam I did speak to a few candidates and they had mentioned that the BP apparatus was hidden and we had to
measure BP. Otherwise there was an ophthalmoscope and knee hammer on the table . Ophthalmoscope – I did till red reflex
but forgot to mention about dimming light and drops. Hyperreflexia was positive here. I forgot to do clonus. In PE when I asked
her to lie and wanted to check fundal height the examiner asked me what do u want to know and gave me the finding for
abdomen as well as the per speculum and everything was normal.
Otherwise in history I asked 5 P, folic acid use, 18-week scans, downs testing seizure medications sweet drink test, support
DD I gave preeclampsia, eclampsia, PIH

PREDOMINANT ASSESSMENT AREA - STATION

EXAMINATION 20

Scenario: Late pregnancy Grade: Fail

Assessment Domain Domain Score (see key below*)
History 5
Choice & Technique of examination, organisation and sequence 3
Familiarity with test equipment 3
Diagnosis/ Differential diagnoses 4
 In the end my pilot stations were ear examination: Conductive hearing loss, otoscopy on mannequin, and inspection and
tuning fork on patient. There was ruptured tympanic membrane on the mannequin

The other one was hematuria case with BPH findings . Dribbling, frequency, low stream ,hesitancy ,blood at the end of
urination, no burning/stinging sensation, no abdominal pain .

31st march f2f

[Link] discharge not responding to topical antifungal and doxicycline.
Ph 7.
Tell dx, ddx complications.
Fishy grey discharge.
Imflamed cerivix.
This was my. First station so i was nervous. I didn't do well. I said bacterial vaginosis, but i feel it could have been trichomoniasis
and complications would be pid, infertility. I didn't say complications as well.
Karen- 76
2. Fussy eater. Hx, counseling
3. Diazepam dependence. Hx Counseling DIAZEPAM DEPENDENT
Initially need to give the same dose Decrease 5% of the dose every 2 weeks

4. Exercise induced amenorrhea. Hx, pefe, ddx Shiri

5. Tremor pe of hands. Risperidone induced Idk how i did. I forgot tap test.. But i did inspection, rebound phenomenon, tremor
exam, finger nose, mocrographia, tone assessments and sensory Marwan
6. Apixaban counseling cases. I did but patient wasnt happy Marwan
7. Abdomen manequin exam. X ray showed small bowel obstruction
8. Obesity with osa with htn. Examination. Didn't know what to do.. I did ent exam.. Looked for thyroid and cushings.. And did cvs
exam as well. Don't know what will happen
9. Respiratory exam.. Copd like I think i did well
10. Knee exam.. Osgood schlatter/patellar tendinitis
11. Urticaria cases.. Im sure to [Link] was urticaria but all history for allergy negative. Recent viral infections history. No
antibiotics use. Rash comes and goes.
12. Relapse of schiso hx dx with reasons
13. Child headache cases for 3 months with occasional vomiting. Fh positive for migraine. Fundoscope revealed papilledema.. I
said raised icp due to sol, infection, idiopathic ic htn, meningitis
14. Another was chest pain case.
Ecg was of mi, history was of pericarditis
 April
5th April: online
1. Cervical Radiculopathy- Marwan case 51
2. Hep B/ C- Marwan 276
3. Febrile convulsion Shiri Paed Neuro
4. PPROM- Marwan 36
5. Hyperemesis gravidarum- Marwan 232

2nd April:

6th April 2022 online

MSM Sauna recall. Feeling unwell, nausea, tummy pain.O/E tender hepatomegaly. Hx, pefe dDX
Fever post chemo in a child. Examination findings given, nasal discharge, red tympangic membrane, pharyngeal erythema. Give
DDs, management
Heel and foot PE. Hind foot pain
Scaly rash PE
Preeclampsia case. Explain findings, what examination steps to patient with reasons, instruments,inx, Explain dx,
? Adjustment disorder brief psych hx, explain diagnosis, immediate mx
Panic disorder with agoraphobia. Postnatal
Hx, dx, pathophysiology
Bartholin abcess, hx dx, mx
RLQ pain in 27 yr Female. Hx, DDx felt feverish, pain first in umbilical area then moved to RLQ. LMP 2 weeks ago.
Tiredness in 67yF stopped taking steroids suddenly. Diagnosed case of temporal arteritis. Had LOW, LOA
Delayed walking in 19 Y boy. Likely constitutional/ familial
Patient came for repeat presentation of quetiapine. MSE had auditory hallucinations.
Colles fracture, post fracture care plus follow up.
Recurrent falls. Tingling numbness in legs. ?alcoholic neuropathy. Hx PEFE DX/DD
Persistent cough in a child for 6 months. F/H of allergy. Dad separated from mom 6 months ago, gets worse when before she
goes to see her dad on weekends
? psychogenic cough

06/04/2022
Details of 6th april cases to the best of my memory.(Dr. Fa6ma Nabeel Malik)
i already saw the list of ques6ons here so if u want it brief, get it from there. this is long.
this exam did not have straight up tasks wriDen like hx give dx and give mx. they were worded wierdly and you had to keep going
back to read the task to be sure you were doing the right thing. some ques6ons had too many sub parts in the task like dx
with reasons and pathophysiology/dx with causes and other diagnoses with reasons or some twisted wording that made
you doubt yourself whether you read and understood the correct thing or not. they dont use the word differen6als much
they use DIAGNOSES and you can misread that and give one diagnosis mistakenly.
prac6cing with my awesome study partners we used to collect like 15 ddx and in the exam you can spill out three easily. the rest
you blabber and think about as if you never knew any more ddx than the ones u told. (at least thats what happened to
me) so focus on the ddx , grind the up, eat them, digest and assimilate them.
(i am including the role player's name because me and my study partners used to take a few seconds to come up with a name.)
sta6on 1:
young man came with history of feeling unwell for one week. it was given in the stem that he visits a sauna where many men
were sick and are seeing their respec6ve doctors. he is taking PrEP which is HIV prophylaxis. He is regular with his
medicines.
take a hx.
pefe will be given in 5minutes i think
give the dx and the reasons for the diagnosis. give differen6als.
in the history his name is Tim. He gave posi6ve yellow complexion and eyes, no changes in urine or stool colour, some abdominal
soreness, no sadma, unprotected sex, mul6ple partners and no safe sex. no lumps bumps but had night sweats.
in pefe there was liver enlarged upto 18cm dont rmr much else
This roleplayer is super serious and takes his 6me with uhh and mmm to answer.
sta6on 2:
que6apine prescrip6on renewal. take hx
present MSE
her name is jaenie her hair was messy, she had auditory hallucina6ons mostly mumbling. no commands right now but used to get
commands in the past, mood was ok, no percep6on problems, no thought abnormali6es, insight judgment intact, seemed
reliable low risk and easy to build rapport. she was a friendly lady, i was afraid of psych role players.
sta6on 3:
lady presented with discomfort down below(not sure about exact wordings).
take hx pefe dx
mx
her name is jane ,on history she gave history of the lump being there for a month now and its been increasing, wasnt painful to
begin with and since two days really painful.. she feels warm but hasnt checked temperature when i asked about fever. no
rashes, 5 ps all good.
pefe showed picture of what looks like bartholins abcess and fever 37.8 or something.
this was a nice lady ac6ng out the pain well moving about in her seat. sta6on 4:
mom came in because she was concerned about her son not walking at 19months.
take hx dx
she is Sam her son is Jack. i asked history about milestones achieved, it was normal for all other milestones , binds, heads
everything was all good. i asked if she had been concerned about the walking earlier. she said she wasn't because the
sibling had also walked late and she came just in case.
lady was casual. i asked when she no6ced that her son wasn't walking?. (which was a rather stupid choice of words) what i meant
to say was when she became worried about him not walking like when she thought it may be something to get checked
out.
she said awkwardly, "well since he hadn't started walking which is since forever because he hasn't started walking yet."
she knocked me off my game. i smiled and said yes thats right lol. n then got my head back into it.
sta6on 5:
woman 67 yo comes with hx of three falls. hx
pefe dx ddx
her name is LEE. lovely lady asian origin. On hx she said she had changed posi6on in two of the three falls from si`ng to standing.
she had no symptoms before the fall and nothing during the fall. aaer the fall she got up by herself. she told me she had hit
her head and got a bruise that was checked out and wasn't something major(i asked this for the ddx but exam brain seems
like it isn't even mine and i didn't even men6on the head injury in my ddx.) sadma is one boDle wine every day, she eats
only one meal in a day because she has to cook her own food. she lives by herself and friends are suppor6ve but family
lives far.
pefe showed loss of sensa6on and propiocep6on bsl is 5.6
all other things are normal i think. i specially checked postural hypotension which was definitely normal. she was trapping me with
that history of hers.
sta6on 6:
Lady came in with her son who has a hx of lymphoblas6c leukemia. he had his last round of chemo a week ago. now presented
with fever.
hx that you need 3mins i think pefe
explain the dx to the mom with possible causes management plan.
her name is michelle and her son is logan. he only has fever as posi6ve thing on hx. nose is runny no problems otherwise.
pefe shows erythematous tympanic membrane, pharyngeal erythema, clear nasal discharge, fever 39 degrees. it specifies the
child is si`ng playing on his ipad. there is no posi6ve sign of dehydra6on or anything alarming of pefe.
sta6on 7:
27yo presents in the ed i think. she had abdominal pain. hx
dx and ddx with reasons
her name is Victoria. she is having some abdominal pain. i asked socrates. right iliac fossa, gradually got worse since last night,
sharp pain, no relieving factors, no radia6on. i asked does it go anywhere she said it started in the middle. i asked was it
the belly buDon area and she confirmed. she was a good role player ac6ng out the pain with her hand over her lower
tummy saying aah aah now n then.
sta6on8:
young lady comes with runny nose. hx
dx ix
mx and give reasons for every step in the management plan.
Sandra was a nice lady with a red nose and 6ssue in her hand. she kept wiping her nose. complained of blocked nose and also
runny nose. she took a spray and some an6histamines that worked for her 6ll last year but this year its horrible and nothing
seems to work. i asked about the spray she gave a brand name i suppose must be common in australia but i assumed it
must be a decongestant. she said she had playground duty and had to be taken off it due to her symptoms.
i empathized with her and asked if she had ever tried a steroid spray and she said she did but doesnt anymore. asked y, she said
cost.
sta6on 9
lady comes concerned about her 12 yo daughter who has a cough. she had been given asthma6c medica6on, an6bio6cs and
nothing has cured her cough.
hx
explain the diagnosis to the mother.
she is kate and is concerned about her daughter who has her cough since 6months. the roleplayers was ac6ng to be very annoyed
and frustrated about not having a proper diagnosis for her daughter. she said the doctors have no idea what this is it is so
bad the cough wont stop.
she told me in the hx voluntarily that her daughter doesnt have symptoms at night. and she sleeps well. i asked ocstar. she said
dry, goose honking caugh, aggravated when she goes to her dads place. she told me this when i asked her if she's no6ced
any days its worse like is it only weekdays or only weekends. she said yes and explained she has two younger siblings as
well that go to their dads but they don't react with any coughs. i asked about any bruising or unusual injuries she's no6ced
she said no. when i asked about any previous episodes she had like this cough, she said when she was in 4th grade there
was a bullying problem at school n my daughter got a runny tummy. when the teacher addressed that problem her tummy
got fine.
as soon as i men6oned psychogenic cough she gave me a irritated stare that its been going on for so long and she interrupted my
explana6on to express her frustra6on with the diagnosis. had to calm her and explain it to her.
sta6on 10
old lady i think in late 60s not sure, comes in with complaints or 6redness. hx
dx with reasons i think ddx
i started with hermifados and she gave me a hx of weight loss of 3kg in one month. rest was nega6ve i asked various ques6ons
regarding weight loss to figure out a diagnosis and history taking 6me was up. sadma was all nega6ve. she said appe6te
and sleep, mood were all fine some days
her mood gets down but mostly is fine. my collegues that day got hx of polymyalgia rheuma6ca and steroid usage that was
probably there but i hadnt asked due to lack of 6me. i repeatedly did ask about medica6on, she said she takes none. my
friends told me she had suddenly stopped steroids as well. though knowing this case comes with pmr and 6redness i didnt
focus on that and focused on weight loss. not sure how 3kg weight loss connects to pmr and steroid stopping though.
sta6on11:
young man 22yo sent by his counsellor because of failing grades and late submission of assignments since one month. he had a
breakup with his girlfriend one month ago.
hx dx mx
this mans name was steven. He said he had been sent because he hasn't felt like himself lately and that the separa6on from his gf
really was hard for him.
he had low mood,
sleep disturbance of not being able to get to sleep, he had poor concentra6on.
he wished he wont wake up one day but had no plans to end his life. all these i thought depression.
my friends said its adjustment disorder.
i am not sure if i had asked about his appe6te. i asked asep6c ques6ons. he didn't have any abnormality there. i asked how he felt
when his gf lea and whether he had same feelings on any previous rela6onship breakups. he said he had a few rela6onships
previously but none lasted as long as this one and he felt angry at first, then sad and just EMPTY inside. emp6ness is a
typical feature i read for borderline but this guys didn't
seem to fit the borderline traits either. he filled at least 4 points for the criteria of major depression not sure if i searched enough
for a fiah one to make the correct dx. we think it may be pilot.
sta6on 12
this was a woman 32yo at 36 weeks who has her obstetric readings with her.
explain to her the abnormal findings of her results take a further hx
explain to her the dx with reasons
explain what further examina6on you will do to the pa6ent tell her what instruments you will use on her
yes all this and not in this simple language. u read, re read and then read again then figure out it was only these things.
they had given everything we do in obs exam in the chart. sf 35cm
cephalic
head engaged 4/5th fetal heart rate 150
urine dips6ck shows proteins blood pressure 155/100
repeat blood pressure in 5minutes 155/100
then it said under the chart that the pa6ent admits she was nervous when the bp was taken because she was ge`ng late for her
appointment this morning.
her name is Joe.
sta6on 13:
woman 60s had a fall on her outstretched hand. the plaster has been applied. they have given certain limita6ons in movements
with various angles i have no clue why and what it meant.
tell the pa6ent the plaster cast care advise about follow up.
i forgot alot of things in this sta6on that i thought were very simple and easy when i roleplayed. i didn't even ask her how her pain
was and how she fell. i suppose i wasn't thinking straight. i forgot to men6on i will do any inves6ga6ons or dexa scan even
though i wrote it down while speaking to her in case i forget. but when i look back at what i had been wri6ng while talking
to her, it sort of looks like scribbles my kid writes on her drawings that are hard to read. no fall preven6on clinic no vit d
calcium levels. all i advised was snap, redflags and plaster care. i had 6me but i was wondering why the role player keeps
asking me if i need to tell her something else. i am generally not a dumb person. so please prac6ce all the cases even the
ones you think are very easy and you know them like you know your own hand.
sta6on14:
woman comes with some hx given in stem post natal class case. she has a baby i think baby is 2 month old or somthing like that.
She had been to the ed a few 6mes claims she has had a heart aDack. and told ecg was done and was sinus tachycardia
and her heart rate was 105. all other findings tests are normal. not listed but said its normal.
hx
dx with reasons and cause for the condi6on explain the pathophysiology of her condi6on
these were the words because i copied them down.
now the lady was frustrated she said she had had a heart aDack the doctors cant figure out why she feels this way and she is very
worried
about her condi6on. it has happened a few 6mes in the past and she fears she will die. she is worried about her kid. i asked y, she
said because if i die, who will take care of him. i asked signs symptoms she experiences during the episode. same as
previous recalls. she was experiencing these symptoms since 6 weeks and was worried. i asked about her limita6on of
ac6vi6es she said i do go out but i avoid places where ambulance cant come to pick me like at the shopping centre. she
needed some convincing to make her admit that she understood the diagnosis.
sta6on: 15
this was a picture that is simillar to the ones already in the group of seborrheic derma66s.
explain the rash to the examiner for 2mins
how will you do the head and neck examina6on in this pa6ent give the dx and ddx
the rash was behind the ear and the scalp as well, extended slightly beyond the hair line over the neck and scalp. stem told that
the pa6ent had dandruff since many years.
sta6on 16:
stem was given as 46yo woman who has been in sports for many years sustained many sports injuries over the years now
presents with heel pain that has been increasing in intensity and interfering with her walk. a senior medical student wants
to know the details about how to examine her. exaplain to him the steps via virtual call or something like that.
examina6on of ankle and foot explaining what possible finding you can find on examina6on of this pa6ent.
please say a liDle prayer for me to pass this exam.

12th April: f2f

13th April f2f
FACE TO FACE EXAM.
Recalls for 13Th April, 2022
1. Visual acquity/Pe of eye / diagnosis with reason to patient
2. Breast examination = explaining to pt and do pe , diagnosis tell dad to examine
3. Cerebral ataxia = sensory done and do lower limb examination
4. Asthma review
5. Ulcerative colitis explaining, implications , management
6. Knee pe with examiner, diagnosis and reasons
7. Palpitations and dizziness ecg Af = history, pe ecg to patient and diagnosis and causes
8. URI with snoring history PEFE diagnosis with reason
9. Mania with reason
10. Video with mmse and explaining to mse to examiner
11. Crying women grieving and depressed
12. I episode of diarrhoea history, vital’s to patient , investigation and causes
13: fussy eater
14:body odour girl
15;hiv positive pregnancy
16:uti with tummy pain

13/04/22 (Face to face)

14/04/2022 (Face to face)
1) Teenager female Abdominal Pain with yellowish discharge Hx
Dx &DD

2) PE Pelvic examination Cervical bleeding

Dx Mx

3) Shoulder neck pain and tingling of thumb,Hx of Cancer. Hx

Dx,DDx

4) Old Male Hospital post [Link] not relieved .task Pain [Link] chart

5) Chest trauma old Man,Injury Mid [Link] survey [Link] PE,Investigations to examiner

6) Video given,MSE Mania

7) Young lady complain of dental [Link] Nervosa History,Dx,Mx

8) Father comes for child 21 months not able to [Link] able to babble.
Hx,Dx,Mx

9) Child 18 months,blood report low Hb,low MCV,Spleen enlarged. Hx,Dx,Further IX,Mx

10) 27 weeks OGTT shows DM Counsel pt

11) Old lady comes with complain of 'nerves'fear new people and surrounding (?Panic disorder with agoraphobia )
Hx,Dx
12) Thyroid PE
13) Old lady smoker,explain Chest X-ray Bronchogenic carcinoma. Hx,Dx,Mx

14) Old Man Chest pain ED

Histort,PE from examiner,explain ECG findings to Examiner.

20th April: online

21st April: online
 21/04/2022

1) Obstetric examination -explain to medical student

36wk, primi, examination findings given in a graph including mid arm circumference, fundal height, etc
List the instruments needed, explain how you examine , medical terms can be used, explain the findings in the graph
2) male in 50's come with a central abdominal pain for several hours, to ED, given pain killer injection, history for 6 minutes,
abdominal distension and past surgery in the abdomen, PEFE at 6 minutes
History for 6 minutes and most likely diagnosis and differentials
3) 26 year old female , came with a letter from national cervical screening program
History for 3 minutes, explain difference between pap smear and cervical screening to patient, explain how to do the procedure
4) a man in his seventies, came with recurrent falls for 2 consecutive nights, history for 6 mins, PEFE given after 6 mins,
differential diagnosis with reasons
positive PEFE- postural hypotension, UDT positive for UTI, positives in history - getting up abruptly from bed at night, skipping
meals at night? hypoglycaemia, but BSL 4. something (normal), positive UTI symptoms, No diabetes, no obstructive
symptoms
5) Man in 50's comes to get counselling for his alcohol use behaviour as insisted by wife. History for 7 minutes and differential
diagnosis
6) Mental state examination assessment - 6 minutes and present in 2 minutes
27 yo mother, chest pain in post natal class, worried about having a heart attack. same lady who spoke about nerves last time
7) 8 year old girl headache, several history findings given. Explain the father about Neurological examination of the child
8) A man in his 50's , came with right knee swelling and pain for 2 days. History of alcohol, HCT and amlodipine. Joint fluid uric
acid lie crystals. History for 4 mins, relevant investigations, management Also gives a history of big toe swelling in the
past unattended and spontaneously resolved
9) 2 year old child, FBC result of iron deficiency anaemia . explain the results to the mother. explain what you are going to
 examine to the mother and explain to the examiner about relevant examination with anatomical land marks
10) a man in his
70's came with a right flank pain for few hours , now settled with pain killers. similar less severe pain, a couple of days ago.
History, possible diagnosis and D/D
11) 3 weeks old baby, crying. exhausted mother. history for 4 minutes, possible diagnosis and management to the mother
12) 27 year old man, referred by dentist to GP, dental caries and poor dental hygiene. knuckles some calosities. History and
possible diagnosis and and D/D
13) a woman in her 20's presented with pain in perianal area. History for 7 minutes and most possible diagnosis and D/D with
reasons
14) A woman in 50's treated for Breast CA, which was diagnosed 3 months ago with chemotherapy. Came with pain and
tingling in feet. History for 6 minutes. Differential diagnosis and investigations
15) A man in 20's came feeling unwell. on HIV prophylaxis. history of going to sauna with some friends . friends too had
similar symptoms
history for 5 minutes .possible diagnosis and D/D 10:28 PM
16) 20 year old type 1 DM, recently diagnosed. history for 3 minutes and counselling about management

28th april Recalls f2f

1. Back pain after lifting heavy object… counselling case
2. RA counselling case
3. Post op Atectasis
4. PTSD
5. cockroach delirium cases
6. comatose patient PE
7. gynaecomastia PE
8. TIA PE… already sensory, cranial nerves done
9. Hip PE… osteoarthritis
10. murmur in preg
11. labor induction
12. Neck lump in 11 year old
13. Food Allergy ( peanut butter)
14. Drooling and crying pt… mother was concerned he swallowed something
15. MI in rural hosp

28/04/2022
29th April f2f
1. Lactational mastitis
2. Influenza vaccine counselling
3. Tremors PE
4. Pancreatitis, up abd pain
5. PE obs, 37 weeks transverse lie, polyhydramnios
6. Incomplete miscarriage with shock
7. Temazepam prescription request, depression
8. CPD, telephone case, labor not progressing, since 9hrs, 4 contrac in 10 mins, G2,P1
9. UGI bleeding with black tarry stool, hb 55gm/dl, jihoba witness, need blood transfusion, counselling
10. Funny turn, young pt, alcohol
11. 17yrs, syncope after marathon, ECG normal, history no more than 3mints
12. Li, travel advice
13. Bilateral pedal edema with COPD
14. PE_ ankle injury
15. 9months old, developmental delay
16. STI pe exam genital male, 27yrs old
 APRIL 2022 TABLE:

5TH APRIL 2022

MEDICINE/SURGERY OBG PEDIA PSYCH PHYSICAL EXAM

Pre op apaxiban Post coital Febrile Nervousness INGUINAL

counselling bleed convulsion take Lymphnode PE
cervical Psychosocial
ectropion history
?????
Cervical PPROM inv MANIA Hx, IMN RASH PE
radiculopathy Dx DX,DDX
and DDx

IVDU + feeling Hyperemesis Greek lady Myocarditis/CHF

unwell [hep C] gravidarum delirium in a PE
Inv except rural hosp
USG
COPD X RAY – DX , Ankle sprain PE
DDX, MX

May
3rd May online
1. was a patient with hallucinations of russian spies and putin, diagnosed with acute schizophreniform illness 2 years back and
was afmitted for a week, take mse and present with ddx
5. Epistaxis in old male, teach how to stop bleeding and take further hx, give counselling regarding management
8. Abdominal PE in a patient with acute abdominal trauma when falling off bike while avoiding mva
Explain relevant PE to medical student and mention what you specifically are looking for

15. post menopausal 57 yr old coming in for repeat HRT, already been using for 6 years, used because of hot flashes and doesnt
want symptoms to return, everything else normal, take further hx, what investagitions would you recommend and why
and counsel regarding management
16. upper and lower limb neuromuscular examination of a stroke patient to a medical student and also mentioning what
instruments and the technique for perfoming the examination

4th May 2022. Online

From another group
1. Exacerbation of Asthma
Task: Hx and Management
-Good compliance and good technique
-Currently smoking, lots of stress in uni
2. Unilateral Eye swelling in a child
Task PE.
3. Funny turns
Task: Hx and Diagnosis
-All examinations normal
-(?Conversion)
-Has a lot of assessments in uni feeling stressed
4. Child with Disruptive behaviour
Task: Hx and likely diagnosis, explain rationale
-Repeating words, poor speech, has routine on toys
-(?Austism)
5. Period pain with US result
Task: Explain US result, Take further hx, and Diagnosis with rationale
-USG all normal except for a right ovarian unilocular cyst 1.9cm
-Has some dyschezia, no dyspareunia
-(?Endometriosis)
6. Ward patient with SOB
Task: Explain ward observation chart, do PE and explain likely diagnosis
-Tachycardic, hypoxic, hypertensive, but no fever
-Currently being treated with ABx for pneumonia
-Has hx of MI
-Has had 3L IV fluids in the last 24hrs
-Currently on DVT prophylaxis
7. Post MVA with CT scan results
-Task: Take further history and what investigations with rationale
-CT all normal except for right adrenal lesion Handbook 303, Marwan -750
8. Breast exam for postmenopausal coming with breast lump
9. "Depressed" patient referred by counsellor, requesting for antidepressant
-Task: history and Diagnosis
-Mother died 2 years ago on the same day today
-Disrupted sleep, no energy to do things, feeling sad, been going on for 2-3 weeks
-No suicidal thoughts, no guilt, still eating
-Still has good functionality to visit her friends and interact with siblings
-(?Anniversary grief)
10.8-weeks pregnant with rash down below
-Task: History, PEFE and image of rash will be shown, explain diagnosis
-Recurrent, has previous similar episode long time ago and resolved
11. Bilateral eye swelling in a child
Task: History, PEFE, Likely Dx and differentials, Investigations
-Has previous hx of URTI, no trauma
12. Perform MMSE in a patient with long term use of alcohol
-Results suggesting poor memory and recall/registration
13. Neck pain with hand tingling
-Task: History, Diagnosis, prognosis, Differentials, Investigations
-Has hx of breast Ca
14. Diarrhea (less than 1 week)
Task: History, Diagnosis
-Hx of Amoxicillin use 2 weeks ago for cough
15. Do MSE for OCD ("King"case)
16. Cervical Screen Results
-Task: Explain results, do further history, and management
-Result showing HPV 16 detected
-No previous STI screen
-No Gardasil jab coz she was scared of needles.

10/05/2022 f2f
1. 42 years old with indigestion for 4 weeks Hx
Dx Management

2. 5 years old lethargic Hx PEFE, Management

3. sudden onset back pain PE

Dx and Ddx

4. 27 years dropping marks worried and came in for advice Hx

Dx and Ddx

5. murmus with another Dr Cvs examination

6. pvb with normal cervical screening 6 months ago Pelvic examination, Dx ?

7. video of a 43 years post op 4-5 hours ago Alcohol withdrawal with some visual hallucinations MSE?

8. 37 years female with hayfever crisis sunglasses on using streroids and antihistamines ,nil help did not want to remove
sunglasses Management and counselling?

9. headaches with multiple complaints Normal physical examination??

Dx??

10. 32 weeks ruptured membranes 300 km from a tertiary hospital PEFE

HX
Management

11.2 years with 12%burn on chest Hx

Mgt

12.76 years old with gynaecomastia on anti htn and spironolactones Hx

Dx Cause?

14.15 years faint episode while outside running Normal ECG

Hx PEFE
Management?

15.27 years old 30 weeks pregnant with right upper quadrant pain radiating to the back
Hx PEFE
Mgt

16.46 years post cholecystectomy wants to be discharged 24 hours post op Surgeon recommended 72 hours at least in the
hospital
PEFE ,Advise management
11th May: f2f
1- 9 year old child with fever, rough rash over chest and abdomen, circumoral pallor, very red
pharynx and exudates on tonsils. Child is not eating or drinking much however well hydrated and
stable. Has not gone to school. Mother is concerned it is meningococcemia. Hx, Dx, explain
implications of Dx to mom and management.-scarlet fever
2-swelling across midline of neck in a 11yr old child. History of 2-3 months. Not enlarging, warm
or tender to touch. Moves on swallowing. No history of frequent infections. Take Hx, Dx, DDx
3- croup child
4- sudden double vision for 2 weeks. PE Eye, Dx with DDx.
5- 47 lady on OCP pills since she was 30 years old and has now stopped as she had heard it's
not good for women her age as she can get a heart attack or stroke. Initial breakthrough bleed
occurred and this was 5 weeks ago. Now wants to start HRT instead of OCP which might be
more appropriate for age. Her lab reports show FSH, LH, B-HCG, cholesterol, BSL are in normal
limits. Counsel her regarding HRT.
6-32yr lady had obstructed labour at 8cm dilation and had emergency LSCS in hospital. Post op
day 2 and she wants to go home. Is running a mild fever. increase PR, and discharge. UDT
leukocyte +, nitrites + RBC+
Hx, pefe, explain DDx and talk re discharge to patient.
7- previously diagnosed schizophrenia pt brought by police from streets, hears God and He is
helping her. Takes marijuana, doesn't smoke and drinks occasionally. Unemployed. Lives in
temporary hostels, no proper home. No partner. No suicidal or homicidal ideation. Non-compliant
with SC meds as God is enough. Psych Hx, explain risk assessment to patient.

8- man 21 yr alcoholic in alcohol rehab and has not had a drink for the last 5 weeks. uncontrolled
DM due to very poor compliance to insulin, fbs- 19.
MMSE. Explain findings to patient with ddx.

9- cut injury wrist PE. Explain findings to examiner. Positive findings - no movement of thumb. No
resistance of thumb on test of power. No sensation felt at thumb and middle finger tip.

10- Middle age woman has weakness and tiredness in history. Perform UL and LL neuromuscular
examination. Explain findings to patient with DDx.
Positive findings- significantly reduced power in bilateral thighs. Reduced power in shoulders.

11- CVS anteroseptal MI, explain ecg to examiner. In rural hospital and there is no method to
transfer to tertiary hospital. Explain Management to husband in current circumstances with
reasons.

12- patient unwell and has fever. Complains of a painful lump in the buttock area. Has a history of
constipation occasionally. Sexual history clean. No trauma.
Picture: Perianal lump , 3cm with excruciating pain, DDx

13. 67 year old lady with Calf muscle pain when walking. Hx, pefe, Dx dax

14. Lady has come to collect her blood results which show decreased Hb, and Mean cell volume.
Hx, Dx and [Link] finding - menorrhagia
15.
16.

12Th May 2022 f2f

1 - Acute gastroenteritis- middle aged man with lower abdomen [Link] in nature an episode of vomitng and loose
diarrhea. Tasks- Hx , Ds and DD

2 - CST- recently started on OCP, stable partner. Tasks-take consent , Do procedure and advice further advise to patient.
3 - Alcoholic neuropathy. Recently cutting alcohol to lesser amount. Task-PE, explain Ds and DD

4 - 13 year BIB mother with sudden onset of right sided scortal pain while playing basket ball. Task- Hx for 3 min, PEFE and what
investigation(s) to confirm the diagnosis(afebrile, Vital stable, paining suprapubic region. No [Link] not enlarged,
nom red no discharge.) and Ds to other and DD

5 - 10 days postpartum presented with vaginal bleeding from 2 hour- Task- Hx for 3 min.,[Link] and Possible Ds
,Management (Hx warm, 2 well soaked pad, no offensive discharge and has pain in lower abdomen.

6 - Epistaxis lady, pinching nose on top of the [Link] red tissue. Task-what measure you do to stop [Link] for 3 min and
explain condition and further plan.
7 - middle age man presented with lower left abdomen pain. Task- relevant PE, possible diagnosis and DDS

8 - 7 year with head ache for 6 month , every 2 weeks having head [Link] with vomiting and photophobia relief when
light off and last for few [Link] FHx of migrane., seprated parent but happy [Link] ti father and no issue, happy
family. Task- HX, PEFE and possible diagnosis.

9 - 42 years old man with erectile dysfunction. Task-HX 3 min, explain probable causes for his condition.

10 - NH nurse phone cal for NH patient

confuse- Hyponatremia and low [Link] HCT. Task- phone cal to NH nurse, HX form sure and tell the causes with reasons.

11- 52 y/o lady p/w shaky and sweaty when going to shopping with [Link] DM (2) was on OHA and 2 weeks ago GP
put on long acting insulin which she take in night .BGL 3.1 .Task-Hx 3 min. Explain causes and further plan.

12 - BDD-nose.,asking for specialist referral, want surgery. Task-HX, Dx and further management plan and address pt concern.

13 - Nurse with severe depression with psychotic feature, suicidal- Task-Present MMSE.
14 - 9 years , right side hip and knee pain for 2 month after basket ball [Link] [Link] by [Link] done.
Tasks- HX 3 min. Explain XR and Dx

15 - 4 y/o child BIB father with bee sting 1 hour ago. Tasks- HX, PEFE, Mg.

16 - 57 year old lady presented with lump and rashes down below. Lump comes and goes. Tasks- HX for 3 min, explain Ds

17th May 2022 (online)

18/05/2022 (online)
1 OCP counselling in 22 year Uni student
2 GB stone with solitary in liver Further work up
DD
Explain to the patient

3 Ulcer at foot , recent fall at street dog chased him, wants to go home MSE
Mx plan

4 67 Yr male with recent flu like symptoms with fever Covid negative Wants hospital admission
Diagnosis explain DD

5 Post op case with visual hallucinations (famous cockroach) case MSE and present to examiner
6 22 Yr boy was arrested by police and under mental health act Council father
MSE questions to father

7 pictures of boy with unilateral facial swelling PE to medical student

8 Rashes in thigh, itchy

Explain rashes to medical student

9 45 Yr mail with pain radiating left arm Post viral infection

Do
DD explain to patient

10 Pain in right iliac fossa in 15 week pregnant lady DIagnosis

DD
Explain to patient

11 PE to medical student a patient who got infectious mononucleosis 2 days ago. Only physical examination

12 Explain Spirometry results to patient who was smoking for 25 years My findings were suggestive of emphysema

13 7 year boy with high grade fever and cough recently returned from Malaysia Diagnosis and DD to Mom
14 2 year crying boy at ED with mom Bruise marks at check
Baby growth chart given Patients uni students DD
Mx plan to mom

15 67 year women fall overnight Taking multiple medications

Dx
Explain results DD

16 Counselling to pre op patient planned for total hip replacement Address her concerns
Immediate and long term mx plan

24/5/2022- online =
1. PE: 57 yr male having 8-9 SD/day came with deranged LFTs, Hb, RFTs normal. Explain to pt what examination you will do on
him focusing on gastrointestinal system.
Explain to examiner what exm you will do with anatomical landmarks. Tell what you are looking for in this pt. No Ix, Mx, dx
needed.

2. Picture of boy with orbital cellulitis.

Explain to med student over virtual conference what Exam you will do with anatomical landmarks.
Tell what you are looking for in this pt.

3. Man came with swelling on his right hand after fight in bar. He has gone for xray now.
Explain what examination you will do with anatomical landmark and medical jargon to med student over virtual conference.

4. Rubella exposure during pregnancy 27 year female recently became pregnant came into contact with child with Rubella.
Relevant Hx for 3mins. Explain what Ix you will do. Give an outline of the mx.
Mx of pregnancy not required.

5. Temporal Arteritis with gradual tapering of steroids..currently compliant on reduced dose. Came with loss of weight and
lack of energy.
Hx for 5mins. Diagnosis with reasons.

6. 55yr old with facial pain. Hx for 5mins.

Dx with reason, ddx.
Positives- electric shock like pain, when wind blows over face, pain on chewing.

7. Uterovaginal prolapse in 60yr old. Hx for 5mins.

Diagnosis with reasons. Pefe given.
Hx All positive for bad obs hx, 3 big babies, prolonged labor, 1 instrumental delivery, bmi 31, lifts heavy weight, cleaner by
occupation, chronic cough chr constipation +ve.
8. Post MVA CT all normal except right Adrenal homogenous lesion.(Incidental finding of adrenal tumor 1.5cm)(We will ask
regarding skin pigmentation, Weight gain increase urination ,Headache ,high BP)
Relevant hx,
what ix you would order, outline Mx.

9. Pt unwell after incident at work. Hx,

give your Differentials.
Fell into septic tank/sewerage worker case.

10. Young female with breast lump. Recently gave birth. Hx, dx, ddx

11. HTN non compliance case came with dizziness and high BP. Dx the condition and give the mx.

12. Pre-preg T1DM +ve patient.

Give her pre-preg advice and tell her about pre-conceptional care.

13. 4mth child with vomitting for few days, 50th centile growth chart. Hx, dx, ddx and mx

14. 6yr child with fever, cough, rash, sore throat, covid -ve test done yesterday. Hx for 5mins, dx ddx and mx.
Pefe shows rough rash over trunk hands legs sparing face perioral pallor. Scarlet fever.

15. 47 yr man with venous ulcer over medial malleolus roaming around street BIB police to you.
Assess him.
Present MSE to examiner.

16. Asthma control assessment case. 32-year-old man with history of asthma admitted to hospital because of worsening of
asthma. He is on budesonide and salbutamol and needs to
use puffer 5-6 times a week and his asthma frequently wakes him up at night nurse notes makes sure that
-the patient is taking his medication regularly
-knows how to use puffer correctly.
-no change in his home or work condition TASK:
-take history from the patient to know why his asthma is not well controlled
-tell him about management of his asthma

25/5/22 (Online recalls)

1- Prostate ca counselling- already know the results. Specialist gave antibiotics for UTI. Discuss tx options and implications

2- Acute abdomen PE to student (27yo with right lower abdo pain). Nil other info given

3- eye PE (both eye red and watery with photophobia, sitting with sunglasses). Explain PE to patient with names of
instruments.
4- Sensory loss PE (on chemo for breast cancer for 8 weeks. Developed numbness at week 6. Now chemo stopped due to the
numbness. Numbness started in toes now reached heel. Pain while walking. Dr said it can be s/ e of chemo. Take history
and describe PE to patient.

5- Dehydration+fever+jaundice in 7 day old baby. Mother was GBS positive, normal vaginal delivery. Baby lethargic and
difficult to wake for last 24 hours. Neonatal sepsis.
History and dx discussion with mother.

6- Urge incontinence (history and dx ddx) same as previous recall

7- Alcohol counselling (came as wife asked. Hx and implication of alcohol use. No need for pharmacology or management
discussion)

8- Schizo relapse (police brought him to ED, non compliance with depot for 8 months and using weed (1 cone a day)

9- Headache (27yo female, presented to ED last week, managed with aspirin iv fluid and antiemetic) 10 episodes in a year.
More after promotion.
Hx and counselling.
Immediate and long term management

10- Anemia in pregnancy. 2nd pregnancy, 1st child 18mnth old ( lack of spacing, turned vegan after 1st child’s birth 18months
back, loss of blood during that delivery too)

11- Child with rash PE (6 months old, whole body rash and NG tube for dehydration) explain PE to mother and then to
examiner.

12- Serotonine syndrome ( escitalopram 20mg mane for 6 months. Someone’s added mirtazapine 15mg nocte 3 days back).
Now nausea, tummy ache, jittery- presented to ED.

13- Vulvovaginitis in child (mother suspects sexual abuse by father)

14- Leg ulcer (PVD, heavy smoker, wore a gumboot and since then started to get red skin and later the ulcer. Keeps saying- its
messy and sticky). Pic given. More like arterial ulcer. PEFE given- loss of pulse.
Task- HX and dx ddx

15- Rectal bleeding. 72 yo female, 1st time painless rectal bleeding this morning. Will give hx of a mass coming out through
back passage in the past when constipated. Hx and dx ddx. Hemorroids

16- Tiredness in lady ( later gives h/o travel to Crains) atypical pneumonia. Hx and ddx dx.

25/5/22
1. Prostate ca counselling
2. Acute abdomen PE
3. eye PE
4. Sensory loss PE
5. Dehydration+jaundice in child
6. Urge incontinence
7. Alcohol counselling
8. Schizo relapse
9. Headache
10. Anemia in pregnancy
11. Child with rash PE
12. Serotonine syndrome
13. Vulvovaginitis in child
14. Leg ulcer
15. Rectal bleeding
16. Tiredness of elderly lady

26th May 2022 online

 June

1st June 2022 online exam:

1)a lady in 32 pregnant , came for results and counseling,
tasks
take history 4 mins
and Explain complications
Further mx

• BP -135\90
• Rubella immuned
• STD neg
• BMI -31
• PAPPA negative for 13,18 and 21 trisomy
• Blood group : positive
• Identify risks of the pregnancy
• *14wk second preg
• 1st miscarriage at 8wk
• Planned on FA
• No STd Hx
• Has reduced 4 kg before pregnancy
• On methyldopa for BP compliant see a GP

2)father with 5 years old boy with high feve x 2 days r, respiratory difficulties and cough since 4 days ago, refused to eat from
yesterday.
Task was-
o explain physical exam to father for 2 min,
o to examiner for 3 min and then card will appear, go for diagnosis with reasons and differential diagnosis with reasons. ( in
pe card there : crft <3sec temp 40 spO2 92
Reduced A/E on r/s and full on percussion where dullness in tap in lower of left lung
Marwan 259

3) 67 years old man in ED with urinary retention, explain physical exam to medical student, what you are looking for and why!
Marwan 246
4) 50 Y old diabetic pt with numbness of tingling on feet and hand, do sensory exam of lower and upper , presented with high fbs
and hba1c
Do sensory neurological examination
Explain to Med student
Gait is performed
tell what will the findings! Alan diabetic foot exam/Marwan 149

5) girl Sophie with wrist cut, very hard one , the pt did not open up till the end, Lives in a shared house. She got angry as her
housemate wore a pink dress! history of nightmares where there , ,
Hx 6min
D and DD
*used kitchen knife
Similar attempts multiple times
No pills or other ways
No current plan
Parents used to fight a lot
Her sister used to wear a pink dress and had a pink doll in her hand every time during fights they had to hide in a cupboard
Sister still lives with parents
No smoking alcohol, I said PTSD and Borderline but she was not happy
6)girl was, red lipstick all over face , in stem it said you assessed the pt ,. At first I thought it is OCD case but when the camera
turned on she looked like this! Very hard case,?Not answering questions, MSE was the task.
lady very stressed, unkept hair with sunglasses bright red lipstick applied in a weird manner. strict parents
PMH NL aggressive and rude Not sexually active university student counsellor sent her due to decreased mark, no alcohol,
no smoking, no previous history of mental disorder
Recently changed behaviour
Do MSE
Explain to examiner
• *startes mumbling only after consent told the name and started answering
• Mood -weird
• Lacked sleep
• Auditory hallucinations no command
• No tactile or visual
• No suicidal/homicidal
• Delusion of reference +
• Thought insertion/steal and broadcast +
• No grandiosity
• Persecutory delusions +
• D — schizoaffective

7)gout case, 67 years old man with ankle pain, 2days Hx of r/AJ pain ,
States was gardening May be had an insect bite! HTN alcohol and thiazides! H on HcT and telmisartan combined on wine daily
more than 2SD history 5 min, pe on card negative lymphangitis, lymphadenitis then give diagnosis with reason and what
investigation you will do
Marwan 267

8) bartholian abscess case with bulging down below, for a month and now with pain . And fever. History 5 min with diagnosis and
management
Bartholin Alan file
9) heroine case 2 wks ago feeling unwell, with fever and tiredness. pEFe: LN enlarged and spleen mildly enlarged
JVP rising
Pansystolic murmur with basilar rales
Ankle oedema
History for 5 min , D and DD with reasons
*states heroin took just once at the party will not take again Multiple sexual partners
Old tattoo
D- IE
DD:
➢ Hep C
➢ Hep B
➢ HIV
➢ CMV EBV
➢ Malignancy
➢ Lymphoma

10) 10 years old girl with headache for 2-3 months, at week days , throbbing all over head, bullying at school, all physical exam
normal, history for 5 min, diagnose with reasons, diff diagnosis with reasons
Headache slide- 11

11) 47 years old with breast lump for 3 wks , history for 6 min, history of breast cancer in mom in 50’s. Exam simple mobile cyst
1.5 cm. Diagnosis with reason, diff diagnosis with reasons
Dx breast cyst

12) nervous man 47, with tiredness, Diagnosed GAD blood work up done including TFT all normal long stem with stressful work
schedule, married no relationship or financial issues. Struggling to sleep. stressful job, coffee 12 cups, smoking 15 sticks a
day)
No PMH or past psychiatry Hx
 No need Hx
Advise on further Mx, (explain why, what is the condition, explain the reasons and risk factors, explain you management)
Key - my friend is on tamezepam will you prescribe me ?

13) nice lady with nose bleeding, enter the room and she was holding nose with tissue and ask for help Hx hay fever on IN
steroids
On BP meds, Immediate Mx
explain to her what to do to stop it, and then she said thanks it is stopped now. History and D and DD
then counseling. In history ashma allergy positive, nasal corton positive.

Marwan case 340

14) boy 11 years old, constipation for 2 years now with soiling. History for 3 min, diagnose with reasons and immediate
management n further . Happy family, no bullying, bad diet, fissure positive
:> Marwan 219

14) 72 with SoB, PFT was there, without normal value, explain Interprets spirometer results in 2 min. History for 4 min.
Differential with reasons. Asbestosis and smoking was positive*Ex smoker 30 y ago
*used to work in asbestos company now retired
.
15)57 lady with tiredness, iron deficiency anemia lab data was there. Hb low
MCV MCHC low WBC and plt NL Fe low
Ferritin low
Fe saturation low
Explain lab data, diff diagnosis with reasons, Hx ,what investigation and management plan.
(Menopause for 3 years , all history was negative)

16)

2nd June: online

[Link] deficiency anemia in child due to inc intake of milk Marwan 199
2. Post op uti in male seems cystitis I said uti Marwan 195
[Link] of aud hallucination relapse of schizophrenia (quetiapine repeat prescription)
4. Burn case in child with management and hx brought by uncle with alcoholic mother Marwan 1
5. Amenorrhea due to inc excercise
6. Wrist inj examination( fall on outstrechwd hand)what u r looking fr
7. Spirometry of copd
8. Ulcerative colitis counselling
9. Examination of suspected pyelonephritis and bph
10. Cvs examination in child with pansystolic murmur with diag to parent
[Link] performance in uni —— ptsd or act stress or mild depression
12. Obs 42 yr with bmi 31
[Link] eruption of preg
[Link] rash with pic given inguinal lymphadenopathy
[Link] pain related to period in 42year and mother ca at 50
[Link] difficulty in walking (subdural hématoma)

3rd June: =====

1. Upper limb. And lower limb . Sensory physical examination. Marwn 160
2. Scrotal examination. Marwan 175
3. CVS. examination. Marwan 128
Task. Man, come with. Severe chest pain. Radiate to jaw. BP 140/80. Task tell equipment to the medical student. Explain.
4. Obstetrics examination. 30 weeks pregnant lady. Plus. leakage of water.
 Task. CTG. Explain. to medical student.
5. Rubella exposure. Marwan- 315
6. Osteopenia. Plus history of COPD plus steroid. Marwan 46
7. Knee pain. Comes for surgery. Plus osteoartritis. Plus steroid. And taking multiple medication.
Task. explained the condition. Risk and benefits.

8. MSE. Cockroaches. Delirium case.

Task. History. MSE. Differentials.
9. Mania. Uni student.
10. HIV. Sauna case. Diagnosis. Relapse. HIV. History and differentials. Young man came with history of feeling unwell for one
week. It was given in stem that he visits sauna where many men were sick and are seeing their respective doctors. He is
taking PrEP which is HIV prophylaixs
Regular with his meds.
Tasks:
o Take hx
o Pefe after 5 mins
o Dx with reason
o Ddx
11. Global developmental delay. mother presents to your GP practice concerned that her 21-month-old child has not started
walking yet.
Task: History. Diagnosis. Causes.
History (spoke 1st word at 14 months, sits with support, plays with other children; has another daughter)
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

12. Sudden infant death syndrome You are a GP. A mother of 6 weeks old newborn here for consultation with you. Her
neighbour had lost their 4 months baby due to SIDS and she was concerned about it.
TASKS
1. Take History for 4 minutes
2. Counsel about her counsel
13. Esophageal atresia, Two days old baby. 8 hours old baby, vomiting. Chest AP xray given. Stable VS. Talk to the nurse in
charge who inserted the NGT. Coiling of tube..
Task: Hx, Explain xray, Dx/DDx, Mx
14. Perianal Abscess. History. Differentials.. Marwan
15. Cervical ectropion. Task. History diagnosis differentials.
16. Acute exacerbation of asthma Presenting complaint. Really unwell. Dry cough. And. Sore throat. Take history of asthma.

7th june 2022 f2f

STATION 1
PREDOMINANT ASSESSMENT AREA - HISTORY TAKING

Scenario: Medication management PASS

Approach to patient/relative 4
History 5
Patient Counselling/ Education 5

This was hypertension noncompliance case

I asked Q of macro and microvascular complications of HTN. Asked pt related, cost related, doctor related causes of
noncompliance. Then explained the complications of uncontrolled HTN.
Told life style modification like explained in JM pt education in type II Diabetes chapter. Adopt N E A T life style
N for nutrition E for exercise
A for avoid C A T S
T for tranquility like meditation CATS stands for
C for caffeine A for alcohol
T for tar, tension S for smoking, salt
Patient was verrrryyyy happpy n asked me to write these for him

STATION 2

PREDOMINANT ASSESSMENT AREA - EXAMINATION

Scenario: Knee pain PASS

Approach to patient/relative 4
Choice & Technique of examination, organisation and 4
sequence
Accuracy of Examination 5
Diagnosis/ Differential diagnoses 5

This was a young girl may be 15, 16. She had some physical findings as well. I did WIPE approach. On inspection I found redness
on the skin and the patient had a valgus deformity of both knees. I did knee examination, did all the tests. She gave me
tenderness bilaterally at the tibial tuberosities.
I told her she has a condition called Osgood schlatters disease. I explained the condition using landmarks of her own knee. Can't
remember the DDx.

STATION 3
It was Delirium case. The greek lady with pnumonia, low Na levels, was also taking medications for heart failure and HTN. Task
was to explain Diagnosis and tell management. Explained delirium, its causes in pts case as mentioned in the senario. Had
to go through the stem again and again. It had so much findings. Then explained Delirium screen n delirium unit in Mx.

Station 4
It was the chest examination PE. Inside was an obese old man, breathless and in pain with a bruise on his left lower axillary
region. I started with WIPE approach, offered pain killer, checked hemodynamic stability and described the general
appearance and inspection findings. Trachea was central. I could not find any findings on percussion and auscultation. The
examiner remained quite. While examining chest the patient screamed once and I froze after that. Didn’t do anything.
Didn’t speak anything. Spent rest of the station quite until the bell rang. Thankfully, this station was unscored.

STATION 5

PREDOMINANT ASSESSMENT AREA - MANAGEMENT/COUNSELLING/EDUCATION

Scenario: Abnormal test result PASS

Approach to patient/relative 4
Interpretation of investigation 4
Diagnosis/ Differential diagnoses 4
Management plan 4

This was the Iron deficiency Anemia case

I think the task was explain results to the patient and explain further Mx
I was upset due to the previous station couldn’t do this well. I was haphazard.
Explained the RBC and told how iron is important in its formation. Then explained the causes of iron def like deficiency in food,
defective absorption, medications, increased body requirements and excessive body losses. In her case it was NSAID use
and excessive menstrual loss, I think.
Can't remember what I told in management.
STATION 6
PREDOMINANT ASSESSMENT AREA - EXAMINATION

Scenario: Visual problem FAIL

Approach to patient/relative 4
Choice & Technique of examination, 3
organisation and sequence
Accuracy of Examination 3
Familiarity with test equipment 2
Diagnosis/ Differential diagnoses 4

This was eye examination station. Elderly man in the room. I started with WIPE n Hemodynamic stability. Did inspection. Forgot
to do palpation. Did visual Acquity. Did visual field, I picked bitemporal hemianopia, patient was picking up the red top pin
much later than me in the temporal fields. Did light reflex, accommodation, eye movements. Then did fundoscopy.
Assembled the fundoscope. I didn’t go very near to the patient. I was able to see the optic disc n the blood vessels.
Examiner gave me pic of hypertensive retinopathy. It showed silver wiring, AV nipping. I explained that he had bitemporal
hemianopia and changes at the back of his eyes. Failed this station due to defective examination techniques.

STATION 7

PREDOMINANT ASSESSMENT AREA - EXAMINATION

Scenario: Mood change FAIL

Commentary to Examiner 3
Accuracy of Examination 3

This was the MSE video case. It was very easy case. The video clearly showed depression with psychosis. The stem said that the
young female was a nurse and a patient died during her duty. There was delusion of guilt, auditory hallucination, suicidal
ideation. There were MMSE findings given in the stem saying that she gave up during MMSE. I could not do a proper
commentary, even though I had 4 mins for that. I was very haphazard. I missed a lot on patients' appearance and
behavior. The examiner was not at all happy with my description and also, I couldn’t finish in time. MSE was one of my
favorite topics during preparation but I failed in exam because I was still under stress and somehow my thoughts and my
words were still not co ordinating.

STATION 8 REST STATION

STATION 9
PREDOMINANT ASSESSMENT AREA - HISTORY TAKING

Scenario: Vaginal blood loss FAIL

Approach to patient/relative 4
History 3
Choice & Technique of examination, organization and 3
sequence
Diagnosis/ Differential diagnoses 3
It was a young female G2P1, two weeks postpartum with vaginal bleeding. I asked hemodynamic stability. Bleeding started
suddenly last night, soaking lots of pads, forgot to ask about clots and tissue pieces. no ho trauma, asked about delivery
duration...normal, difficulty or injuries during birth...none, if placenta delivered completely.... she didn’t know. Any fever
post-partum...NO, foul smelling discharge...no. Asked about baby, breast feeding, all normal
Task was history, ask PE n tell diagnosis to pt.
In asking PE, vitals were normal. Os was open n pt was bleeding, no foul-smelling discharge. I forgot to ask any RPOC uterine size,
if uterus was contracted. I was rushing because I wanted to finish in time but missed some important stuff.
I told it was Postpartum hemorrhage [I SHOULD HAD SAID ‘SECONDARY PPH’], due to multiparity and
endometritis, [although there was no fever no tummy pain].
I was still haphazard in everything, missed a lot in history, and asking PE. Failed this station as well.

STATION 10

PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION

Scenario: Foot pain PASS

Approach to patient/relative 4
Choice & Technique of examination, organisation and sequence 4
Diagnosis/ Differential diagnoses 4
Choice of investigations 4
Management plan 4

Long stem with sudden onset of pain in big toe, pt was alcoholic, on thiazides, ate a lot of red meat. Task was ask PE, tell
diagnosis, tell inv, tell further Mx
I entered and asked HD stability, started asking PE from examiner. He gave me the pic of foot with red n swollen big toe. The
patient kept screaming throughout the station. I offered painkillers n reassured that the pain will be better in a while. Told
him that he has GOUT. Then explained it with a 5 C approach.
Told him routine invx and specific invx for Gout. Mx was to stop medications, lifestyle modifications, address risk factors, dietary
modifications. I missed referral for CV risk assessment.
Had to go back to stem again n again to find out risk factors in his case n address them one by one. Apologized to the pt for
reading my notes again told him that I want to make sure I am not missing anything.

STATION 11 NOT SCORED

It was a GDD case. Pt was diagnosed with GDD. Task was explain the condition to pt n its Mx

STATION 12

PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION

Scenario: Fever in a child PASS

Approach to patient/relative 4
History 5

Choice & Technique of examination, organisation and sequence 5

Diagnosis/ Differential diagnoses 4

It was a 5-year-old child with high grade fever not settling with medication. I asked all the fever Q. Head to toe Fever causes. Rash
n all rash related Q. Well baby Q, BINDS. Travel, childcare, anybody else sick?
In asking PE, somehow, I went systematic, with ENT then neck signs, Rash, blanchable, no blanchable. I asked about red tongue.
Examiner gave me a pic of strawberry tongue. Then I just asked all distinguishing features of kawasaki and scarlet fever.
Turned to pt, explained what is kawasaki disease, don’t remember what other DDs I gave.

STATION 13 REST STATION

STATION 14
PREDOMINANT ASSESSMENT AREA - HISTORY TAKING

Scenario: Abdominal pain PASS

Approach to patient/relative 4
History 4
Diagnosis/ Differential diagnoses 4

38 year old female, C/O lower abdominal pain for 2 months. Pain was dull, constant, non radiating, no aggravating or relieving
factor. No abdominal mass, melena or [Link] urinary complaints. History of constipation +, wasn’t sure about any
change in bowel habits, history of wt loss+, lost a dress size.
Forgot to ask about H/O bowel cancer. Nothing positive in 5Ps. Sexual history was –ve too. No urinary symptoms.
I told my probable diagnosis was cancer because if the wt loss. Other causes could be constipation itself,
ovarian mass …. other DDs I don’t remember

STATION 15.

PREDOMINANT ASSESSMENT AREA - MANAGEMENT/COUNSELLING/EDUCATION

Scenario: Leg pain PASS

Approach to patient/relative 3
History 4
Diagnosis/ Differential diagnoses 4
Management plan 5
Patient Counselling/ Education 4

Middle age lady with H/O leg pain, diagnosed with DVT. Task was ask history, tell diagnosis n DDs and explain the pt Mx n the
condition.
I asked about any current pain n ant SOB currently. Asked COSTVMPF. Air travel was positive, smoking was +, family history was
positive. I explained the Dx and DDx. Drew a pic of knee, explained what is DVT and its risk factors + in her. Explained the
Mx, explained Invx both routine n specific, blood thinning medication, maintaing INR, and prophylaxis in case the
thrombophilia screen is –ve and in case it is +ve.

STATION 16
PREDOMINANT ASSESSMENT AREA - MANAGEMENT/COUNSELLING/EDUCATION

Scenario: Behavioural change PASS

Approach to patient/relative 5
Diagnosis/ Differential diagnoses 5
Patient Counselling/ Education 4
Middle age female already diagnosed with schizophrenia, was on olanzapine, presented today for repeat prescription. Task was
to take history explain diagnosis n DDs and tell the condition to the pt.
Inside was a middle age rude role player, irritable, playing with her mobile ph, not making eye contact. I gave confidentiality
statement. First, I asked all possible S/E of antipsychotics like anti cholinergic, dopaminergic, etc. She was non-compliant
to medication. I asked pt related, medicine related and cost related causes of noncompliance. Then I took all psychosocial
history. Asked about suicidality, but couldn’t ask all depression Q. Asked Organic causes. HEADS etc. + in history was
auditory hallucination, noncompliance was due to voices saying that she doesn’t need any medicine and she is ok. She
looked after her medication by herself. Was not interested to tell if her family was cooperative. Very difficult patient. I
would wait little for her response to my Qs, if she was reluctant to answer, I wouldn’t insist rather ask next Q so I can ask
everything. Told the pt that I am afraid that the disease is coming back.
Told the Dx as relapse of Schizophrenia can't remember DDs.

STATION 17

PREDOMINANT ASSESSMENT AREA - MANAGEMENT/COUNSELLING/EDUCATION

Scenario: Health Review PASS

Approach to patient/relative 5
Patient Counselling/ Education 4
Choice of investigations 3
Management plan 4

This was AF case. Pt was diagnosed with AF. I made a diagram of heart and explained its wiring system. Explained various causes
of AF. Explained complications if not treated. Told routine and specific invx, echo, S/E, can't remember others. Referral to
specialist. Told about scoring system n the need to put him on blood thinners and the need to maintain INR. Told about
depending on the cause the blood thinners can be given for few months to life long.

STATION 18 .......... REST STATION

STATION 19 BREAST PAIN

PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION

Scenario: Breast pain PASS

Approach to patient/relative 5
Choice & Technique of examination, organisation and sequence 5
Accuracy of Examination 5
Diagnosis/ Differential diagnoses 5

Pt in her thirties, C/O breat pain, task was to take history, PE, tell Dx n DDX
I asked pain Q. Its relation to menstrual cycle, which was +, no swelling or nodularity, couldn’t ask about
good supporting undergarment. Asked H/O breast cancer,-ve.
Then took WIPE approach. Did examination on the dummy lying on the couch. It was normal.
I reassured the pt that the examination is normal and she has what we call cyclical mastalgia. Told DDx like fibrocystic disease,
fibroadenoma, CA, trauma. Pt kept making wiered faces when I explained the diagnosis n DDx. Seemed like she was not
able to understand what I was telling her, but I was happy to see the score.

STATION 20

PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION

 Scenario: Menstrual difficulty PASS

Approach to patient/relative 6
History 6
Choice & Technique of examination, organisation 4
and sequence
Diagnosis/ Differential diagnoses 6
Can't remember this senario at all. All I remember was it had two diagnoses, one was endometriosis and other was PID. Sexual
history with abnormal discharge with multiple sexual partners was positive.

Another feedback

I have cleared my exam in first attempt with a score of 11/14, on 7th June, Alhamdulillah. So thankful to the Almighty for this
success and for giving me the strength to prepare for it.

I started to prepare for the exam in 2020 with Marwan notes. Took an online clinical course and joined a study group. Later I
started self-study with Karen notes. I found it the best resource because it contained all possible exam topics and quite some
topics from the handbook as well, so partially covering hand book. The only issue with Karen notes is that, most of the
managements are outdated and some are insufficient. So, I made my own notes referring to guidelines like RCH guidelines for
Paeds, STI guidelines etc. I frequently watched various You tube videos to clear my concepts specially in Psychiatry. Then I joined
one more online course but could not continue it. My studies remained quite interrupted due to corona and my personal
circumstances. I gave two online mock tests before I decided to take a date. The main reason was, I was too scared of the failure
stories and I knew, that I cannot afford retaking exams, so I decided to prepare hard. I failed one and passed one. Then I took
the date and sat for 3 mock tests. I passed two of them, but I learnt a lot from my mistakes in the mocks. In the last two months
I came to know about Dr Amirs workshops and I was really happy to find them affordable, so I attended all the workshops.
These workshops helped to refine me and I was able to fix my mistakes, align my questions, refine my counseling techniques.
My exam was face to face so I took a PE only course at one of the institutes in Sydney. I was lucky to find a PE teacher because
he made PE simple and I learnt it quickly. I passed 2/3 PE stations in the exam.

On the exam day, I was very nervous and extremely anxious. I tried to overcome my anxiety through the supplications that I
remembered. I n the first few stations I developed some kind of dyslexia and a brain block. But later, I gained confidence and to
be honest, I enjoyed doing may last few stations. I felt like I am in my clinic addressing patient and asking history, explaining
diagnosis, and the role players looked quite happy too.

So that's my journey. I did not have time to do much role playing to be honest due to my personal circumstances. I focused on
studying my topics well. learning my clusters and the questions that help me to differentiate between them.

I would suggest to

• learn your topics well. You can speak only if you know about it. Know ur DDs n management very well.
• Have a good study partner who can challenge you to think logically during roleplaying
• Attempt multiple mock tests.
• Last minute workshops are very helpful.
• Organize your study material in a way that you can quickly do your last minute revisions.
• Plz read hand book, the way the questions are given are the way they come in exams. In feedbacks and recalls, we do
not have full stem and task and we cannot formulate our approach to the tasks.
• Plz do recalls, but as a topic. I was not able to do much recalls
• Always expect to have more than one diagnosis in the exams. I had at least two diagnosis in most of my history taking
questions.

• I only thing I wish I had done more before my exams was doing role playing.
Hope my experience will help.

Examination Station Results

Station 1 Pass

Station 2 Pass

Station 4 Assessed, Not Scored

Station 5 Pass

Station 6 Fail

Station 7 Fail

Station 9 Fail

Station 10 Pass

Station 11 Assessed, Not Scored

Station 12 Pass

Station 14 Pass

Station 15 Pass

Station 16 Pass

Station 17 Pass

Station 19 Pass

Station 20 Pass
Overall Total: 11/14

Station 4

It was the chest examination PE. Inside was an obese old man, breathless and in pain with a bruise on his left lower axillary
region. I started with WIPE approach, offered pain killer, checked hemodynamic stability and described the general appearance
and inspection findings. Trachea was central. I could not find any findings on percussion and auscultation. The examiner
remained quite. While examining chest the patient screamed once and I froze after that. Didn’t do anything. Didn’t speak
anything. Spent rest of the station quite until the bell rang. Thankfully, this station was unscored.

STATION 5

PREDOMINANT ASSESSMENT AREA - MANAGEMENT/COUNSELLING/EDUCATION

Scenario: Abnormal test result PASS

Approach to patient/relative 4
Interpretation of investigation 4
Diagnosis/ Differential diagnoses 4
Management plan 4

This was the Iron deficiency Anemia case

I think the task was explain results to the patient and explain further Mx

I was upset due to the previous station couldn’t do this well. I was haphazard.

Explained the RBC and told how iron is important in its formation. Then explained the causes of iron def like deficiency in food,
defective absorption, medications, increased body requirements and excessive body losses. In her case it was NSAID use and
excessive menstrual loss, I think.

Can't remember what I told in management.

STATION 6

PREDOMINANT ASSESSMENT AREA - EXAMINATION

 Scenario: Visual problem FAIL

Approach to patient/relative 4
Choice & Technique of examination,
3
organisation and sequence
Accuracy of Examination 3
Familiarity with test equipment 2
Diagnosis/ Differential diagnoses 4

This was eye examination station. Elderly man in the room. I started with WIPE n Hemodynamic stability. Did inspection. Forgot
to do palpation. Did visual Acquity. Did visual field, I picked bitemporal hemianopia, patient was picking up the red top pin
much later than me in the temporal fields. Did light reflex, accommodation, eye movements. Then did fundoscopy. Assembled
the fundoscope. I didn’t go very near to the patient. I was able to see the optic disc n the blood vessels. Examiner gave me pic of
hypertensive retinopathy. It showed silver wiring, AV nipping. I explained that he had bitemporal hemianopia and changes at
the back of his eyes. Failed this station due to defective examination techniques.

STATION 7

PREDOMINANT ASSESSMENT AREA - EXAMINATION

Scenario: Mood change FAIL

Commentary to Examiner 3
Accuracy of Examination 3

This was the MSE video case. It was very easy case. The video clearly showed depression with psychosis. The stem said that the
young female was a nurse and a patient died during her duty. There was delusion of guilt, auditory hallucination, suicidal
ideation. There were MMSE findings given in the stem saying that she gave up during MMSE. I could not do a proper
commentary, even though I had 4 mins for that. I was very haphazard. I missed a lot on patients' appearance and behavior. The
examiner was not at all happy with my description and also, I couldn’t finish in time. MSE was one of my favorite topics during
preparation but I failed in exam because I was still under stress and somehow my thoughts and my words were still not co
ordinating.

STATION 8 REST STATION

STATION 9
PREDOMINANT ASSESSMENT AREA - HISTORY TAKING

Scenario: Vaginal blood loss FAIL

Approach to patient/relative 4
History 3
Choice & Technique of examination, organisation and
3
sequence
Diagnosis/ Differential diagnoses 3

It was a young female G2P1, two weeks postpartum with vaginal bleeding. I asked hemodynamic stability. Bleeding started
suddenly last night, soaking lots of pads, forgot to ask about clots and tissue pieces. no ho trauma, asked about delivery
duration...normal, difficulty or injuries during birth...none, if placenta delivered completely.... she didn’t know. Any fever post-
partum...NO, foul smelling discharge...no. Asked about baby, breast feeding, all normal

Task was history, ask PE n tell diagnosis to pt.

In asking PE, vitals were normal. Os was open n pt was bleeding, no foul-smelling discharge. I forgot to ask any RPOC uterine
size, if uterus was contracted. I was rushing because I wanted to finish in time but missed some important stuff.

I told it was Postpartum hemorrhage [I SHOULD HAD SAID ‘SECONDARY PPH’], due to multiparity and
endometritis, [although there was no fever no tummy pain].

I was still haphazard in everything, missed a lot in history, and asking PE. Failed this station as well.

STATION 10

PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION

Scenario: Foot pain PASS

Approach to patient/relative 4

Choice & Technique of examination, organisation and sequence 4

Diagnosis/ Differential diagnoses 4

Choice of investigations 4

Management plan 4

Long stem with sudden onset of pain in big toe, pt was alcoholic, on thiazides, ate a lot of red meat. Task was ask PE, tell
diagnosis, tell inv, tell further Mx
I entered and asked HD stability, started asking PE from examiner. He gave me the pic of foot with red n swollen big toe. The
patient kept screaming throughout the station. I offered painkillers n reassured that the pain will be better in a while. Told him
that he has GOUT. Then explained it with a 5 C approach.
Told him routine invx and specific invx for Gout. Mx was to stop medications, lifestyle modifications, address risk factors, dietary
modifications. I missed referral for CV risk assessment.

Had to go back to stem again n again to find out risk factors in his case n address them one by one. Apologized to the pt for
reading my notes again told him that I want to make sure I am not missing anything.

STATION 11 NOT SCORED

It was a GDD case. Pt was diagnosed with GDD. Task was explain the condition to pt n its Mx

STATION 12

PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION

Scenario: Fever in a child PASS

Approach to patient/relative 4

History 5

Choice & Technique of examination, organisation and sequence 5

Diagnosis/ Differential diagnoses 4

It was a 5-year-old child with high grade fever not settling with medication. I asked all the fever Q. Head to toe Fever causes. Rash
n all rash related Q. Well baby Q, BINDS. Travel, childcare, anybody else sick?

In asking PE, somehow, I went systematic, with ENT then neck signs, Rash, blanchable, no blanchable. I asked about red tongue.
Examiner gave me a pic of strawberry tongue. Then I just asked all distinguishing features of kawasaki and scarlet fever.

Turned to pt, explained what is kawasaki disease, don’t remember what other DDs I gave.

STATION 13 REST STATION

STATION 14
PREDOMINANT ASSESSMENT AREA - HISTORY TAKING

Scenario: Abdominal pain PASS

Approach to patient/relative 4
History 4
Diagnosis/ Differential diagnoses 4

38 year old female, C/O lower abdominal pain for 2 months. Pain was dull, constant, non radiating, no aggravating or relieving
factor. No abdominal mass, melena or [Link] urinary complaints. History of constipation +, wasn’t sure about any change in
bowel habits, history of wt loss+, lost a dress size.
Forgot to ask about H/O bowel cancer. Nothing positive in 5Ps. Sexual history was –ve too. No urinary symptoms.

I told my probable diagnosis was cancer because if the wt loss. Other causes could be constipation itself,
ovarian mass …. other DDs I don’t remember

STATION 15.

PREDOMINANT ASSESSMENT AREA - MANAGEMENT/COUNSELLING/EDUCATION

Scenario: Leg pain PASS

Approach to patient/relative 3
History 4
Diagnosis/ Differential diagnoses 4
Management plan 5
Patient Counselling/ Education 4

Middle age lady with H/O leg pain, diagnosed with DVT. Task was ask history, tell diagnosis n DDs and explain the pt Mx n the
condition.

I asked about any current pain n ant SOB currently. Asked COSTVMPF. Air travel was positive, smoking was +, family history was
positive. I explained the Dx and DDx. Drew a pic of knee, explained what is DVT and its risk factors + in her. Explained the Mx,
explained Invx both routine n specific, blood thinning medication, maintaing INR, and prophylaxis in case the thrombophilia
screen is –ve and in case it is +ve.

STATION 16
 PREDOMINANT ASSESSMENT AREA - MANAGEMENT/COUNSELLING/EDUCATION

Scenario: Behavioural change PASS

Approach to patient/relative 5
Diagnosis/ Differential diagnoses 5
Patient Counselling/ Education 4

Middle age female already diagnosed with schizophrenia, was on olanzapine, presented today for repeat prescription. Task was
to take history explain diagnosis n DDs and tell the condition to the pt.

Inside was a middle age rude role player, irritable, playing with her mobile ph, not making eye contact. I gave confidentiality
statement. First, I asked all possible S/E of antipsychotics like anti cholinergic, dopaminergic, etc. She was non-compliant to
medication. I asked pt related, medicine related and cost related causes of noncompliance. Then I took all psychosocial history.
Asked about suicidality, but couldn’t ask all depression Q. Asked Organic causes. HEADS etc. + in history was auditory
hallucination, noncompliance was due to voices saying that she doesn’t need any medicine and she is ok. She looked after her
medication by herself. Was not interested to tell if her family was cooperative. Very difficult patient. I would wait little for her
response to my Qs, if she was reluctant to answer, I wouldn’t insist rather ask next Q so I can ask everything. Told the pt that I
am afraid that the disease is coming back.
Told the Dx as relapse of Schizophrenia can't remember DDs.

STATION 17

PREDOMINANT ASSESSMENT AREA - MANAGEMENT/COUNSELLING/EDUCATION

Scenario: Health Review PASS

Approach to patient/relative 5
Patient Counselling/ Education 4
Choice of investigations 3
Management plan 4

This was AF case. Pt was diagnosed with AF. I made a diagram of heart and explained its wiring system. Explained various
causes of AF. Explained complications if not treated. Told routine and specific invx, echo, S/E, can't remember others. Referral to
specialist. Told about scoring system n the need to put him on blood thinners and the need to maintain INR. Told about
depending on the cause the blood thinners can be given for few months to life long.

STATION 18 ...... REST STATION

STATION 19 BREAT PAIN

PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION

Scenario: Breast pain PASS

Approach to patient/relative 5

Choice & Technique of examination, organisation and sequence 5

Accuracy of Examination 5

Diagnosis/ Differential diagnoses 5

Pt in her thirties, C/O breat pain, task was to take history, PE, tell Dx n DDX

I asked pain Q. Its relation to menstrual cycle, which was +, no swelling or nodularity, couldn’t ask about
good supporting undergarment. Asked H/O breast cancer,-ve.

Then took WIPE approach. Did examination on the dummy lying on the couch. It was normal.

I reassured the pt that the examination is normal and she has what we call cyclical mastalgia. Told DDx like fibrocystic disease,
fibroadenoma, CA, trauma. Pt kept making wiered faces when I explained the diagnosis n DDx. Seemed like she was not able to
understand what I was telling her, but I was happy to see the score.

STATION 20

PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION

Scenario: Menstrual difficulty PASS

Approach to patient/relative 6
History 6
Choice & Technique of examination, organisation
4
and sequence
Diagnosis/ Differential diagnoses 6
Can't remember this senario at all. All I remember was it had two diagnoses, one was endometriosis and other was PID. Sexual
history with abnormal discharge with multiple sexual partners was positive.

STATION 1

PREDOMINANT ASSESSMENT AREA - HISTORY TAKING

Scenario: Medication management PASS

 Approach to patient/relative 4
History 5
Patient Counselling/ Education 5

This was hypertension noncompliance case

I asked Q of macro and microvascular complications of HTN. Asked pt related, cost related, doctor related causes of
noncompliance. Then explained the complications of uncontrolled HTN.

Told life style modification like explained in JM pt education in type II Diabetes chapter. Adopt N E A T life style
N for nutrition E for exercise
A for avoid C A T S

T for tranquility like meditation CATS stands for

C for caffeine A for alcohol
T for tar, tension S for smoking, salt
Patient was verrrryyyy happpy n asked me to write these for him

STATION 2

PREDOMINANT ASSESSMENT AREA - EXAMINATION

Scenario: Knee pain PASS

Approach to patient/relative 4
Choice & Technique of examination, organisation and
4
sequence
Accuracy of Examination 5
Diagnosis/ Differential diagnoses 5

This was a young girl may be 15, 16. She had some physical findings as well. I did WIPE approach. On inspection I found redness
on the skin and the patient had a valgus deformity of both knees. I did knee examination, did all the tests. She gave me
tenderness bilaterally at the tibial tuberosities.

I told her she has a condition called Osgood schlatters disease. I explained the condition using landmarks of her own knee. Can't
remember the DDx.

STATION 3

It was Delirium case. The greek lady with pnumonia, low Na levels, was also taking medications for heart failure and HTN. Task
was to explain Diagnosis and tell management. Explained delirium, its causes in pts case as mentioned in the senario. Had to go
through the stem again and again. It had so much findings. Then explained Delirium screen n delirium unit in Mx.

ALL THE BEST......

8th June. F2f

1. Secondary amenorrhea. Exercise. History. Diagnosis. Differentials.
2. Spirometric. Task. Explain for two minutes. Second, diagnosis to patient differentials. Third. Management to patient.
Bing.
3. HPV 16+, 18 -ve, LBC=NORMAL
a. Explained to patient. Next history.
b. Focus to history.
c. Management.
4. Body dysmorphic disorder. Nose.
a. History.
b. Diagnosis with reason.
c. Management.
5. Patient had bypass surgery. Now patient is worried. He has Weight loss.. Smoking.
a. Focused history for serious risk.
b. History. What risk you found?
c. Physical examination from the examiner.
d. Management.
6. Alcohol related. Young males. Alcohol. Intoxicated coma. Came to emergency department.
a. Medical and psychosocial history.
b. Decide if patient is eligible for discharge.
7. MSE. Video for schizophreniform 2 years ago.
a. Auditory hallucinations. Grandiose.. Delusion.
8. Secondary. PP H
9. 35 weeks delivery. ANXIOUS mom. Regional Hospital.
a. History from mother.
b. Diagnosis and differentials.
c. Management.
10. Abdominal pain. Slash. Male aged. A regular stool pass. Now bleeding PR. Bleed.
a. Do relevant examination.
b. Diagnosis and other reasons
11. Back pain. God meds. Now have tummy pain. Oxytocin. Physical examination. Has. Abdominal distention faecal matter
positive. Oxytocin induced Constipation.
a. History.
b. Diagnosis and differentials.
c. Physical examination.
12. Foot pain.
a. History. Hiking in Tasmania. Stress. positive.
b. Do focused Foot. examination.
13. Centre abdominals pain. Rating 8/10., After dinner 2 hours after. Every positive. Alcohol normal. Pain radiates to back.
a. history.
b. Physical examination.
c. Diagnosis and differentials.
14. Tingling and numbness. Lower limb 2 days ago got hurt during Squat.
a. Relevant physical examination.
b. Diagnosis..

9th June 2022 f2f

Station 1

15y old child with cystic fibrosis. mother here to discuss daughters current situation.
Inside the room 2 charts were given on the table like below. Age and Weight and age vs FEV 1 over last
5 years 10y to 15y.
Hx from mother
3
Explain charts to mother
Discuss causes for the presentation and concerns
FÉV, percintu.
-Age
loy
lly
lay
agu
After greeting and introduction, I quickly asked, as your daughter is 15y do you have permission to
discuss about her health. Role player said yes
For hx I asked about concerns, mum straightaway told daughter has not been doing her recommended
Rx properly and may be not taking medicine and she is not exactly sure, as for reason she was vaguely
saying problems at home and later tald me about her divorce 2y ago. Asked few things to see if
daughter is depressed, and sounded like depressed. Asked other general Qs can t exactly remember
now.
from 10y to 13y both were dropping slowly, then steep drop from 13y to 15y
I explained charts saying initial slight drop recent fast drop in W for age and FEV1 to age,
said reason can be poor compliance with r and then related to home situation as well. also
Said child probably has depression and need to see her to come to conclusion
PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION STATION 1
Scenario: Health review
Grade: Pass
Approach to patient/relative 6
History 6
Interpretation of investigation
Diagnosis/ Differential diagnoses

Station 2
Patient wants vaginal delivery in next pregnancy (Marwan 272)
Take hx-
2. Give management plan to patient
Opening statement didn't give much information. So had to find. Planning another pregnancy, previous
ECS, child 18m now, labour not progressing, when I asked what was the problem patient said "back to
back".i was not sure what it was. Had to ask more questions to determine what she meant. I assumed
baby's back to mothers back so not turning properly. Not breach. Pt does not know anything else, so
asked other relevant Qs 5Ps, gen health, medications. Nothing significant.
So told her sound like baby not turning properly and if that's the case, unlikely to recur, will check
records, prev scans etc,
Said will do scan, refer to specialist for assessment and few other things. Definitely not adequate. Didn't
pass it.
PREDOMINANT ASSESSMENT AREA - HISTORY TAKING
STATION 2
Scenario: Pre-pregnancy counselling 4
Approach to patient/relative 3
History 3
Patient Counselling/Education 3 Management plan 3
Grade: Fail

Station 4

Pre op hernia preparation, on Warfarin for AF, metformin, atenolol (Marwan 277)
[Link] hx from pt
[Link] plan to examiner
Old recall
Hx- asked about hernia any current symptoms (any pain, change in bowel motions, then details about
each medical condition and compliance with medication any SE, SADMA, I can't remember if I had time
to ask previous Sx, it will be relevant,
To examiner-I will arrange blood Ix, referral to specialist about warfarin, decide if need bridging therapy
based on Risk of bleeding vs risk of thrombosis and gave how I will convert to heparin 5days before
surgery and do monitoring, then said I will stop Metformin on the day of the surgery and give insulin
according to blood sugar, atenolol will be continued and monitor BP. Everything in consultation with
anesthetists and surgeon
PREDOMINANT ASSESSMENT AREA - MANAGEMENT/COUNSELLING/EDUCATION
Grade: Pass
Scenario: Preoperative review
Approach to patient/relative 4
History 4
Management plan 5

Station 5
Calf pain history was given and smoker
Do relevant PE
Give most probable Dx
STATION 4
Oommonly given recall. Unfortunately, I could not finish examination before bell. So failed the case
I started with greeting and introduction, explained and took consent. then we had to sanitize hands and
put gloves. Pt was on the bed. I asked pt to walk first which I feel not necessary in this case as could not
see anything. Pt got out of the bed and walked, but it cost me time.
Then started with inspection, commented as no hair loss, no ulcers, sole had callosities and some nail
changes
Then checked for warmth and CRF, examiner gave a stop watch to do it. Then looked for dorsalis pedis
pulse and I could not feel, so I was rechecking, spent lot of time there.
Then checked posterior tibial pulse and bell rang at that point. I was surprised, so I just mentioned I
need complete by doing other pulses, CVS, cartotid bruits, burger test ABPI and said dx is most
probably PVD based on hx. But it was not enough
PREDOMINANT ASSESSMENT AREA - EXAMINATION
Scenario: Lower limb pain
Grade: Fail
Approach to patient/relative 4
Choice & Technique of examination, organisation and sequence 3
Accuracy of Examination 3
Diagnosis/ Differential diagnoses 1
STATION 5
3
Station 6- Pilot-
Male patient with urinary problem middle age
Take hx-
PEFE
Dx with reason to the patient, can t remember if DD was asked
I thought of DDS as BOO with BPH or cancer, DM, UTI, STI,
asked for BOO symptoms- hesitancy, urgency, dribbling and poor stream all were present, no UTI
features, no DM features, no unprotected sex/casual partners, no cancer features, SADMA negative,
occupations cant remember, PMHX and PShx nothing significant
PEFE- vitals normal, abdomen- examiner said mass palpable in the suprapubic region with mild
tenderness. Here I realized I should have asked at the beginning about any urge pass urine and when
was the last time. Probable expected find as acute retention
DRE-prostate enlarged smooth, non tender
Dx and DD- mentioned most probable is urine retention with BOO due to BPH explained a bit to pt, cant
remember if I gave any DD
Station 7-MSE video
Watch the video and present MSE to examiner. DD was not asked
This was bit atypical case, I thought may be a pilot but was not.
male patient, well dresses, speech all features normal, upset after a breakup, but not very depressed
Mood ok. Affect congruent, No hallucinations
thought form linear, no delusions, insight ok.
Cognition and judgement was not assessed
Presented in ASEPTIC J format
REDOMINANT ASSESSMENT AREA - EXAMINATION
STATION 7
Scenario: Behavioural complaint
Commentary to Examiner 4
Accuracy of Examination 4
Grade: Pass
Station 9
Young female with abdo pain, 7weeks amenorrhea and weakly + home PT
Do PE-
Most probable dx and other dd to the patient
Young female with abdo pain, 7weeks amenorrhoea and weakly + home PT
Do PE-
2.
Most probable dx and other dd to the patient
After WIPE, I mentioned need to know vitals, BP cuff and stop watch given, had to show examiner by
putting the cuff, then values given PR 70 and BP 110/70.
Then I said vitals stable and asked for temperature, given as 36.7
Then I did face, checked hydration, hands abdomen, inspection palpation, RIF tender.
I told examiner I m skipping deep palpation at RIF, auscultated for bowel sounds and said want to do
pevic Ex. Examiner gave me a card - OS closed no bleeding from cervix, no MT, R adnexal tenderness +
DD-| said most probably ectopic pregnancy- patient sked what is it Dr, so I explained a bit, then bell
rang, I quicky said other possibilities Appendicitis, intestinal obstruction ( should have mentioned
ovarian torsion, cyst rupture, PID but did not have time)
PREDOMINANT ASSESSMENT AREA - EXAMINATION
STATION 9
Scenario: Abdominal pain
Grade: Pass
Approach to patient/relative 4
Choice & Technique of examination, organisation and sequence 4
Accuracy of Examination 4
Diagnosis/ Differential diagnoses 3

Station 10
Recent onset anxiety in a 52 year old female
1
Hx for 6min
2.
Most probable dx and other DD to patient
Thinking time- from stem I knew need to take hx for all main causes of nervousness. So decided to cover
post menopausal, hyperthyroid, panic attack/phobic disorder, phaeochromo, tea, coffee, medication
After greeting and introduction, I asked the pt to tell me bit about her problem. She said for last few
month she has been feeling nervous all the time, disturbing work and husband wanted her to come and
see a doctor. Little vague, periods-some change cat remember now, mood irritable, dyspareunia again
cant remember answer, she gave a hx of loose stools, no wt loss, so it was not clear perimenopausal or
hyperthyroid, I covered both in detail, then quickly other questions for my DDs, SADMA, nothing else
was positive
So I said most probably symptoms can be due to perimenopausal period, but hyperthyroidism also
possible. Other possibilities I quickly listed and said less likely.
PREDOMINANT ASSESSMENT AREA - HISTORY TAKING
Scenario: Anxiety
Grade: Pass
Approach to patient/relative 5
History 5
Diagnosis/ Differential diagnoses 6

STATION 10

Station 11
Female with neck pain, past history of mastectomy
Hx for 4min.
Explain Dx and DD to pt
Further management plan
Hx- all pain QS, any asso numbness, patient said numb showing C6 and C7 area, then asked LOA LOW,
other jt problems all negative, bit about mastectomy and followup- all clear
PMHx and SADMA nill
Dx I said most probably cervical spondylolystheis with radiculopathy, can be fracture, other Jt condition
like OA RA
Mx plan -I gave stronger analgesic, Neck imaging xray followed by MRI if needed, FBE ESR, LFT, kidney
function, and specialist opinion on breast follow up
Pt councelling was not a separate task but given marks separately, I think they have scored it from
explaining Dx and DD to pt and mx
PREDOMINANT ASSESSMENT AREA - MANAGEMENT/COUNSELLING/EDUCATION
Scenario: Neck pain
Grade: Pass
Approach to patient/relative 4
Diagnosis/ Differential diagnoses 4
Patient Counselling/Education 3
Management plan 5

Station 12
Middle aged male patient facial pain
Take hx.
STATION 11
PEFE-
Most probable dx and dd-
all SORTSARA qs asked - answers were towards trigeminal neuralgia,
PEFE- specifically asked vitals and then face- pallor icterus, dental caries sinus tenderness, neurology- all
normal
gave trigeminal neuralgia and other DD for facial pain like JMJ dysfunction, dental caries sinusitis,
trauma, RA of joint
PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION
STATION 12
Scenario: Facial pain
Grade: Pass
Approach to patient/relative 4
History 4
Choice & Technique of examination, organisation and sequence 5
Diagnosis/ Differential diagnoses 4

Station14
There were 2 cases which can fit in to this description, one adult and one paed case.
One will be this station and other one must be a pilot (station 16).
as I can not remember by number will write adult case here
Previous schizophreniform hx given 18m back, advised to follow up with local mental health clinic
Take hx
Most probable Dx and dd
Said will do scan, refer to specialist for assessment and few other things. Definitely not adequate. Didn't
pass it.
PREDOMINANT ASSESSMENT AREA - HISTORY TAKING
STATION 2
Scenario: Pre-pregnancy counselling
Approach to patient/relative 4
Historv 3
Patient Counselling/Education 3
Management plan 3
Grade: Fail

Station 4
Pre op hernia preparation, on Warfarin for AF, metformin, atenolol
1
Take hx from pt
2. Management plan to examiner
Old recall
Hx- asked about hernia any current symptoms (any pain, change in bowel motions, then details about
each medical condition and compliance with medication any SE, SADMA, I can't remember if I had time
to ask previous Sx, it will be relevant,
To examiner- will arrange blood Ix, referral to specialist about warfarin, decide if need bridging therapy
based on Risk of bleeding vs risk of thrombosis and gave how I will convert to heparin 5days before
surgery and do monitoring, then said I will stop Metformin on the day of the surgery and give insulin
according to blood sugar, atenolol will be continued and monitor BP. Everything in consultation with
anesthetists and surgeon
PREDOMINANT ASSESSMENT AREA - MANAGEMENT/COUNSELLING/EDUCATION
Scenario: Preoperative review
Approach to patient/relative 4
History 4
Grade: Pass
Management plan 5

Station 5
Calf pain history was given and smoker
Do relevant PE
Give most probable Dx

Very commonly given recall. Unfortunately, I could not finish examination before bell. So failed the case
I started with greeting and introduction, explained and took consent. then we had to sanitize hands and
put gloves. Pt was on the bed. I asked pt to walk first which I feel not necessary in this case as could not
see anything. Pt got out of the bed and walked, but it cost me time.
Then started with inspection, commented as no hair loss, no ulcers, sole had callosities and some nail
changes
Then checked for warmth and CRF, examiner gave a stop watch to do it. Then looked for dorsalis pedis
pulse and I could not feel, so I was rechecking, spent lot of time there.
Then checked posterior tibial pulse and bell rang at that point. I was surprised, so I just mentioned I
need complete by doing other pulses, CVS, cartotid bruits, burger test ABPI and said dx is most
probably PVD based on hx. But it was not enough
PREDOMINANT ASSESSMENT AREA - EXAMINATION
Scenario: Lower limb pain
Grade: Fail
Approach to patient/relative 4
Choice & Technique of examination, organisation and sequence 3
Accuracy of Examination 3
Diagnosis/ Differential diagnoses 1

STATION 5

Station 6- Pilot- Male patient with urinary problem middle age

Take hx-
PEFE
Dx with reason to the patient, can t remember if DD was asked
I thought of DDS as BOO with BPH or cancer, DM, UTI, STI,
asked for BOO symptoms- hesitancy, urgency, dribbling and poor stream all were present, no UTI
features, no DM features, no unprotected sex/casual partners, no cancer features, SADMA negative,
occupations cant remember, PMHX and PShx nothing significant
PEFE- vitals normal, abdomen- examiner said mass palpable in the suprapubic region with mild
tenderness. Here I realized I should have asked at the beginning about any urge pass urine and when
was the last time. Probable expected find as acute retention
DRE-prostate enlarged smooth, non tender
Dx and DD- mentioned most probable is urine retention with BOO due to BPH explained a bit to pt, cant
remember if I gave any DD

Station 7-MSE video

Watch the video and present MSE to examiner. DD was not asked
This was bit atypical case, I thought may be a pilot but was not.
male patient, well dresses, speech all features normal, upset after a breakup, but not very depressed
Mood ok. Affect congruent, No hallucinations
thought form linear, no delusions, insight ok.
Cognition and judgement was not assessed
Presented in ASEPTIC J format
REDOMINANT ASSESSMENT AREA - EXAMINATION
Scenario: Behavioural complaint
Commentary to Examiner 4
Accuracy of Examination 4
STATION 7
Grade: Pass

Station 9
Young female with abdo pain, 7weeks amenorrhoea and weakly + home PT
Do PE.
2.
Most probable dx and other dd to the patient
After WIPE, I mentioned need to know vitals, BP cuff and stop watch given, had to show examiner by
putting the cuff, then values given PR 70 and BP 110/70.
Then I said vitals stable and asked for temperature, given as 36.7
Then I did face, checked hydration, hands abdomen, inspection palpation, RIF tender.
I told examiner I m skipping deep palpation at RIF, auscultated for bowel sounds and said want to do
pevic Ex. Examiner gave me a card - OS closed no bleeding from cervix, no CMT, R adnexal tenderness +
DD-I said most probably ectopic pregnancy- patient sked what is it Dr, so I explained a bit, then bell
rang, I quicky said other possibilities Appendicitis, intestinal obstruction ( should have mentioned
ovarian torsion, cyst rupture, PID but did not have time)
PREDOMINANT ASSESSMENT AREA - EXAMINATION
STATION 9
Scenario: Abdominal pain
Grade: Pass
Approach to patient/relative 4
Choice & Technique of examination, organisation and sequence 4
Accuracy of Examination 4
Diagnosis/ Differential diagnoses3

Station 10

Recent onset anxiety in a 52 year old female

1.
Hx for 6min
2.
Most probable dx and other DD to patient
Thinking time- from stem I knew need to take hx for all main causes of nervousness. So decided to cover
post menopausal, hyperthyroid, panic attack/phobic disorder, phaeochromo, tea, coffee, medication
After greeting and introduction, I asked the pt to tell me bit about her problem. She said for last few
month she has been feeling nervous all the time, disturbing work and husband wanted her to come and
see a doctor. Little vague, periods-some change cant remember now, mood irritable, dyspareunia again
cant remember answer, she gave a hx of loose stools, no wt loss, so it was not clear perimenopausal or
hyperthyroid, I covered both in detail, then quickly other questions for my DDs, SADMA, nothing else
was positive
So I said most probably symptoms can be due to perimenopausal period, but hyperthyroidism also
possible. Other possibilities I quickly listed and said less likely.
PREDOMINANT ASSESSMENT AREA - HISTORY TAKING
Scenario: Anxiety
Grade: Pass
Approach to patient/relative 5
History 5
5
Diagnosis/ Differential diagnoses 6

STATION 10

Station 11

Female with neck pain, past history of mastectomy

Hx for 4min-
Explain Dx and DD to pt
Further management plan
5 of
Hx- all pain QS, any asso numbness, patient said numb showing C6 and C7 area, then asked LOA LOW,
other jt problems all negative, bit about mastectomy and followup- all clear
PMHx and SADMA nill
Dx I said most probably cervical spondylolystheis with radiculopathy, can be fracture, other Jt condition
like OA RA
Mx plan -I gave stronger analgesic, Neck imaging ray followed by MRI if needed, FBE ESR, LFT, kidney
function, and specialist opinion on breast follow up
Pt councelling was not a separate task but given marks separately, I think they have scored it from
explaining Dx and DD to pt and mx
PREDOMINANT ASSESSMENT AREA - MANAGEMENT/COUNSELLING/EDUCATION
Grade: Pass
Scenario: Neck pain
Approach to patient/relative 4
Diagnosis/ Differential diagnoses 4
Patient Counselling/Education 3
Management plan 5

Station 12

Middle aged male patient facial pain

Take hx-
STATION 11
PEFE-
Most probable dx and dd-
all SORTSARA qs asked - answers were towards trigeminal neuralgia,
PEFE- specifically asked vitals and then face- pallor icterus, dental caries sinus tenderness, neurology- all
normal
gave trigeminal neuralgia and other DD for facial pain like JMJ dysfunction, dental caries sinusitis,
trauma, RA of joint
PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION
STATION 12
Scenario: Facial pain
Grade: Pass
Approach to patient/relative 4
History 4
Choice & Technique of examination, organisation and sequence 5
Diagnosis/ Differential diagnoses 4

Station14
There were 2 cases which can fit in to this description, one adult and one paed case
One will be this station and other one must be a pilot (station 16).
as I can not remember by number will write adult case here
Previous schizophreniform hx given 18m back, advised to follow up with local mental health clinic
Take hx
Most probable Dx and dd
and councel pt
taking hx was difficult. patient was very slow to answer. But talking clearly, not acting abnormally. Took
lot of time. Mostly negative symptoms, I can t remember what was positive now. I asked if he went for
follow up as advised and said no. if I asked about reason and medication ,I cant remember.
Then said most probably schizophrenia, or drug related, poor compliance
PREDOMINANT ASSESSMENT AREA - HISTORY TAKING
Scenario: Assessment of change in behaviour
Approach to patient/relative 4
History 4
Diagnosis/ Differential diagnoses 4
Patient Counselling/Education 3

STATION 14
Grade: Pass

Station 15
12m old child sudden stiffening
Hx- while changing nappy, rolled eyes up lasted 3min. had fever for 2days or some thing before
PEFE- card given-had just one line saying all Ex normal
Dx to mother- febrile fit, other epilepsy, low blood sugar
Management in the future- explained what to do if get another fit, not sure if that's what was expected
PREDOMINANT ASSESSMENT AREA - MANAGEMENT/COUNSELLING/EDUCATION
STATION 15
Approach to patient/relative 4
History 4
Choice & Technique of examination, organisation and sequence 4
Diagnosis/ Differential diagnoses 4

Patient Counselling/Education

Station 16- Pilot most probably ADHD case

4y old child aggressive at kinder
Take hx from father
PEFE from ex
Most probable dx and other dd with explanation to farther
hx- mostly suggestive of Autism, covered ADHD, hearing vision problem bullying at kinder. BINDS all
good
PEFE all normal
Said possibly Autism spectrum, then told other DDs I covered in Hx
Station 17-hearing problem,
middle aged lady complaining of hearing loss in Lear.
tuning forks and otoscope given with patient and manikin
tasks
Do hearing exam
and other relevant exam- giving running commentary to examiner
Most probable Dx and DD
Introduced, wore gloves, explained and gained consent
Introduced, wore gloves, explained and gained consent
Started with whisper test. Found L ear reduced hearing on whisper, Weber localized to L ear and Rinne
Rear AC>BC, L/ear BC>AC,
otoscopy I said it was perforation with cholesteatoma.
I probably didn't give a proper running commentary and didn't mention any DD, I think should have
given DD for conduction deafness of L ear after Rinne and Weber and then do otoscopy
PREDOMINANT ASSESSMENT AREA - EXAMINATION
Scenario: Hearing complaint
Grade: Fail
Approach to patient/relative 4
Choice & Technique of examination, organisation and sequence 4
Familiarity with test equipment 5
Accuracy of Examination 2
Diagnosis/ Differential diagnoses 3

STATION 17
Station 19
Recurrent genital ulcers in a young female, 22y
Dx/DD
Management plan
Hx- ulcers features suggestive of HSV but no ulcers now, gets recurrences, cant remember details.
Said most probably HSV
Advised on safe sex, avoid sex if active ulcers, told about possibility of starting on suppressive treatment
with acyclovir if recurrences are problematic, can treat acute episodes as well.
Then talked about what to do if she get pregnant but then she said she does not want to have babies!
PREDOMINANT ASSESSMENT AREA - MANAGEMENT/COUNSELLING/EDUCATION
Scenario: Vulval complaint
Grade: Pass
Approach to patient/relative 4
History 3
Diagnosis/ Differential diagnoses 4
Patient Counselling/Education 4
STATION 19

Station 20

Middle aged male foot pain

Hx-
PEFE
Dx and DD
Investigations to examiner if any
Hx-
Sudden pain while gardening, thought if an insect bite, no fever no trauma, no other jt sx, hx was
towards gout so ask risk factors directly-heavy alcohol use +, red meat +, has HT. I asked about
medication, he mentioned a brand name and asked me do you know it, I said not sure, then he showed
me a piece of paper written hydrochlo'thiazide.
PEFE- vitals normal, when I said foot examination,
showed a picture, like this
red around base of R big toe with slight swelling, I think was tender, no skin damage or bite marks
No other JT involvement
DD- I said most probably gout, based on hx and Ex, then other like OA, RA, trauma, bite, cant remember
if I mentioned septic arthritis.
Bell rang at that point, I quickly mentioned FBE, ESR, serum uric acid
PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION
Scenario: Foot pain
Grade: Pass
Approach to patient/relative 5
History 4
Choice & Technique of examination, organisation and sequence 4
Diagnosis/ Differential diagnoses 5

9th June 2022

Station 1
15y old child with cystic fibrosis. mother here to discuss daughters current situation.
Inside the room 2 charts were given on the table like below. Age and Weight and age vs FEV 1 over last 5 years 10y to 15y.
1. Hx from mother
2. Explain charts to mother
3. Discuss causes for the presentation and concerns

Marwan 264
After greeting and introduction, I quickly asked, as your daughter is 15y do you have permission to discuss about her health. Role
player said yes
For hx I asked about concerns, mum straightaway told daughter has not been doing her recommended Rx properly and may be
not taking medicine and she is not exactly sure, as for reason she was vaguely saying problems at home and later tald me
about her divorce 2y ago. Asked few things to see if daughter is depressed, and sounded like depressed. Asked other
general Qs can t exactly remember now.
from 10y to 13y both were dropping slowly, then steep drop from 13y to 15y
I explained charts saying initial slight drop recent fast drop in W for age and FEV1 to age, said reason can be poor compliance with
rx and then related to home situation as well. also Said child probably has depression and need to see her to come to
conclusion

PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION STATION 1

Scenario: Health review Grade:

Pa
ss
Approach to patient/relative 6
History 6
Interpretation of investigation 6
Diagnosis/ Differential diagnoses 7

Station 2
Patient wants vaginal delivery in next pregnancy
1. Take hx-
2. Give management plan to patient

Opening statement didn’t give much information. So had to find. Planning another pregnancy, previous ECS, child 18m now,
labour not progressing, when I asked what was the problem patient said ”back to back”.i was not sure what it was. Had to
 ask more questions to determine what she meant. I assumed baby’s back to mothers back so not turning properly. Not
breach. Pt does not know anything else, so asked other relevant Qs 5Ps, gen health, medications. Nothing significant.
So told her sound like baby not turning properly and if that’s the case, unlikely to recur, will check
records, prev scans etc,
Said will do scan, refer to specialist for assessment and few other things. Definitely not adequate. Didn’t
pass it.
PREDOMINANT ASSESSMENT AREA - HISTORY TAKING STATION 2
Scenario: Pre-pregnancy counselling Grade:
Fa
il
Approach to patient/relative 4
History 3
Patient Counselling/ Education 3
Management plan 3

Station 4
Pre op hernia preparation, on Warfarin for AF, metformin, atenolol
1. Take hx from pt
2. Management plan to examiner Old recall
Hx- asked about hernia any current symptoms (any pain, change in bowel motions, then details about each medical condition and
compliance with medication any SE, SADMA, I can’t remember if I had time to ask previous Sx, it will be relevant,

To examiner-I will arrange blood Ix, referral to specialist about warfarin, decide if need bridging therapy based on Risk of bleeding
vs risk of thrombosis and gave how I will convert to heparin 5days before surgery and do monitoring, then said I will stop
Metformin on the day of the surgery and give insulin according to blood sugar , atenolol will be continued and monitor BP.
Everything in consultation with anaesthetists and surgeon

PREDOMINANT ASSESSMENT AREA - MANAGEMENT/COUNSELLING/EDUCATION STATION 4

Scenario: Preoperative review Grade: Pass Approach to patient/relative ...................................................... 4
History 4
Management plan 5

Station 5
Calf pain history was given and smoker Do relevant PE
Give most probable Dx

Very commonly given recall. Unfortunately, I could not finish examination before bell. So failed the case I started with greeting
and introduction, explained and took consent. then we had to sanitize hands and put gloves. Pt was on the bed. I asked pt
to walk first which I feel not necessary in this case as could not see anything. Pt got out of the bed and walked , but it cost
me time.
Then started with inspection, commented as no hair loss, no ulcers, sole had callosities and some nail changes
Then checked for warmth and CRF, examiner gave a stop watch to do it. Then looked for dorsalis pedis pulse and I could not feel,
so I was rechecking, spent lot of time there.
Then checked posterior tibial pulse and bell rang at that point. I was surprised, so I just mentioned I need complete by doing other
pulses, CVS , cartotid bruits, burger test ABPI and said dx is most probably PVD based on hx. But it was not enough

PREDOMINANT ASSESSMENT AREA - EXAMINATION STATION 5

Scenario: Lower limb pain Grade: Fail
Approach to patient/relative 4
Choice & Technique of examination, organisation and sequence 3
Accuracy of Examination 3
Diagnosis/ Differential diagnoses 1

Station 6- Pilot- Male patient with urinary problem middle age Take hx-
PEFE
Dx with reason to the patient, can t remember if DD was asked
I thought of DDS as BOO with BPH or cancer, DM, UTI, STI,
asked for BOO symptoms- hesitancy, urgency, dribbling and poor stream all were present, no UTI features, no DM features, no
unprotected sex/casual partners, no cancer features, SADMA negative, occupations cant remember, PMHX and PShx
nothing significant

PEFE- vitals normal, abdomen- examiner said mass palpable in the suprapubic region with mild tenderness. Here I realized I
should have asked at the beginning about any urge pass urine and when was the last time. Probable expected find as acute
retention

DRE-prostate enlarged smooth, non tender

Dx and DD- mentioned most probable is urine retention with BOO due to BPH explained a bit to pt, cant remember if I gave any
DD

Station 7- MSE video

Watch the video and present MSE to examiner. DD was not asked This was bit atypical case, I thought may be a pilot but was not.
male patient, well dresses, speech all features normal, upset after a breakup, but not very depressed.
Mood ok. Affect congruent, No hallucinations thought form linear, no delusions , insight ok. Cognition and judgement was not
assessed Presented in ASEPTIC J format

REDOMINANT ASSESSMENT AREA - EXAMINATION STATION 7

Scenario: Behavioural complaint Grade: Pass
Commentary to Examiner 4
Accuracy of Examination 4

Station 9
Young female with abdo pain, 7weeks amenorrhoea and weakly + home PT
1. Do PE-
2. Most probable dx and other dd to the patient
After WIPE, I mentioned need to know vitals, BP cuff and stop watch given, had to show examiner by putting the cuff, then values
given PR 70 and BP 110/70.
Then I said vitals stable and asked for temperature, given as 36.7
Then I did face, checked hydration, hands abdomen, inspection palpation, RIF tender.
I told examiner I m skipping deep palpation at RIF, auscultated for bowel sounds and said want to do pevic Ex. Examiner gave me
a card - OS closed no bleeding from cervix, no CMT, R adnexal tenderness +

DD-I said most probably ectopic pregnancy- patient sked what is it Dr, so I explained a bit, then bell rang, I quicky said other
possibilities Appendicitis, intestinal obstruction ( should have mentioned ovarian torsion, cyst rupture, PID but did not
have time)
PREDOMINANT ASSESSMENT AREA - EXAMINATION STATION 9
Scenario: Abdominal pain Grade: Pass Approach to
patient/relative 4
Choice & Technique of examination, organisation and sequence 4
Accuracy of Examination 4 Diagnosis/ Differential diagnoses 3

Station 10
Recent onset anxiety in a 52 year old female
1. Hx for 6min
2. Most probable dx and other DD to patient

Thinking time- from stem I knew need to take hx for all main causes of nervousness. So decided to cover post menopausal,
hyperthyroid, panic attack/phobic disorder, phaeochromo, tea, coffee, medication

After greeting and introduction, I asked the pt to tell me bit about her problem. She said for last few month she has been feeling
nervous all the time, disturbing work and husband wanted her to come and see a doctor. Little vague, periods-some
change cant remember now, mood irritable, dyspareunia again cant remember answer, she gave a hx of loose stools, no
wt loss, so it was not clear perimenopausal or hyperthyroid, I covered both in detail, then quickly other questions for my
 DDs, SADMA, nothing else was positive

So I said most probably symptoms can be due to perimenopausal period, but hyperthyroidism also possible. Other possibilities I
quickly listed and said less likely.

PREDOMINANT ASSESSMENT AREA - HISTORY TAKING STATION 10

Scenario: Anxiety Grade: Pass Approach to
patient/relative 5
History 5
Diagnosis/ Differential diagnoses 6

Station 11
Female with neck pain, past history of mastectomy Hx for 4min-
Explain Dx and DD to pt Further management plan

Hx- all pain QS, any asso numbness, patient said numb showing C6 and C7 area, then asked LOA LOW, other jt problems all
negative, bit about mastectomy and followup- all clear
PMHx and SADMA nill
Dx I said most probably cervical spondylolystheis with radiculopathy, can be fracture, other Jt condition like OA RA
Mx plan -I gave stronger analgesic, Neck imaging xray followed by MRI if needed, FBE ESR, LFT, kidney function, and specialist
opinion on breast follow up
Pt councelling was not a separate task but given marks separately, I think they have scored it from explaining Dx and DD to pt and
mx

PREDOMINANT ASSESSMENT AREA - MANAGEMENT/COUNSELLING/EDUCATION STATION 11

Scenario: Neck pain Grade: Pass Approach to
patient/relative 4
Diagnosis/ Differential diagnoses 4
Patient Counselling/ Education 3
Management plan 5

Station 12
Middle aged male patient facial pain Take hx-
PEFE-
Most probable dx and dd-

all SORTSARA qs asked – answers were towards trigeminal neuralgia,

PEFE- specifically asked vitals and then face- pallor icterus, dental caries sinus tenderness, neurology- all normal
gave trigeminal neuralgia and other DD for facial pain like JMJ dysfunction, dental caries sinusitis, trauma, RA of joint
PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION STATION 12
Scenario: Facial pain Grade: Pass Approach to
patient/relative 4
History 4
Choice & Technique of examination, organisation and sequence 5
Diagnosis/ Differential diagnoses 4

Station14
There were 2 cases which can fit in to this description, one adult and one paed case. One will be this station and other one must
be a pilot (station 16).
as I can not remember by number will write adult case here

Previous schizophreniform hx given 18m back, advised to follow up with local mental health clinic
1. Take hx
2. Most probable Dx and dd
3. and councel pt

taking hx was difficult. patient was very slow to answer. But talking clearly, not acting abnormally. Took lot of time. Mostly
 negative symptoms, I can t remember what was positive now. I asked if he went for follow up as advised and said no. if I
asked about reason and medication ,I cant remember.
Then said most probably schizophrenia , or drug related, poor compliance

PREDOMINANT ASSESSMENT AREA - HISTORY TAKING STATION 14

Scenario: Assessment of change in behaviour Grade: Pass Approach to patient/relative ................................... 4
History 4
Diagnosis/ Differential diagnoses 4
Patient Counselling/ Education 3

Station 15
12m old child sudden stiffening
Hx- while changing nappy, rolled eyes up lasted 3min. had fever for 2days or some thing before PEFE- card given-had just one line
saying all Ex normal
Dx to mother- febrile fit, other epilepsy, low blood sugar
Management in the future- explained what to do if get another fit, not sure if that’s what was expected
PREDOMINANT ASSESSMENT AREA - MANAGEMENT/COUNSELLING/EDUCATION STATION 15
Approach to patient/relative 4
History 4
Choice & Technique of examination, organisation and sequence 4
Diagnosis/ Differential diagnoses 4
Patient Counselling/ Education 4

Station 16- Pilot most probably ADHD case

4y old child aggressive at kinder
Take hx from father PEFE from ex
Most probable dx and other dd with explanation to farther

hx- mostly suggestive of Autism , covered ADHD, hearing vision problem bullying at kinder. BINDS all good
PEFE all normal
Said possibly Autism spectrum, then told other DDs I covered in Hx

Station 17-hearing problem,

middle aged lady complaining of hearing loss in L ear . tuning forks and otoscope given with patient and manikin tasks
Do hearing exam
and other relevant exam- giving running commentary to examiner Most probable Dx and DD

Introduced, wore gloves, explained and gained consent

Started with whisper test. Found L ear reduced hearing on whisper, Weber localized to L ear and Rinne R ear AC>BC, L/ear BC>AC,
otoscopy I said it was perforation with cholesteatoma.
I probably didn’t give a proper running commentary and didn’t mention any DD, I think should have
given DD for conduction deafness of L ear after Rinne and Weber and then do otoscopy

PREDOMINANT ASSESSMENT AREA - EXAMINATION STATION 17

Scenario: Hearing complaint Grade: Fail
Approach to patient/relative 4
Choice & Technique of examination, organisation and sequence 4

Familiarity with test equipment 5

Accuracy of Examination Diagnosis/ Differential 2
diagnoses 3
 Station 19
Recurrent genital ulcers in a young female, 22y Hx
Dx/DD
Management plan

Hx- ulcers features suggestive of HSV but no ulcers now, gets recurrences, cant remember details. Said most probably HSV
Advised on safe sex, avoid sex if active ulcers, told about possibility of starting on suppressive treatment with acyclovir if
recurrences are problematic, can treat acute episodes as well.
Then talked about what to do if she get pregnant but then she said she does not want to have babies!

PREDOMINANT ASSESSMENT AREA - MANAGEMENT/COUNSELLING/EDUCATION STATION 19

Scenario: Vulval complaint Grade: Pass

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

Station 20
Middle aged male foot pain Hx-
PEFE
Dx and DD
Investigations to examiner if any

Hx-
Sudden pain while gardening, thought if an insect bite, no fever no trauma, no other jt sx, hx was towards gout so ask risk factors
directly-heavy alcohol use +, red meat +, has HTN. I asked about medication, he mentioned a brand name and asked me do
you know it, I said not sure, then he showed me a piece of paper written hydrochlo’thiazide.
PEFE- vitals normal, when I said foot examination, showed a picture, like this

red around base of R big toe with slight swelling, I think was tender, no skin damage or bite marks No other JT involvement

DD- I said most probably gout, based on hx and Ex, then other like OA, RA, trauma, bite, cant remember if I mentioned septic
arthritis.

Bell rang at that point, I quickly mentioned FBE, ESR, serum uric acid

PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION STATION 20

Scenario: Foot pain Grade: Pass Approach to
patient/relative 5
History 4
Choice & Technique of examination, organisation and sequence 4
Diagnosis/ Differential diagnoses 5
 9Th June:
1. Ear examination
2. Recurrent herpes
3. Gout
4. Cystic fibrosis
5. VBAC
6. Pre op counseling
7. PVD examination
8. MSE video
9. Abd examination
10. Behavior complaint ( autistic spectrum or ADHD)
11. Hyperthyroidism
12. Cervical spondylosis counseling
13. Facial pain
14. Relapse of schiz
15. Febrile convulsion
16. Urinary problem

15th June 2022 Online

Questions from a friend. Please keep her in your prayers.

[Link] ,came for influenza vaccination,mother is going for the aged care facility.
Diagnosed with essential hypertension two years ago,non compliant with the medication.
Financial issues +, thinking that he is healthy.
Task
[Link] for 6minutes.
[Link] counselling
[Link] risk assessment,counselling

2.30years daughter, for father is having ICH. DNR signed.

Tasks
[Link] about daughter’s concerns ( Pain, Abnormal breathing)
[Link] in 4minutes
[Link] the PEFE to the Daughter.

[Link]- to HSIL ,HPV 16 +ve.

Gardasil vaccine- not vaccinated.
Tasks,
[Link] 4min
[Link] the investigations.
[Link] management

[Link]( cervical pathology in past- LEEp done)

Tasks.
[Link]
[Link],DDX

[Link] AAA
PE to medical student

6.7,9,10,11 cranial nerve examination.

[Link] patient,smoking history,DIB,
Tasks
[Link] to examiner
[Link] to be performed
[Link]
[Link]

8. Knee injury in a netball player

PEFE-Couldn’t do any PE due to pain.
Tasks
[Link]
[Link]
[Link]

[Link]- Panic attack in postnatal class,several episodes

10. 72 years,female,dog died,daughter died years ago due to leukaemia,husband died,no suicidal ideation,having sleep [Link]
nightmares,no flashbacks.( detailed stem )
Tasks,
[Link]
[Link] for his emotional response
[Link] management

[Link] with Egg allergy,Asthma history

[Link]
[Link] Counselling .

12.21 month Global developmental [Link] -hypotonia +ve, reflexes brisk

[Link]
[Link]
[Link]

[Link] T2DM ,BMI -high

Tasks,
[Link] advise
[Link] usage

[Link] 6 weeks,mild bleeding,no clots,no tissues

PEFE -Normal ,no cervical motion tenderness.
Uss- NO sac,corpus luteum cyst in one side
HCG-800
Task.
[Link]
[Link]
[Link]

15.52 yrs Female,Right sided tummy pain radiates to the back,aggravated with large [Link] relief with bending forward.
Alcohol history +ve
Hx
Diagnosis
DD

[Link] with Rash in the cheek PE, fever +ve

? herpetic meningoencephalitis

16th June (online)

1. Cervical screening test, Hxfor 3 min, explaining procedure & significance
2. DVT+ haemorrhoid + prolapse
3. Postnatal depression with psychosis(MSE)
4. Smoking cessation with (copd recently diagnosed)
5. Croup, hx, dx, pefe, mx
6. Lactational mastitis
7. Benign essential tremor
8. Tiredness with heroine use( mx, dx,ddx)
9. CVS examination (pericarditis)
10. Abdominal examination (cholecystitis)
11. Hand examination( OA)
12. Schizophrenia relapse
13. Peanut allergy
14. IDA exam
15. Panic attack with agoraphobia
16. Pneumothorax hx, dx,ddx

17th June (online)

[Link] herpes pregnant lady hx dx
[Link] intracranial hydrocephalus
[Link]
[Link] nose sudden cough wheeze (Asthma)
[Link] alcoholic -insight lost
[Link] turns - bing alcoholic
[Link] chemo neutropenia
[Link]
[Link] nest syndrome
10Pre-eclampsia
[Link] class -Panic disorder
12.6 weeks amenorrhoea hcg 800 no sac or mass in uterus or adnexa same recalls
[Link] now have heart failure-pe
[Link] leg pic cellulitis
15Macroscopic Haematuria pe
[Link] case -hb

21st June f2f

1) ELBOW PE
2) OBS PE
3) demonstrate how to test and do Peak Flow Meter
4) 47 Year old man with lump in R breast. On PEFE- lobulated hard lump found. PEFE, Arrange Ix, Give D/D
5)17 year old with tiredness
Take history and present your assessment findings
6) 47 year old comes for Mirena insertion. Take history, counsel about Mirena insertion
7) 7 month old child k/c/o CF. Now comes with vomiting. X-ray reveals obstruction.
History
D/D
8) Mother discovers child watching pornography. History and counsel
9) CT scan reveals bladder stone. Explain CT, order investigations and treatment
10) Patient with binocular diplopia. Case of uncontrolled DM and HTN Take history
Give D/D
11)MSE of conversion disorder- video
12) Young boy with falling grades. History of girlfriend leaving 6 weeks ago. History
D/D
13) Middle aged woman with diarrhea for 7 days. Patient is on amoxicillin for 9 days.
D/D
Tell investigations
Give management
14) Recurrent headaches. History
D/D
15

22/06/2022 f2f
1) cvs exam - htn
2) cst Cervical screening pelvic pe n perform procedure.
3) foot exam – carpenter Foot pain young carpenter. Hx of fall 1 yr back, inversiin n eversiin were painfull, antalgic gait,
rest was normal. Time was finished n i couldnot do sensations. Dx was osteoarthritis.

4) croup - 9month, runny nose, cough, cold, - hx, dx , mx. breathing difficulty
5) septic arthritis
6) threatened abortion- 27yr , vaginal bleeding all of a sudden
7) uc counselling
8 ) acute cholecystits- right sided pain , radiating to back , murphy +
9) tension headache - confused with migrane .
10) postnatal depression- She was a regular pt .. already came 3times since 3rd day of babies birth .. but the baby is fine..
she is having issues with coping, no support sleep. Anhedonia. Thinks she is not done enough,but came with 7weeks baby
bcoz the baby was crying excessivly
11)Quadreplegic baby with too much crying, carer was here, not opening up n was hell irritated. Anyways it was spiral
fracture of tibia. X ray was only given to those who specifically asked for it, so some ppl missed the diagnosis. Non
accidental injury.
12) 2.5 yrs child, mother saying not eating [Link] other positive history. Pe findings all normal.

13) mse - vdo mania voice was very low n unclear. It was the worst station.
14) spirometry= restrictive lung , hx , dd
Spirometry, restrictive pattern. Was either fibrosis or interstitial disease. Pt also loosing wt. Didnt go well with this
Preg c sec counselling.
15) 62yr BPH - Red colour urine Blood in urine, aspirin positive.
16) Syncope Hypoglycemia counselling pt on metformin n gliclazide.

23rd June (Face to face)

[Link] do relevant Pe?? Fibroid

[Link] with SBO PE (Xray given at 6 or 4mins and to interpret and give ddx) —-?Small bowel obstruction
[Link] cancer (PSA 7; GLEASON 8) [Link] in hand PE (median nerve)
5. Resp PE with ABG and CXR - ask examination findings and then explain (no history) (I’m not too sure on this so I don’t want to
comment)
??Emphysema ,Respiratory acidosis
[Link] discharge (atrophy) (brown discharge)
7.4yr with limping - watch vid at the beginning or limping and child - hx 4mins/ PEFE (internal and external rotation painful)
Limping started in the morning; mother is extremely stressed—? Transient synovitis
[Link] (hypothyroid)
[Link] MSE recall but the tasks report the risks (suicidal and psychotic features)
[Link] with headache - bullied at school but fathers main concern is brain tumour—?Tension headache

[Link] praevia – ED bleeding hasn’t stopped but vitals are normal and shes extremely worried.
[Link] with results of gastroscopy results and hiatus hernia [Link] alcoholic with attention and memory affected
[Link] back pain with X-ray - FHx of osteoporosis and she does not eat dairy and avoids sunlight
[Link] pain - felt it with gardening everything else was negative costvmpf—PVD
[Link] - URTI 10days ago now px with coughing and vomit afterwards discuss with mother (pertussis) mother is angry why he
wasn’t diagnosed in the first meeting

23rd june 2022 f2f

1) ca prostrate counselling - patient came with biopsy results that showed adenocarcinoma, urine culture grew E. Coli

55 yr old man who initially presented to your GP with frequency, urgency and pain when passing urine was referred by you to
a urologist because you found on the pr examination an enlarged prostate.
The urologist sends you a letter with the results of a range of investigations he has initiated:
1. MSU showed growths of [Link]
2. PSA 6 ng/ml ( <4ng/ml normal, 4-6 ng/ml intermediate, >10 ng/ml high)
3. The core biopsy with 8 samples from the prostate was positive for adenocarcinoma
4. Gleason grade 7
5. A cystoscopy did not reveal a bladder neck obstruction
6. the whole body radioisotope scan did not show metastases
7. CT pelvis and spine did not show any tumour outside the prostate capsule (stage T2)
The urologist mentions that he explained to patient that there was cancer but he suggested to see you for further counseling.
Tasks:
1. Explain results and its implications
2. Discuss treatment options

2) intestinal obstruction PE, explain condition to patient

3) transient synovitis 4 year old boy with limp, on a video - take history, PEFE, explain diagnosis to dad with reasons
4) depressed nurse, suicidal for a MSE, with diagnosis and differentials,
5) lady with tiredness, all features of hypothyroidism - history and explain diagnosis with reasons
6) 28 week old lady with ante partum haemorrhage - post-coital bleed, USG at 20 weeks showed placenta praevia - history
and management
7) elderly woman with watery yellow vaginal discharge - atrophic vaginitis and urethritis
8)Woman with menorrhagia- fibroid for PE from vitals onwards
9) headache in 8year old. Tasks - history 6min, PEFE from examiner, explain diagnosis to dad with reasons - has been
bullied in school
10) whooping cough management of a 4 year old child who is immunised. He has a younger sibling who is 6weeks old.
11) carpal tunnel syndrome PE
12) Folstein’s MMSE and explanation to patient with chronic alcoholism
13) hiatus hernia - explanation of condition and management
14) acute exacerbation of COPD- ask relevant PEFE, inventions, explain diagnosis to patient
15) 72 year old lady with low back pain- vertebral fracture secondary to sev osteoporosis - history, investigation from
examiner, explain diagnosis with reason to patient
16) 40-50 yr old man with pain on walking - was peripheral arterial disease of right leg - for history, PEFE, explain diagnosis
with reasons to patient.

28th june online

1)
oesophagi atresia
2) abd pe
3) headache child pe
4) leg ulcer pe
5) cvs pe

6) hyperemesis gravidarum
7) Ultralsound Praevia

8) cast care
9) ct mets

10) sleep apnea child

11) rheumatoid arhtritis
 12) psychiatry history depression

13) psy history pat had 10 diazepam tablet after fight with boyfrnd -take
history and diagnosis

14) old men forgetfulness and mild confusion- talk to daughter

15) pnuemonia treatment old age patinet - talk with son

16) lichen sclerosis

29th June online exam

1) Urinary retension immediately after hernia surgery. Surgery was successful. Pation could not urinate after surgery and due to
irritability of retension, morphine was precribed in recovery.
Sonography showed 500 cc urine in bladder.
1- talk to pt about cause of condition & immediate Mx in 3 or 4 min
2- explain catheterisation procedure to pt

2) Hereditary spheeocytosis case.

Around 2 yo child with intermitent palor sice 6 month age.
1- Hx (4min)
Ix appears
2- Dx with reason (no management)
* In Hx everything nl.
At promp time Ix showed low Hb and spherocyte and high billirubin

3) Hyperemesis gravidarum.
Severe case. severe during past days. In Ix keton in urine.
1- Hx and Ix
2- Mx

4) Around 1 yo baby not using his left side. Parents concerned.

1- Take Hx and relevant information regarding development
At promp PE appears. Abnormal left side tone and reflex. Developmental milestones were normal (very long list)
2- Explain Dx with reason
* They noticed baby not using left side while crowling, now more obvious because he is trying to stand up. I could not find any
finding in Hx. I dont think it was global developmental delay

5) Woman in 40s with SOB

1- Hx
2- Dx and DDx with reason
* Heavy smoker. SOB for several months, gets worst with exersion and lying down, uses extra pillow. Coughs blood (first when
ask about sputum color told yellow but when specificly asked blood, told about blood strains)

6) 14 yo girl admited with psychosis symptoms (shouting about aliens and running in street). Reviewed by CAT team and is going
to be admited. Parents concerned about her.
1- Hx from parents
2- Explain Dx with reason and immediate Mx to parents
* Father concerned, first episide of this problem. Parents have no idea why. Strange behaviour for couple of weeks, sleepless
from some nights before but no excesive money spending. No FH of psychological issue or schizophrenia. Parents dont
think she uses drug. No organic symptom noticed
7) Telephone foot PE.
Young man had some truma to foot (other player jomped on his foot) during sport. The next morning noticed swelling around
ankle. Now Pt is on phone.
1- Guide patient through Physical exam. He will tell you his findings
At promp time a pic appeared showed tenderness over mid part of 5th metatarsal bone
2- Explain if any imaging needed or not and what kind of imaging

8) Post-op delirium case.

Doughter concerned about her father who went through surgery and after that had behavioral issues. Father is now calm.
There is a very long list of assessments that have been done on father before surgery (heavy drinker, high liver enzymes, spider
nevi, Hb level of 9. Heart and lung normal). And also long list of assessment of the intern last night after the surgery
(delirium symptoms, T=37.8, will not cooperate for some part of examination)
1- Explain pre-operative assessment to doughter
2- Explain post-operative assessment to doughter
3- Explain causes of condition with reason

9) OCP induced HTN

Young woman went for blood donation where found high BP was checked 3 times.
1- Hx
2- Dx and DDx with reason

10) Patient experienced SOB and chest pain couple of days after surgery. Pain gets worst with breathing. Pt is not naking Asprin
after surgery.
Explain PE to med student and explain what your are looking for.
It was given in stem that the med student is familiar with a normal respiratory exam of a healthy patient.

11) Patient experienced generalisd seizure and after that has numbness in upper and lower limb.
Explain PE to med student and what findings looking for and what instruments needed.
No need for gait or sensory exam

12) HSP physical exam

A picture of a posterior thigh and buttom of baby with HSP rashes. History given.
Explain rash and other relevant physical exam to examiner and explain what are you looking for in history
(No promp time nor medical student or patient. Just to examiner)

13) Young woman with some bleeding.

1- Hx (in history menorrhagia. No spotting or dysmenorhea. Uses mirena and she has not checked thread for pas year)
In promp time pic given. No thread seen.
2- Dx and DDx with reason

14) Young man here for pre-employment checkup. Your have done PE and everything normal. At end he askes you to prescribe
some tamazepam for sleeping which he is taking for 1 year.
1- Take relevant psychologic Hx
2- Explain causes of insomnia to patient
* having sleeping problem for around 3 years. Takes tamazepam for 1 year bud still has sleep problem. Has not increased dosage
of it. Has low mood. Lives with parents and some stress at home. No major stress. No suicide no psychosis. No organic
15) Man in 60s with severe acute diarrhea 6 times a day. Takes Amoxicillin for bronchitis and couple of pills left to finish. No
blood in diarrhea. No fever. Mocus is dry
1- Hx
2- Mx

16) 36 week pregnant with triedness. Refered by nurse. BP of 135/?

1- Take Hx and explain what Ix you need with reason (5 min)
At promp time list of Ix showing and a little high ALP i guess
2- Dx with reason
* In Hx there is severe generalised itchiness. There is Hx of itchiness in previous pregnancy too. No preeclampsia symptoms.

29 Jun 2022 online

PREDOMINANT ASSESSMENT AREA - EXAMINATION ................................................................................................................ STATION 2
Scenario: .................................................................................................................................................................................. Examination
Grade: ........................................................................................................................................................................................ Pass
Assessment Domain .................................................................................................................................. Domain Score (see key below*)
Approach to patient/relative ..................................................................................................................................................................... 5
Choice & Technique of examination, organisation and sequence ............................................................................................................. 5
Explanation of procedure .......................................................................................................................................................................... 5
Upper limb and Lower limb neurological examination motor to the student
I was not given the prompter time. There was a scenario of patient having seizure thendo neurological examination
1. Started with the Introduction
2. WIPE
3. Vitals
4. Gait was done
5. Romberg sign
6. Inspection for Scar, swelling, redness, rash, wasting, involuntary movement, tremors from front side and back
7. Palpation for tenderness and temperature, pulse and CRT
8. Power
9. Tone
10. Reflexes
11. Coordination
12. Complete with the sensory and cranial nerve examination
13. Mentioned a couple of differentials as I had time remaining
14. Asked for understanding after each step

PREDOMINANT ASSESSMENT AREA - EXAMINATION ................................................................................................................ STATION 4

Scenario: .............................................................................................................................................................................................. Rash
Grade: ........................................................................................................................................................................................ Pass
Assessment Domain .................................................................................................................................. Domain Score (see key below*)
Commentary to Examiner .......................................................................................................................................................................... 5
Accuracy of Examination ............................................................................................................................................................................ 5
Choice & Technique of examination, organisation and sequence ............................................................................................................. 5
Explanation of procedure .......................................................................................................................................................................... 5
There was a picture of the HSP rash and they had given a scenario with a young boy coming to with rash and haematuria with
abdominal and joint pain so you knew it was HSP rash. They asked to do examination and describe rash to examiner and
also tell differentials. There was no role- player here just a black screen. Also there was no prompter time
1. Introduction
2. WIPE
3. Rash description…site, size, morphology, distribution, petechia, pupura, maculopapular, FLU BED
4. Hands: Clubbing, koilonychia, leukonychia, pallor and cyanosis also check palmer and dorsal surface of the hand
5. Forearm: rash, petechia, purpura, bruise,
6. Epitrochlear lymph node
7. Axillary lymph node
8. Face: eyes (pallor, icterus, discharge) nose(discharge and epistaxis) ear (rash, discharge) oral and mouth(cheilosis, mucosal
petechia, tongue, tonsil and pharynx)
9. Otoscopy and fundoscopy
10. Cervical lymph node and neck stiffness
11. Sternal tenderness
12. Resp : palpate for tenderness, auscultate for bilateral equal air entry and added sounds
13. CVS : auscultate heart and added sounds
14. GIT : inspect for rash, distention, palpate for tenderness and organomegaly
15. Hernia orifices and pelvic with parents’ consent
16. Leg and DRE
17. Had some time left so told differentials

Date: 29 Jun 2022

PREDOMINANT ASSESSMENT AREA - MANAGEMENT/COUNSELLING/EDUCATION ................................................................. STATION 5
Scenario: ........................................................................................................................................................................... Advice to parent
............................................................................................................................................................................................... Grade:
Pass
Assessment Domain .................................................................................................................................. Domain Score (see key below*)
Approach to patient/relative ..................................................................................................................................................................... 4
History ........................................................................................................................................................................................................ 4
Patient Counselling/ Education .................................................................................................................................................................. 4
Scenario of the teenage girl brought to the Emergency department with symptoms of acute psychosis. Task was to take
comprehensive history from the parent. Advice about the immediate management and counsel accordingly. Prompter
time at history was 4 min

I started with the introduction

Gave lots of reassurance that her daughter is under the care of good doctors and ill keep him updated about any change in her
condition
Gave confidentiality
Asked SOCRATES and associated fever, head injury and change in weather preference
He gave 2 week history of high mood isolation sleep problem changes history. Delusion of paranoia as well hallucination was
positive. The daughter was scared of alien abduction. Asked about her insight, cognition and judgement which was
impaired.
Asked about smoke, drugs, alcohol after again giving confidentiality.
Stress at home or school, study or bullying
Rules out depression, GAD, adjustment, PTSD , phobias and organic causes
Past medical and surgical history
Family history of mental illness
On promoter explained briefly about acute psychosis by 5 C approach
Gave various differentials
RX: Talked about evaluation by CAT AND PSYCHIATRIST
Anti-psychotic and mood stabilizers
Investigations to rule out organic causes
When stabilized psychologist with talk therapy and GP shared care
Inform the school about the condition and social worker involvement
PREDOMINANT ASSESSMENT AREA - EXAMINATION ................................................................................................................ STATION 6
Scenario: ......................................................................................................................................................................................Weakness
Grade: ........................................................................................................................................................................................ Pass
Assessment Domain .................................................................................................................................. Domain Score (see key below*)
Approach to patient/relative ..................................................................................................................................................................... 4
Choice & Technique of examination, organisation and sequence ............................................................................................................. 5
Explanation of procedure .......................................................................................................................................................................... 5
Upper limb and Lower limb neurological examination motor to the student
I was not given the prompter time. There was a scenario of patient having seizure thendo neurological examination
1. Started with the Introduction
2. WIPE
3. Vitals
4. Gait was done
5. Romberg sign
6. Inspection for Scar, swelling, redness, rash, wasting, involuntary movement, tremors from front side and back
7. Palpation for tenderness and temperature, pulse and CRT
8. Power
9. Tone
10. Reflexes
11. Coordination
12. Complete with the sensory and cranial nerve examination
13. Mentioned a couple of differentials as I had time remaining
14. Asked for understanding after each step

Date: 29 Jun 2022

PREDOMINANT ASSESSMENT AREA - HISTORY TAKING ............................................................................................................ STATION 7
Scenario: .......................................................................................................................................................................................... Vaginal
bleeding ................................................................................................................................................................................. Grade:
Fail
Assessment Domain .................................................................................................................................. Domain Score (see key below*)
Approach to patient/relative ..................................................................................................................................................................... 4
History ........................................................................................................................................................................................................ 3
Diagnosis/ Differential diagnoses .............................................................................................................................................................. 3
This was the old recall of a patient coming with HMB. I was confident that I would pass but I have no idea why I failed this case
I started with the introduction and vitals stability
Asked about SOCRATES
Asked about the period history: cycle, no of days of bleeding , pads used per day, clots , colour, smell
Pregnancy previous pregnancies questions
Partner questions esp. STI and safe sex practices
Contraception
Cervical screening test
Differentials
1. Trauma : any injury to private area
2. Tumour: loss of weight , loss of apatite, lumps and bumps, inter menstrual bleed, post coital bleed
3. PID: fever, discharge, lower abdominal pian, burning micturition
4. Endometriosis: dyschazia, dysmenorrhea, dyspareunia
5. Fibroid: intermenstrual bleed, heavy abdominal feeling
6. Thyroid: change in weather preference
7. IUCD displaced: checking threads after periods or not
8. Blood thinner
9. Bleeding disorder
Past medical and surgical and family history of gynaecological conditions
Reassured her that we are going to manage her with investigations and referral and gave the above differentials
She gave me history of iucd placement with no checking so I gave diagnosis as displaced IUCD
PREDOMINANT ASSESSMENT AREA - HISTORY TAKING ............................................................................................................ STATION 9
Scenario: ........................................................................................................................................................................................ Elevated
BP ........................................................................................................................................................................................... Grade:
Pass
Assessment Domain .................................................................................................................................. Domain Score (see key below*)
Approach to patient/relative ..................................................................................................................................................................... 6
History ........................................................................................................................................................................................................ 7
Diagnosis/ Differential diagnoses .............................................................................................................................................................. 6

This was a new case for me the scenario was a young female having high BP on multiple occasion
Task take history and give diagnosis and differentials

I started with vital stability after introduction

Asked if patient is having headache, blurring of vision, weakness in body, speech and vision problems,
Asked about chest pain, palpitations, SOB
Asked about frothy or bubbly urine
Asked for tingling numbness in legs and foot
Then started with the differentials of HTN TRACK PADS
Asked about change in weather preference,
waterworks,
pigmentation, muscle cramps, anxiety,
weight gain, easy skin bruising, muscle and bones aches and pain, took whole menstrual history ,
pregnancy , partner , contraception, cervical screening
abdominal pain with mass
episodic headaches, flushing, palpitation
apnoea
drugs
past medical and surgical
family history of high blood pressure
she gave me one year history of OCPS
so I gave this as diagnosis and differential as other
gave reassurance that it’s a manageable condition but investigations is required to rule other causes

PREDOMINANT ASSESSMENT AREA - EXAMINATION .............................................................................................................. STATION 10

Scenario: .................................................................................................................................................................................. Examination
............................................................................................................................................................................................... Grade:
Pass
Assessment Domain .................................................................................................................................. Domain Score (see key below*)
Approach to patient/relative ..................................................................................................................................................................... 4
Choice & Technique of examination, organisation and sequence ............................................................................................................. 4
Explanation of procedure .......................................................................................................................................................................... 3
Diagnosis/ Differential diagnoses .............................................................................................................................................................. 4
FOOT EXAMINATION EXPLAIN TO THE PATIENT ON PHONE

• Introduction
• WIPE
• PAIN KILLER if any at home
• Inspection for scar, swelling, redness, rash, deformity
• Palpation for tenderness temperature
• Do the movements active and passive
• Special test windlass. Maulder, squeeze test , syndossmosis test, talar tilt , Thompson test
After the prompter time they gave a pic for 5th base metatarsal swelling
Ordered x ray anterior posterior and lateral view
Gave reassurance

PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION ........................................................................................ STATION 11

Scenario: ............................................................................................................................................................................................. Pallor
Grade: ........................................................................................................................................................................................ Pass
Assessment Domain .................................................................................................................................. Domain Score (see key below*)
Approach to patient/relative ..................................................................................................................................................................... 4
History ........................................................................................................................................................................................................ 4
Diagnosis/ Differential diagnoses

Old recall of the mother coming with 4 year with the complains of intermittent pallor. Task history and gave diagnosis and
differentials

I started with the introduction and vitals stability

Asked about SOCRATES of pallor
Asked about associated chest pain , SOB , palpitation
Differentials
Asked about diet in detail, bleeding from nose, mouth , pee , poo, parasites in poo, coeliac disease,
Asked malignancy loss of weight, loss of apatite, lumps and bumps, bruise, rash
Asked about yellowish discoloration of skin, abdominal pain and mass, change In the colour of pee and poo
Well baby questions sleep, appetite, pee and poo
BINDSMA
TMAC
Past medical and surgical;
Family history of blood disorder
She gave me history of intermittent, jaundice with abdominal pain
I gave hereditary spherocytosis as diagnosis
Iron deficiency anaemia, Thalassemia, vitamin deficiency, leukemia, lymphoma, coeliac disease, parasites

Date: 29 Jun 2022

PREDOMINANT ASSESSMENT AREA - MANAGEMENT/COUNSELLING/EDUCATION ............................................................... STATION 12
Scenario: ............................................................................................................................................................................... First trimester
complication .......................................................................................................................................................................... Grade:
Pass
Assessment Domain .................................................................................................................................. Domain Score (see key below*)
Approach to patient/relative ..................................................................................................................................................................... 4
History ........................................................................................................................................................................................................ 4
Choice of investigations ............................................................................................................................................................................. 4
Management plan ...................................................................................................................................................................................... 5
This was the previous recall of a young female with LMP 7 weeks ago coming to the emergency department with vomiting
Task is to take history for 5 min
Investigation
Management

I started with introduction and vital stability

This was my first station
I asked her if she wants to lie down
She had a bucket in hand
I asked with confidentiality and reassurance the questions and gave reassurance and asked her condition multiple times
I stated with SOCRATES and CCVO of the vomiting
I asked associated nausea, abdominal pain, fever
She had nausea
Then asked differentials with the periods, when she had it last time, regular, had she checked for pregnancy
She checked with UPT which was positive
Then asked if Ist pregnancy
Asked if she had antenatal check ups blood test and infection screening done or not
Asked about stable partner, STI diagnosed before or not, enough support
Asked about form of contraception used before and the CST updated with the result
Then asked along with vomiting and nausea if fever
Asked if burning stinging sensation during pee
Asked about any bleeding from the down below
Asked if passage of clots and grape like vesicles
Smoke, alcohol, drugs and folic acid
Past medical and surgical history
Family history of twins

Gave diagnosis as hyperemesis gravidarum with dehydration

On PEFE 3 ketones so admitted
NPO
IV fluids
Call the senior
Start anti emetic metoclopramide with vit b6 if not helping ondansteron
Investigation like blood B HCG, urea electrolytes, LFTS, USG
She kept saying the baby is not giving nutrition so I reassured that once you are stabilized we will do usg and senior and specialist
is going to review the baby . I also reassured that as early pregnancy even if you are not eating baby taking from your
reserves.
Finished with 4R

PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION ........................................................................................ STATION 14

Scenario: .................................................................................................................................................................................. Shortness of
breath .................................................................................................................................................................................... Grade:
Fail
Assessment Domain .................................................................................................................................. Domain Score (see key below*)
Approach to patient/relative ..................................................................................................................................................................... 3
History ........................................................................................................................................................................................................ 6
Diagnosis/ Differential diagnoses .............................................................................................................................................................. 3
Case of patient a 45 year old female coming with 3 months shortness of breath
Task history
Diagnosis/differential
I don’t remember any prompter time here
Started with introduction and vital stability
Asked about the SOCRATES of the shortness of breath
Asked about associated cough she said yes then asked SOCRATES, character , sputum , colour of sputum here she said grey colour
asked about blood no blood in sputum and any particular triggers
Asked about chest pain, palpitations, apnoea, musical sound from chest, stopped breathing and turned blue, noisy breathing .. all
nil
Asked about any sleeping difficulties and if she is using pillows she said yes
Then differentials
Cardiac causes….any chest pain before, flushing, sweating, palpitation, swelling in the body esp legs.. all no
Respiratory causes… fever, recurrent runny nose, asthma and allergy history, travel recent, smoking history was positive so said I
would like to arrange another appointment with consent for counselling regarding smoking habit , occupation history ,
stress at work or home, loss of weight loss of apatite, …nil
Liver and kidney problems…nil
Past medical and surgical …nil
Family history of COPD positive in father
Asked how father was doing right now
PEFE
ALL VITALS NORMAL BUT DULL PERCUSSION NOTE WITH INCREASED VOCAL FREMITOUS
Here I gave disgnosis as effusion and gave causes as COPD, mass , TB , pneumonia, occupational lung.
Here I think diagnosis was cancer. Please refer to the past feedback of this case

Date: 29 Jun 2022

PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION ........................................................................................ STATION 16
Scenario: ...................................................................................................................................................................................... Antenatal
consultation ........................................................................................................................................................................... Grade:
Fail
Assessment Domain .................................................................................................................................. Domain Score (see key below*)
Approach to patient/relative ..................................................................................................................................................................... 4
History ........................................................................................................................................................................................................ 5
Choice of investigations ............................................................................................................................................................................. 0
Diagnosis/ Differential diagnoses .............................................................................................................................................................. 3
This was the scenario where a third trimester pregnant female is coming with tiredness
Task was history, investigation, diagnosis/differential

I started with exploration of tiredness she gave history that she is unable to sleep on further inquisition she said itchiness on the
body especially on hands and feet at night I took SOCRATES history of the itchiness
Asked associated rash, vesicle, pain, redness, strias ,ulcer, bleeding, discharge, change in the colour of the skin where itchiness
happens…no to all
I asked about differentials
Contact dermatitis …in contact with any chemical, animal or plant
Changed her cosmetics, shower gel or creams
Diagnosed with any skin condition like eczema and psoriasis
Fever with upper respiratory infection(infectious disease)
Itchiness on the abdomen especially on the lateral parts and any red plaques in that areas?(PUPPPS)
Any change in the colour of the skin, pee , poo(Intrahepatic cholestasis of pregnancy)
No to all

Then asked 5 p
Period history
Pregnancy history: antenatal check ups, blood test, blood group, infection screening, dating, anomaly , growth usg, down
screening, OGTT, fetal kicks, headaches, tummy pain, blurry vision, discharge and bleeding from down below and swelling
of the legs along with fits
Partner history
Pill
CST
Past medical and surgical
Family history of similar problems

Before I could say investigation they came on the screen so that’s why failed the station
Investigation LFTS
DX; cholestasis of pregnancy
Differentials
PUPPPS
Pemphigoid gestationitis
Psoriasis
Eczema
Atopic dermatitis
Contact dermatitis

PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION ........................................................................................ STATION 17

Scenario: ..................................................................................................................................................................................Post-surgery
delirium.................................................................................................................................................................................. Grade:
Pass
Assessment Domain .................................................................................................................................. Domain Score (see key below*)
Approach to patient/relative ..................................................................................................................................................................... 4
Interpretation of investigation................................................................................................................................................................... 5
Accuracy of Examination ............................................................................................................................................................................ 5
Diagnosis/ Differential diagnoses .............................................................................................................................................................. 4

This was a case where a lot of physical examination findings were given and lab investigation so you have to explain to the
patient relative about that
Started with introduction and asked about guardianship
Gave confidentiality and explained in simple terms everything
Gave diagnosis as alcohol withdrawal
hepatic encephalopathy,
substance abuse
Electrolyte imbalance
Fever
Infection
Tumour
Trauma
Drugs
Psychosis
Thyroid
Uraemia
Date: 29 Jun 2022
PREDOMINANT ASSESSMENT AREA - MANAGEMENT/COUNSELLING/EDUCATION ............................................................... STATION 19
Scenario: ...................................................................................................................................................................................... Diarrhoea
Grade: ........................................................................................................................................................................................ Pass
Assessment Domain .................................................................................................................................. Domain Score (see key below*)
Approach to patient/relative ..................................................................................................................................................................... 6
Diagnosis/ Differential diagnoses .............................................................................................................................................................. 5
Choice of investigations ............................................................................................................................................................................. 6
Management plan ...................................................................................................................................................................................... 5
This case came with an elderly patient having diarrhea for 4 days on antibiotics for the tonsilitis he had 4 days ago
Explain causes
Investigation
Diagnosis/differentials
Management

As history was not a task so I explained causes after asking it side by side
Started with introduction and vital stability
Asked if any pain or dizziness
Asked if feeling thirsty
Then explain by asking causes one by one
Acute gastroenteritis…. Fever, nausea, vomiting, abdominal pain, diarrhea…yes to pain and diarrhea
HIV and hepatitis….travel, sex history, food consumption while on travel, drugs iv, blood transfusion, … no to all
Thyroid…change in weather preference, loss of weight…..no to all
Cancer.. alternative bowel habits, blood , mucous, loss of weight and apatite, lumps bumps…..no to all
IBD….mouth ulcers, joint pains, rash…no
IBS… excessive flatulence, stress… no
Antibiotics associated diarrhea…..yes
Malabsorptive syndromes…coeliac, lactose intolerant, cow milk protein allergy, cystic fibrosis
INVESTIGATION….CBC, urea electrolyte, LFTS,RFTS, urine complete examination, stool microscopy and culture along with toxin
for clostridium difficile
Diagnosis…antibiotic associated colitis
Differentials as above
Management
ORS as much as you can tolerate
Anti-spasmodic
If toxin present then metronidazole for 10 days
Soft food
Stop antibiotic
Gave lots of reassurance
4R

PREDOMINANT ASSESSMENT AREA - HISTORY TAKING .......................................................................................................... STATION 20

Scenario: ............................................................................................................................................................................................. Sleep
complaint ............................................................................................................................................................................... Grade:
Pass
Assessment Domain .................................................................................................................................. Domain Score (see key below*)
Approach to patient/relative ..................................................................................................................................................................... 5
History ........................................................................................................................................................................................................ 5
Diagnosis/ Differential diagnoses .............................................................................................................................................................. 5

Old recall where a patient came for a repeat prescription of the temazepam he has been taking for one year because of sleep
problems
Task history
Diagnosis
Differentials

I started with introduction and vital stability

Gave confidentiality
Asked about why he was taking medicine , who prescribed the drug, what dose, any change in dose , any side effect
Psychosocial history
Mood
Sleep detail…. What problem, nightmares and vivid dreams, early morning awakening
Apatite
Suicide ideation
Delusion and hallucination
Insight
Cognition
Judgment
Phobias, anxious person, Traumatic event in the past,
Past medical and surgical
Smoke and alcohol and drugs and organic causes: fever, rash, trauma to head, change in weather preference
Home situation was bad as parents did not understand him
Family history of mental history
Diagnosis: mild depression leading to insomnia
Differentials
Psychosis
Substance abuse
Generalised anxiety disorder
PTSD
Phobias
Panic disorder
Thyroid
Infection
Trauma

30th JUNE
[Link] patient with blocked nose and nasal discharge
a)History
b) Causes for her condition and ddx with reasons
2.36 weeks pregnant lady with the itching in the tummy and thigh areas worsens at night,no rashes,but some skin changes in the
[Link] patient on diet control
a)History
b)Explain the diagnosis with reasons and other possible causes?
[Link] with R/ knee pain while playing basket ball,knee giving away,no past history of trauma,injuries,or pain.
Do the relevant PE to the medical student with anatomical landmarks
[Link] stomatitis PE child
a) explain the condition to the mother
b) examination to the examiner
c)what u wil check in the history
5. Nurse is here to talk to you regarding a patient with fever and bacteremia,recently diagnosed BPH catheterised for 24 hours
and removed after straing tamsulosin
PEFE
Temperature -40
HR-130?(tachycardia)
BP-80/50
RR-35
Spo2-91%
a) Explain the condition to the nurse in two minutes,
b) Immediate management with reasons
c) Investigations with reasons.

[Link] in a child came at night to ED,

a) History
b) explain the investigation – polysomnography was given
c) diagnosis with reasons
PE- enlarged tonsils and bulging tympanic membrane,Growth chart was normal.

7)woman with R/abdominal pain,on her mid cycle

a)History
b)Explain the investigation ( USS- ruptured follicles,fluid in the pouch of douglas,few gallstones,but no dilatation or no signs of
infection,appendix is not visible,no past history of appendicectomy)
c)Diagnosis and management

8) .L/ facial pain,medical student is here,do the Trigeminal nerve examination with anatomical land marks

9)young female with pelvic pain from the [Link] 21 days ago
a) History
b) explain the condition and causes. PEFE and USS was given showing some ruptured haemorrhagic cyst with irregular margins
and fluid collection in the pouch of douglas.

10) Pregnant woman on her 8 weeks of POA,coming with some bleeding,

a) History
b) what investigations u will do?after that scan results came, FHR+,Fetal growth correlating with the gestational age,small
retroplacental clot.
c) explain the condition and immediate management

11) child of 15?/18? months (forgot the months) presenting with delayed walking.
Other milestones are normal,older sibling was walking on time,don’t know about the father,but mothers walking was not
[Link] was given- no spasticity,no exaggerated reflexes
a) History
b) Explain the condition with reasons
12)Gp doing home visits,visting an old lady with confusion,grand daughter is there to discuss her condition.
a) history from granddaughter
b) PEFE was there,urinalysis is not done explain the condition with reasons

13) Elderly lady with abdominal pain in the umblical area,worsen over the last two days, Nauseous. BNO, no flatus passed.
a ) history
b) PEFE -irreducible hernia in the L/groin,exaggerated bowel sounds
c) diagnosis with reasons and DD

14) parent of a 14 years old child presented with feeling [Link] issues,6 cups of coffees a day.u have checked with the
registrar who is looking after the daughter and she is improving
a) history
b) explain the condition with reasons and DDx
(No need to assess about the risk or history of daughter’s condition)

15) young female feeling nerves,thyroid exam is normal,family history of thyroid problems.?social phobia
a) History
b) diagnosis ,possible causes for her condition with DDx
16. CVS PE ,adult patient with heart failure features,PE to the medical student.

30th June 2022 Online exam

[Link] patient with blocked nose and nasal discharge

a)History
b) Causes for her condition and ddx with reasons
A female patient was complaining of runny nose. On further history she said that it’s seasonal associated with sneezing and post
nasal discharge. Pollen allergy was positive. Family history of allergy was also positive. No difficulty in breathing no history
of asthma. I gave allergic rhinitis as DX. And asthma, URTI, polyp pneumonia etc as [Link] less likely. I also tried to add
few details as I was ruling out ddx. I kept on reassuring the patient as she said it is distressing for her and affecting her
work. I scored good in this case.

2.36 weeks pregnant lady with the itching in the tummy and thigh areas worsens at night,no rashes,but some skin changes in
the [Link] patient on diet control
a)History
b)Explain the diagnosis with reasons.

Pregnant lady with rash on lower tummy. I took all the rash history. Nil Family hx and contacts. I tried to rule all rash ddx. It was
uncomfortable as pt was not able to sleep. No aggravating or relieving factors. Took history for antenatal checkups and
late pregnancy complications. No positive hxwas there apart from rash.

I was really confused as I was not getting any positive findings. Than picture appeared which looked like this.

I gave pupp as the diagnosis. But I forgot what it stands for so I just said it is rash which appears in pregnancy. The letters PUPPP
stand for pruritic urticarial papules and plaques of pregnancy.
I gave all other rash related ddx like rubella. Chicken pox scabies. Psoriasis eczema seborrheic but less likely. Reassured the
patient. I scored good in this case.

[Link] with R/ knee pain while playing basket ball,knee giving away,no past history of trauma,injuries,or pain.
Do the relevant PE to the medical student with anatomical landmarks
Followed the knee examination and all special tests. I went fast because I was afraid I might not finish in time. But I was left with
1 min in the end. Student asked me 1 question in the beginning which I did not understand so I offered to repeat the test
in the end. But student said she was ok and exam was good.

[Link] stomatitis PE child

a) explain the condition to the mother
b) examination to the examiner
c)what u wil check in the history

Typical herpes case. I greeted the mother ask few questions regarding pain, assessed for dehydration and ruled out any contact
history. Than explained quickly what to look for in the examination. I stressed on dehydration cz that is the key point
here. Than I excused mother and started with wipe approach to the examiner. Mentioned pain management vitals
especially temperature monitoring and assess for dehydration and correct it if present. Gave Panadol local lignocaine than
proceeded with the rest of herpes [Link] history again mentioned about dehydration signs, rash
history, well baby questions immunization status and contact hx to be asked for.
I practised this case very well so I was able to finish it before time. Rest of the time I reassured the mother.

5. Nurse is here to talk to you regarding a patient with fever and bacteremia,recently diagnosed BPH catheterised for 24 hours
and removed after straing tamsulosin
PEFE
Temperature -40
HR-130?(tachycardia)
BP-80/50
RR-35
Spo2-91%
a) Explain the condition to the nurse in two minutes,
b) Immediate management with reasons
c) Investigations with reasons.
I asked for the conscious level of the patient. Nurse said she needs to go and check the patient. I described UTI which might have
led to sepsis and confusion. Explained all the vitals and immediate management to stabilise vitals. Than I tried to rule out
infections in other parts of the body like meningitis, pneumonia and gastroenteritis but to all my questions nurse said she
needs to go and check the patient. I gave septic screening for investigations. Plus I added blood cultures, ESR/CRP. All
baselines, and ABG’s in the end as spo2 was low. Not sure if they wanted anything else in this [Link] was pilot station.

[Link] in a child came at night to ED,

a) History
b) explain the investigation – polysomnography was given
c) diagnosis with reasons
PE- enlarged tonsils and bulging tympanic membrane,Growthchart was normal.
Mother gave history of 3 year old child snoring at night. Asked OSA questions. Daytime somnolence was there no hearing or
speech problems. Hx of repeated URTI infections was positive. Explained transient decrease in spo2 in polysomnography.
Causes enlarged adenoids and tonsils causing obstruction also tried to draw a diagram and patient looked at diagram with
great interest. Mentioned little about management that we need to remove obstruction [Link] check hearing and
speech. I scored good in this case.

7)woman with R/abdominal pain,on her mid cycle

a)History
b)Explain the investigation ( USS- ruptured follicles,fluid in the pouch of douglas,few gallstones,but no dilatation or no signs
of infection,appendix is not visible,no past history of appendicectomy)
c)Diagnosis and management

it was my second station and I totally messed it up in anxiety. It was simple abdominal pain. Asked pain questions. Asked for ddx.
Ruled out urine retention. Patient was a business lady and this pain happens for the first time. only mild pain was there
which relives with rest. I interpreted the results for investigations. Give mithchelshimers as 1 of cause cz of fluid in the
pouch of douglas, than I started talking about gall stones and said it could be biliary colic cz of stones. I just recall biased
but it was wrong to mention as patient said her mother had gall bladder removed and she is afraid of surgery in the hx.
And I mentioned future management of gall stones including lowering fats, SNAP and surgery as it could happen. She got
panicked and said did u say surgery. I tried to explain but time was over and I new I have lost this station. I failed in this
case.

I think reason why I got confused cz last task was to mention short and long term treatment. In long term I thought of gall stones
management as mithchelshimers has no long term Rx.

8) .L/ facial pain,medical student is here,do the Trigeminal nerve examination with anatomical land marks
I started with telling some ddx of facial pain. Than inspection, palpation than explaining trigeminal nerve exam and in the end do
the other cranial nerve exam. I did finish this early. Student asked me why do u check sensation on both sides of the face.
I just said that to compare for any deficit as part of examination protocol we look on both sides.
9)young female with pelvic pain from the morning.LMP21 days ago
a) History
b) explain the condition and causes. PEFE and USS was given showing some ruptured haemorrhagic cyst with irregular margins
and fluid collection in the pouch of douglas.
Took all the pain history. Only pain was there no bleeding or discharge. She was not sexually active, no previous [Link] no
history of pelvic surgeries. I explained pain could be due to fluid irritating abdominal covering. But investigation did
mention heterogeneous appearance of ovary so I said I would like to look further for it rule out any nasty changes with
senior consultation. Although less likely. I failed this case.

10) Pregnant woman on her 8 weeks of POA,coming with some bleeding,

a) History
b) what investigations u will do?after that scan results came, FHR+,Fetal growth correlating with the
gestational age,smallretroplacental clot.
c) explain the condition and immediate management
Took hx for early pregnancy bleed. Antenatal checkup. Drug history she said I am taking heroin. I did not prob further but I said I
would like to arrange separate consultation as It is dangerous for baby and she needs to stop taking it. Pt was ok with that.
Her pregnancy was confirmed with blood B-HCG test I guess. So I just did blood group cross match. Baselines and USG.I reassured
that baby is doing fine. Pt was relieved. Explained as threatened abortion she needs to stay in hospital for the time being if
everything is ok she can be discharged with follow up. Have a complete bed rest. I failed this case in Ix and conselling.

11) child of 15?/18? months (forgot the months) presenting with delayed walking.
Other milestones are normal,older sibling was walking late also.
PEFE was given- no spasticity,no exaggerated reflexes
a) History
b) Explain the condition with reasons
Took history for all milestones and ruled ddx. All history was normal except for delayed walking. So I gave it as physiological delay
also s sibling hx is positive for delayed walking. Reassured the patient. I scored good in this case.

12)Gp doing home visits,visting an old lady with confusion,grand daughter is there to discuss her condition.
a) history from granddaughter
b) PEFE was there,urinalysis is not done explain the condition with reasons
symptoms of UTI were positive. Asked all delirium questions. Gave sepsis due to UTI. She gave me history of multivitamins
and many calcium tablets intake. I forgot to address that.

13) Elderly lady with abdominal pain in the umblicalarea,worsen over the last two days,
[Link],no flatus passed.
a ) history
b)PEFE -irreducible hernia in the L/groin,exaggerated bowel sounds
c) diagnosis with reasons

pt said pain in lower tummy so I started thinking of urine retention but it was ok. No other hx of abdominal pain ddxwas positive.
I was confused. Than she said look doctor I have this large mass for long period of time now it’s getting bigger and painful.
When I asked for location she said left side of tummy. I started ti think of any renal mass. I was not able to get clear site of
mass. I ruled wt loss it was negative. Than pefe appeared with obstructed inguinal hernia S/S. so I described the situation
and gave all other ddx of abdominal pain. I did not do it well but luckily it was pilot case.
14)parent of a 14 years old child presented with feeling [Link] issues,6 cups of coffees a day.u have checked with the
registrar who is looking after the daughter and she is improving
a) history
b) explain the condition with reasons and DDx
(No need to assess about the risk or history of daughter’s condition)
It was the father presenting as a patient. He was distressed after his daughter was admitted due to relapse of schizophrenia. He
was distressed but negative hx for depression. I ttok all the psychosocial hx. His wife and other family members were
doing fine. I gave adjustment disorder as the dx. Depression, anxiety etc as the [Link] explanation. He seems to be very
irritated than I started talking about management. I said as ur daughter is improving it’s better if u take some time out
for urself. Talk about SNAp, hobbies, psychotherapy, family meeting if required psychiatrist for further Rx. Than I asked
how hw feels about that. He said that yes u r right and I can give it a try. I said that we will be looking after ur daughter
so plz don’t worry too much about her. And if u want may be u can bring in other family members if they need help. He
seemed to be very happy and I scored good in this case.

15) young female feeling nerves,thyroid exam is normal,family history of thyroid problems.?social phobia
a) History
b) diagnosis ,possible causes for her condition

I started with the hx of anxiety. Tried to rule out hyperthyroidism, phobia. Panic attack, GAD, ptsd, increase caffeine. Everything
was normal. On further questioning she opened up that she has got new project at work. After that her symptoms stared.
She can’t sit in café and carry out conversation with other colleagues. It si very distressing for the patient. I could not take
much hx for depression as I wasted time to figure out what is the reason for her anxiety. I gave phobia and GAD first. Than
mentioned all ddx for [Link] soon as time was over I remembered that it could be adjustment and I did not even
mentioned that, I thought that I have lost this case as task was Dx with reason no ddx. But luckily I passed this case.
Again it is difficult to get 2 adjustment cases in 1 exam.

16. CVS PE ,adult patient with heart failure features,PE to the medical student.
It was simple CVS exam. Student asked me to explain BP measurement in detail so I described palpatory auscultatory method and
postural hypotension as well. I was able to finish it in time.

July 2022
5th July 2022

PREDOMINANT ASSESSMENT AREA - S

MANAGEMENT/COUNSELLING/EDUCATION TATION
1
Scenario: Skin lesion
Grade: Pass

Assessment Domain Domain Score (see key below*)

Approach to patient/relative 5
Interpretation of investigation 5
Patient Counselling/ Education 4
Management plan 5

Case same as Marwan: patient around 50yo and farmer came with the result of a bx that confirmed basall cell carcinoma on the
 face. Task was to explain the patient the condition and management. She asked me whether it was like melanoma and
about cosmetic results.

I explained what it is and treatment option: local burning with like cryotherapy, excisional bx and mohs surgery. Also to do self
check up for other skin lesions+ annually GP check up+ sun protection. For the second qx I referred her to the plastic
surgeon and reassured her.

PREDOMINANT ASSESSMENT AREA - EXAMINATION STATION 2

Scenario: Examination Grade: Fail
Assessment Domain Domain Score (see key below*)
Approach to patient/relative 5
Accuracy of Examination 4
Choice & Technique of examination, organisation and sequence 3
Diagnosis/ Differential diagnoses 3

Common recall of rash in both legs in a 25 yo male patient, no blanchable and no palpable. previous history of URTI. Task was to
explain to the medical student and explain differential dx.
I did the approach of purpura physical examination (rashd description,anemia, bleeding signs, lymph nodes,
hepatosplenomegaly) but I missed mentioning Henoch purpura on dx which is important so I believe that’s why I failed it.

PREDOMINANT ASSESSMENT AREA - S

MANAGEMENT/COUNSELLING/EDUCATION TATION
4
Scenario: Breathing difficulty
Grade: Pass

Assessment Domain Domain Score (see key below*)

Approach to patient/relative 5
History 5
Diagnosis/ Differential diagnoses 5
Management plan 5

Patient came to the ed due to sob. Task to hx and dx and differential and explain its mechanism
Patient was watching a movie when he started to feel symptoms of a panic attack (sob, sweting, feeling he was going to die). I
asked trigger to rule out phobias but everything was negative. rest of physico history was normal. He had a previous
episode of the same symptoms but he couldn’t recall at all the situation. Pheochromocytoma and hyperthyroidism
symptoms were negative. positive: bit stress life + like 6/7 coffees per day.
I said panic disorder due to both episodes but couldn’t find any trigger to say phobia. I explained about the release of hormones
why the body does it and the result of their action.

PREDOMINANT ASSESSMENT AREA - EXAMINATION STATION 5

Scenario: Cognitive impairment (STM) Grade: Pass
Assessment Domain Domain Score (see key below*)
Approach to patient/relative 6
Explanation of procedure 5
Performance of procedure 5
Accuracy of Examination 4

It was a case of MMSE. first what is the test, that its purpose is screening, no dx. The steps were on the screen, I just had to
explain to the patient what to do and then talk about results and differentials. There was impairment on time, recall,
registration, and attention. I think history of alcohol as well.

PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC S

FORMULATION TATION
6
Scenario: Pelvic pain
Grade: Pass
Assessment Domain Domain Score (see key below*)
Approach to patient/relative 6
History 5
Choice & Technique of examination, organisation and sequence 3
Diagnosis/ Differential diagnoses 4
Patient Counselling/ Education 6

Young female patient with a history of painful periods since always. Normal amount of bleeding, normal quantity of days long
and in between. It doesn’t respond to common painkillers. I believe positive family history. No symptoms of PID. NO
PREVIOUS HX OF SEXUAL intercouse. US was normal but showed like small 2 cysts in the ovary.

Task was hx, which physical examination you will do and explanation of the most likely cause.

I again followed Marwan as it was the same. On physical examination I said that as the person is a virgin, I won’t perform a
speculum examination.

PREDOMINANT ASSESSMENT AREA - EXAMINATION STATION 9

Scenario: Assessment of change in behaviour Grade: Fail
Assessment Domain Domain Score (see key below*)
Approach to patient/relative 5
Commentary to Examiner 4
Accuracy of Examination 3
Diagnosis/ Differential diagnoses 5

It was the case of MSE on a patient with change of behavior and previous hx of schizophreniform disorder. They only gave me 4
MINUTES so I couldn’t finish the qx like hx of drugs and suicidal ideas so I was expecting to fail it.
She has a relapse of symptoms including delusions and visual hallucinations after she stopped taking the medication.
As dxx I said relapse of schizophreniform disorder, schizophrenia, substance abuse, mania, depression with psychotic features
PREDOMINANT ASSESSMENT AREA - HISTORY S
TAKING TATION
10
Scenario: Failure to thrive
Grade: Fail

Assessment Domain Domain Score (see key

below*)
Approach to patient/relative 4
History 2
Diagnosis/ Differential diagnoses .............................................................................................................................................................. 3

It was a case that showed a pic of a growth chart with a decrease in weight (below 3) but normal height. I think I did a complete
hx following the Marwan approach. She told me she prepared 3 bottles of milk per day for the kid but he only drinks like
half of one or something like that (I didn’t get why she was preparing so much). Gastrointestinal symptoms were normal,
no rash, everythimg normal. On social hx, she was a single mum with no job nor studying. I asked about financial problems
but she said she was receiving money from the government which was not too much.
I think my mistake was to believe it was a case of a fussy eater (only likes milk) but then I was told by other candidates later that
the mum didn’t have enough money to buy other food.
Task do a history and differential diagnosis and the most likely.

Assessment Domain abdominal pain Domain Score (see key below*)

Approach to patient/relative 4
Interpretation of investigation 2
Diagnosis/ Differential diagnoses 2
Patient Counselling/ Education 1

Patient at the ED with acute abdominal right pain, she just had an US. Task small hx, dxx and counselling. She is worried she had
appendicitis.
She was on the day 14 of the period. The pain was getting better, it was sharp, acute but short-lasting, no radiation, no
aggravating or alleviating. No nausea or diarrhea, no bleeding or discharge or fever. The US was normal, just stones on the
GALL BLADDER.
I told her it was mittelshmerz and gave the reasons why it wasn’t appendicitis (no typical pain history, was getting better by itself,
us normal). I made to big mistakes: I said I was going to discharge her (you can’t say that if you are an intern)
+ during the exam I read that the stones were in the bladder so I counsel her about that as well which of couse was wrong
because they were in the GALL bladder.

Assessment Domain breathing difficulty Domain Score (see key below*)

Approach to patient/relative 5
History 5
Diagnosis/ Differential diagnoses 5
Patient Counselling/ Education 4

PREDOMINANT ASSESSMENT AREA - MANAGEMENT/COUNSELLING/EDUCATION STATION 14

Scenario: Antenatal care Grade: Pass
Assessment Domain Domain Score (see key below*)
Approach to patient/relative 4
History 5
Patient Counselling/ Education 3
Interpretation of investigation 4

A patient pregnant came to ask about NIPT because a friend of her told her about it.
Hx and counseling
Everything during the pregnancy was going alright, no medical hx, no medication, she was taking folid acid, no symptoms, first
baby, I don’t remember her age. She had a family hx were the aunt? Or their baby? Had Down syndrome.
After you explain what it is, they show you the result of it which was normal so you have to explain it to her. One important thing
is that they tell you on the result the sex of the baby BUT SHE DOES NOT WANNA KNOW.

PREDOMINANT ASSESSMENT AREA - HISTORY S

TAKING TATION
16
Scenario: Groin pain
Grade: Pass

Assessment Domain Domain Score (see key

below*)
Approach to patient/relative 4
History 5
Diagnosis/ Differential diagnoses 5

I have never seen this case. It was a patient with strong pain on one of the groin areas for 12 hrs, getting worse.
Hx, most likely dx and differential

I tried to rule out lymph node enlargement, hernia, abdominal causes, trauma but everything was negative. Luckily I found this
positives findings: more pain on walking, fever since last night, hip replacement on the same hip joint years back + a visit
to the dentist a week before.
I said the main dxx was septic arthritis which seems that it was alright. dentist procedure- bacteriema as the cause

PREDOMINANT ASSESSMENT AREA - HISTORY TAKING STATION 17

Scenario: Opportunistic health review Grade: Pass
Assessment Domain Domain Score (see key below*)
Approach to patient/relative 4
History 4
Patient Counselling/ Education 4
Ptient come beause her wife was worried about her drinking habbits, I don’t remember too well but he was deinking daily above
normal limit and also on the weekends doing binge drinking with friends. He didn’t increased the amount or had
 withdrawal symptoms or dependance (cage was all negative). social and psycho history normal. hx of increase alcohol
level on police control.
Task was hx and counselling
I explain to him that even when he didn’t have a dependance, he was drinking above the normal limita and then I educated him
about effects of the alcohol on health and social life

PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC S

FORMULATION TATION
19
Scenario: Diarrhoea
Grade: Pass

Assessment Domain Domain Score (see key below*)

Approach to patient/relative 4
History 4
Diagnosis/ Differential diagnoses 3

It was a case of toddler diarrhea. I followed Marwan approach.

PREDOMINANT ASSESSMENT AREA - HISTORY TAKING STATION 20

Scenario: General malaise Grade: Pass
Assessment Domain Domain Score (see key below*)
Approach to patient/relative 5
History 4
Diagnosis/ Differential diagnoses 5

Patient with like 6 weeks of general malaise. Hxx, dx and differentials

I followed hemifadoc approach which was all negative. Positive findings: dry cough, headaches, tiredness all the time and getting
worse, loss of weight, night sweats. Also, he had traveled to cairns close to the day the symptoms started but I couldn’t
investigate more about it as I run out of time. Also a course of augmentin with no answer
I said ATYPICAL PNEUMONIA due to the typical symptoms+ no response to common ATB. I mentioned other tiredness dxx and
why they weren’t.

ANOTHER CASE: breathing difficulty, passed, hx, dxx and management

mum came but I don’t remember the chief complaint. on hx, kis snores at night but she is unsure whether he stops breathing,
repetitive ear infections, problems hearing (had to speak to him louder), tired during the day.
I don’t remember too well what I said, I talked about sleeping apnea and how it is related to repetitive ear infection. Inrefer her
to the ent + speech therapist +hearing test. I followed marwan so please read from there to have it complete
PILOT, IMPORTANT

1 Patient with long hx of schizophrenia with no response to treatment. Presented to the ed with 2 days hx of chest pain. She
said that the pain was being given by someone else to her.
Hx, dx and inmidiate management.

On questioning, she had typical symptoms of angina: central chest pain with radiation to the neck, worse when walking. I don’t
remember the associated symptoms. She kept saying that some people were giving the pain to her.
I said it was angina and followed the management according to Marwan.

2 Patient certification of death

Task: explain the son that was there in the room what you will do to confirm her death, then explain to the examiner the physical
examination and then say which documents do you need to sign the certificate of death.
It was very weird to have the son there and explain it to him, I said I was sorry about his lost bla bla but he was alright, no cry or
any response. I had like 3 minutes left with nothing else to say.

6th July 2022 online

 Station 10:
Teenage boy complaining of abdominal pain.
Task: Hx, PEFE, Dx and DDx [prompt timer at 6 min]
In this case I had a technical problem with my headphones and had to adjust the setting in the zoom options.
So, I started with introduction and acknowledging concern, the RP was a bit aloof and not forthcoming initially but was helpful
I did SIQORAAD1 – pain for 6 months, periumbilical area. I was convinced that its IBS but when I asked about dietary relation to
pain, he said that every time he takes dairy, he gets central crampy pain and turns pale, and it clicked that it could be
abdominal migraine. There was positive personal and family history of migraine.
My tip would be – please specifically ask about dairy and any paleness after that otherwise we can lose this case.
Unfortunately, this case was PILOT

Young male c/o abdominal pain. Task: hx, PEFE, Dx, Ddx
Started with the pain questions, to which patient said it started 6 motnhs ago, intermittent, over periumbilical region. Denied any
nausea/vomiting. Positive finding of alternating diarrhea and constipation. Denies any LOW/LOA, any stools which are
difficult to flush, no one in the family on special diet. Denies being triggered by anything specific. I asked about
psychosocial history, everything was fine. Gave the dx of irritable bowel syndrome.
PILOT CASE

Station 11:
37-year-old pregnant female was 35 weeks pregnant and was feeling unwell.
Task: Hx, Dx and DDx and tell her about risk
[ when the stem mentioned unwell, I was thinking it could be PPROM recall]
I acknowledged her concern and asked what’s going on – she said I have chest pain!!! [ I was like taken aback]
So I did the SIQORAAD1 – she said chronic chest pain behind the breast bone, it gets worse on lying down, it was burning in
nature and also had positive history of heartburn
Her antenatal history was normal.
Tried to rule out DDX- asked about MI, Angina, Pul embolism, heart failure due mitral stenosis and also psychogenic – all were
negative.
I explained to her that as the baby is growing its compressing the stomach due to which the acidic content is entering the food
pipe + there also might be problem with GE sphincter.
I couldn’t ask her about downs screening due to time constraints- I thought I didn’t to well but I passed
37yo lady at 36 weeks pregnant, 3rd pregnancy
Came for routine ANC
Task: history, dx, ddx
PEFE: BP 130/70
Clonus positive x1 bilaterally
In history taking everything seemed uneventful. No similar events in past 2 pregnancies, antenatal was uneventful.
Pain stared 2 weeks ago, she described it as burning sensation in the central tummy, denies taking any spicy
or oily food. Some heartburn symptoms present. I was trying hard to rule out any late pregnancy
complications (HELLP syndrome, pre eclampsia) but no signs present, she was very well otherwise. Ruled out
all other possibilities-MI, pancreatitis, peptic ulcer disease, lobar pneumonia, cholecystitis
Finally gave her the dx of GERD, told her it’s because of the compression of the gravid uterus on her tummy that’s
causing this and also the hormonal changes cause delayed gastric emptying and the relaxation of the valve of
the food pipe that prevents the back flow of acidthat could be the contributing factor as well.
Passed this case.

Station 12: FAILED

Women in early 30’s is feeling unwell after heroin use. Task – Hx, DDx
This case was my worst performance that day – the role player was very weepy, didn’t give information even after confidentiality
and kept saying “I shouldn’t have done it” – so I said I know your upset but this is a very nonjudgmental place and I would
like to know more information then only she started giving me more. I guessed I got frustrated and panicked in this
station.

The symptoms were nonspecific, so I started by doing systemic review by asking all symptoms head to toe.
I don’t know why I mostly asked HEMIFADO q’s rather than ABFIT NO SEX question and couldn’t take proper history of drug use as
well.
I knew I will fail this case.
That’s why I failed this case – please practice all the Hepatitis cluster properly

30s, female, c/o feeling unwell after heroin 2 weeks ago

Task: history, dx
I have to thank Dr Amir for this. I did a trial exam with him 1 monthprior to exam and was not familiar with a good
approach for this case.
Asked the usual HEMIFADOS for not feeling well and patient kept saying ‘I feel guilty’. Asked about her psychosocial
history and ruled out depression.
No other risk factors, claims went for holiday but didn’t do much activities, said shehas some rest few days ago but it went away.
Denied any h/o multiple sexual partners
PEFE: enlarged liver
Gave a ton of ddx for this mentioning it could be hepatitis, and all the HEMIFADOS causes, also need to rule out the
possibility of HIV seroconversion in view of history of needle sharing. Reassured her she’s in safe hands and
will do some investigations to find out more
Passed this case

Station 13 – REST

Station 14
Lady in her Mid-20’s wants repeat temazepam script and has sleep issues
Task: hx, ddx
I started with confidentially – I first analyzed her medication use – there was no evidence of tolerance and dependance in her
Then I did psycosocial history – most of depression cluster question in SIGECAPS was positive
I told her – its because of your depression that’s affecting your sleep.
DDX – I gave it for depression rather for insomnia – I got low score in DDX domain but passed this case – so please be careful
 . Temazepam repeat prescription
Task: history, dx
*pt has been taking temazepam 1 year, got prescription from different GPs
Was started on it for insomnia
No increase in dose, claims initially helped with sleep but now not really, she is afraid to stop and has never tried stopping either
Said she tried sleep hygiene but doesn’t work
Some features of anhedonia
I mentioned that she was dependent on temazepam and has underlying depression that is causing her insomnia.
Explained that temazepam is not meant to be for long term and isn’t a solution to her insomnia. Told her she is
probably having some depression that is causing her insomnia and that is what needs to be addressed. Gave
her other differentials like mania, bipolar, thyroid disorders
Passed this case

Station 15:
Patient is unwell since last half an hour with initial unstable vitals – relative is here – take history and tell him what’s going on. The
wording of the task has escaped my mind – they were bit complicated.
+ve finding – Bee sting 40 min ago, positive history of atopy in family Dx – anaphylactic shock
Thankfully it was a PILOT case

20s lady, had insect bite, brought to ED

Task: history from relative, PEFE, dx
PEFE: BP 97/50 (approx.)
HR 130 O2sat 92% wheezing (+)
History from cousin was that patient was walking in the park and suddenly had a bite over the back of her neck. She started
scratching and then after a few minutes was breathless. This is the first time, she has history of asthma, not on inhaler, no
h/o ICU admissions. Not sure what had bitten her. No first aid to try to remove anything from the wound. Asked more
about the wound, redness/discharge/swelling. Any other rash seen, swelling of eyes/lips/hoarseness of voice-all negative.
She just c/o chest tightness, no audible wheeze. No turning blue
Then just asked a little about systemic review as I had time.
PEFE appeared and I gave the dx of anaphylactic shock. Explained about that immune response to the bite, causing allergy
reaction that’s severe enough to cause her low BP, tachycardia, and wheezing.
PILOT CASE
 Station 16: FAILED

This was prostate cancer recall case. Initial complain was urinary frequency.
I had to explain investigation and talk about management with the risk
So, I explained the anatomy first, step by step investigation, in treatment I talked about radical prostatectomy, brachy therapy
and hormonal therapy and explained the surgical risk associated with prostatectomy
I also referred him to talk therapy to deal with the diagnosis.
I thought I had it in the bag as I practiced this case multiple times but to my surprise, I have failed this case – I don’t know why –
please refer to passed feedback

Prostate Ca counselling (usual case)

I was really happy to see this case as I have practiced it multiple times during roleplays. Started by asking the pt how
much does he know about what the urologist explained, what he understood from the explanation, what’s his
concern right now. He said the urologist said cancer and everything was blurry after that. So he wants to know
more about how bad it is and what can be done. Asked if he came alone and would like anyone to be present
with him. Started explaining the UTI results and how it’s been addressed with antibiotics, we will follow up with a
repeat sample once he completes the antibiotics to make sure all the bacteria is eliminated. Then explained
about the cancer. Told him what a prostate is and the function of it.
Explained it’s large hence we did the biopsy unfortunately it’s confirmed to be cancer. Pause, asked if he would like
me to continue or give him some time. He said carry on. Told options of treatment:
surgical/hormonal/conservative. Radical prostatectomy is one of the options, the whole prostate is removed
along with the cancer. Pros: the cancer is completely removed; cons: incontinence, impotence. Asked if he was
still planning on expanding his family. Explained other options: brachytherapy, radiotherapy-requires repeated
sessions. Wait and watch approach-as it’s a slow growing cancer this is an option too but you need to be aware
that during this period it can spread , however, you will be on frequent monitoring to make sure it doesn’t
happen. The best option however would be decided by your Urologist and with your approval. He said he’s not
sure for now, would like to discuss with the wife. I said take your time, I know it’s a lot to take and maybe I can
arrange another session with him and his wife to explain to her. I’ll arrange for counsellor if needed, support
group. As the treatment might interrupt your work, do let me know if you would require financial assistance so
I can refer you to Centrelink. Offered some reading materials.
Passed this case

Station 17: FAILED

18-month-old with fever, dx and ddx
I asked about fever and did systemic review as per fever and rash cluster.
I have failed this case as well. I have no idea why. Please refer to passed feedback. I was a surprise to me
 Station 18: REST
Station 19:
Bullimia with dental carries – I followed Dr. Anita approach for this case that will be present in Marwan or Alan notes.
Just one additional point – this lady has previous history of starving her self as well – so one DDx was ANOREXIA NERVOSA as well.

20-something lady referred by dentist for dental carries. Task: history, Dx, ddx

Started with confidentiality statement, asked if she knew why she was referred. Ruled out all other causes: pregnancy, thyroid,
depression etc
Dx as bulimia nervosa
Passed this case

Station 20:
55-year-old man with high ambulatory BP reading + stage one hypertensive retinopathy
Task – counsel and talk about further investigation
I started by explaining that why we did ambulatory BP monitoring due to white coat HTN and also quickly explained the
retinopathy findings.
Then I took the 5c approached and explained HYPERTENSION. Talked about primary and secondary causes.
Also talked about future implication – like MI , stroke, retinopathy , nephropathy and it being a silent killer
Investigation – to look for co-morbid condition like DM, cholesterol etc and also evaluation of secondary causes as per
TRACKPADS
I felt role player was not entirely convinced but I have passed this case

Another
42yo male, ambulatory BP done as previous readings in GP was high (approx. 170/90) Ambulatory BP 153/70
Fundoscopy: silver wiring changes
Non-smoker, occasionally drinks, exercises regularly, healthy diet
Parents: IHD, mother: DM, hypertension
Task: -explain findings of ambulatory BP
Explain the risk of findings
Further investigations
It was a very clear stem, asked the pt a few questions: at what age was his parents diagnosed with hypertension, he
said he wasn’t sure. Explained to him what hypertension is, how it’s already doing damage to his organs as in
the fundoscopy findings, and the further complications that can arise if [Link] him it’s
manageable and he’s in safe hands and it’s a good thing we detected it early. Explained all the basic blood
investigations that needs to be done to look for evidence of complications and presence of other
comorbidities, ECG, urine protein. Since he’s quite young to be having BP this high I would like to discuss with
my senior colleague to see if we need to further investigate for causes of secondary hypertension. I was a bit
confused as the age was borderline so I just wanted to reconfirm if it was needed, explained a bit about the
investigation like kidney ultrasound TRO renal artery stenosis.
Passed this case.

Station 1:
Cervical screening test results – HPV 16 positive but no cervical changes Task: explain results, implication, and Management
So, when I saw this question, I was a bit confused as there were no changes in the cervix.
Then I remembered revising with my study partner regarding different scenarios of cervical screening test – even if HPV 16 or 19
are positive you must refer to specialist for colposcopy.
I explained the patient the rationale behind the cervical screening test, then told her she has the virus but does not have any
changes now and has no cancer at this point of time but is at high risk of developing cancer in near future.
But to be safe she needs further evaluation.
Referred her for colposcopy and advised her about safe sex practices and was able to pass this case.
CST, came to review results
HPV 16 positive, HPV 18 negative, non 16/18 negativeLBC: no SIL seen
Explain results, history, management

It’s a simple case but I did a blunder with this one. I had practiced this and gone through the chart multiple times and yet I was
distracted with the LBC: no SIL seen
I explained it wrongly so please refer to passed feedback
Failed this case

Station 2:
University student submits work late. Task: Hx, MSE
This case was classic procrastinator – he is very critical of everything as his family has placed very high expectations on him. He
takes a lot of time perfecting what ever he is doing due to which he is always late to submit the task
No mention of word “KING”, no OCD feature, no repeated handwashing or security check
MSE according to me was completely normal Dx. OCPD not OCD
I was not sure what to say in thought form and thought content – I said there are no obsessional thought
I gave dd’s – OCD, mania, depression, organic causes
I passed this case

University student, delay in submitting work, sent by counsellor.

Task: history, MSE
The famous ‘King’ case. He was doing well in school, now taking history classes, every time he studies and sees the word ‘King’ he
feels triggered. Asked him about intrusive thoughts and this was what he revealed. Asked what he does about it and he
said he has to walk around the room. Ask what happens if he doesn’t? He can’t get rid of the thought. Asked if the word
‘King’ holds special meaning to him or it’s referring to him? He said no.
He admitted to having a perfectionist like personality, things have to be in order always, like his wardrobe. Gave the dx of
obsessive compulsive personality disorder
Passed this case

Station 3: rest
Station 4:
Pnuemothorax x ray was given, I had to explain x ray and explain PE – I said that the broncho vascular marking were extending till
periphery on one side but not on the other side and there is a clear demarcation of lung border on the effected side.

Student specifically asked me about pneumothorax finding in the PE

I did vital, WIPE – did the whole respiratory exam with hand to toe approach
I explain that trachea will be deviated to opposite side, JVP might be increased due to pericardial compression, told about
decreased lung movement and asymmetrical expansion, told about hyper-resonant percussion note and also absent
breath sounds.
I passed this case

Another
Pneumothorax PE
-pt is in 20s, male, p/w sudden onset SOB
-explain x-ray findings to medical student
-explain PE with relevant findings correlating to x-ray

I started by approaching step by step according to the order of the task given. I think it’s better this way so you
don’t miss out on any tasks.
Explained the X-ray findings of pneumothorax, what we are looking for in the X-ray: bones, trachea, soft tissue,
explained why I said it’s pneumothorax. Next I explained the PE and what would be the normal finding of a
chest examination and what to expect in a pneumothorax case.
Passed this case

Station 5:
Right iliac fossa pain in a young female– do PE

I did PE as per Alan notes, followed acute abdominal pain approach

Talked about appendiceal signs first- Mcburney point, Psoas sign rovsing sign
Did costovertebral tenderness to rule out pyelonephritis Also told about murphy sign
Then I mention we need to do per rectal exam to rule out bleeding per rectum
Also mention pelvix exam to rule out PID and ovarian pathology Mention doing dipstick and urine pregnancy test at end

Another
20s, female p/w right lower abdominal pain
Task: PE to medical student
Usual PE of abdomen, vital signs were given, asked about pain and offered some pain killers. Examined the general appearance,
hydration status, went straight to focus examination of the abdomen and with consent and presence of chaperone do a pelvic
examination and DRE. Gave the ddx of ovarian torsion, PID, appendicitis, ruptured ectopic pregnancy, salphingitis, UTI, urinary
tract calculi.
Passed this case.

Station 6:
Acute cough in 3-year-old

In exam everything was normal except bilateral wheez and history of atopy
Dx. Acute asthma exacerbation due to URTI
DDX. Foreign body, epiglottitis, pertussis, croup etc Follow respiratory cluster in pediatric
 Another
. 3 year old child, brought in by father as having cough for 2 days. H/o prematurity, mother has h/o asthma, dad said it has been
happening a few times when child is active and plays as well.
Task: hx, dx, ddx

For this I followed the paediatric history taking, particularly trying to exclude pertussis, croup, pneumonia, foreign body
inhalation, epiglottitis
Gave working dx as viral wheeze secondary to URTI, told the dad it could be asthma as well given the family history but child is
too young still for me to make that dx. We will follow up and see how the symptoms are.
Passed this case

Station 7:
Handbook case 129 - Migraine counselling
This case came in my first exam as well which I passed previously. I completely followed the handbook approach

Another
27yo lady, c/o headache past 1 year, 6-8 times per month, left sided headache withphotophobia, MRI: normal
Pt works as an engineer, been assigned with many responsibilities
Financially stable, doesn’t smoke/drink
No relationship problems
Task: explain dx, short term and long term management

It was a very detailed stem giving all the information you need. I diagnosed it as migraine, explained what it is and told her it
could be contributed by her stress that she’s undergoing at work. Told her she must be really worried as it’s happening so
frequently but we have done the MRI and it came back normal. So that excludes tumor. Told her about all the other
possibilities too: sinusitis, temporal arteritis, cluster headache, otitis media, visual problems, dental carries, meningitis
Short term mx: pain killers, if it doesn’t work escalate to sumatriptan
Long term mx: delegate tasks to colleagues to reduce work burden, relaxation techniques, refer psychologist for CBT
Failed this case, kindly refer to passed feedback

Station 8: Rest
Station 9: Failed
Elbow exam case
When I saw the question, I was so disheartened as I revised it just 2 times as it didn’t show up very often in recalls
I recollected the basic format and mills and cozens test for lateral epicondylitis
But the test for medial epicondylitis totally evaporated from my brain –
and I was exhausted as it was my last station
So, I followed look feel and move approach and explained mills and cozen test – the student interrupted me and asked what is
carrying angle and I couldn’t explain it
The student specifically asked me about medial epicondylitis test – so I just said that I will get back to her in my next session
So, I failed this case due to forgetting medial epicondyle test So, guys please practice all examinations properly
Final thoughts – I have given both face to face and online – I felt that the evaluation for online format is much stricter than face
to face as when I compared my pervious global rating it was all in 5 and 6 in face to face but in online majority was just 4
meaning borderlines.
Don’t take online examination lightly.
But please don’t get disheartened as this journey is though and long but, the feeling that you get after passing is just
unexplainable. The relief that you feel is worth all the hard work

Another feedback
1. Explain elbow examination to medical student
30 yo man, history of playing basketball years ago, p/w locking of right elbow joint
h/o fall few years ago
no h/o joint problems otherwise

I started with this case and it was confusing as the history given was quite complete but I could not pinpoint it to a
certain diagnosis. I approached it in the usual elbow examination method: look, feel, move, did the Cozen and
Mills test. Gave the ddx of epicondylitis, OA, RA, fracture, septic arthritis. Roleplayer asked to show how to
examine for crepitus when I mentioned it, so I demonstated it. I thought I was ok in this case but I failed so
please refer to a passed feedback. I can’t emphasize enough on the importance of doing PE over and over
again. If there was one thing I wish I had done more it would be revising my PE cases.
Failed this case

Best of luck guys

12th July face to face

[Link] history hefe"explain-diagnosis-immediate•management-T
2. Developmental delay T
3. Body odourT dds gum infection phenylketonuria, bromhydrosis
[Link] /imminent eclampsia T
[Link] complete /Threatened miscarriage T
[Link]-hysterectomy-requestI
[Link]-go-home.T
[Link] failure wax; explain to examiner then explain-cause-to-patient-and-immediate-management.1
[Link]-chart-prescribe-ceftriaxone. For pneumonia-therewas•[Link]:in-the-room-to-check-dosef
10.. [Link]-meds-task-was:history-and-Pain-management-T
11. Lower limb motor exam and relevant
12. Cockroaches delirium me diagnosis and differentials1
13. Knee exam young girl T
14. Cld exam alcoholic liver T
15. Gynaecomastia exam on-ramipril-T
16.-Lifestyle•stress/GAD/OCPD not sure-was very weird tolenlaxer was- asking twice every question looking towards
examiner with side eyes as to ask what to-reply

20th July recall 2022 FTF

1. 4 yr old sent by midwife as mother is concerned about influenza vaccine.

History (4min)
Council the mother
Positive findings
Child has asthma on Ventolin PRN, well controlled, gets attack only when has respiratory tract infection
Has egg allergy and had anaphylactic reaction when she was two years old.
Other immunization done no reaction
2. old girl with lower tummy pain for since morning presenting in emergency dept. you haven’t seen her before
Take relevant history
PEFE from examiner (Examiner will give u what u ask)
Diagnosis with reasons
Positive findings from history
Dull pain, 233?10, no radiation,
No fever no discharge
She is sexually active, stable partner, not using condoms , no hx of STI
Increased urination and burning urination, dark yellow urine
PMH, SH- normal
Sadma- nil
PEFE, lower abdominal tenderness
Temp normal
No renal angle tenderness
Pt refused speculum exam, only inspection- normal
UDT, nitrate +, RBC++, leucocytes++
Lower urinary tract infection, cystitis
3. old girl with lower abdominal pain for two days (Not sure). She has vaginal discharge for two months, Three partners,
long stem
Hx (3min)
PEFE
Dx and immediate Mx
Positive findings
Lower tummy pain, no radiation,
Pv discharge, no blood stained
Not feeling well, no NV, no urinary problems, not practicing safe sex
Menstruation, normal
Sadma-N
PEFE: Adenexa tender, CMT +ve, Ut tender , discharge +ve cervix and vagina
UDT, N, PT -ve
Fever 38/39
Dx- PID, admit , investigations , broad spectrum ab
4. PROM- pregnant lady need to see you immediately, waiting for you.
Hx (6min)
PEFE
Dx with reasons
Positive findings
She was watching tv suddenly started leaking, watery discharge, no bleeding, lots of pads, no abd pain, no fever , Fetal
movement +ve, 35wks POG, US, screening tests – N
Supportive partner
One abortion when teenage and one miscarriage first trimester
PEFE: Cephalic, long, FHR-N, FH 32,
P/s, water discharge coming from the cervix, os closed,
PROM
5. 17 yrs boy working in the farm, feeling unwell for week, now parents brought him to hospital
HX
PEFE
explain the Dx to patient
(Same Marwan case)
6. (Bulemia Nervosa) Same as Marwan file with dental issues ( girl is asking a lot of questions)
Hx
Dx and management
Video case and present MSE, no need to tell Dx or Mx
Appearance well kempt holding coca cola bottle,
Had mental issues before and has auditory hallucination, no eye contact, sleep was not disturbed. No alcohol now but
was taking before. Was interrupted by auditory hallucination

7. Back pain, Man in 30s had back pain since morning, was lifting some heavy boxes, got back pain. Long stem with exam
findings, +ve paravertebral muscle tenderness, sensory and neurological exam-N, SLR -ve , movements restricted due to
pain, no problem with urination or bowel. PMH, SH _N
Explain Dx to the pt with reasons
Tell Mx and write the sick leave form (Sick leave form given, fill in the blank)
8. Knee injury, Middle age man presenting with knee pain since morning
Hx relevant
PEFE, examiner give only what u ask
Give Dx with reasons
Positive findings
He was getting ready to go to work and twisted his knee. Got knee pain, not reduced so wife told he rto get medical
help. He came to hos[ital, knee is swollen
No redness, no laceration or injuries or bruises . PMH, SH- N
Sadma, no smoking, don’t remember about alcohol
No Joint rpblem in the family
PEFE, Knee swollen, all tests cant be done due to pain and all movements restricted. Cant extend the led due to pain. He
refused to move the leg.
Medial aspect of the knee is tender told to one of the candidates
Once pain settled we can do further exam
9. Father brought his son 4yr old who has R knee pain for one week.
Hx
PEFE from examiner, he will give only what you ask, ask investigation results
Xray and bloods done by your colleague
Explain the Dx to father
Positive findings
Knee pain one week, now worst for two days and is limping
No redness, swelling or fever, otherwise well
No one smokes at home . no flu like illness, no rash
Pain not radiating,
Internal rotation and abduction was painful and roll test positive
Xray showing, femoral head distorted (Avascular necrosis)
10. PP depression, lady went for six weeks check up. Baby was all good. BF, mother health is good. Midwife concerned as
she was teary. Her husband and realtives live interstate , friedns are busy, doesn’t have any help
Take Psychosocail Hx
Dx and Mx
Positive findings
 Mood is low, appetite is low, no psychotic features, sleep is disturbed, difficult to get into sleep and wake up early.
Anhedonia+ve, lack of energy, duration is more than six weeks
Psychotherapy, LSM, family meeting and referral to psychiatrist and she asked if I take medication will this affect my
baby. Told that specialist will give you the safer medication and will discuss with you.
11. (Indigestion) Same as Marwan case. Middle age lady with indigestion for two weeks or one month. She was concerned
about it. A bit more information, I forgot
Hx
Ddxx with reasons
Positive findings
Has indigestion for one month, no NV, no burning sensation but dull pain in the epigastrium, not radiating, pain getting
worse after eating. Vomited once, food particles only.
Stool has become darker for one month, No other changes. She was on blood thinner medication for clots in the lungs,
work stress +ve
Sadma-N
She has lost wt( significant) and she feels that her stomach is full even when she eats little . no anemia symptoms
Dx, peptic ulcer disease, ca stomach, esophagitis, gastritis, duodenal and gastric ulcer

12. ED, Teenage girl presented with itchy rash. New lesions appearing and old ones disappearing. Pic is given. No SOB, no
resp symptoms, vitals stable. No history, no allergies
Explain the Dx
Tell Mx to the pt
Positive findings
Raised red rash, no vesicles or discharge , in the lower back and hand in the pic, Generalized rash. Similar rash as below:

PE cases
13. Chronic smoker , stopped smoking two yrs ago, 20 Pcks /day for a long time. Truck driver, not working now. Cough with
mucus , no blood, loss of wt within one month, PMH, Sx-N
Do respiratory PE, running commentary to examiner
DDx
14. Motor vehicle accident. Young man, primay and secondary survey done. Neck injury evaluated and collar removed.
Vitally stable. Complain of rt sided head pain. Pic given, rt sided eye hematoma (Raccoon eye)
Do relevant PE with running commentary to the pt
Dx
Positive findings : Eye movements painful rest normal, Eye and temporal are is bruised, Rt side of face is tender

15. Cerebellar ataxia, Middle aged woman, long stem, LFTS deranged, numbness and tingling of lower limbs and she was
prone to falls. Heavy drinker 5-6 glasses of wine/day. PMH, SHx – n
Upper and LL neurological exam N
Do lower limb neurological exam
Give reasons for her presentation
Positive findings
Gait ataxic, Coordination tests impaired

21st July:
 1) PE Breast
2) Abdomen
3) UL neuro+ tremor
4) Preg induced hypertension
5) Coeliac disease ( adult)
6) Periorbital Celluitis\
7) MSE mania
8) Travel advice lithium
9) Bleeding pr hemorrhoids
10) Relapse schizo risk assessment
11) Persistent cough( pt gave weird history)dx and dd
12) Burns child<10% management give carer assessment of the situation
13) Mild hypercalcemia( PTH was high) dx and ddx
14) Urine Pcr chlamydia +ve male implication and management
15) Tingling and numbness in upper arm after lifting heavy object(C6-C7 affected) diagnosis pefe from examiner Ix and
management
16) exercise induced amenorrhea

26th July online

I passed 12/14 stations on 26th July 22 online [Link] was my first attempt.
Thanks to all of my study partners and to the group, to the all passed candidates so far who shared their feedbacks.

Station 1 Assessed, Not Scored

Jhon Had history of head trauma when playing football and came in the hospital in the emergency department after a brief loss
of consciousness. diagnosed with concussion
CT scan was done ,its normal and he is already observed in the emergency department. U were not present when he came to ED
And during his assessment.
• take history for two minutes because to know if safe for discharge .
• tell the patient what is concussion
• what is the management plan

Station 2 Pass
man with lump in right groin USG done showing lymphadenopathy
• Task appropriate PE to medical student with technique
• Tell what you are looking for with anatomical Landmarks
D/D:
o Lymphoma . U have to check all LN e.g Cervical,Axillary,popliteal LN. Hepato-spleenomegaly
o Genital infection: STI, epididymo orchitis
o Infection /cancers in Scrotum skin, [fore skin] penis [lower 3 rd of vagina],skin of perinium
o Viral: EBV/ CMV/ toxoplasma
o Leukemia
o Lower limb infection
o Skin cancer BCC,SCC,Me
o ulcer

WIPE
1. Ask your patient to lower their trousers and underwear to expose the inguinal region.
2. Instruct the patient to lay flat on the bed.
chaprone
Pain
GA…chaexia,LN
 PICLED
Vital…….infective symptoms (e.g. fever).
1. Lump exam
lymph node

• Site: assess the lymph node’s location in relation to other anatomical structures.
• Size: assess the size of the lymph node.
• Shape: assess the lymph node’s borders to determine if they feel regular or irregular.
• Overlying skin changes: note any overlying skin changes such as erythema.
• Consistency: determine if the lymph node feels soft, hard or [Link]
• Tenderness: note if the lymph node is tender on palpation.
• Mobility: assess if the lymph node feels mobile or is tethered to other local structures.
Interpretation of lymph node findings
Benign lymph nodes: typically less than 1cm, smooth, rounded, non-tender and mobile.
Reactive lymph nodes: typically smooth, rounded, tender, mobile and associated with infective symptoms (e.g. fever).
Lymphadenopathy associated with haematological malignancy: widespread enlarged rubbery lymph nodes.
Lymphadenopathy associated with metastatic cancer: regional lymphadenopathy in lymph node groups draining the affected
organ. Lymph nodes typically feel hard, firm, irregular and are often tethered to local structures.

2. inguinal LN (superficial horizontal/vertical) with anatomical landmarks

To assess for inguinal lymphadenopathy:
Palpate immediately inferior to the inguinal ligament (which runs between the anterior superior iliac spine and pubic tubercle) to
assess the horizontal group of superficial inguinal lymph nodes.
approximately 3cm lateral to the pubic tubercle and then palpate vertically downwards to assess the vertical group of superficial
inguinal lymph nodes.
Examine left inguinal region

[Link] and scrotal exam : for any possible cancer

and inflammation, infections . rash, masses, discharge.
4. skin exam below umbilicus for skin cancer and infection,
8. Lower limb inspection for any trauma and infection

5. DRE for anal cancer below pectinate line

6. examination of abdomen : Hepato-spleenomegaly [lymphoma and leukaemia], Bruising/petechiae: suggest low platelets.
[Link] of other lymph nodes
Epitrochlear lymph nodes
the inner aspect of the arm just above the medial epicondyle of the humerus.
CL,Axilla,pop

Whole body skin for scratch mark..lymphoma, rash,brusing,sternal tendeness

Station 3 : Break
Station 4 Pass
60 year old Maya comes to your GP complaining of a feeling of something bulging from down below.
• take history for 5 min[PE will appear at 5 min]
• diagnosis and risk factor.
1-Prolapse questions + incontinence
-How long have you been having this? (Last 1 year)
-Is it there always, or just at times? (Assess degree of prolapse. If it is always there, it is 3rd degree) (it is just there at times)
-When do you have the feeling of the bulge? (When she stands for a long time)
-What relieves you of the feeling? (When she lies down, she can feel the bulge going inside) (Probable 2nd degree prolapse)
-Associated symptoms: bleeding, discharge, itching, rash? (Prolapse can get infected)
-any involuntary leakage of urine? (Incontinence) key ques
2-past medical history
Chronic cough:
-any chronic cough?
Constipation
-how is your bowel motions?
-Any history of constipation? Do you open your bowels regularly?
UTI
ask about waterworks as well (can be associated with a cystocele or urethrocele, can have urinary retention)
-any problems with passing urine?
-Is there any burning or stinging during urination?
3-Past surgical history (hysterectomy)
4-past obstetrical history:
-have you been pregnant before? how many pregnancies have you had? (3 pregnancies and 3 deliveries),
-any complications during the pregnancy?
-Were all your deliveries vaginal? Any C-sections?
-Any history of big babies? Any obstructed labor? Any prolonged labor?
-Any tears or lacerations that you had at the time of delivery?
-Any instrumental deliveries?
5-Past gynaecological history (Menopause)
-period history: have you had your menopause?
-Any menopausal symptoms like hot flashes, heavy sweating, mood changes?
-are you on any hormones or HRT?
-Any bleed after menopause?
-When was your last pap smear and mammogram? What was the result?

6-Social
-Sexual history: are you sexually active? Are you in a stable relationship? Any problems with intercourse? Any bleed after
intercourse?
-Do you smoke? How long have you been smoking? How many sticks per day?
-Alcohol drinking?
-medications and allergies

Physical Examination
1-General appearance: BMI (35, obese - can lead to weakness of the muscles), pallor
2-Vital signs
3-Systemic exam
Respiratory system
CVS:
Abdomen
(abdomen is soft and non-tender)
4-Pelvic exam
Atrophic changes
Bulging from anterior and posterior vaginal wall

Dx
Utero-vaginal prolapse
Positive points
So the lump is there for six months. And from this what I found constipation for three years and menopause from 51 years old
and three normal vaginal delivery, forcep delivery . baby was 4.1 kg other one is 4.3 kg okay and she didn't do pelvic floor muscle
exercise.
Station 5 Pass
Right sided facial swelling in a 7 year old boy. Has toothache and is due for an appointment with dentist in a week. Also he was
complaining of pain on chewing the food. Eye examination was done and it was normal (photos given)
h/o egg allergy before. But now well tolerating.
• Explain the Picture to med student [time wasn’t mentioned]
• Tell the med student about how you will do the examination
• what findings you are looking for with anatomical landmarks
 1. wipe
2. vitals plus dehydration status.
explain the picture first.
On inspection can appreciate swelling of the face and redness plus there is no rash.
Palpation look for temperature and tenderness.
Compromised airway with or without stridor
Ask the patient to open their mouth and inspect the oral cavity using your light source. Note if the patient has difficulty opening
their mouth due to pain, suggesting the presence of trismus.
❑ Teeth
• Missing teeth: may be secondary to infection or trauma.
• Tooth decay: indicative of poor oral hygiene.
❑ Gums
• Gingivitis
• Periodontitis
• Ulceration
❑ Tongue
Ask the patient to stick out their tongue and inspect for abnormalities such as:
• Oral candidiasis
• Glossitis
• Ulceration: may be secondary to trauma, infections
❑ Buccal mucosa
• Aphthous ulcers:
❑ Parotid duct opens opposite to the second upper molar teeth
• Parotid gland sialolithiasis: a calcified stone
• Parotid gland sialoadenitis: erythema around the duct and visible discharge.
• Pleomorphic adenoma: a solitary, slow-growing, painless, firm single nodular mass.
❑ Palate and uvula
• Oral candidiasis: a fungal infection
• Ulceration
❑ Floor of the mouth
Ask the patient to lift their tongue to the roof of their mouth and assess the floor of the mouth stone , erythema and visible
discharge around the Submandibular gland duct.
❑ Ulceration
If permitted by the patient proceed to bimanual palpation of the mouth.
• gently Palpate the lateral walls of the mouth to assess the parotid gland and duct.
• Palpate the floor of the mouth to assess the submandibular gland and sublingual gland.
Any intraoral swelling should be described according to its site, size, thickness, colour, texture, consistency and tenderness.
Keeping these in mind I did complete ENT examination plus check all cervical lymph nodes.
Also the patient had history of allergy so just mentioned that I would like to examine the rest of the body if there is any rash.
To complete my examination will quickly go for the rest of systemic examination as well.
cranial nerve VII ,V
examine CVS and Respi and do Head to Toe examination for any rash to see for signs of Anaphylaxis
Urticaia,rash,child abuse,neck stiffness

Station 6 Pass

Sheila aged 30 years presents to your GP clinic with history of sudden onset of palpitations, trembling, sweating and chest
tightness in post-natal [Link] is worried of heart Attack. She had similar episodes in the last few months and was investigated
in the hospital with negative [Link] and resp exam normal
• MSE 6 min
• Present MSE 2 min
Patient was cooperative but worried about having heart attack. Appearance- well dressed, groomed, it anxious, maintaining eye
contact, 3rd episode in the postnatal class
Speech was normal, mood was upset, thought form linear, thought content had some overvalued ideas about her health that
she is worried of heart though CVS and resp exam,inv normal, insight is partially intact as worried about some heart related
problem but is not aware of psychiatric issue,
J- NORMAL, C- normal, low risk as no suicidal ideation, good support, history reliable but would like to take colateral history from
husband and mother,would like to see her baby, rapport I was able to build.

Station 7 Pass
handbook cystitis case.

• tell the diagnosis and ddx with reason

• immediate management plan ,long term management plan
Dx
LUTI [Cystitis]
DDx
pyelonephritis.
urethritis,
prostatitis,
-stone
-STI
-UTI
-FB

immediate management

INV:
UFR and culture,
[Link] give Ab (nitrifuranton or trimethoprine due to penicillin allergy), you need to take it for
2 weeks. you need to take it according to prescription and complete the course.
we will change the antibiotic after the c&s result come out. you need to do
urine c&s again 1 Week after completing the antibiotic to make sure infection is clear.
3. For the prevention, you need to drink a lot of water /Take plenty of water.
do not hold urine and pass urine frequently.
• Drink at least 64 ounces of water a day to stay hydrated.
• Urinate often. Whenever you feel the need to go, do it. Also, make sure to urinate immediately after sexual activity
involving your penis.
• When you shower, clean your genital area gently with just warm water.
long term management
it is not common for man to have urinary tract infection ,hence once the infection has settled we shall do a couple of more
investigations/imaging to look out for causes like stones / prostate enlargement / Stricture
UEC, RENAL FUNCTION TESTS, FBS , PSA, USS KUB .[HB> CT of abdomen and pelvis]

will manage accordingly if underline cause found.

Referral to a urologist who may arrange:
~ cystoscopy,
~ voiding cystourethrogram.
Station 8 Break
Station 9 Pass
Pt complaint of facial pain
• tell the medical student about how to examine Trigeminal nerve
• what you are looking for and why with normal and abnormal finding
Followed geeky medics Trigeminal nerve

Station 10 Pass
30 yr old fmale wd complains of headache and sleep problem
• relevant history , psych and social history 5 min [PE will appear]
• Dx,DDX
Positive points
headache. And also in the history she said there is some tummy rumbling. in the physical examination, high blood pressure.
paravertebral muscle stiffness
History
1-Headache questions
-Hi—my name is --- I will be the doctor looking after you today. I can see from the notes that you are suffering from headaches
for 4 weeks is that right? (yes)
it must be very distressing for you so how’s your pain now from 1 to 10; 1 is least 10 is the most. (5 or 6). do you want pain killers
I can arrange one for you (yes please) do you have allergy to any medication (no). I’m gonna arrange painkiller for you
-now I just want to ask you a few questions in order to unravel the nature of the problem would that be ok? (yes)
-You say you have headaches for 4 weeks, is it constant or come and go (constant)
-has it started suddenly or gradually (gradually)
-is it increasing or decreasing in severity?
-can you show me exactly where you have it? (all around my head)
-does it go anywhere else?
-does anything make it better or worse?
-can you describe it for me? Is it like a band or tight? (Yes)
-Has this happened before?
2-Associated symptoms questions (to rule out Ddx)
-Any nausea or vomiting? is it associated with sensitivity to noise or light?
-Any fever? Recent viral infections?
-Any blurring of vision?
-any pain anywhere else? Neck or face pain?
-weakness, tingling or numbness?
-neck stiffness, rash?
-LOW, LOA, lumps or bumps?
-head trauma?
3-Psychosocial history
-now I just want to ask you a few other questions and let me assure you that everything we gonna discuss will be confidential
between you and I unless there is a harm to yourself or others? (ok)
Mood questions
-how’s your mood? (low)
-have you lost interest in things you used to enjoy? ( yes)
-for how long have you been feeling low with lost of interest? (more than 6 weeks)
-how’s your sleep? Do you find it difficult to get to sleep or you wake up early in the morning and find it difficult to get back to
sleep? (wake at 4 am and find it hard to go back to sleep)
-have you lost or put on weight recently? (lost some kg don’t remember)
-do you find it hard to concentrate on things? (yes)
-do you feel guilty about something?
-have you ever thought of harming yourself or others? Any previous plan or attempt? (no)
-Now I’m just gonna ask you questions that would be sensitive but there are just routine to ask all my patients
do you feel, hear or see things that others don’t? (no)
do you think someone is following you or trying to harm you? No
HEADS.
-who do you live with? Any stress at home? Any support?
-What do you do for living? Any stress at work? (lot’s of stress at work and can’t concentrate life very hard)
-how’s your social activity? (hard to go out with friends)
-SAD (no illcit drugs but maybe drinking or smoking heavily so we need just to say it is important to drink alcohol within the safe
limit which is no more than 2 standard drinks a day I can arrange another consultation to help you with it)
4-General
-PMH, PSH, Medications
-Family history

-most likely cause is tension headache which is headache like tight or band around the head constant associated with stress as
from the history you are going through lots of stress at work and this affecting your mood as well and disturbing your sleep.
I can understand that you have lots of stress but you also need to deal with it by do some relaxation technique like yoga or
meditation even at work and also find some hoppy
-it could be due do spasm of neck muscles as there is some tenderness on the back of the neck or it could be problems with
backbone of the neck.
- it could be migraine but less likely as it usually present on one side of the head and not persist for that long time like 4 weeks
sometime with nausea, vomiting, sensitivity to Nosie or light and family history +ve.
-It could be due to infection of sinuses or air sacs around the face also unlikely.

Station 11 Pass
57-year-old lady comes with palpitations and dizziness of 3 days duration.
TASKS:
1. Take a 4-minute history
2. ECG will appear , Explain the ECG to the examiner
3. Discuss the diagnosis with reasons and the underlying causes
History :
❑ Hemodynamic stability
❑ Hx of presenting complaint: Palpitation
When did it start? Suddenly / gradually? What were you doing at that time? Is it for the 1st time ? (Ask details of the previous
episodes if present). Anything makes it better? [Like holding your breath or deep breathing ]Anything makes it worse?
Continuous or on and off? How long did each episode last(if previous episode is present,also ask how did it stop? Did u do
anything or visit any dr? did it resolve spontaneously?) does anything bring on the palpitations? Like coffee or sleep deprivation.
❑ Associated symptoms:
❑ CVS:during this episodes do u feel dizzy/ lightheadedness? Any chest pain/ sob? Any nausea , vomiting or excessive
sweating?
❑ CNS:Any headache/any problem with vision or speech? Any weakness or any loss of consciousness ?
❑ DDx:
 ❑ Hyperthyroidism : any change in weather preference? (Do u feel cold in hot sunny days?Do u feel very hot or sweaty
even its cold?) Any change in bowel habit ? Any change in weight ? Have u noticed any neck swelling?, Any hand tremor?
Sweating? Any eye changes?
❑ Pheochromocytoma: any episodic headache,sweating, flushing of the face?
DDx of palpitation/ Nervousness :
❑ CVS : IHD/ MI / HTN / Arrythmia / valve disease/HF
❑ CNS : Stroke/ TIA , epilepsy, Infection, trauma
❑ Endocrine : Hyperthyroid , hypoglycemia , pheochromocytoma
❑ Anemia
❑ Anxiety disorder/ Panic / Stress
❑ Menopause
❑ Excess Tea/ coffee/ recreational drug
❑ Medication induced
❑ electrolyte imbalance

I only found she's taking alcohol and taking five cup of coffee.
❑ Explain ECG to EXAMINER:
I would like to describe the 12 lead ECG of my patient, Mr. john, 25 years old gentleman who came with sudden onset
palpitations and giddiness.
The ECG shows:
❑ Heart rate 150 b/min
❑ Regular in rhythm
❑ Absent p wave
❑ Narrowed QRS complex
❑ No ST wave changes
❑ T wave normal in size and shape
❑ QT interval in normal as well
Draw a picture(pic of heart with SA node). This is your heart. The electrical impulses originate from here and then goes all over
the heart to pump the blood to your body. [generator in the heart called SA node, which generates the electrical impulse that can
cause the heart to beat.]In your case there is some abnormality in this electrical impulses causing your heart to beat faster than
normal. That’s why you are having racing of your heart and as your heart is not getting enough time to fill ,so your brain is not
getting enough blood which is causing this lightheadedness you are having.

Station 12 Assessed, Not Scored

Sam came here because his father is drowsy, confused. Sam has consent to talk regarding his father
• take history from son
• talk about the diagnosis and differentials.

So in the history patient has a problem with shaving and he is not showering for one week and also not sleeping well mood is
low. And companies taking medicine high blood pressure medicine. Appetite is okay. And high blood pressure for last 10 years.
And because osteo arthritis and taking paracetamol,Buprepion for that. So in the history, I asked all that dementia question.I
gave her diagnosis of dementia. And I just said what dementia can be it can be fronto- temporal dementia, Alzheimer's disease.
And vascular dementia ,as having high blood pressure
And lewi body dementia, depression hypothyroidism diabetes
Station 13 Break
Station 14 Pass
Father came with 5 years old Child having cough and fever 39
• 4 minutes for history [PE appeared]
• Explain chest X ray
• diagnosis ,DDx
 parapneumonic fusion. So I get there this is the diagnosis and rest of the cough DD like coupe epiglottitis and foreign body
❑ POST VIRAL COUGH
❑ ASTHMA/Bronchiolitis
❑ PERTUSSIS
❑ PSYCHOGENIC COUGH
❑ ALLERGIC RHINITIS
❑ GERD
❑ CONGENITAL HEART DISEASE
❑ CYSTIC FIBROSIS
❑ IRRITANT INDUCED like parental smoking
❑ Foreign body
❑ Sinusitis
❑ Habit cough/Tics
Full cough history
Does it wake him up from sleep?
Anything makes it better or worse(like change of season, dust, pollen or smoke)?
Is it dry or productive?ccvo
How is the child in between the episodes? [psychogenic,pertussis normal in betwn the episodes]
How is it affecting his life? Does the breathing stop for a while?
❑ Associated Features:Along with the cough does the child has any
[ Fever ,Chest pain][Shortness of breath /fast/noisy breathing/ drooling of saliva? Any unusual chest movements? Does his
chest suck under his ribs? ]
❑ D/D:
❑ Post viral cough: any recent flu like illness?
❑ Asthma: (Cough+Chest tightness+SOB+Musical sound from the chest) any hx of allergy/eczema? Any
FHX of Asthma,allergy,eczema or hay fever?
❑ Pertussis : Does the child turn blue during cough?/ is the cough followed by whoop or vomiting? [makes a noise
afterward, and her face becomes red afterwards?)
❑ Psychogenic: Does the cough occur at any particular time or situation?
❑ Allergic rhinitis: any runny nose,sneezing,watery eyes
❑ CF: Does he get recurrent infection/flu like illness? Any diarrhea? Any FHx of lung disease? Failure to thrive?
❑ CHD: Any difficulty in feeding/playing? [is he gaining weight? Failure to thrive? Recurrent/repeated chest infections?]
❑ GERD: any bitter fluid in the mouth?/does the cough come after feeding?
❑ HABIT COUGH/TICS: Repetitive throat clearing?
❑ FB :Any choking episodes?/Any time that the child is unsupervised?
Well baby ques:
❑ Is he Active /irritable /drowsy?
❑ Is he feeding and sleeping well?
❑ Any change in the pee or poo? Any change in no. of wet nappies?>for child not infant
❑ Any change in the weight?
BINDS:
Birth History:Baby has any problem after birth
Immunization History: How about his immunization or vaccination? Contact with covid pt or other
Nutrition:
Developmental history: How is his growth and development?
Allergy hx:
Contact hx: Any one in the family having similar cough?
Does the child go to childcare?
Any recent contact with covid + patient?
Visited to covid hot spot?
Physical examination from examiner
1-General appearance
2-Vital signs especially RR + O2 saturation (temperature 39)
3-Growth chart
4-ENT
5-chest examination
inspection: deformity, chest movement
palpation: chest expansion, tracheal position
percussion: dullness. (dullness in the bottom of rt lung)
Auscultation: air entry, breathing sounds, no wheeze or crackles ( bronchial breathing.)
6-CVS, abdomen

Explain X-ray
-this is the chest x-ray of your child.
-lung field looks clear, heart border size looks normal.
-when comparing both lungs there is white shadowing on the bottom of the right lung field,
-the X-ray findings showing what we call a Para pneumonic effusion which is accumulation of fluid between two membranes
surrounding the lung in this case the right lung that occurs secondary to pneumonia or infection of the lung usually by a bug; a
bacterial one as he has high fever.
- Croup
- Epiglottitis
- Upper RTI
- Bronchiolitis/Asthma
- Pneumonia
- FB
Station 15 Pass

a pregnant lady comes in 35 weeks of gestation complaining of an itch ( did not mention where ) .
• take history 6 min
• give diagnosis,DDx
• Which part ? Duration? Is it the first time? Any rash? Discharge ? open sores ? painful?
hot to touch? Any anywhere else on your body?vesicle
• Changed any cream or medication?
• Any contact history? Any fever?
• Any changes in urine and bowels? Any nausea and vomiting?
• Pregnancy and antenatal care history
• Any history of allergy, eczema, asthma in you or your family?
• Dx - pruritic urticarial papules and plaques of pregnancy rash which is a common skin
condition. (also called polymorphic eruption of pregnancy)
• This type of rash usually starts in stretch marks on the abdomen and spreads to the legs and chest.

Station 16 Pass
A university student referred by supervisor for loud and disruptive behavior in the class, argumentative,
• History for 6 mins
• the diagnosis and the differential
Positive points
University counselor referred here because patient is having aggresiveness disruptive behavior. history I found she said other
person's jealous of her and her abilities more than others. And it is for one month she's energetic, sleeping less and she has spent
10,000 money and take alcohol and risky behavior. She's not practicing safe sex, multiple sexual partner
• how long have you been feeling this for?" all these for one month,
• comes and goes or stays all the time (stays all the time)
• anything happened one month ago?
• are there any days she feels down (no)
• has his excited state even happened before in her life (No)
• Mood>Have you been feeling especially good in yourself?
• SSSS > special power, Shopping,Sleep, Sex
✓ Do you think you have special power?
✓ do you think you are spending more money than usual?"
✓ Do you think you need less sleep?/ "do you sleep less than usual?"
✓ Sexual activity:
o Do you mind if I ask you something about your sexual life?"
o Are you sexually active, are you in a stable relationship, How long have you been in this relationship?
Do u practice safe sex? (for STI, trace contacts for 6 months) Apart from this, do you have any other
casual or sexual partners? how many partners do you have at the moment?

• Depression
Is there any depressed episode in the past?

• Psychosocial History: [ mood,sleep,appetite,Suicide] Ask a complete history of Delusions and Hallucinations

,Insight,Judgement,cognition
• HEADSSS : Stress
• SADMA: recently going to a lot of parties, having more alcohol than usual, I asked about recent binge drinking
• PMH
• FH : history of depression in her grand mom
I just told after her every answer I can understand,
Most likely –
Acute mania
Differential Diagnosis
1. Acute relapse of schizophrenia
2. Manic episode of bipolar disorder[where there is alternatively high and low moods]
3. Acute psychosis
4. Drug-induced psychosis or drug-withdrawal stage[as she was going to a lot of parties]
‐ Schizoaffective Disorder
- Hypomania
‐ Anxiety disorder
‐ Hyperthyroidism / thyroid hormone disorders
- Medications, e.g. steroids, isoniazid, L-Dopa, sympathomimetic amines
I can see that you are a bit disturbed and are having more energy than usual, I suppose you might have some chemical
imbalance in your brain or a condition called Mania. I explained mania as a mood disorder.
in mania a patient exhibit excessively elevated mood, physical and mental over-activity, and self-important ideas, increased
energy and sleeping less
Station 17 Fail
A 25 years old lady came to you who had a history of seizure four months back, and she was diagnosed as epilepsy. After that
she startedon anti-epileptic medicine Carbamazepine and doing well with that. Due to the epileptic attack her driving licence
has been suspended. She wants to talk to you as she wants her driving license back.

Tasks:

1. Take History for 4 minute

2. Counsel patient accordingly.

Failed in Mx,Reason for failing in Mx I think
Was very slow, as the station was after lunch,feeling drowsy,didn’t get time to talk about regular follow up by doing blood test
CBC ,S,electrolyte,LFT,Regular eye check up, Family meeting,avoiding danger area
Station 18 Break
Station 19 Pass
You are a HMO at a hospital. You are going to see Neel, 55 years old
patient, diagnosed with diverticulitis, now it was infected and resulted
in diverticular abscess. He is currently on antibiotics and IV and under
watchful waiting. If not improved in 2-3 days, surgery will be carried
out. He is a case of AF but it is controlled and he is on Apixaban (NOAC)
and Atenolol and Atorvastatin.
1. Take History
2. Ask concerns
3. Address his concerns
History
Asked detail history of medicine and according to CHASVAS and HASBLED
The pain is concerned about stroke her mother died of a stroke and also concerned about colostomy
■ If I stop the medications, I can have a stroke, If continue it, I can bleed to
death?
We have to outweigh the benefits and the risks, and in this situation, it seems you are at a low risk to develop a clot, but at higher
risk to have a bleeding complication if you continue to take the medication.
■ Will I have a colostomy?
A colostomy is usually not done for this type of surgery. If needed to
be done, it would only be temporary.
Station 20 Fail
Cristina 15 yrs old already diagnosed with cystic fibrosis . Mom is concerned about poor school performance of her daughter
Cristina. Cristina was diagnosed with cystic fibrosis when she was 5 years of age, and she is under treatment now. You have 2
charts showing progressive decline in growth chart, as well as her FEV1 as per her age over the last 5 years.
• Take history from the mother for five minutes after that the graph will appear that was showing weight decline and
decline in lung function tests .
• Explain the results
 • Tell the cause why are cystic fibrosis is not controlled and there is school performance declined

Positive points
in the history mother said she has divorced two years back and child's mood is very low she the stress and also your school
performance is poor here and she is not taking medicine properly. she takes care of the medicine by herself, mother dont take
care of her medicine

History
o For how long have you noticed that she is having poor school performance?
o Any recent change in the environment at home or at school?
o Any recent change in her behavior?
o How about her vision and hearing?
o Do you think that she is facing school bullying?
o Is she hyperactive or unable to finish the given task?
o Does she ever complain of any headache, vomiting?
o Does she suffer from frequent infections?
o How is her health, otherwise?
o I understand that she was diagnosed with cystic fibrosis, when was the last time that she
visited the specialist?
o Is she taking the medications as it was prescribed?
o How is the home situation?
o Are you a happy family? How about her relationship with the other family members and her friends?
o BINDSMAR: immunization, weight loss, growth
I have checked her growth chart which shows that she has poor weight gain. Also, her lung function shows progressive decline of
FEV1. FEV1 is the amount of air that can be exhaled forcefully in the 1st 1 second. It is the predictor of lung function, and it also
dictates the progress and outcome and cystic fibrosis
Diagnosis
Most likely Cristina's poor school performance is due to the recent stress in her life. but I am more concerned about her weight
loss and abnormal lung function.
. It is decreasing which may be due to poor compliance to the treatment
Reason of failing I think
I didn’t explain the investigation thoroughly,I was very quick
In dx I said non-compliance to the treatment and [Link] b they wanted to hear depression.

27th July online

August
3 August 2022 f2f
1. 8 day old with vomiting, NGT inserted (xray shown), task: 3 min hx from nurse, explain xray findings to nurse, diagnosis and
immediate management
Marwan 35
2. 52 yo male complaining of pain in urination and hypogastric pain, no STI, stable partner, hx, dx and ddx
Marwan 228

3. PE hearing loss
Marwan 159
4. PE pregnant 32 weeks
Notes anit / marwan 207
5. PE Male LIF pain and diarrhoea, dx and ddx

6. 27yo lady with SLE wanting to be pregnant hx and consult (Alan file)

7. Lady with post coital spotting, no CST. hx, pefe, dx and ddx ( Alan case 31}

8. Male with schizophrenia positive symptoms, Hx, MSE and dx ( page 440 Alan)

9. Male with 2 month hx of fear of meeting people due to contamination, hx, dx DDx Alan 458

10. Male with chest pain, ecg ST elevation. Hx, pefe, ecg finding to examiner, dx and DDx --- Marwan 124

11. Male with lower back pain, hx, PEFE positive SLR, dx DDx Marwan 114

12. 12 yo chronic cough with full investigations done to r/o whooping cough, CF, allergy, mother seeing you for dx (psychogenic
cough) 77

13. 72 yo with repair of L NOF, fever, drowsy at ward, delirium with fever. pefe from examiner for 6 minutes, explain dx and ddx
to daughter --handbook case 149
[Link]

14. 17 yo with low mood and some hallucinations (seeing dead mother sometimes), seeing counsellor, counsellor referred for
?starting antidepressants vs antipsychotics, hx, dx ddx and mgt

15. Woman with newly dx epilepsy 4 months prior on carbamazepine asking for review to get drivers license back, hx, counselling
Idiopathic epilepsy in alan pg 669

17. 2 yo burn from hot bowl of noodle, left with dad, mum at work, no sx of NAI.
Tasks: Hx, pefe card 12% tbsa, superficial burns with blisters to the chest, no airway involvement, immediate management to dad
Alan file burns cluster

4th August 2022 f2f

1. GP setting, 9-month-old baby with failure to thrive. They provided the growth chart until the last appointment and the current
weight.
a. Plot the growth chart of the appointment
b. Take history from father (ask for PEFE card)
c. Most likely diagnosis and differentials with reasons to the patient

2. Postmenopausal woman with vaginal bleeding (two days, bright red, small amount, painless). Very complete stem (widow, not
sexually active, no history of HRT, non-smoker, normal cervical screening 2 years ago normal). Actress in room +
mannequin
a. Perform physical examination
b. Explain most likely diagnosis and differentials with reasons to the patient
3. RMO at paediatric ward. 3-year-old child admitted with upper respiratory tract infection with snoring and noisy breathing.
Overnight SatO2 and X-ray on stem.
a. Take history
b. Ask PEFE
c. Explain investigation (x-ray) to parents
d. Give most likely diagnosis to the patient
Marwan 220

4. ED setting. Father brings his 10-year-old son with pain in scrotum for 2 hours.
a. Take history
b. Ask PEFE card
c. Explain most likely diagnosis and differentials with reasons to the patient
d. Explain investigations that may be required to the patient Marwan 117

5. 62-year-old farmer that you have biopsied a temporal lesion. Explain the biopsy report (SCC in situ with deep margins of 0.8,
lateral margins of 0.5)
a. Explain biopsy report to the patient
b. Explain management to the patient

6. GP setting, 2-year-old playful child who is refusing to use his left arm for the past 4 hours
a. Take history from the parent
b. Ask PEFE
c. Explain diagnosis and demonstrate to the parent how you would manage

7. 27-year-old men comes with blurry vision in his left eye for the past few months. No DM, no HTN, no headaches, no pain in his
eye.
a. Assess visual acuity and report
b. Do physical examination
c. Explain most likely diagnosis and differentials with reasons to the patient

8. You did the appointment and the health check-up with a patient. When she is about to leave, she asks you a repeat
Temazepam prescription. Stem reported that she always asked for prescription in consultations for other complaints.
a. Take psychosocial history regarding insomnia
b. Explain to the patient the most likely cause for her insomnia

9. College student referred by his course coordinator because of poor performance. Very complete STEM (patient didn’t have
many friends, no relationship, parents were not very present)
a. Take psychosocial history
b. Explain to the patient most likely diagnosis with reasons
c. Answer patient’s questions

10. 42-year-old man with no known medical comorbidities came to you because of a two day history of swelling of the ankles and
nocturia. On physical examination he’s hypertensive. Past medical history – no DM, no HTN, no asthma, no use of
medication, no family history of coagulation disorder. No patient in the room.
a. Do urine dipstick
b. Report findings
c. Discuss possible diagnosis and differentials with reasons to the examiner

11. 27-year-old woman with amenorrhea for 9 weeks. Positive home pregnancy test from 2 days ago. Five Ps on the stem. Very
large and detailed stem (irregular periods varying from 3 to 6 weeks, social drinker, healthy diet, BMI 23, non-smoker,
planned pregnancy).
a. Explain investigations you want for the patient
b. Describe preventive measures to the patient during her pregnancy

Polycystic ovary syndrome and pregnancy

Hyperandrogenism and insulin resistance form the metabolic hallmark of PCOS women. A significant section of lean PCOS women
have baseline intrinsic insulin resistance. Those with superimposed obesity have additional insulin resistance contributed
 by the excess adipose tissue. The baseline insulin resistance seems to be exacerbated with entry into pregnancy. There is
an increased risk of pregnancy complications in PCOS women. In a population-based cohort study, women with PCOS were
more often obese and more commonly used assisted reproductive technology than women without such a diagnosis.[9]
PCOS was strongly associated with preeclampsia and very preterm birth and the risk of gestational diabetes was more
than doubled. Infants born to mothers with PCOS were more prone to be large for gestational age and were at increased
risk of meconium aspiration and having a low Apgar score (<7) at five minutes.[9] These increased risk of pregnancy
complications was also confirmed by two meta-analyses which were conducted to evaluate the risk of pregnancy and
neonatal complications in women with PCOS.[10,11] They are at increased risk of EPL, GDM, hypertensive disorders of
pregnancy (HDP), and premature delivery.

12. ED setting. 27-year-old man came because of a funny turn. Brought by his mom.
a. Take history for 6 minutes
b. Ask for PEFE card
c. Explain to the patient your most likely diagnosis

13. ED setting. 52 years-old woman comes with 2 days history of left iliac fossa pain and one episode of diarrhea. STEM stated
“Do not take history”
a. Do physical examination
b. Run commentaries to the examiner
c. Explain diagnosis and differentials with reasons to the patient

14. Middle-aged man with palpitations, nervousness, unintentional weight-loss, weather intolerance
a. Do relevant physical examination
b. Run commentaries to the examiner
c. Explain most likely diagnosis and differentials with reasons to the patient

15. Middle-aged woman with urinary incontinence. Patient came 4 months ago with urge incontinency with a colleague. Urine
culture and glucose were normal, only observed.
a. Take history
b. Ask PEFE
c. Give your most likely diagnosis and differentials with reasons to the patient

16. Previously healthy young woman using OCP (Microgynon 30) with hypertension in the last appointment. You ordered control
at the clinic and at home and it was consistent with hypertension. STEM very long (healthy diet, physical activity, normal
BMI)
a. Take history (long)
b. Explain most likely diagnosis and differentials with reasons to the patient
c. Initial management

09th August 2022

BY GULNA SHEHRYAR

Hello, I passed my exam on 09th August 2022, Alhamdulillah. All thanks to Allah and my study partners. I did around 12 months of
prep for AMC Clinical and took 8 weeks course from ARIMGSAS. I think that was the best decision of my life to start my
prep by taking that course. I also took a few sessions with Dr Amir apart from his classes at ARIMGSAS, they are best for
clinical and highly recommended. All thanks to my study partners, you guys are the best.

My main aim in this exam wasn’t to pass this exam, but to pass it with good marks, I mainly focussed on patient care and I
provided support to all my patients, I was very empathic throughout my exam and I appreciated all my patients for
coming. In My PE stations, I kept on asking the med student if he is understanding so far or not.
Station7: Fail

A patient comes to you with a history of falls.

Take HX
Dx DDX
The patient had a history of high BP, taking ARB plus diuretic, and temazepam. Had hx of depression. The patient had a history of
numbness and tingling.
PEFE all was normal
Please refer to the passed feedback.

Station 8: Passed 5,5,5,5

A patient comes with eye swelling.
Explain swelling to Med student
Do PE.

WIPE,

General Appearance
I started by telling that I see a swelling in the right eye of a patient, size looks approximately 5*5cm, looks oval in shape, the
colour of the skin is red, I ll like to do palpation after wearing gloves, check temperature tenderness, surface if regular or
not, consistency, ill like to do fixation fluctuation mobility and transillumination too but I didn’t explain anything how to do
as it's not relevant.

Then I started telling DDS, Orbital and periorbital cellulitis, Trauma, insect bite, Allergy, Anaphylaxis, Heart liver kidney failures,
nephrotic syndrome and use of steroids.

Started exam. Inspection of head neck looking for scar swelling redness rash bmd, bruises or sign of trauma. Palpation of the
whole face including sinus tenderness, ear n otoscopy, to rule out otitis media neck n neck stiffness to rule out meningitis
and cervical lymph nodes, Quickly started with 2,3,4,6 nerve exams. I was able to finish it within 8 mins.

Station 8: Pass 5,5,5

An old case of bulimia. I started by confidentiality and asked about any pain right now or any complaints he is having. Asked
about diet, he said he tries to stick to a healthy diet plan but sometimes he has cravings and he eats a lot, asked what he
does after that, he said he induces vomiting. No water pills but uses laxatives on and off, also exercise 7 days a week an
hour. What do u think about ur appearance and have u been told u are big? hx of childhood obesity? Also asked about
home situation n any stressors. The mood was low, Anhedonia negative, no suicide homicides, lack of energy and
concentration positive, all others were fine, asked whole psychosocial and HEADSS. No chest pain, no funny racing of
heart, no thyroid problems or fever rash.

Dx; Bullemia with Mild depression

DDX: Anorexia, BMD ,Obsessive Compulsive and Related Disorder, Eating disorders, Adjustment, Schizoaffective, Bipolar, Thyroid
disorders.

Station 9: Passed 4,4,4,4

The young Patient comes with an insulin script and was diagnosed with type 1 DM a few
months ago.
Take History
Management

History was 3 mins, so I quickly started by asking DM-related q, when were u diagnosed with dm? symptoms at that time and
now? What meds are u taking? Compliance? Side effects? How do u take it, pen or needles. He said pen, changing it
regularly, yes, taking 4 times a day. Having any problems with that? No. The site where he takes it? Hypo or DKA episodes?
hospitalizations? Blood sugar diary and can I have a look, patient said he forgot it at home, how many times u check it? He
 said 3. Asked about stressors at work and home n financial problems if any?. Informed VIC roads about your condition,
and he said yes. Any follwup? no

Time up

Management: Appreciated him first of all, appreciated how he is doing this all and regularly checking his sugar levels, need to do
it 4 times a day before meals and before exercise and also driving. Bring a Sugar diary next time as well and ill do BSL,
HbA1c and tell him ideal sugar levels pre and post-prandial. Since u are taking one long acting and 3 short-acting so make
sure your meals are ready when u take the insulin as it causes drop in sugar levels quickly. Told him he needs to rotate by
thigh and abdomen to decrease irritation n pain. Told him about Hypoglycemia and hypoglycemic action plan, told him
about DKA and why we need 3 monthly HBA1c and what should he do in case he feels hypoglycemic during driving.

Referrals: eye, dental, podiatrist, kidney, heart specialist. Ill make u a member of NDSS as well(the national diabetic service
scheme)

Station 10: Passed 5,5

patient presents with neck swelling.

Do PE to med student
Instruments used

WIPE,

GA: I elaborated It a bit, Dressed acc to weather, heat intolerance in hyper and cold in hypo, greet the patient to check for
hoarseness in case of hypo, anxious or depressed in case of hyper and hypothyroidism. Told DDS: Simple thyroid nodule,
multinodular goitre, Hashimoto, grave, thy cancer, thyroglossal cyst, trauma, cystic hygroma, brachial cyst, cervical rib,
post-viral post bac lymphadenopathy and lymphadenitis, lymphoma, dental abscess.

Head to toe starting with hands, Thyroid arthropathy, clubbing, sweating erythema pallor, tremors, looked for hypo peripheral
cyanosis, swelling, thick coarse dry hands, checked pulses rate rhythm volume for AF and H failure. Reflexes bicep triceps
for brisk and delayed relaxation phase for hyper hypo. Proximal myopathy by doing chicken wings and asking the patient
to get up from the chair.

Hair thin and loss of lateral eyebrow in hypo, EYE: exophthalmos, lig lag, lid retraction, Eye movements, Mouth for central
cyanosis, tongue swelling. neck swelling did inspection: scar swelling redness rash, asked to take a sip of water and stick
out tongue to diff btw goitre and thyroglossal cyst. Palpation from behind, site size shape surface, the colour of overlying
skin, consistency smooth in simple nodule-stony hard in cancer, rubbery in Hashimoto, tenderness temp, fluctuation,
fixation, mobility, transillumination positive in cysts. Again asked the patient to take a sip and stick out his tongue to see if
it's moved or not. Checked for the tracheal position which could be deviated in case of retrosternal extension of the
thyroid. Percussion if swelling present, auscultation to check thy bruit. Checked for pretibial myxedema and also did
Pemberton sign. Concluded with upper lower limb neurological and time up.

Told instruments as well somewhere during the examination.

Station 11: Passed 4,5,5,4

A child presents to ED after having a seizure, brought by ambulance, teacher notes are

given. Talk to mother

HX
Dx Management

It was a case of unprovoked seizure, Mother was very anxious, calmed her down by offering her water, and reassured that child
is stable and had been taken care of. HX; 1st episode, dehydration, fever rash uti constipation diarrhea, head trauma,
missed meal, fam hx.. during and after the episode was written by school teacher and mother didn’t know anything, it
was all like upward rolling eyes etc after seizure child was having dizziness for a while and then was able to walk n no weakness,
no behaviour problems, stressor at home and school. BINDS, Well baby q. past med surgical al normal
Gave diag an Unprovoked seizure, defined it and said we need to keep you hospital for a while and a specialist will see you, to
rule out other conditions we need to run a few tests.. baselines, CXR, Urine culture, Ct scan. After discharge referred to
the first seizure clinic where he ll seen by a specialist, he might need to run a few tests but it depends on the specialist
what tests he needs to do. Didn’t mention EEG at all.

Station 15: Passed 4,5,5,5

A woman presents with tiredness. Blood tests done shows Hypoch microcytic anemia

features
Explain Inv
Hx
Tell d and ddx

Started by asking the patient how are u feeling, any sob, or funny racing . then told all inv

and explained what it means

Hx:
IDA: diet
Meds: taking NSAIDS(Ibuprofen) for back pain for 2/3 months, no tummy pain and no
change in stool colour, asked all hx of meds since mwhen, how much, compliance, increased
decreased dose, side effects.
Celiac
Cancer
Pregnancy, Periods
Thalassemia, Anemia of Chronic diseases,
Past medical: hx of hemorrhoids but not bleeding and doing lifestyle modifications

Diag: IDA due to iBuprofen, could be due to diet celiac cancer periods preg ,bleeding hemorrhoids etc but unlikely, dd
thalassemia, chronic diseases, hereditary shero, g6pd, sideroblastic, aplastic, megaloblastic but unlikely

Station 16: 4 4 5
A 22 patient comes with an OCP request.

Hx 6 mins
Counselling 2 mins

Hx: appreciated patient that she came for consultation. Asked about 5 P. Period, and intermenstrual bleed, preg plus nausea
vomiting breast tenderness, contraception: partner was using condoms but she wasn’t happy as she heard that condom
can rupture, Gardisil took as she was 22 years of age, asked about all contraindications, only positive was the patient was
smoking on off, I offered her counselling by her consent.

Past med: epilepsy and was taking topiramate, asked all q, when were u dig, what meds, compliance, missed doses, side effects,
followups

Counselling:

A good candidate for OCP, will do UPT first and start u on OCP, Ocp has two hormones, ill start you on high -dose estrogen. Will
refer u to a specialist for a review of epilepsy meds too. 28 pack and u can start from the first day of your period or even
now but in that case need to use condoms for one week as well. Side effects: told all but imp was breakthrough bleed,
disadvantages were doesn't protect against STI so need to use condoms. Start cervical screening at 25 and it's done 5
yearly. Time up
Station 17: Failed
A patient presents with leg ulcer hand having a hx of schizophrenia.
HX
MSE
Please refer to passed feedback

Station 20: Passed 5 5 5

A patient presents with a sob , has a history of smoking for 20 years.

Tell Exam steps tp patient in 2mins

Tell exam steps to the examiner in 4 mins
PEFE card, Tell Dx and DDX

Followed Dr Amir approach for this, highly recommended!

I started with greeting the patient, WIPE, and told him ill be examining you from head to toe starting with hands and looking for
some changes, eyes, ENT and time up and I got so so so much confused that ivent even mentioned a word about lung
exam. I started with the examiner and I was so fast that I finished before time. WIPE, GA and looking for signs of resp
distress, posture, and shifting to resus cubicle and monitoring vitals and if sat drops so ill start on o2.

Hands: clubbing wasting perip cyanosis, pulses, BP, Prox myopathy, Eyes : look for a sign of horners synd, fundoscopy for hypoxic
changes, nose and tip pf tongue for central cyanosis, ENT including otoscopy, cervical lymph nodes, Neck : JVP

. Chest: Inspection: scar swelling redness rash BMD, pectus excavatum carinatum, sub cut emphysema, Barrel chest.

Palpation :
Expansion, tracheal position(conditions in which its deviated away and towards affected side) n tug, Cricostrenal distance,
Hoover sign

Percussion: Front or back at supra infra interscapular, bases and axilla and front supra infra clavicular base axilla looking for note
told normal and hyper resonant and dull note DDS, Auscultation: same percussion areas with diaph of stethoscope normal
is vesicular, look for wheeze, crepts, absent DDS

Vocal resonance: auscultate at same sites, asking pt to say 99 in same tone and volume, increased and decreased DDS.

Conclude by CVS and hearing for heart sounds at mitral tricuspid pul aortic, sacral edema, leg edema and also an abdominal exam
to especially looking for the liver which can be pushed down due to hyperinflated lungs.

PEFE: COPD signs

Dx: COPD and explained

DDX: Cancer, Pancoast, ILD, Mesothelioma, Pneumonia, pl effusion, pul embolism. Post op atelectasis, anemia, angina, mi, tb

Station 1: Passed 5,5

Father came with a child with a rash.

Hx
Diag DDX

Hx: empathy, asked about rash site size colour itch painful bleeding discharge, asked about fever and it was negative, the child
had a rash around mouth and it was a bit itchy and red but not painful, he was having bfast before that and he was eating
fruits, I asked anyone else on the dining table with him, he said yes his brother and when I was asking what he was eating,
 peanut butter, so child shared his brother's peanut butter sandwich. Past his of mild eczema relieved by moisturiser,
family hx positive of asthma hayfever. BINDS, Well baby. Asked about all anaphylaxis details and all negative except this
rash on face.

Dx: Urticaria

DDX. Anaphylaxis, eczema, allergic contact seborrheic dermatitis, meningococcemia, Kawasaki, Scarlett chicken pox, erythema
infectiosum, and roseola infantum but all unlikely.

Station 2 : Passed 5,4,4

Young male present with Urinary problems.

Hx
Diag
DD

Hx:

Confidentiality, asked about ODPARA1,

Asked about UTI: burning stinging positive, fever no, colour of pee, pain in the tummy, BPH and prostate cancer: negative, DM
negative, Trauma negative, Stone negative. Sexual: Multiple sexual partners, discharge from the penis, no sore throat, no
constipation diarrhea or back passage discharge, no fever flu-like Symp, no blurring vision., yellowish disc skin pee poo,
Past med surgical, SADMA.

Diag: Urethritis or lower UTI due to STI most likely due to Chlamydia but need to run tests to find the cause.

DD: pyelonephritis, BPH, DM, Prostrate cancer, stone, trauma, HIV, Hepatitis ABC, syphilis, gonorrhea, chlamydia

Station 4: Spine 5,5,6

Patient presents with back pain.

Hx
Dx DDx
Followed Dr Amir approach for all msk, really realllllly helpful

Hx: SIQORA1, redness rash stiffness swelling, fever.

Patient lifted some heavy weight last night, was in severe pain, couldn’t lie down coz of pain, no numbness tingling, had severe
pain over RT buttock, asked about osteomyelitis, sep arthritis, ankylosing spondylosis, cauda equina, OA RA PA, Cancer,
occupation, past med surgical, SADMA

PEFE: SLR positive 45 degrees

Neurological exam all normal

Diag: Mechanical back pain, dd: lumber radiculo, L5 S1 radiculo, osteo, sep arth , cauda equina, and etc all mentioned in hx

Station 6: Passed Obstetric Counsellinng 4 4 5

ELCS request
Hx
Counselling

The patient was in the early stage of preg, asked why she wants ELCS, she said her friend had CSEC and she told her that CSEC is
pain free so her main concern was pain, asked about the current stage of preg and antenatal visits, asked about 5 Ps, past
med, past Surg, sadma
Counselling: Told her what CSEC is, types of csec, elective and emergency indications, complications on patient and baby and
long-term complications, Told her about NVD, Positive points and also pain relief pharmacological and non-
pharmacological. Told her decision is urs, we cant force you to do anything. When u are going to ur specialist, you can
have a discussion with her too, not covered by Medicare, 3R and time up.
PILOT:
-Son comes to know details about ECT as his mom was being referred for the procedure.
- Young Patient comes with Lump pain around anus. Most likely diag was Perianal Cyst

10th August, 2022 - online

1. For flu vaccination. Noted to have elevated BP. Counsel
2. Anemia in pregnancy (possible thalassemia)
3. PVD utz, explain and then management
4. Mania. Perform psychosocial history. Diagnosis and differential
5. Perfom CST and bimanual exam. Explain materials
6. Rpoc (snapped cord). Management
7. Rotator cuff tear UTZ. Interpret then history for 5mins
8. PE: Pulmonary edema due to decompensated heart failure
9. PE: UL and LL motor n
10. PE: facial trauma
11. Syncope after a 100m run
12. Diagnosed case of cystic fibrosis now complaining of vomiting. Has history of surgery due to delayed passage of meconium.
13. CT scan finding with cholelith, diverticulosis and single mass on liver. Explain
14. PE: EBV
15. Smoking cessation counselling
16. Heroin cessation counselling

16th August 2022 F2F Passed feedback

#Med St 01: Tremor (Pilot)

middle-aged female coming to the Gp with the Tremor, which was recently noted, concerned about Parkinson dx. She has dx
with some mental illness with psychotic features and started risperidone and Mirtazapine. Big stem. Mentioned in the
stem MSE is normal. PE finding was given in the stem which are resting tremor. Cock wheel rigidity. Finger nose test,
writing, when extending the arm normal, some other PE also given
Task: Hx for 3 mins, explain the PE to Pt, Dx and DDX. Not sure whether there was mx or not (I think no mx)
Hx- how long, how frequent, first time, when did you noticed first time, asked specifically is it after taking the medication? Have
you increased the dose of meds, any over counter meds, how’s affecting ur life, family hx of tremor, SADMA, didn’t ask
anything regarding psychosocial hx as in the stem mentioned which is normal. Hx of stroke, trauma.
Then explained all PE finding in lay man terms one by one which has mentioned in the stem. On and off check her understanding.
Then gave Parkinsonism due to the current medication which is well known SE and justify the dx and gave some ddx (Parkinson
dx, BET, other medication induced, cerebella diseases) and justify why they’re unlikely in ur condition.
Had a lot of time after it, so I didn’t leave the room and checked her understanding and gave some reading materials and told
that I’ll refer her back to for medication review.

#Med St 02: Dysuria

middle-aged man with C/O of burning sensation while passing urine. Big stem. Stable partner. No tummy pains. DRE was normal.
UDT- Nirates +, Leucocytes +, Glucose Not sure what was, Protein +, RBC +. He is allergy to penicillin allergic
Task: DX, Interpret the investigation and MX
Mentioned in the stem no need further hx.
This was my last stion. Case is smiler to HB case 95
After introduction said I’m here to help you, told that I am sorry u re felling thins way. And talk about all the possibilities of the
burning sensation (stones, STI, Pyelonephritis, trauma, BPH) and justify why they re unlikely. Then told DX as UTI why I’m
thinking so at the same time explain the urine dipstick finding along with it. Then specifically said lower UTI which can be
cystitis, urethritis. And justify why not upper UTI. As he doesn’t have fever, no loin pains.
Then UTI is less common in male compared to female and explain why. Therefore, we need to find the course is there any
problems in the urinary system also draw picture as well.
Talk that now I’m gonna Tx with AB mentioned cefalexin and send the MSU for culture and sensitivity. Then adjust the AB
according to result. Then repeat the UFR after the course of AB around 10 days.
Then told I’ll refer to urologist to for further evaluation, told PSA, USS KUB, CT KUB, Pre and PVR Cystoscopy explained a bit as
had more time.
Told to drink plenty of water and gave red flags with reading materials. Had plenty of time so checked the understanding of pt, is
he happy with the plan.

#Med St 04: Post operative complication

Post operative cholecystectomy Day 1, Given post op chart, (there was no complaint from the pt) which is actually very hard to
read as not good quality of picture. Anyhow manages to find out that he is having fever which is around 38.3. Patient on
enoxaparin and big stem. Like this chart but the different is green in background and different values.

Task: Take Hx for 3 mins, Pefe, Dx and DDx

This was my first station.
After reading the stem outside, try to get into the chart, which is not good in clear pic, and got panic, so while looking at the chart
again and again try to figure it out what is the hint at the chart as patient C/O was not mentioned in the stem. So, I was
recalling all the post op C/O (Fever, fluid overload, dvt ect,) in my subconscious level. At last, I figure it out temp is high,
but I am not sure about the fluid whether is overload or not.
When I entered the room, pt was lying in the bed with hospital gown, at the time he didn’t act SOB. After formal introduction and
stated taking hx
Asked about pain, any discharge, elaborate the fever, bowel abd bladder habitis, SOB, chest pain. Is is the first sx have u had,
pretty much smiler to post of fever pattern hx.
Then asked the Ex PEFE one by one what whatever you asked only ex gave me. When I ask the vital, he mention in the chart, so I
checked again the chart inside the room not clear.
Dehydration, pale, then moved to Rep Ins, pal, per, auscultation, positive was Rt/S crackles), CVS, Abdomen, is there any drains,
catheter in situ? I was not organised here as I jumped from one to another.
Then I started explaining by drawing pic and Ex came near to me and check my drawing, I am pretty sure there was no mx plan
but they have scored the Mx plan as well, because I have finished before the time, while explain the condition to the Pt,
he started to act SOB on and off, I didn’t pay attention at the time as my aim was to explain the condition to the patient (
may be this caused to failed the station), after explained still had time, so then I checked my task there is no mx plan,
though I just talk that, as my pt having SOB right now on and off I mentioned I’ll give oxygen and get opinion on specialist.
That’s why I score 3 not 1 or 2 in MX.
I should have probably said after seen by specialist they might do CTPA, and chest physiotherapy and PCM for the fever, may be
this another reason they have failed me the case, anyhow check with the passed feedback as I am recalling after 3/52
from the exam date.
Explain the probable diagnosis and ddx as Gave atelectasis and plural effusion Pneumonia. I was confident that I will pass this
case, but I couldn’t.

#Paed St 05: Lethargy

baby is sleepy for last 12 hours. Age of the baby around 6 days?? Doesn’t remember exactly. Mother is worried about the baby. I
think it an GP setting.
Task: Hx for 3 mis and pefe and probable dx
In Hx, second baby, normal delivery, after the delivery the baby was fine up to previous day. Brother had a cold,
On PEFE big list, Dehydration was there, but temperature was normal, not sure.
Gave septicaemia with dehydration
When I entered in the room mother was holding baby doll which was swaddled well.
After instruction and I stared taking hx
In Hx, second planned baby, normal delivery, no complication during pregnancy and followed antennal clinic. after the delivery
the baby was fine up to previous day. Brother had a cold, 2 to 3 days before now he’s fine. Other family members re fine,
happy family, she is having good support from partner and happy family, her moods are fine too.
I asked specifically duration and how frequent and how’s the child between, asked about the feeding, whether exclusive feeding
or not how frequent feeding. Asked about the well-baby question, reduced wet nappies was positive, poo was ok.
I forget to ask any skin colour changes, after finishing my exam I asked other candidates they mentioned that there was jaundice.
May be that’s way got 3 in Hx??
On PEFE you must ask one by one. moderate to severe Dehydration was there, but temperature was normal, not sure as a lot of
things going on my mind subconscious level and my second station too. I asked head to toe PEFE and urine dip stick (like
sepsis approach)
Gave septicaemia with dehydration, while giving the dx I was in doubt as no temperature though without any second though
gave it. Told that need to do some investigation to find out the reason why she’s sleepy but didn’t mention specifically. I
didn’t mention the degree of dehydration that’s why may be got 4. I didn’t give any DDx for this may be another reason
got 4.
So, I thought I would fail the case. But I managed to pass the case.

#PE St 06: Menopause

47 or 57 not sure yrs old Female with hot flush, big stem 5 kg weight gain. Stem features were suggestive of menopause. GP
clinic.
Task: Explain the condition to patient and then Do relevant examination for 5 mins for support or refuse the diagnosis, Possible
other DDx, and explain the condition to the pt
Didn’t get idea when I enter the room, mentioned in the stem below that do not require to take additional hx. No idea where to
started.
So first I introduce myself, then explained the condition most like as you have a menopause which is a condition that all females
go through this is a natural phenomenon where the female sex hormone reduced in ur blood. Then mentioned there are
other possibilities which can be also possible such as thyroid problem which is a butter fly glad produce hormone to
maintain out body function. (I didn’t specifically say whether hypo or hyper as the stem are contradicted to menopause
and hypo where stems says weight gain) also mentioned some nasty growth (lymphoma or leukemia) where again
contradicted that weight gain. So, at some point I confused what to do for PE
Then I decided to go with head to toe one by one may be OSA also lead to weight gain.
Then mentioned to the role player to find out the condition I would like to examine you. I just mentioned I need proper exposure
(didn’t mentioned exactly) as I didn’t get any hint which system, I am goanna examine.
Then start with head PICKELD, eyes, ear, nose, mouth checked tonsils, examiner giving all normal finding as a mentioned the
name. then mentioned that I am goanna examine thyroid to the patient and looked the examiner as I was expecting that
he will give the finding as he gave me above mentioned. then examiner told to do it, then only I figure out need to do
thyroid.
Then I looked inspection, swallowing, tongue protrusion at the same time giving running commentary. (The funny thing is that
the role player is wearing the sweater. Collar of the sweater is fully coving whole neck) I said to pt I’m sorry I need the
proper exposure, she just put down the neck collar)
On examination I found that enlarged thyroid but not pain full, couldn’t do the rest of the examination as time passed, just
mentioned to Ex I have to do the rest of the system. (Didn’t specifically mentioned anything what I need to do further)
As time ran out, I couldn’t do the reflex, auscultation of the thyroid, pretibial oedema, check the hand. Even I didn’t mention
verbally to the examiner bec whole time was finished to the station. I didn’t tell the pt what is the condition she is having
after the examination. That’s why I have failed this station.
There was no time prompt to this station. I knew that I would fail this case at the time I left the station.
Head to toe then hyper thyroidism exam do PE n then bone tenderness then vaginal dryness n reflexes n clonus

#PE St 07: Shaky hands

45 yrs old female with the hx of tremor for 10 yrs, she didn’t concern much about it, but family member was concerned it, so she
came to GP clinic. Nurse has made a noted that her gait was normal, and vitals are normal which was under the big stem.
Mentioned no need further hx and mx
Task: Do the upper limb Ex and probable dx
middle-aged female coming to the Gp with the Tremor which recently started, concerned about Parkinson dx. She has dx with
some mental illness with psychotic features and started risperidone and Mirtazapine. Big stem. Mentioned in the stem
MSE is normal. PE finding was given in the stem which are resting tremor. Cog wheel rigidity. Finger nose test, writing,
when extending the arm normal, some other PE also given
Task:
Hx for 3 mins,
explain the PE to Pt,
Dx and DDX. Not sure whether there was mx or not
When I enter in the room old lady was wearing the long sleeve blouse. After introducing myself to her and explained the
procedure and started my PE.
When I walked into the room, I notice the instruments for the neurological examination was on bed and examiner was trying to
hide by standing in front of the bed, and the pt was sitting on the chair. So, my mind was preoccupied with upper limb
examination instead of focussing the tremor of the upper limb ex.
Gave running commentary, Inspection, then walking, Examiner said already assessed by the nurse which is mentioned in the
stem. Then did Romberg test. After it I asked the pt to lay down on the bed Ex told do as she was in the chair.
Then come to focus inspection of upper limb, no resting tremor, but she had intentional (action tremor) then checked the tone
and examiner come near to me and checked carefully, checked the power, then reflex as I couldn’t elicit any of the reflex
and got panicked ( In preparation I was able to get the reflex with study mates) there for I have done thrice all the reflex
and wasted my time. Did the coordination. She was very very slow and showing action tremor and mentioned to Ex as
well and got annoyed myself as she was consuming a lot of time, and as I am running out of time. Prompt bell sound heard
and mentioned to the examiner I need to do the sensation and he mentioned all normal.
Then I mentioned that what she has a condition called BET, bec I asked that is it getting better after taking alcohol she said yes.
I thought I will pass this case until I discuss with study mate as she wanna discuss my exam recall as he having exam following
week. After discussion with her only I realized that I am goanna fail this too as I did as upper limb ex, totally forget the
upper limb of tremor examination.
I misinterpreted that as upper limb neurological examination instead of upper limb exam. That’s the reason I failed this case
(choice, organisation, and sequences 2). So, guys please be careful while reading the task.

#PE St 09: Assessment of change in behaviour

22yrs old male was having abnormal behaviour BIB someone. He was diagnosed schizophreniform 4/12 before at the pervious
hospitalization. Stayed at the hospital for 2/52 and discharged with medication.
Task: Take psychosocial hx for 4 mins, then present it to the examiner, and discuss the possible dx and ddx

when I entered to the room the pt was sitting in the chair and examiner introduce the pt to me and told to do the task.
When I sat on the chair the pt started to look at the corner in awkward potion for a couple of second. I introduce myself to the
patient and the pt now turn back side and looked for a while. Suddenly talked himself I try to build the rapport to the
patient, so I asked what re u looking over there. He said something he’s hearing over there, and I asked what you are
hearing, he started to be talking like Putin gave some order and something bla bla.
Then only I realised myself I didn’t tell the confidentiality. Then gave confidentiality and asked more about it. Since how long,
how frequent, are they talking themself or with you, anything else? (2 nd ry or 3rd auditory hallucination, positive was 2nd)
no visual or tactile hallucination.
I followed ASEPTIC3R pattern and asked the question. He was groomed appropriate to weather, wearing hat, asked any special
reason for that, he was keeping green colour threads in the pocket denim and which he pulled out in the middle of the
history. He was restless throughout the hx and on and off looking to the wall and not maintaining the eye contact at all
from the beginning.
Speech was normal tone and rate, mood he was mentioned afraid, not sleeping. He is having persecutory and paranoid delusion.
Denied others. No suicidal ideation. Thought form is leaner. Cognition partially impaired as he doesn’t know the time,
judgment he mentioned AMC NTC centre fitted with fire sensors so can’t get fire.
Prompt time sound, I didn’t finish my Hx, due to the pt respond slowly and distracted which caused time consumption.
Examiner told me to present MSE, so I firstly introduce the pt and go with ASEPTIC 3R, (I forget the patient’s name as well) and
mentioned due to the time I couldn’t assess the insight and told I would like to take the collateral hx from family relative
and he his moderate to high risk to suicide as having hallucination, not sleeping. Gave the dx as relapse of Schizophrenia
and told other Ddx as substance abuse, thyroid, and head injury.
Still had time for me, so told the examiner as I couldn’t access the other things due to the time, if you (examiner) allow me I
would like to talk with my Pt. He allowed me, Quickly I asked about past hx of mental illness, compliance with medication,
why have you stopped, recreational drugs, over counter medication, weather preference, head injury, alcohol. Then I
justify my DDx and time up.

#Med St 10: Health review

RASH picture of both hand and back. Which is stated 12 hrs before and which is very itchy, and the vitals was given along with the
stem outside. A kind of similar picture was given. Mentioned in the stem no need to talk about the MX

Task: Hx for 6 min and possible dx and ddx.

In Hx she mentioned, sudden, spreading all over the body, had hx of allergy to Ibuprofen when she was around 10yrs not sure
exactly when. Started before going to bed
Gave dx as Urticaria and ddx allergic reaction, insets bites, viral exanthem and justified the dx
#Paed St 11: Crying
8/12 old Crying for last 12 hrs and father is here at ED worried about the child. Mentioned no need Mx below the stem.
Task: Hx for 6 min, DX, DDX
In Hx: he gave the vague hx and speaking very fast difficult to grab what is he says. (Doing intentionally to confuse) initially he
said continues cry then when I ask again clearly, he said on and off. Said for 4 hrs. first time, other everything normal
Asked about C/O and elaborate the frequency, onset what the child was doing at the first-time u have noticed, what you have
done so far and how is the child bt the cry, 1st time? Is the child drawing legs towards to chest? (I don’t know what he said
exactly, as I can recall he said not sure or don’t know) Well baby question, BIND, happy family? Support? Who looks after
the child most of the time, siblings, any bites?
Gave the dx as intussusception, DDx UTI, ear pain, trauma, unsettle baby

#Med St 12: Confusion

78 yrs old male living at aged care and had routine (not sure the purpose of) investigation. You are HMO, and ur consultant is
busy and not available for 30 min as he is attending meeting. The consultant has asked you to inform the repot to the
nurse. (Big stem with unnecessary information purposefully added to consume the time of the candidates). Mentioned in
the stem below no need Mx
investigation result was charted Na 118, low Cl and Osmolality too. Rest normal, I think K, Phosphate and some more chemical
was there
Task: inform the repot to nurse, and hx and possible dx with reason and Ddx
(No time prompt in this station and the no examiner in the room as well)

After 2 min I waked in the room, there was no examiner and the marshal who was outside guided Inside and checked my id and
told this is the telephone (which was on the table and handset free), whenever your ready press the 1 key then speaker
button. Then read the task again carefully for couple of seconds then I did as told to do so, once the nurse started to talk
the marshal left the room from the behind door.
The call was received by male nurse, and I introduced myself and asked his name, gave a female name, got bit confuse and
suddenly asked the age, then he made a joke do you wanna know my age, then I apologize for it and confirm the pt and
 the age who we are talking. Then I inform the result to nurse, then I mention that I want to know the more hx about the
patient to find out the course of the condition.
Then asked about the pt any C/O does he have, on and off confusion+, then elaborate more, then asked about the past medical
hx then he mentioned HT, some other things not remember, drug hx, he mentioned HCT, atenolol, statin with dose telling
very very slowly to consume our time, then any recent changes of dose or medication, SADMA, checked the vital the BP
was high mentioned something like 145/90 and rest was normal.
Then explained about the course of hyponatremia due to HCT medication. And other possibilities, head injury, infection,
diarrhoea, or vomiting. Then still I had time, so I said that I will get my consultation attention, still had time so I read the
task again as mention no need MX, so I told that as the medication caused the hyponatremia need to be changed, then he
asked what medication, I told HCT also told as his BP is high, so needed medication review. So told to monitor the patient.
I didn’t say that I need to admit the pt, so I thought I am goona fail, but I passed.

#OG St 14: Post-partum Review

After 6/52 of post-partum, mother is coming to ur GP for the routine check up
Task: Hx, PEFE, any investigation wishes to order, further mx (I am not sure about the last task)
I knew that I would fail this case once I finished my station. Plz follow the passed feedback, any how I have attached some notes
down below.

In Hx: Mother had GDM, First baby, no complication.

[Link] ([Link])
In the above link check the page No 147
#Med St 15: Leg pain
GP setting, around 45 yrs old male C/O of leg pain which is relived with the rest. Big stem and which is pointing toward to PVD.
On PE found no pulse palpable below femur?? Not sure something written not palpable) ABPI was 0.7. Burger test
mentioned in the stem could remember which is positive or negative.
Task: Possible Dx, which investigation would like to order and mx and outcome of mx
Mentioned no need to do further hx or PE below the stem. No time prompts

After formal introduction, I said that there are a lot of possibilities to the legs pain, (cellulitis, OM, DVT, Nerve impingement,
Thrombophlebitis, #) and explain one by one in lay man terms to the patient and justify these are not that you have. And
told at last the PVD as we find in the ex and typical hx (Paraphrase the stems for the reason and justify my diagnosis)
So, to confirm my dx I am goanna to order the Ix also for the risk factors. FBC, SE, Bu, Lipid profile, LFT, TSH, RBS if it’s high go for
the HbA1c. then the specialist will do the doppler USS see the veins and artery, also they might do CT angiogram to see
the degree of the block and find where the block. ECG if need they might do Echo. Maybe I should have said uss abdomen
as well.
Then depends on the Ix finding, mentioned specially the block degree the vascular surgeon will come up with good plan. Also
told as ABPI 0.7 which is intermittent claudication and apricate the pt to come early which can managed well with the
SNAP approach and early intervention if specialist decided to do so.
Mean time I asked SADMA hx then examiner interrupted me and said no HX. Then I changed my statement as if you re drinking or
smoking and stop and I will arrange another counselling for those, Pt was obese too, told to maintain ideal weight. Still
had time then talk about the graded exercise. Told the Mx prognosis is good. Told about bypass and some medication to
reduce the fat in blood. Always checked the pt understanding and told I’ll give reading materials as I had time.
Maybe I should have talk about the stenting as well.
Examiner was very old.

#Psy St 16: Tearfulness

Lady is coming to ur GP for the medical certificate with her friend, after that her friend left her at clinic and went as she has some
work to do. Lady is off for the work for around 4 weeks. Her husband had MVA and passed way 4/12. Big stem with
unnecessary information to consume the time.
Task: Hx for 6 min, Probable dx and ddx
When I enter the room, she started cry while holding the tissue and acting like that wiping the tears. There was water bottle with
cups on the table as well.
While I introduce myself to her, she started crying, I said I’m sorry as you re crying and let me assure you that I am here to help
you. After this statement she started to cry more. I maintain a silence for a few sec until she come to normal. Then
mention confidentiality.
Then asked may I know the reason for your cry and then she opens that she lost her husband, I said I’m really sorry to hear what
has happened to your husband and reassured that I’m here to help to as much as I can. Then she cried more and wiping
out tears, then I offered would you like to have some water, she said she’s fine.
Here we need to talk very slowly and calm in manner and respect her feelings at the same time. Also gives more support that
you’re here to help her.
Then I mentioned that it could be very hard to lose our loved one, I can’t imagine how you’re going through this tough situation
and let me assure that you’re not alone we are here to help you.
Then asked that do you have enough support, she mentioned that her neighbour is supporting and giving foods. I appreciated it,
that’s good that some is there to look after you.
Then moved to since how long do you feel like this and try to elaborate more. Asked I am really sorry to ask you and it must be
very hard for you to remember, then asked what has happed to your husband. She said it’s ok dr and explained the
situation a bit the accident. Then I asked, have you with him at the time, not sure what she has said.
Then asked about the mood, started cry more and told that “I miss him a lot” I said I am really sorry for your lost, and again said I
am here to help you. Asked about sleep, nightmare, flash back, appetite.
Then asked Do you think life is worth living and asked any suicidal ideation. Saied I’m gonna ask some routine question which
might sound strange which I am asking to all my pt, Hallucination and delusion.
Asked MSIGECAPs to R/O depression and avoid repetitive question, SADMA, Past mental illness.
After it I thank her for the information given and said the reason for cry can be Depression, grief, adjustment disorder, early
onset pf PTSD. Didn’t specifically say what she is going through is grief that’s the reason got 3 in Dx and ddx.
I thought I would fail this case as I didn’t say specifically grief. As predominant dominant assessment is Hx taking, so I passed the
station.

#PE St 17: Back pain

25 yrs old male C/O of back pain following heavy lifting
Task: Do the relevant Ex, Dx and DDx
Pt was lying on the bed.
After introduction I expiation in lay man term and get the consent for the Ex.
Then started with general inspection, Gait and heal to toe walking. He was in pain, so said examiner I will skip the toe and heel
walking. He was wearing T shirt. So, I excuse him told to remove as I need to inspect the back.
Then palpation, + in lower back pain. Then movement. Mild restriction. Then I skipped the sober test asked to lay on bed. Then
checked the power, ex come near to me and checked, then moved to reflex which is lost in left side angle. (I have done
both knee, R/S ankle which all I was able to elicit, then move to left examiner said absent)
Then I moved to sensation, initially I forget to pick the fresh one, there was used tooth prick. I picked that first then I realized
then picked the new one then did all dermatome, examiner said lost on left side L5 and S1. Then said I wanna do with
cotton he said moved to next task. Then I remembered I forget to do SLRT, quickly done which was positive in the left side.
Then thank the Pt, and draw the picture and examiner again come near to me and check. Gave dx as L5, S1 radiculopathy due to
disc prolapse caused by the weight lift. DDx #, muscular pain.
I missed to mention I have to do DRE.

#Med St 19: SOB (Pilot)

42to 50 (not sure) year Female come for the second opinion of her exertional dyspnoea which she is having for long time. Big
stem…. Previous doctor had some investigation, and which was mentioned in the stem, which are ECG normal, CXR= mild
thickness in the bronchi, FBC and blood film is normal, blood eosinophil is high (IgE) One more IX as I remember it was
total 4. Abdomen is normal?? Not sure what is the last one.
Task: Hx 3 min, PEFE, ask investigation whatever asking you will be provided interpret it and dx ddx
In Hx: More than 6/12 SOB, Hx of childhood asthma and feel better with the puffer, then she didn’t use it, some 2 cig/ day a long
time ago and stopped (Not sure) allergy to aspirin. Affecting her life. Not on any medication.
No orthopnoea, using one pillow, no problem with sleep. No chest pain, no fever, no recent travel hx, Not on OCP, asked about
her 5P. not remember what she has said.
SADMA, FHx, Occupation; she mentions that driver don’t remember exactly, asked about any conducts with asbestosis, silicon,
mine factory works. She said no.
PEFE, I think all was normal. In IX, asked spirometry and chart was provided and asked to interpret it. Which is pointing towards
Asthma as FEV increased after the bronchodilator.
Chart was given something smiler like this,

Gave Exacerbation of Asthma, DDx COPD, restrictive lung dx, heart failure justified they’re unlikely.

#Paed St 20: Throat pain

8 yrs old child father came to GP due to the rash which appeared 2 days??? Not sure about the duration. Big stem. In that
mentioned the description of the PE finding of the child along with the rash. No rash picture was provided.
Blanchable rash face, cheeks, trunk, and upper shoulder area???, normal hydration, tonsil enlarged. LN palpable,
Task: Dx, advice to the parents and mx
No need to take further hx or PE mentioned below the stem.

After introduction, Father anxiously said what it this rash Dr and said I am so afraid as it is meningococcemia as he read from the
news and worried about the child.
I said I understand your concern and told that I am here to help you, apricated him that he come to discuss about the child and
told you did the correct thing.
Then I gave a signpost to father that firstly I’ll talk about what ur child is having the condition then we will talk about what we re
gonna do, then I’ll address your concerns. He said OK dr and mentioned whatever you say he’s agreed with that.
Gave the Dx as Scarlet fever and justified why this and why can’t be meningococcemia. When I mentioned blanchable rash, he
asked what is that dr. then explained in lay man terms.
Talk about what is scarlet fever and how is spreading, if not treated what will happened (Sepsis, RF, kidney injury ‘’PSGN’’),
explain a bit the reason for the rash, due to the toxin which were produced by bugs which will disappear after few days
then it will peel off the skin.
Talk about family hygiene to prevent spread within family members and exclusion from the school after 24hr from the stated of
AB.
Always checked the understanding of the father and is he happy with the mx plan. I had more time as I finished earlier so I try to
interact with him more and asked does he have any question. He said does he should know anything else; I try to recall
subconsciously, am I missed anything, then gave reading material and advice for adequate food and hydration, gave some
red flags.

17th Aug, 2022 recalls

1. MSE video with major depression
2. CVS PE ➔ physiological murmur
3. Intestinal obstruction paeds delayed passage of meonium
4. Bulimia nervosa
5. COPD with osteoporosis/ osteopenia
6. Child with rash (peanut allergy)
7. Stroke with AF
8. Wrist cut PE
9. Hypoglycemic attack ➔ fall é BSL 3.1
10. Pelvic examination ➔ ectropion
11. Secondary PPH with management
12. CTscan liver mets
13. PVD
14. Anaemia in pregnancy
15. CVS risk assessment
16 9 month old baby unable to sit

23rd august 2022 PASSED FEEDBACK

Examination Station Results
Station 1 Assessed, Not Scored
Station 2 Fail
Station 4 Pass
Station 5 Fail
Station 6 Pass
Station 7 Fail
Station 9 Pass
Station 10 Pass
Station 11 Pass
Station 12 Pass
Station 14 Pass
Station 15 Assessed, Not Scored
Station 16 Pass
Station 17 Pass
Station 19 Pass
Station 20 Pass

Overall Total: 11/14

Station 2
Admitted for diverticulitis, surgeon said needs surgery. Has AF and is on apixaban. Registrar told to stop apixaban. Patient is
worried
Hx from patient 4min, summarise patient’s concern, counsel patient
Afraid of bleeding to death, cardiologist said that
Neighbour had colostomy, afraid she’s getting colostomy
Cardiologist said there is no reversal for apixaban
Alone – patient started crying as candidate enters room, no family no support
Bleeding history – I cut myself in the garden once and the bleeding wouldn’t stop
Counsel patient about her concerns
Marwan 288

PREDOMINANT ASSESSMENT AREA - MANAGEMENT/COUNSELLING/EDUCATION STATION 2

Scenario: Counselling Grade: Fail

Assessment Domain Domain Score (see key below*)
Approach to patient/relative 3
History 4
Patient Counselling/ Education 3

This was apixaban counseling, patient had 3 concerns. First about colostomy bag as she was going for operation for diverticular
disease. Second, apixaban as she had atrial fibrillation and on apixaban so said what if will have clotting if I stop apixaban.
And third, some family concerns as who is going to look after her family. I think I covered all aspects but guess still not
enough. Counseling stations are a mystery to me still.

STATION 4
) MSE- video for 4 mins
Present MSE – young man, feeling depressed after breaking up with his girlfriend, keeps talking about ex, good support from
mother, goes out with friends, working, lack of sleep (keeps thinking about her), everything else negative
Alan file

PREDOMINANT ASSESSMENT AREA - EXAMINATION STATION 4

Scenario: Behavioural complaint Grade: Pass

Assessment Domain Domain Score (see key below*)
Commentary to Examiner 4
Accuracy of Examination 4

This was MSE Video case. It was adjustment disorder but clearly they mentioned diagnosis is not required. You have to watch the
video and then present to examiner. There was a young man in video, post breakup with girlfriend. He was teary, sad
throughout video. No depression symptoms, no suicidality, he feels worth living just sad because of breakup. Many things
were not assessed in video so please be careful if something is not assessed don’t say it’s negative. Like delusions and
hallucinations were not asked so I mentioned they were not assessed. Judgment was not assessed. Cognition was not
assessed. So before video starts write ASEPTICJRRR and start filling it along video. Then I presented to examiner with
positives, negatives and not assessed things. Social support was good, he has family to look after so I mentioned.
There was no name given for patient so before presenting I asked examiner about name of my patient and he said just leave it
and present your findings.

Station 5
Swelling in neck in 11 years old child history, pefe, diagnosis and d/d ( everything negative no thyroid findings, moving more on
swallowing and little bit on tongue protruding)

Lump on neck, 11yo child

Hx, PEFE, Dx to patient
Hx was negative for everything else
PEFE – mass midline neck, solitary, mobile, non-tender/ not red. Moves with swallowing
?Thyroglossal cyst

PREDOMINANT ASSESSMENT AREA - HISTORY TAKING STATION 5

Scenario: Neck swelling Grade: Fail

Assessment Domain Domain Score (see key below*)
Approach to patient/relative 4
History 3
Choice & Technique of examination, organisation and sequence 3
Diagnosis/ Differential diagnoses 0
This station was confusing for me, it was pediatric case and I couldn’t get any positive finding in history and pefe. Swelling was
midline and increasing in size a little bit since it has appeared and I am sure it was located at thyroid position because
examiner told me in detail it’s location. It was moving with swallowing and little bit moving with tongue protrusion. No
 other thyroid signs, no LOW/LOA and fever, nothing suggestive of salivary glands swelling, no history of travel of sick
contact. I couldn’t reach diagnosis and d/d task as bell rang so got 0 in
that domain. But my impression was thyroid nodule with eythyroid Midline
phase. But confirm with someone who passed. Don’t leave any task Thyroid nodule (moves upon swallowing)
unattempted. If I had given D/Ds even I could have passed but I ran Thyroglossal cysts (moves upwards on tongue
short of time. protrusion)
Dermoid cyst (beneath chin)

Station 6
Fluid chart, Vital charts – pneumonia, given IV ab
Sudden SOB today and can’t lie down
Inquire from examiner about PE required, explain chart to examiner
explain diagnosis and cause to patient
PEFE – B/L oedema of shins, B/L crackles of lung base, decreased air entry on R side, JVP 5cm, Hepatojugular reflux+, 4th heart
sound+, Abdomen normal
Input >> Output, BP increasing, Sats dropping, RR increasing
?Fluid Imbalance
Marwan 273

PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION STATION 6

Scenario: Shortness of breath Grade: Pass

Assessment Domain Domain Score (see key below*)
Approach to patient/relative 4
Choice & Technique of examination, organisation and sequence 4
Interpretation of investigation 4
Diagnosis/ Differential diagnoses 4
It was post op fluid overload case. Outside so many tables and a very long stem was there that was enough to scare you. Fluid
charting, nursing chart, medication chart and operation details were given. I think it was post cholecystectomy case with a
known case of heart disease. Inside middle aged man was lying down with a drip running. Interestingly you don’t have to
talk to patient but start your station by pefe. Still I introduced myself to patient and then started asking PEFE from
examiner. JVP raised, 3rd heart sound present, basal crackles audible, pitting edema on legs up till mid lower leg. So in fluid
chart clearly input was more than output. So it was heart failure because of fluid over load stressing already diseased
heart. Then you have to explain your diagnosis to examiner with reasons. So nothing to ask from patient in this station.

Station 7
) 25 yo female, late periods
Tasks – Hx, inv from examiner, Dx
8 weeks late, PV bleeding 2 days, sexually active, no contraception
Inv – UPT – pos, bhcg 70,000 normal for 8 weeks, US – foetus 6 weeks, FHR 80/min
? Threatened miscarriage
Marwan 76

PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION STATION 7

Scenario: Vaginal bleeding Grade: Fail

Assessment Domain Domain Score (see key below*)
Approach to patient/relative 5
History 5
Choice & Technique of examination, organisation and sequence 5
Choice of investigations 3
Diagnosis/ Differential diagnoses 2

It was threatened abortion. Outside stem was ‘women is not having periods’ so that’s why I wasted a bit of time in asking all
causes of secondary amenorrhea. But then I realized it’s pregnancy. It was history, pefe, investigations and counsel
accordingly. Patient was opening up very reluctantly and very casually she mentioned about little bit bleeding that has
stopped now. So I failed in picking up the clue and went on asking other causes for secondary amenorrhea. Same I did in
PEFE, asking about all findings like hirsutism, acne, hot flushes, weight gain. I was going good but as I mentioned
Pregnancy as the cause of amenorrhea and didn’t mention about threatened abortion so failed the station.

When I came outside I realized it was threatened abortion. So message is even if you know the topic very well, role players are
told to give information reluctantly so u can overlook important information.

Station 9
Left sided headache, with photophobia – hx and exam given – normal, MRI – normal
Started from 1y ago, started working full time 1 year back, drinks coffee 1-2 cups/day
Tasks – Dx, immediate and long-term management. (Marwan 237]

PREDOMINANT ASSESSMENT AREA - MANAGEMENT/COUNSELLING/EDUCATION STATION 9

Scenario: Headache Grade: Pass

Assessment Domain Domain Score (see key below*)
Approach to patient/relative 4
Diagnosis/ Differential diagnoses 6
Patient Counselling/ Education 5
Management plan 4
To me it was pilot station till result arrived as I have never seen this kind of headache case in recalls. Very long stem outside
telling all history, photophobia+ with no neck stiffness, this headache happening I guess from a year and now frequency
has increased. I think 5-6 times in a year, not sure. No family history of migraine, no aggravating or relieving factors. So
you have to make the decision outside what is this headache because inside its counselling about the diagnosis and
immediate and long term management of migraine. For a moment I got confused what is this headache as no family
history and no relation with food or anything. But then I thought is not fitting in anything else as well and migraine has so
many variants so sometimes it can present in an unusual way as well. So do study its management in detail. I talked about
general measures (identifying and avoiding risk factors, analgesics and lifestyle modifications) and also about prophylactic
treatment.

station 10
Male genital exam - mannequin
27 yo M concerns of STI – No hx given
Do PE and arrange Ix
Negative PE
STI screen – urine and blood

PREDOMINANT ASSESSMENT AREA - EXAMINATION STATION 10

Scenario: Health review Grade: Pass

Assessment Domain Domain Score (see key below*)
Approach to patient/relative 4
Choice & Technique of examination, organisation and sequence 4
Accuracy of Examination 4
 Choice of investigations 4
It was male genital system examination for STI screening. Role player was sitting on side and dummy on couch. So I followed all
the examination steps WIPE Approach, talked about chaperone and started my examination from inspection. When I
started palpation examiner came behind me to see how I am palpating both testes. So make sure you know proper way of
palpation. I mentioned epidydimis and spermatic cord palpation. Palpation of penile shaft and inguinal lymphnodes was
also done. Then in the end I performed cremasteric reflex, it was normal. So every thing was normal, no finding in the
examination. I covered the dummy and then it was about arranging investigations for STI’s with the patient so I mentioned
all tests and say thank you.

Station 11
60 yo, truckie, upper abdominal pain
Task – Hx ,Dx/Differentials with reasoning
Dull pain, not like heartburn, nil radiation, worse with food, relieved by alcohol
Takes Quick-eze, PCM, nurofen
DDx? – stomach ulcer, duodenal ulcer, pancreatitis, pneumonia, heart disease
Marwan 301

PREDOMINANT ASSESSMENT AREA - HISTORY TAKING STATION 11

Scenario: Abdominal pain Grade: Pass

Assessment Domain Domain Score (see key below*)
Approach to patient/relative 4
History 5
Diagnosis/ Differential diagnoses 5
This was my first station. Patient presented with upper abdominal pain, relieved with food, he was not sure about any relation
with spicy and fatty food. Water brash was there. Alcohol intake was high and he was taking NSAID’S. I all d/d questions
for upper abdominal pain for hepatitis, cholangitis, pancreatitis, lower lobar pneumonia, MI. I asked about change in stool
color for upper GI bleeding and dysphagia, LOW,LOA for malignancy but everything was negative. My provisional diagnosis
was peptic ulcer disease and I mentioned all d/d and explained why they are unlikely. You have to mention investigations
as well So I mentioned blood picture, ESR,CRP, amylase, lipase, cardiac enzymes, CXR and didn’t go in imaging but you
should be mentioning endoscopy I guess but still I manage to pass.

Staton 12
Feeling unwell, referred by boss, 35yo truck driver
Task – Hx (6-7min), Dx and DDx with reasons
What’s wrong? – went into the truck this morning felt head about to explode, back to work today after 1 month holiday. 2 days
before start of holiday, something happened – young man jumped in front of his truck and died. Flashbacks, can’t sleep,
keeps thinking of incident
Depression – negative
?PTSD, organic causes – ICH, acute stress disorder, GAD, panic attacks

PREDOMINANT ASSESSMENT AREA - HISTORY TAKING STATION 12

Scenario: Behavioural complaint Grade: Pass

Assessment Domain Domain Score (see key below*)
Approach to patient/relative 4
History 4
Diagnosis/ Differential diagnoses 4
This is psychiatry case, PTSD, truck driver, with flashbacks, nightmares about accident happened when she started her job. She is
not able to drive since and can’t resume her job. I asked screening questions for depression, anxiety, alcohol,drugs,
psychosocial factors bit nothing was positive. She was living with her husband, no financial issues, good support. No
 SADMA, HEADSSS. When I asked MSIGECAPS just few things positive like sleep disturbance, appetite a bit low and low
concentration. Nothing else significant. No suicidility.
Rule out all anxiety disorders like OCD and phobias that I forgot but still manage to pass the case. In the end it was explaining
most probable diagnosis to the patient and rule out other less likely causes with the patient.

Station 14
sudden fainting in front of friends ?25yo
GCS chart given to fill, temp 37.6
Perform level of consciousness and relevant exam
Explain differentials
Fundoscopy, otoscope, tendon hammer – given inside
Neck stiffness positive
?Meningitis

PREDOMINANT ASSESSMENT AREA - EXAMINATION STATION 14

Scenario: Unconscious Patient Grade: Pass

Assessment Domain Domain Score (see key below*)
Approach to patient/relative 5
Choice & Technique of examination, organisation and sequence 4
Accuracy of Examination 2
Diagnosis/ Differential diagnoses 3
It was old case of unconscious patient examination with meningitis. Neck stiffness was positive but we have to follow all the
sequence to rule our CNS, Cardiac metabolic causes. In d/d I mentioned heart problems, stroke, meningitis, head trauma,
Intra cranial bleeding, hypoglycemia.
Important thing is that they are giving a different fundoscope I was not aware of. I couldn’t turn it on and this happened to other
candidates on the same day as well. That’s why got 2 in accuracy of examination. Good think is that when I couldn’t turn it
on I said to examiner I will do fundoscopy later and want to proceed with other examination. Please familiarize yourself
with this new fundoscope as they are giving it again and again even after my exam. So I completed other examination,
listened to heart, carotid bruit, JVP, checked for head trauma, checked tone in upper limbs and insulin marks. It was long
case and lot of time wasted in fundoscopy and putting on gloves as I went for small size accidentally and then had to
change to bigger size. But fortunately passed the station.

STATION 16
) Pregnant woman, generalised abdominal pain
Task – Hx, PEFE, Dx and differentials
26 weeks, Abdominal pain all over tummy, nil bleeding
Normal antenatal care, first pregnancy
PEFE – contractions+ every 5 mins, FHR normal, Speculum – nil bleed, Os 3cm dilated
?preterm labour
Alan file

PREDOMINANT ASSESSMENT AREA - HISTORY TAKING STATION 16

Scenario: Abdominal pain Grade: Pass

Assessment Domain Domain Score (see key below*)
Approach to patient/relative 5
History 5
Choice & Technique of examination, organisation and sequence 6
Diagnosis/ Differential diagnoses 4
This station was preterm labour, I think it was 28 weeks pregnancy. I kept in mind all differentials of abdominal pain in late
trimester like preterm labour, placental abruption, trauma, preeclampsia and asked questions to rule out these
conditions.
Pain were coming and going, no h/o trauma, no bleeding or water break, feeling baby kicking. There was PEFE so I asked all
obstetric examination in detail. Fundal height was according to gestation, fetal heart audible, no tenderness. On asking
pelvic examination, cervical os was open a bit and effaced, water bag intact and no bleeding. There were no investigations
and management. So I talked to the patient in the end about most likely diagnosis and how I ruled out other d/d’s.

STATION 17
)
1. Back pain history, pefe, diagnosis and d/d( weight lifting with tingling and numbness) decreased Anal tone

Low back pain, 40 yo,

Task – Hx 4min, PEFE, Diag/Differentials, explain to patient
1week since lifting rock, landscaper, trouble walking, hold on to rails, pain and cannot walk
Shooting pain down to sole, tingling numbness+, nil joint issues
PEFE – cannot stand up, power hip reduced due to pain, sensory decreased lateral side of left leg down to sole, ankle reflex
reduced left side, SLRT+v left
?Sciatica
Marwan 114

PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION STATION 17

Scenario: Back pain Grade: Pass

Assessment Domain Domain Score (see key below*)
History 4
Choice & Technique of examination, organisation and sequence 4
Diagnosis/ Differential diagnoses 4

Patient was lying down on couch, in severe pain. It was 8/[Link] station was history, pefe and tell patient diagnosis and d/d.
There was history of heavy weight lifting and then this pain started. He was mentioning same happened to him few years back
but he recovered then. Tingling and numbness positive, but no loss of bladder and bowel control. On pefe ,SLR positive on both
sides (more on one side than other), decreased anal tone, numbness in L5/S1 areas. When I asked examiner about lumbar
movements (flexion, extension, rotation, bending) he said do you think this patient is even able to move. So he wanted to tell me
patient is in severe pain. Then I turned to patient, and draw diagram and explained about disc prolapse with nerve impingement.
Told other diagnosis that are least likely like mechanical back pain (he asked me what is mechanical back pain), osteoporosis,
trauma/fracture, joint problems.

STATION 19
Mo coming with concerns of 3 yo child having frequent cold for the past 1 year
Tasks – Hx 5min, PEFE, Diagnosis and differentials with reasons
Colds 8 times in the past year – mild symptoms, fever
PEFE – all normal, only fever 37.6
Advised normal and doesn’t require special tests – are you concerned about anything?
Marwan 264

PREDOMINANT ASSESSMENT AREA - MANAGEMENT/COUNSELLING/EDUCATION STATION 19

Scenario: Recurring respiratory problem Grade: Pass

Assessment Domain Domain Score (see key below*)
Approach to patient/relative 4
History 4
Patient Counselling/ Education 4
This is the recalls of recurrent viral respiratory infections in children. In history, I asked questions for asthma, pertussis, croup,
pneumonia, cystic fibrosis, heart conditions. Nothing was positive. Child was healthy, going to childcare and father only
concern was why he is getting cold again and again. So you have to reassure father that it’s normal for this age children to
have 8-10 viral illnesses in a year and it’s not serious. Talked about childcare as a possible cause as it is caught from other
children. I talked about management like lots of fluids, rest, panadol if fever, avoid childcare if possible. Talked about hand
hygiene, flu vaccination and lots of reassurance as it’s not serious and your child is healthy.

STATION 20

PREDOMINANT ASSESSMENT AREA - EXAMINATION STATION 20

Scenario: Visual problem Grade: Pass

Assessment Domain Domain Score (see key below*)
Approach to patient/relative 4
Choice & Technique of examination, organisation and sequence 4
Familiarity with test equipment 5
Accuracy of Examination 3
Diagnosis/ Differential diagnoses 4
This was Amourosis fugax. Outside history showed 60 years old women heart patient, diabetic, hypertensive and high cholesterol
levels. She came with sudden loss of vision but now she is fine. Inside an old lady was sitting on chair. She was a smiling
lady but was looking so sleepy, she even slept during my examination and I had to repeat my instructions. I did eye
examination including inspection, palpation around the eye and eyeball as well for glaucoma. Then I did visual acuity that
was normal, light reflex normal, visual field normal,eye movements normal, accommodation normal, fundoscopy when I
turned on and started doing it examiner said normal. Then I was doing cranial nerves I guess I checked facial but time was
finished. Later I realized I missed temporal arteritis completely so was worried but fortunately passed the station. I told
amourosis fugax as most probable diagnosis and I had to explain why I think this is the diagnosis so gave reasons from
history including all risk factors.

Weight concern, referred by nurse: history, plot growth chart, diagnosis and counsel patient ( normal findings)Referred by school
nurse, child is small – 8 yo. Child is not growing as per nurse.
Hx in 3 mins, plot height and weight in chart, diagnosis and management
Hx – all normal, family hx (patient handed paper with heights of mo, father and grandmother)
Growth chart normal
Counsel mother ?constitutional delay
Alan file xxx short stature

13. Right chest pain ( burning and dermatomal distribution ) history, diagnosis and d/d, herpes
30 yo woman right chest pain
Tasks – Hx, Dx and management
Stabbing sharp pain, back to front of right side, dermatomal, neurological, tingling, numbness – no rash, mild fever, colds 1 week
back, has had chicken pox as a child
Financial advisor
Dx – early herpes zoster - prodromal
Blood tests, acyclovir, analgesia
Dx – differentials, slipped disc, muscle spasm, biliary colic
24th August 2022 Melbourne NTC ( Face to face ) passed feedback
By sushmita
I started with station no 16

Station 16:
. Rubella counselling - 28-year-old schoolteacher presented in your GP clinic concerned she was exposed to an 8-year-old student
History
Investigation
Counsel the patient

Assessment Domain Domain Score (see key below*)

Approach to patient/relative 5
History 4
Choice of investigations 4
Patient Counselling/ Education 4

2 mins thinking outside: Pregnancy symptoms, rubella symptoms, Pregnancy test and antenatal blood test, Rubella serology and
explanation, Complication of rubella, notification, reassurance to mom
I was very happy as I practiced this case several time. I entered the room, introduce with examiner and patient. She was very
anxious as it was her first pregnancy. I started with history taking

Rubella questions:
-When and where were you exposed? Few days back, one of my students have it.
-Was it a confirmed case of rubella? Yes
-Do you have any symptoms recently like fever, cough, throat pain, rashes? None
-Do you have an updated immunization?
-Have you had rubella before? No.
5Ps:
-Period: delayed
-Pregnancy: + UPT, first pregnancy if ever, no check-ups yet, -planned
-Partner: stable, with good support
-Pills/Contraception: No
-Pap/HPV: updated, normal
-Past Med: unremarkable
-Family Hx: unremarkable
-SADMA:

Congratulations on your pregnancy! Since this is your first check-up, I need to confirm your pregnancy if that's alright with you. I
will arrange some antenatal tests as well which I'm going to discuss to you later. First, I would like to address your concern
regarding rubella. Do you know what rubella is? No. Rubella is caused by a bug causing rashes and some flu like symptoms.
It may look mild in your case however I am worried that it could be harmful for your baby. It could lead to eye, hearing,
brain, and heart problem. (Role player gave me worried reaction) I know you are worried about this but let me walk you
through on what's going to happen. I will run some test and there are 3 scenarios: (I wrote on paper IgG & IgM and
described)
IgG + IgM -: this means that you are immunized and nothing to worry about.
IgG - IgM +: you are infected. Now in this case you have an option to not continue with the pregnancy. OR I can refer you to high-
risk pregnancy clinic and we'll do more frequent tests to check for complications.
IgG - IgM-: you are not immunized, but not yet sure if you're infected or not, hence we'll repeat the test and see if we fall back to
scenario 1 or 2 after several weeks

Do you have any questions? None. Ok, if it turns out positive, I need to report this to the department of health for statistical
purposes alright? For now, we'll do all the antenatal check-ups which involve blood workups (tried to roughly enumerate
it) and ultrasound. Once with results I'll give you a ring.
Please watch out for any changes like fever and the like or if any problems do not hesitate to come
back. If you need a time off from work, I can give you a medical certificate especially if there's a recent case in school.
At the end of the conversation, she was not happy and gave me weird look. I was nervous thank the patient and examiner and
left the room.

Station 1
Middle aged man comes to your GP practice due to headache for 4 weeks and poor sleep. -
Take Hx with psychosocial and social Hx for 5mins.
On PEFE: (+) paraspinal tenderness in Cervical area. No radiculopathy. Normal UL NE. CVS
N. ENT N.
Discuss findings to the px.

Assessment Domain Domain Score (see key below*)

History 4
Choice & Technique of examination, organisation, and sequence 6
Diagnosis/ Differential diagnoses 3

2 mins thinking outside: Confidentiality, Pain medication offer, DDX – Migraine, Tension, psychogenic headache, Sinusitis,
temporal arteritis, stroke / TIA .

Entered the room, greeted the patient and examiner. “Hello my name is [Link] , I am one of the
GP’S here”. I understand that you have headache, is that correct? Yes Dr.
-Do you have headache right now- no
-Let me assure you whatever we will discuss it will be remain confidential and information will be used for treatment purpose.
-Then I Started with SORTSARA
Headache DD questions:
-Migraine n/v, Photo or phonophobia→ Do bright eyes/loud noises hurt your
-eyes and ears? Aura- sparkling lights before you get a headache? - No
-SAH and intracranial haemorrhage → (initially occipital pain then generalized? trauma, vomiting)? No.
-Stroke/TIA -weakness? Loss of consciousness? Slurring of speech? No.
-Any recent flu like illness- NO
-Any toothache or ear pain – No
-Temporal arteritis: you have tender cord like structure on side of the head? Blurring of vision? Pain worse on chewing & combing
- no
-Neoplasia- Loss of weight, Loss of Appetite, Lumps and bumps, - no
-Cluster Headache (watery eyes and runny nose).
-Trauma (any h/o hits/injury to head)- no
-Meningitis → fever, Sore neck- NO
-Sinusitis → facial pain, Otitis media → ear pain or discharge? – No
-Mood - worried
-Sleep – can’t sleep well for same duration
-Hallucination or delusion – NO
-Suicidal ideation - NO
-Stress at work -YES
-Living alone
-No financial stress
-SAMDA

Then I explained it to as stress induced headache and explained Mind body axis by drawing a picture.
I also mentioned others DDS like Tension headache, Migraine, Sinusitis, Stroke/TIA, Temporal arteritis with reason.
I wasn’t happy about my performance.

Station 2
30s lady working in customer service came in to your GP practice complaining of eye swelling and requesting for Medical
Certificate to have some break at work. Picture supplied like this.
Hx 3mins.
Explain Dx and ddx

2 mins thinking : Literally I didn’t have any idea about this case. I was nervous. Luckily it was unscored
DDS: Stye, Chalazion, conjunctivitis, allergic reaction, Foreign body , Orbital cellulitis , insect bite On Hx: RP was wearing sun glass.
This started a few days (1 week?) ago.
Initially consulted the chemist and was given eyedrops but was not working. (+) tenderness on the site.
No fever, eye discharge, eye redness. N eye ROM.
I did a great mess here as I didn’t prepare this case. Please see other feedback. It was unscored case

Station 3
6mos old infant brought in by mother in your GP practice for their routine vaccination. Prior to vaccination, patient was referred
by the nurse for you to assess the patient as upon plotting patient’s chart, noted this discrepancy - charts supplied as
follows:
Head circumference at 98th percentile (3 plots fall in this percentile) Weight chart at 50th percentile.
Hx (? unsure if with time prompt) PEFE
Dx/DDx
On Hx: U/R BINDSMA Hx. Not a sick kid since birth. Has another sibling. Happy family. Mother does not seemed concerned.
Mother happy with developmental milestones (just recently, baby was able to sit with support). Interactive child. (-)
symptoms of ICH in a child.
PEFE: All normal. U/R findings. Candidate requested if there is evident “Sunset eyes” - none as confirmed by Examiner.
Dx: ?Hydrocephalus
I literally have no idea about this case. Please see other feedback, luckily it was unscored case as well.

5yo boy brought in by mother due to lethargy.

Hx PEFE. Dx with reasons + DDx

Requested from examiner for HD stability prior to starting Hx.

Define complaint: “unusual tiredness” for 1 month now.
Tried to do HEMIFADO - can’t seem to decipher the cause. When asked about appetite and diet, mother replied
“not usual as before”. U/R FHx. U/R PMHx.
 On PEFE: when asked for VS and AVPU - stable VS and “Px is noted to be playing in the room”
U/R PE
Office tests requested: BSL = 14. U/A = trace ketones and glucose ++
CASE 15 MARWAN

Rest Station

Station 4
30s lady came to your GP practice due to breast pain.
Short Hx.
Perform Breast PE.
Dx/DDx.

assessment Domain .................................................................................................................................. Domain Score (see key below*)

Approach to patient/relative ..................................................................................................................................................................... 4
Choice & Technique of examination, organisation and sequence ............................................................................................................. 4
Accuracy of Examination............................................................................................................................................................................ 4
Diagnosis/ Differential diagnoses .............................................................................................................................................................. 4
2 mins thinking: Fibroadenoma, Breast Cancer, Lipoma, Fibrocystic disease, Traumatic fat necrosis
Enter the room and introduce with patient. Hello My name is [Link], one of the GP’s here.
I will look after you today. Can you tell me more about your problem?
-Do you have breast pan right now? – no
-SORTSARA
-Do you get pain before your period – yes
-Any lump and bump- no
-Any history of weight loss – no
-Any history of fever – no
-Any history of injury to you breast – no
-Any discharge or pus or bleeding from nipple- no
-Any colour or skin changes of breast – no Family hx of breast cancer – no
Then I told the patient I would like to examine your breast this examination includes having a look at your breast tissue and feel
for any lump and, I will check your lymph node around breast and neck. During the examination a female chaperone will
be present. Let me know if you feel any pain or discomfort, I will stop the procedure.
RP– ok Doc
Examiner – There is a mannequin on bed, do the breast examination on mannequin. I was about to
start examination. Examiner interrupted me saying “Dr pls put on gloves pointing towards the glove
box on the wall”. I told the examiner thank you for reminding me. I asked vital signs which were
normal.

On inspection, comparing both sides, both breasts are symmetrical in size. There is no erythema, no ulcer, no surgical scars, no
dilated veins, no radiation marks. Nipples are healthy and no crack, no ulcer, no erosion, no retraction. I cannot see any
lumps, no Peau d orange, no skin dimpling as well.
RP: can u put your hands on your waist and press them? (RP followed my instruction, she is sitting on a chair throughout
examination) I can’t appreciate any mass, no skin dimpling.
Patient: can u put your hands behind your head? (At the same time, I showed her how to do) I can’t
see any mass, no dimpling. (I should have told no mass in axilla region)
Ok, good. U can put your hands down now and lean forward. Both breasts are hanging down symmetrically.
Thank you. Palpation
Now, I am going to feel your breast. Is that ok? (Yes Dr)
Do u have any pain in both of your breasts? (No)I started palpating Rt breast in manikin in radial manner from outside towards
nipple saying “ Rt breast is soft, temperature is normal, no mass, no tenderness (I look at the role-player’s face)” and
palpating axillary tail “ Axillary tail is clear”
Then, I did the same on Lt breast. It was Normal. I asked RP, would u mind to press your nipple gently. She intimated it. “There is
no nipple discharge on pressing nipple” Then I do axillary LN examination on both side. I asked RP to put her arm on me
and keep relaxed for me. I examined anterior, posterior, lateral, central, apical groups in manikin. Then, I checked
supraclavicular and cervical LN.
Well, , I have examined your breasts today. I couldn’t find any abnormality.
There are a couple of reasons like it can be due to premenstrual syndrome due to hormonal changes in body before period
(Cyclical Mestalgia didn’t come to my mind), Fibroadenoma which is non- cancerous proliferation of breast tissues. It could
be fibro adenosis which is lumpy bumpy breast, or abscess, or traumatic injury to your breast, or nasty growth.
To confirm the diagnosis, i need to run some investigation. I thank the patient and left the room.

Station 5
77year old had fall incident this morning. Daughter is concerned and urged him to be seen.
Hx for 6mins.
Dx with with reasons
Ddx

Assessment Domain ..............................................................................................................Domain Score (see key below*) Approach to

patient/relative .................................................................................................................................................................................
5
History ........................................................................................................................................................................................................ 5
Diagnosis/ Differential diagnoses .............................................................................................................................................................. 5

2 Mins thinking : Hypovolemia due to diarrhoea, vomiting, anaemia CVS causes like arrythmia, MI, postural hypotension, CNS-
stroke, epilepsy, neuropathy- DM, drugs like anti-hypertensives, others idiopathic. Diabetic neuropathy, Arthritis, Hearing
and vison problem.
I entered the room and introduced with patient. There was an Aussie patient sitting on chair. He was very nice and decent
throughout the conversation. He Mr x, my name Dr. Susmita, one of the GP’S here, I will look after you today. Then I
started with fall cluster question.

Fall questions
-How many times have you had fall? (3 times this month)
-When did you fall? -this morning
-What were you doing at each time you fall? (Last time he tripped over at garden & Grounds and other 2 while he was changing
his position from sitting to standing)
-Did you get any warnings like strange smell or feeling nauseous? -No
-Did you have any dizziness, chest pain or palpitations? Felt dizzy
-Any headache, blurring of vision, weakness, or numbness? – No
Before
-Have you skipped your meal? - No
-Do you black out or feel dizzy when you stand up quickly? - No
-has anyone seen you when you fell? - No
-have you lost your consciousness? -No
-have you passed urine, bitten your tongue or has jerky movements? - No
-did you hurt your head? - No

After
-were you able to get up yourself?- Yes
-any confusion, N&V, headache or any weakness after the event? Any speech
difficulty?- No
General questions
-PMH; have you had any past illnesses like:
-DM? (Yes) what medication do you take for it? (Metformin) do you take it regularly? -yes
-Do you Have regular check-ups? (No)
-Hypertension?-
-Heart problems?- No
-Arthritis? (Has OA and joint pain) - No
-How is your vision and hearing? (Checked his eye 1 year ago and it was normal)
-Have you had any fractures?- No
-do you smoke? Drink alcohol?- Occasional drink
-do you have good support?- Living alone

PEFE:
General appearance: Pallor, dyspnoea, cyanosis, signs of trauma
Vital signs
-BP + postural drop: Present, PR + regular or not….. Temp….. RR
CVS
-JVP + carotid bruit
-Heart sounds+ murmurs - Normal
Respiratory – Normal
-air entry
-breathing sounds
-added sounds.
Neuro – Normal
- tone, power, reflex, sensation
-crania nerves + fundoscopy and vision - Normal
Joints
Any tenderness or restriction of movements? - No
GIT
-tenderness, organomegaly- Normal
ENT
-ear was, tympanic membrane – Normal
Office test UDP AND Blood sugar: Unremarkable

Explanation: There are few possibilities but from the history what I am suspecting that you have a condition we call postural
hypotension or sudden drop in BP from sitting to standing. What happens is when you stand up your blood pressure falls
hence brain does not get enough blood that’s why you are having dizziness. It can be due to dehydration, can be due to
Diabetic neuropathy but your DM is well controlled, Poly pharmacy or multiple drug unlikely in your case. However,
dizziness can be also due to heart disease where a heart vessel gets narrowed, can be due to anaemia, Stroke, Due to
hearing and vision problem, can be due to joint problem but these are unlikely.
I had time so I started with investigation: To identify the cause I will run some basic blood test and I will refer you to fall clinic.
Review you once results are come back.
Patient and examiner both were very happy. I thank the patient an left the room.

Station 6
5yo boy brought in by mother due to lethargy.
Hx
PEFE.
Dx with reasons + DDx

2 mins thinking outside: Sepsis, Anaemia, Diabetic ketoacidosis, Thyroid, Malignancy

Approach to patient/relative ..................................................................................................................................................................... 5
History ........................................................................................................................................................................................................ 5
Choice & Technique of examination, organisation and sequence ............................................................................................................. 5
Interpretation of investigation................................................................................................................................................................... 6
Diagnosis/ Differential diagnoses .............................................................................................................................................................. 6
I Entered the room there was a mom sitting on chair. I introduced with mom, and asked hemodynamical stability from examiner.
Examiner: Patient is stable you can proceed.
-Can you tell me what you mean by Lethargy (Feeling very tired for few weeks)
Does he feel tired the whole day or specific time? (He feels tired the whole day)
Does he feel tired the whole body or specific part? (No specific part)
Constant or intermittent (Constant)
-Hemochromatosis (skin colour changes)

Endocrine Q
-Any weather preference, any change in bowel habits (No)
-Diabetes (polyuria, polydipsia, nocturia, weight loss)
-Does he feel thirsty more frequently? (Yes)
-Does he pass large amount of urine? (Yes)
-Does he need to go to toilet more frequently? Does he need to wake up at night more frequently to pass urine? (Yes)
-Any lost weight recently? (Yes, few kg over some period).
Malignancy/ Infection
-Any loss of appetite, any Lumps and Bumps? (No)
-Any fever? Rash? Any recent viral infection? (No)
Complication of DM
-Any nausea or vomiting, tummy pain? (No)
-Any chest pain, funny racing of the heart? (No)
-Any confusion, drowsiness? (No)
-Any tingling, numbness, or weakness? (No)
-Any blurring of vision? (Yes, a bit)
BINDS
Did you have gestational Diabetes – No Immunisation- Up to date – Yes
4-General questions
-Family history of DM? (No)
-Is he taking any medication or OTC? (No)
-Past surgical history (No)
Physical Examination Card from the Examiner
-GA (DR PJL) , any rapid deep breathing (no dehydration, pallor, jaundice, LAP, rash)
-VS (normal)
-ENT (normal)
-Chest and heart (normal)
-Abdomen (clear)
-Office test: Urine dipstick (ketone Traced glucose +ve, no blood or leukocyte)
BSL (high) 13
From history and examination, most likely he has e a condition we call diabetic ketoacidosis. It usually occurs in people with type
1 DM. This means that there is a high sugar level in blood, but there is not enough insulin hormone. Insulin usually lets
sugar get into the body’s cells so if there is not enough insulin, the body cannot use glucose for energy and starts to use fat
instead. And the glucose level becomes high. This usually happens when the body’s demand for insulin suddenly
increase may be due to stress or recent infection or illnesses. so, when the body uses fat for energy, chemicals called ketones are
released into the blood causing DKA. As the level of ketone increases, it can lead to dehydration, confusion and if not
treated the patient can become unconscious. It can be due to Anaemia, Thyroid, Infection or Malignancy. But in his case,
this is unlikely. This is an emergency condition I need to send him to the Hospital.
I Thank the mom and left the room.

Station 7
30s man complains of “different coloured urine”.
Hx for 4 mins.
PEFE card given.
Dx/DDx.

2 Mins thinking outside: Viral Hepatitis, Alcoholic Hepatitis, Liver abscess, Gall stone , Pancreatic cancer, Pancreatitis
Assessment Domain .................................................................................................................................. Domain Score (see key below*)
Approach to patient/relative ..................................................................................................................................................................... 5
History ........................................................................................................................................................................................................ 5
Diagnosis/ Differential diagnoses .............................................................................................................................................................. 5

I entered the room and introduced with the patient. Hello Mr.X , I am one of the attending doctor here, I will look after you today
-What do you mean by different colour urine? Is it dark yellow, or reddish? Any fresh blood?
(Dark colour urine)
-Since when-2/3 days
-Any burning or stinging sensation? - No
-Any problem with your stream- no
Any frequency or urgency – o
Any feeling of incomplete evacuation – No 3-Associated symptoms:
-Any yellowish discoloration of skin, or change in colour of urine or stools? Jaundice and pale stool present
-Any nausea, vomiting? Fever?- Nausea
-Any abdominal pain? - Yes
-Any loss of appetite? LOW, lump or bumps?- Loss of appetite AND LOW present
-Any joint pains, any rash?
-Any Itchiness?- no
-Risk factors questions:
-Any recent intake of possible contaminated food and water? - yes
-Any recent travel? Travel to bali 2 weeks ago
-Any blood transfusion? – no
-Any past history of tattoos, piercings, dentist procedure? - no
-Any IV drug use? - no
-Confidentiality statement: Are you sexually active? Are you in a stable relationship? -yes, In a stable relationship
-Before this, did you have any other partners? Do you practice safe sex? Casual unprotected sex while in the trip
-Any recent exposure to sick persons or known hepatitis cases?
-Any past history of any liver problems?
-Any conditions that run in the family, especially affecting the liver? – no SADMA:
-Do you Smoke?-no
-Do you drink Alcohol?- yes
-Do you take recreational Drugs?
-Do you take any over the counter or prescription Medications? – no
-Any known Allergies? - no

PEFE: Jaundiced px. (+) RUQ scar from previous surgery. (+) Pale stools.
1- General appearance:
- Jaundice +, pallor, Icterus, rash, LAP
IV drug marks - no
Parotid enlargement, fetor hepaticus, spider nevi- no 2- Vital signs: pulse, BP- Normal
3- ENT especially throat and thyroid 4- Chest and heart- Normal
Abdomen:
-signs of portal hypertension – No
-hepatomegaly (yes)
Office test: UDT (urobilinogen +), BSL (bilirubin + ve)

From the history and examination most likely, you have a condition that we call Hepatitis that is Inflammation of liver. It can be
due to viral. It can be due to alcoholic liver disease, gall stone, pancreatic cancer, pancreatitis, Liver abscess, Nasty growth
in the liver but these are less likely in your case. To confirm the diagnosis, I will arrange some investigation.
Ball rang and I thank the patient and left the room. Marwan 242

Rest Station
 Station 8
Post-menopausal woman complains of unable to control bladder with small amount of passing urine. Had 2 kids in the past via
NVD (Birth wt Kid1: 3.1kg, Kid2: 3.9kg).
Do Pelvic Examination Give Your Diagnosis and DDs
On PE: Mannequin and RP are in the same direction of candidate’s eye view.
Mannequin is full covered by blanket

Assessment Domain .................................................................................................................................. Domain Score (see key below*)

Approach to patient/relative ..................................................................................................................................................................... 4
Choice & Technique of examination, organisation, and sequence ............................................................................................................ 5
Accuracy of Examination ............................................................................................................................................................................ 4
Diagnosis/ Differential diagnoses I entered the room and introduced myself and wash hands. Examiner, Dr take large gloves to wear.
Me: Examiner, I prefer to wear medium size, is that ok?
Examiner: Alright, you can start. I will be doing a pelvic examination on you. This would involve me inspecting your genital area
for any discharge, bleeding, or ulcers. After that I will perform speculum examination with this instrument to view the
neck of your womb or cervix clearly. After doing speculum examination the next step is bimanual examination feeling for
vaginal wall, the cervix, uterus, tubes and ovaries between my 2 hands. Are you happy for me to carry out the
examination?
A female staff will be present during the examination. If you could go behind the screen and undress yourself from the waist
down, then lie down on the coach with your both legs be bent with your heels towards your buttock and with knees apart.
You can cover yourself with the sheet provided and when you are ready, please call me. I will try to be as gentle as
possible but if you feel excessive pain at any time please you can feel free to stop me.
On standing position: Can you please stand and give cough, looking for leakage of urine; examiner: leaking of urine present. Any
lump is visible or coming down from vagina? – No
On lying position : -Inspection :ulcers, rash, vesicles, discharge, bleeding- no
Speculum examination: Ok well now I’ll be inserting this speculum.
Let me reassure you again it won’t be painful, but it may cause you some discomfort. Ok? Sure doc. I applied some gel and as I
was going to put it in, I kept speaking and reassuring the patient. Take deep breaths for me, it’s going in ok, deep breaths,
deep breaths, how are you, may I continue? I’m good doc. I’ll just fix the speculum and great it’s in position. You are doing
great. I will just have a look inside, ok? Sure doc. Cervix healthy, no bulging over ant and post walls of vagina, vaginal walls
healthy. Strain down for me please. Examiner said leakage of urine +. Thank you, examiner. Thank you. You are doing
great. We are done ok; I will just remove the speculum. Deep breaths for me as I remove it. There we go it’s out. Patient
was updated with cervical screening test and there is no discharge or bleeding, therefore I didn’t take swab. I wanted to
start Bimanual examination, but examiner stopped me and told me Bimanual examination findings- Normal
I thank the patient, clean the patient, and covered with sheet.
Thank you for your assistance. After examination, I think you have a condition that we call stress incontinence. I drew a diagram.
Explained possible causes like menopause and lack of oestrogen, birth trauma, constipation, chronic cough. Explained
other possible causes like UTI ad prolapse.

Sation 9
MSE schizophreniform. Video 4 mins. Do MSE. No need to do Dx/Ddx
Please watch some videos from YouTube. And see some passed feedback

Assessment Domain .................................................................................................................................. Domain Score (see key below*)

Commentary to Examiner .......................................................................................................................................................................... 3
Accuracy of Examination ............................................................................................................................................................................ 3

Station 10
Middle aged woman with lethargy and cold intolerance. She’s worried to have hypothyroidism
as her mother has hypothyroidism.
Perform Thyroid PE and comment on what you see Give your Dx and DDX MARWAN 156

Assessment Domain .................................................................................................................................. Domain Score (see key below*)

Approach to patient/relative ..................................................................................................................................................................... 5
Choice & Technique of examination, organisation and sequence ............................................................................................................. 6
Accuracy of Examination ............................................................................................................................................................................ 6
Diagnosis/ Differential diagnoses .............................................................................................................................................................. 5

When I entered the room started to introduce myself, good morning! My name is D. Susmita, I am your Gp today. I would like to
examine your Thyroid gland and explained about the examination, and asked for consent, then I washed my hand. Started
with general appearance:
In general appearance, she is a young, thin, and lean lady, however she does not look cachectic or ill. On inspection of the eyes, I
addressed that I cannot notice a real lid retraction or exophthalmos, in conjunctiva inspection, there was no pallor, as well
no other signs of anaemia such as angular cheilosis, or glossitis in the mouth. Then proceeded to the examination of the
movements of the eye, which were normal, and no lid lag was present. On inspection of the neck, there was no swelling. I
explained to the patient that I need to stand behind her and palpate her neck for the examination of the thyroid. I could
not feel the thyroid gland, as it was hardly palpable, and there was no lymphadenopathy in the neck. Also, no bruit in the
auscultation of the thyroid gland. During the examination I asked the patient to swallow her saliva twice and palpated
each side of the gland. Then proceeded to the auscultation of the heart. I listened to four spots on the chest and
mentioned that I can hear S1 and S2 clearly, without any added sound. Then the examiner said heart is normal. Then I
asked the role player to get up from the chair without using her hands or arms, and sitting again, there was no signs of
proximal myopathy. I checked her legs and feet for pretibial myxoedema. It was positive. Then proceeded to hands,
checked her pulse, I mentioned that pulse rate is regular. Then checked her Tremor there was no fine tremor in the hands,
the hands were dry, but no palmar erythema, and no swelling. no clubbing, no thyroid acropachy, also checking the biceps
reflexes on both sides which were normal.
I finished the examination and thanked the patient. Then started to explain that from the examination, most likely you have a
condition that we called hypothyroidism. Thyroid is a butterfly shape gland in the throat. It produces some hormones
which keeps us active. But in you case I think your gland is not producing enough hormone. Let me tell you what other
possibilities could be, infection in the thyroid gland that thyroiditis, In can be due to Autoimmune thyroiditis when your
immune system is work against your own body tissue, It can be due to any nasty growth in the thyroid gland but less likely
in your case. To confirm the diagnosis, I will arrange some investigation including Thyroid profile and some basic blood
test.
I thanked the patient and left the room.

Station 11
7. Toddler brought in by mother to the ED due to noisy breathing.
Hx.
PEFE card given.
Dx/DDx.
Mgmt. MARWAN 126

Assessment Domain ..............................................................................................................Domain Score (see key below*) Approach to

patient/relative .................................................................................................................................................................................
4
History ........................................................................................................................................................................................................ 5
Diagnosis/ Differential diagnoses .............................................................................................................................................................. 4
Management plan ...................................................................................................................................................................................... 4
Patient Counselling/ Education .................................................................................................................................................................. 4

2mins thinking outside: Croup, epiglottitis, Asthma, Bronchiolitis, Foreign body

-Is my patient hemodynamically stable?

-Examiner- Patient is stable, you can procced
Noisy Breathing
-can you tell me more? For how long?
-can you describe it for me? (High pitch sound while breathing)
-Onset (sudden or gradual/ continuous or intermittent)
-Does it occur at rest? During sleep?
-Does anything make it better or worse?
-Have you noticed that she is breathing too fast? - no
-Any particular posture the child prefers?- no
-Any chance of foreign body inhaled?-no
-Has this happened before?- no
Fever questions:
-Any recent fever? have you checked it at home? Is it continuous or intermittent?
-Have you given any medication? – no
-Rash? Fit or seizure? Vomiting? - no

Cough questions:
-Onset: for how long is she having cough? Sudden or gradual? What time of the day?
-Type: can you describe it for me? Is it like barking? ( yes Barking)
Is the cough followed by vomiting? - No
-Does she turn blue when she coughs? Does the breathing stop for a while? Any drooling of saliva? - No
-Pattern of cough
-Anything makes it better or worse?
-Runny nose- No
Dehydration:
-Activity? Sleepy or drowsy? – not active like before
-Eating or drinking well? – Irritable
-Any change in the bowel motion or urine? Number of wet nappies? - reduce
-BINDS
-Birth history
-Immunisation
-Growth and development
-Any other kids at home? Sick contacts?
-Anyone smoke at home? Pets/Carpets? (None)
-Past medical history (asthma, allergies, eczema, recurrent infections)- nil
-Family history (asthma, eczema, hay fever) + contact with someone with similar symptoms – nil
Physical Examination from the Examiner General appearance
-alert, irritable, restless, drowsy
-position (is he sitting still, in tripod position, drooling saliva) - Nil
-dehydration, rash, pallor, jaundice, cyanosis, LAP
-STRIDOR AT REST- No
-respiratory distress signs
*Nasal flaring
*Accessory muscle use
*Subcostal or intercostal recessions.
Vital signs especially temperature and O2 sat. (All normal just temperature high)
Growth chart
Ear and nose only Clear
Chest examination (clear)
Inspection: deformity, chest movement Palpation: chest expansion, tracheal position Percussion: dullness.
Auscultation: air entry, breathing sounds, wheeze, or crackles (Inspiratory stridor present) 6-Quick CVS, abdomen

From history and examination most likely, He has a condition that we called Croup. It is an infection or swelling of voice box and
windpipe making the airway narrower, so it is harder to breathe. It is usually caused by viral infection. Other possibilities:
epiglottitis, foreign body, asthma, bronchiolitis, pneumonia but less likely in his case. I will prescribe him steroid, 1 dose of
steroid now and 2nd dose he can have at home. Also, Panadol for temperature. We will keep him hospital and observe
him for few hours. If he is stable and you are confident, you can take him home. But keep an eye about some symptoms. II
thank the patient and left the room.
Rest Station

Station 12
30s man came in to your GP practice because he wants to finally stop smoking as father was recently diagnosed with Lung Ca.
Take history and asses his motivation
Counsel his accordingly
Assessment Domain Domain Score (see key below*) Approach to patient/relative 4
History 4
Patient Counselling/ Education 4
Management plan 4

-I entered the room and introduced myself.

-How are you today Mr.X
I am sorry to hear about your father condition! How is he now?
I really appreciate that you are here to discuss about smoking cessation.
-Let me just ask you a few questions about your smoking habits so we can appropriately plan for you, will that be alright? – Yes
doc
Let me assure you whatever we will discuss it will be remain confidential unless there is a chance to harm yourself or anyone
else.
-How many cigarettes do you smoke every day? -10 /12
-For how long have you been smoking? 10 years
-What time of the day do you smoke more? – any time of the day
-How soon after you wake up do you have your first cigarette? -
-Do you find it difficult not to smoke in a non-smoking area? - YES
-Is the first cigarette of the day the hardest to give up? - YES
-Do you smoke even when you are sick? - Yes
-Have you tried to stop smoking for good in the past but found you could not? What
happened? What happens if you don’t smoke? – Yes, I tried before before but I gave up.
-Do you drink alcohol? Do you take any illicit drugs? - yes, I drink alcohol but occasionally
-What is your occupation? (can’t remember now)
-Any history of epilepsy, kidney disease, or any mental illness? (Contraindication to nicotine replacement therapy- no)
-How motivated are you to quit smoking on a scale of 1 to 10, 1 being the least motivated, 10 being the most motivated? (9/10)
-To encourage you more on your journey to quit, I would discuss with you the risks associated with smoking and the benefits that
you will experience when you quit smoking. (For both ready and not ready to quit)
-Are you aware of the risks of smoking on your health? - Not that much
I really appreciate your decision of quitting as smoking not only affects your lungs, but it affects your whole body like heart, brain,
nerves and also your sexual life, so by quitting you will protect yourself from all these bad affects that it has on our body, u
will smell better, u will be able to save money, and will be able to concentrate on other things and on your work better. All
u needs to do is decide a date within 2 weeks. From now and u will be going cold turkey from that day. To help you with
cravings and all the other withdrawal symptoms like mood irritability, sleep disturbance, there is something we call it as
Nicotine replacement therapy which comes in the form of gums, patches, inhaler, and sprays, you will have to use it for 6-
8 weeks. We can involve your family with your consent for the emotional support and I can also refer you to Quitline and
support groups. For the stress that you have in your life try some yoga, meditation and swimming and have a good
lifestyle like avoiding alcohol and recreational drugs, having a healthy diet like citrus fruits as they are good for cravings. I
will follow you up in a 1-week time after going cold turkey to see how u r going and will give you the reading materials as
well.

Station 13
Post-menopausal woman presents with bleeding down below for 5 days now and is presently back in the clinic to discuss
requested Pelvic USG done. Px has been menopause for 5 years now.
USG results: (+) endometrial thickness of 11mm.
Relevant Hx.
PEFE. Explain results.
Dx and DDx.

Assessment Domain Domain Score (see key below*)

History 5
Choice & Technique of examination, organisation, and sequence 5
Interpretation of investigation 6
Diagnosis/ Differential diagnoses 5
2 mins thinking outside: Atrophic vaginitis, Endometrial hyperplasia, Endometrial or cervical polyps, Endometrial or cervical
cancer
I entered the room and introduced with the patient. There was an aussie patient sitting on Chair. I asked the examiner is my
hemodynamically stable: Yes stable, you can start.
Thank you, examiner.

History:
Hello Marie, my name is Dr. Susmita, I am one of the GP’S here. I will look after you today.
I can see you have bleeding from down below for 5 days can you tell me more?
Are you using any pad now? -yes
-How many pads have you used so far? Are they fully soaked (3/4 pads per day)
-What is the colour of the bleed? Are there any clots? (Fresh but no clot)
-Is it smelly? - No
-Has this happened before? - NO 2-Associated symptoms/ DDX
-do you have any abdominal pain, fever, nausea, and vomiting? - no
-do you feel dizzy or tired now? (Anaemia)- No
-any dryness from down below? Any burning or itching sensation down below? Any
abnormal discharge? (Atrophic vaginitis)- No
-any bulging from down below? (Polyps)
-any weight loss? Any lumps or bumps around the body? (Cancer)- NO
-any bleeding disorders? Do you take any blood thinner medications? - No
-are you aware of your blood group?
Menopause (instead of period)
-When did you have your menopause? 5 Years ago
-Do you experience any hot flashes, mood swings, heavy sweating? Do you experience burning or tingling when you pass urine?
Have you experienced any incontinence? Do you open your bowels regularly?
-Are you sexually active? Yes, Stable partner
-Do you experience painful intercourse? (Atrophic vaginitis) -Yes discomfort during sexual activity
-Any bleed after intercourse? (Cervical cancer) - No
-How many pregnancies have you had? (3?) HRT (instead of pill)- No
-Are you on any hormone replacement therapy? (Can predispose to endometrial hyperplasia)- No
Have you done your pap smear? What was the result? Mammogram? - Up to dated

Physical Examination from examiner:

General appearance: BMI + PODL
-BMI, pallor, lymph node enlargements, dehydration, oedema
Vitals: BP with postural drop, temperature CVS, R/S, CNS
Abdomen: Visible distention, mass, tenderness (abdomen is soft and non-tender) Pelvic exam
Inspection of the vulva and vagina:
-bleeding (+), discharge (no), rash, vesicles Speculum:
-does the cervix appear healthy?
-any bleeding from the cervix?
-vaginal wall (vagina is thin, dry and atrophic with diffuse erythema) Bimanual examination
-uterine size and tenderness of the uterus, adnexal mass and tenderness (uterine size is normal, no tenderness)

Explanation
From the history and examination, most likely you are having a condition called endometrial hyperplasia. The endometrium is the
normal inner lining of your womb. After menopause, the endometrial thickness should be less than 5mm. But in your case,
the thickness has gone up to 7 mm. When there is an increase in the endometrial thickness, it is called endometrial
hyperplasia. It is due to an unopposed stimulation of the endometrium by estrogen in the absence of progesterone. After
menopause, the ovaries shut down completely, so that only very low levels of estrogen are formed, with no progesterone
at all. However, estrogen is still being produced in the body through peripheral conversion of fat tissue and this estrogen
causes the stimulation of the endometrium. It can be due to atrophic vaginitis, cervical polyp, and endometrial cancer but
less likely in your case.
 Station 14
50s old female, presents in ED due to “upper abdominal pain with fever.”
Perform abdomen PE with commentary.
Discuss PE findings and DDx to the px.

PE: (+) RUQ PE. (+) Murphy’s sign. (+) peritonitis. DRE N.

Assessment Domain Domain Score (see key below*)

Choice & Technique of examination, organisation and sequence 4
Accuracy of Examination 4
Diagnosis/ Differential diagnoses 4
2 mins thinking time: Cholecystitis, Cholangitis, pancreatitis, Hepatitis, Liver abscess, Ca of head of the pancreas, Abdominal
Trauma, Lobar pneumonia, Gastritis
I entered the room and introduced with my patient. Asked examiner: Is my patient hemodynamically stable? Yes, you can start
the examination.
-How severe is your pain? 1 is less and 10 is severe ?7/8
-Would you like to have pan killer? Yes, doc that would be nice.
-Are you allergic to medicine? N0
-Ok I am going to arrange some painkiller.
I am going to examine your tummy this examination includes having a look, feel and listen to your tummy. Would that be alright?
During the examination I will be gentle as much as possible. Let me know if your feel any pain. I washed my hand and wear
gloves. Started with General appearance - in pain, No pallor
Hand examination: CRT, Pulse, Bp
Abdominal examination – inspection – flank not full, no signs of injury, abdomen moves with respiration,
palpation – light palpation – tenderness present in RHC, no rigidity, no guarding,
special test –murphy sign - +ve , deep palpation – no organomegaly, Bowel sound was present..
I didn’t mention about DRE.
I thank the patient and cover with sheet.
I explained the patient cholecystitis by drawing a picture.
As DDx I explained cholangitis, Hepatitis, Liver abscess, basal pneumonia, gastritis, Abdominal trauma, pancreatitis
Patient gave me weird look and examiner was not happy at all. Bell rang and I quickly left the room and took deep breath.

Station 15
20 years old man presents to your GP practice due to rash in the lower limbs. Picture provided
of “petechial, pinpoint rash” from the legs down.
History for 6mins.
Dx/DDx
Arrange Investigation
(Similar type of picture outside of room)

Assessment Domain Domain Score (see key below*)

Approach to patient/relative 4
History 4
Diagnosis/ Differential diagnoses 4
Choice of investigations 4

2mins thinking outside: HSP, ITP, Scarlet fever, Kawasaki, Meningitis, CMV, Rubella
-I entered the room and introduced myself with the patient. Hello Mr, Mike my name is Dr, Susmita
-I am one of the attending doctors who will look after you today.
-I can see you are complaining of rash on your leg, can you tell me little bit more about it?
Do you have similar type of rash anywhere else? Any pain or itching in the rash?
-Any discharge from the Rash? Does it go way if you press it?
-Do you have fever, cough, any flu like illness recently? ( URTI 1 week ago + )
-Nausea, Vomiting, Headache?
-Any stiffness in your neck?
-Any pain in your tummy
-Any yellowish discolouration of skin?
How is water works and bowel habits?
-Low, LOA?
Are you sexually active? Do you practice safe sex?
Any recent travel history?
Do you have contact with any sick person?
-Any personal or family history of bleeding disorder?
Are you taking any blood taking medication?
-Are you taking any over the counter, prescribed or herbal medicine?
-SADMA
Most likely you are having a condition called HSP. Have you heard about it? This is an inflammation of small blood vessels of the
body for example the skin, causing rash. It can also involve small blood vessels of the kidneys, intestine or very rarely lungs
and the brain. The cause is usually unknown.
However, it is usually an autoimmune disease usually triggered by the viral infection he had 1 week ago. So normally, our body
produces certain substances called antibodies to fight infection. In HSP these antibodies are attacking own body tissues
 and the small blood vessel It also can be due to ITP, blood thinning medication, CMV, Scarlet fever, Dengue but less likely
in your case.
To confirm the diagnosis, I would like to arrange urinalysis looking for protein and blood. FBC, UCE, Coagulation profile, stool
analysis looking for blood.
I will review you once results are come back. Bell rang, I thank the patient and left the room.

31st Aug 2022 Online Exam

1- Inguinal Hernia PE
2- Pediatric CVS examination with murmur
3- obstetric examination with CTG explanation
4 PE of rash- Urticaria?
5- Warfarin counselling
6- Unprovoked seizure in child
7- Rash on cheek of child- child abuse
8- Mania - patient’s father
9- Schizophrenia relapse
10- Cough due to GERD
11- Chronic foot pain
No specific cause identified
Foot movements restricted
12- Urinary incontinence
13- Breast lump in a lactating lady
No fever, wt loss is present
14- Antenatal for lady with high BP, high BMI with anemia and miscarriage 1 year back
[Link]- muffled heart sounds
16. Tension headache

September

6th September 2022 ftf

1) slipped capital - xray given ( hip and knee)
History, explain xray and diagnosis
Marwan 61

2) Dizziness case - everything normal , smoking history and taking HTN medication
History and contributing factor
Marwan 280

3) prostate counselling- old case

Gleason score 7 , no metastasis
Marwan 131

4) Allergic Rhinitis - stuffy nose and dry cough

History and diagnosis
Marwan 283

5) preeclampsia
History, examination from examiner , diagnosis and dd
Slide 179

6) Hyperemesis gravidarum - nausea and vomiting, lmp 6 week , urine pregnancy test positive
History, Pefe , diagnosis
Marwan 232 (handbook case)

7) Microcytic hypochromic anemia

Investigation given
History, diagnosis and dd
Marwan 199

8) 4-month child - vomiting - Gerd

History, diagnosis and dd
Alan file gerd case

9) Serotonin Syndrome - Taking escitalopram and add mirtazapine fewdays ago

Psych notes Marwan 244

10) mse and mmse video

Present to examiner

11) Red leg - no fever history.

All history given in stem
Take history 3 min
Diagnosis and immediate management
230 marwan

Examination:-
1)Shoulder examination
2)Abdominal examination - Fibroid - uterus retroverted and 14 week mass size➔ PE notes case 3
3) Abdominal examination- left iliac fossa pain

06 SEP 2022 (F2F)

STATION 6 (Pass)
60yr old farmer presenting with R/leg pain and redness. No fever. HTN on ACEI. A pic of the leg given in the stem.
Tasks : Hx, Dx with reasons, immediate mx

(The photo looked similar to this with redness extending from below knee to ankle)

(PAD+cellulitis recall) Going in to this station, I hadn’t the faintest idea it was this recall. The photo of the leg was given on screen.
Asked all Qs for DVT, insect bite, wounds as subconsciously I was trying to connect red, painful leg and no fever together. Nothing
was positive. I hit a thought block and had to take a few seconds to get myself back on track. Remembering he’s a farmer I asked
what sort of activities he does on the farm and he said “I have to walk a lot”! That sparked the thought of PAD and yes his pain
was brought on by walking a certain distance and relieved by rest. No rest pain. No night pain.

Thinking back, I may not have followed through with all of SIQORRAA or I would have got to the diagnosis earlier. Im blaming it on
the first station jitters for not being focused enough.

I mentioned PAD along with cellulitis or erysipelas as PAD alone will not give the redness. For Mx- mentioned Ix : Venous doppler
of lower limbs (can’t recall if I mentioned MRA at all), blood investigations FBC, CRP, Blood lipids, FBS. Antibiotics, graded
exercises and time was up.

Global score 4
Approach to patient/relative 5
History 3
Diagnosis/ Differential diagnoses 4
Management plan 4
STATION 7 (Unscored)
55yo man having dizziness. Hx, Dx and contributory causes

No positives for PICA Sx or any other central or vestibular causes of dizziness. Hx

revealed heavy alcohol use and daily cannabis use. No head injury.
Washout period
STATION 8 Rest
Why medicine was added
STATION 9 (Pass)
47yo lady with anaemia. Ix given in stem FBC - MCV low, MCHC low, PLT nl, WBC Proper dose?
nl, Poikilocytes and Anisocytosis seen in peripheral smear.
Tasks : Explain Ix to patient, Hx, Explain the Dx to pt with DDs When medicine was stopped

(Hx revealed NSAIDs for knee pain for 2 years, diet good, no obvious GI bleeding, Don’t ask long psychosocial history
menses regular and minimal bleeding, no suspicions of Thal)
Again the typical recall. Anaemia was a very frequent case this year. A bit of extra Explain condition in 2 min
practice on the common cases paid off here.
Then mx in 2 min
Global score 6
Approach to patient/relative 7
Interpretation of investigation 5
History 5
Diagnosis/ Differential diagnoses 7
STATION 10 (Fail)
GP setting, 30yo man diagnosed 4 weeks ago with depression. Started on antidepressants then. Has problems with sleep. No
improvement yet. 2 days ago Mirtazapine was added. Now having fever, irritability and profuse sweating. Tasks: Hx, Dx with
reasons, Immediate mx

Recall of Serotonin Sx. I’ve lost this case bcos of management. I don’t remember mentioning stopping meds.

Approach to patient/relative 6
History 5
Patient Counselling/ Education 4
Management plan 2
Global score 3
STATION 11 (PASS)
4 month old baby vomiting.
TASKS : Hx, PEFE card, Dx with reasons, management

The usual recall of GOR. Mom didn’t seem overly concerned. Asked CCVO of vomitus. Milk colored, small amounts. When asked if
the vomitus goes far away from the baby, she said “no its not projectile, more like posseting”.
Vomiting since few days after birth. Almost after every feed. Breast-fed. No excessive crying. Well-baby Qs all normal. Otherwise
healthy well-grown baby. BINDS all normal. PEFE card all normal. Gave the growth charts as well.

I gave the diagnosis as Gastro Oesophageal Reflux and explained the cause as ‘the sphincter at the lower end of the food pipe not
developed yet’. Drew a small diagram showing the oesophagus and stomach. Gave DDs for vomiting as Infections such as UTI,
meningitis, gastroenteritis, Pyloric stenosis, Duodenal atresia, Intussusception, Intestinal malrotation, hernial obstruction, CAH (I
honestly can’t remember if I said all of these)

Mentioned what the mom can do about this. Wind the baby after every feed, keeping the baby in an upright position at least for
20 mins after feeds, add milk thickeners to expressed breast milk, tummy time helps too, also elevating the head-end of the cot
slightly. Reassured the issue most likely will settle within a few months specially when weaning starts and feeds are more solid.
Couldn’t offer review, redflags or reading material.

GLOBAL SCORE 4

STATION 12 (Pass)
Middle aged lady, stem gave the idea of anaemia due to menstrual problem. Tasks : Perform relevant? PE while explaining to
patient, Give Ix that you’d do.

Patient was seated on a chair in the middle of the room. Clock and BP apparatus was available and was expected to do. Abdomen
on real pt, when asked for gyn exam, said

Approach to patient/relative 5
History 4
Diagnosis/ Differential diagnoses 5
Management plan 4
uterus 14 wks size. No other positives. Was just able to say USS over the examiner telling me times up. Didn’t think I’d pass this
but I have.

Global score 4, Average score just above 3

STATION 13

Rest

STATION 14 (Unscored??)
POA 36 weeks lady not feeling well. (Stem gave minimal details) Hx, Pefe ask from examiner, Dx to patient with reasons

(Typical recall of Pre-eclampsia. Pt complained of headache, RUQ pain, ankle swelling. Pefe BP high, protinuria on UDS)

STATION 15 (Pass)
60 yo man with pain in R/shoulder. Fallen on the shoulder 1 month ago. Tasks : PE, Dx and DDs to pt

Role-player was seated on a chair, had a gown on him. Was holding the right arm close to his body in a protective posture. He
showed difficulty in taking the gown off as if painful. He was so good in his acting I automatically offered to help.

Inspection of both shoulders normal. Not warm or tender. Palpation I did on left(normal) side first and then the right. All
movements of the R/shoulder were painful and restricted. He grimaced whenever I tried to move his arm and couldn’t complete
any of the movements or special tests. I tried doing empty can test, drop arm test and Neers test. Can’t recall if I mentioned
sensation over the lateral arm.

Therefore I said most likely Adhesive capsulitis of the R/shoulder (Frozen shoulder) and gave DDs as rotator cuff impingement or
tears, biceps tendon injury, labral tears but didn’t have the time to mention septic arthritis, osteoarthritis.

Approach to patient/relative 5
Choice & Technique of examination, organisation and sequence 5
Accuracy of Examination 5
Choice of investigations 0
Choice & Technique of examination, organisation 5
and sequence
4
Accuracy of Examination
Diagnosis/ Differential diagnoses 4
Global score 4

STATION 16 (Fail)
15yo had LOC after running a race. Child looks a bit pale but otherwise recovered. Ecg given as normal in stem. Blood sugar 4
mmol/L ? Tasks : Hx from mom, Dx with reasons and Immediate management.

When I asked an open question, mom mentioned that the child ran the race, at the finish line she sat on the ground and collapsed.
No abnormal body movements noted. When questioned specifically, said didn’t have breakfast and it was a very hot and sunny
day.
Sorry I can’t recall anything about PEFE here.
I explained the diagnosis as hypoglycaemia and dry hot day so possibly vasovagal as well. I can’t remember if I told any other DDs
here. I honestly didn’t know what to say for initial management. I think I mentioned some thing sweet to eat or drink like 6-7 jelly
beans or a glass of juice followed by a proper meal. Then looking at the stem, I suddenly noticed that it was mentioned that she
was pale. I panicked and said I’d like to do a FBE just to be sure that there’s no underlying

anaemia. I may have lost the case bcos of this.

Approach to patient/relative 4
Global score 3, average score 4
History 4
Choice & Technique of examination, organisation 4
and sequence
3
Diagnosis/ Differential diagnoses
Management plan 3

STATION 17 (Pass)
Young lady with nasal congestion for 4 days.

Tasks : Hx for 6 mins, Dx & DDs to pt.

Open ended Q didn’t reveal much here. Further questioning revealed stuffy nose, wheezing and dry cough for 4 days. No fever, no
precipitating event like exposure to

allergens. Tried using husband’s ventolin puff. Can’t remember if symptoms improved with it. Has a childhood hx of asthma. On
OCP, no other meds. No significant PMHx. I just can’t remember what I gave as the main DD but I mentioned allergic rhinitis,
common cold precipitating an episode of asthma, sinusitis, adenoid and tonsillar hypertrophy.

Global score 5

STATION 18 Rest
STATION 19 (PASS)
Prostate Ca identified by urologist and Dx told to patient. Ix given in stem - [Link] positive for UTI?, PSA high, Prostate Bx
stating malignancy but no capsular invasion, No mets. Gleason 7.
TASKS : Explain Ix to patient, Implications of Dx?, Mx options

This again is a recent recall. I greeted the patient and immediately he said, “Doctor the specialist told me I have cancer but
nothing else went into my mind afterwards.” So I explained all the investigations stating their name and what it means. With
more words of empathy I told him that he does have cancer of the prostate which is limited within its capsule. Explained the slow
growing nature of this cancer and talked about management options available. The specialist may decide to watch and wait,
orchidectomy, radical prostatectomy which may have complications such as erectile dysfunction.

Global score 4

Approach to patient/relative 4
History 5
Diagnosis/ Differential diagnoses 5
Approach to patient/relative 4
Interpretation of investigation 4
Patient Counselling/ Education 4
STATION 20 (Pass)
27yo lady in early pregnancy, c/o nausea and vomiting. Tasks : Hx, PEFE from examiner, Dx with reasons

(Hyperemesis G.)
In hx asked HOPC of vomiting, “can you keep anything down?” - she said no, DD Qs in early pregnancy vomiting such as molar
pregnancy, gastroenteritis, fmhx of multiples - nothing else positive, 5Ps (First pregnancy, everything else good)
In Pefe asked for all signs of dehydration, only dry mucous membranes positive. UDS ketones positive, no nitrites.

Global score 4 marwan 232

Approach to patient/relative 5
History 4
Choice & Technique of examination, organisation 4
and sequence
4
Diagnosis/ Differential diagnoses

STATION 1 (Fail)
55yo lady with LIF pain. Had a bowel motion that morning. Tasks : PE and Dx, DDs to patient

Examine on real patient. HD stable, T 38c?, tenderness over LIF. I didn’t palpate over the LIF as it was tender but mentioned I’m
not able to check for guarding bcos of it. DRE (can’t remember the exact findings the examiner gave. Was inconclusive) Gyn
findings I didn’t have time to ask in detail. ?Diverticulitis

Here I messed up on the sequence a bit and didn’t give good enough DDs I feel. Also in my hurry, put gloves on without sanitizer

Global score 3

Approach to patient/relative 4
Choice & Technique of examination, organisation and sequence 3
Accuracy of Examination 3
Diagnosis/ Differential diagnoses 3
STATION 2 (Pass)
67yo lady with SOB. Farmer’s wife.
Tasks : Hx for 6 mins, explain the Dx, DDs to patient

Hx revealed SOB on minimal exertion, she finds farm work increasingly difficult. Had palpitations - drummed a very irregular
rhythm, and Orthopnoea. No evidence of anaemia. No Hx of chest pain. PMHx - DM on Metformin, Gliclazide. Also on ACEI. Good
follow up and control. Not a smoker.

I gave the diagnosis as Heart failure and said could be due to silent MI then gave other DDs for SOB such as anaemia, asthma,
COPD, lung cancer, occupational lung disease.

Global score 5

Domain Score STATION 3 Rest

Assessment Domain
(see key below*)
Approach to patient/relative 5
History 3
Choice & Technique of examination,
3
organisation and sequence
Interpretation of investigation 5
Diagnosis/ Differential diagnoses 4

STATION 4 (Fail)
9yo basketball player. R/thigh and knee pain for 1 month.
Tasks : Hx from mom, PEFE from examiner, Explain X-rays to mom, Explain Dx and DDs to mom

(SCFE) 2 X-rays were available on the table of the Right knee and the hip joint.
Thought I would pass this one. Seemed to be a pretty straightforward case. Looks like I missed some important points in hx and
Pefe. In pefe I wasn’t specific enough in asking the Qs and the examiner asked me ‘which joint on which side are you asking
about?’

Approach to patient/relative 5
History 5
Diagnosis/ Differential diagnoses 5
Global score 3, Average score just above 3

STATION 5 (Pass)
MSE video. Stem gave a 22 yo man with heavy alcohol use getting into fights. Tasks : Present the MSE to the examiner

Once in the station and ID checked, a count down from 20 was on the screen which gave me just enough time to jot down
ASEPTICJ3R.
In the video they started assessing the orientation, registration and recall. Did a frontal lobe test (name as many animals as you
can) and then asked about hallucinations, a bit about delusions. Task was to explain MSE to examiner.

I had to check the task again after the video bcos the video was a jumble of many components. I commented according to the
MSE sequence and then gave the additional findings of Registration, Recall and Frontal lobe test.

Global score 4
7th Sept 2022 FTF pm session
Physical examinations:
1. Ankle pain, marathon runner.
2. Eye, Uniocular diplopia..hx of DM,HTN, PE
3. Acute abdomen..generalized abdominal pain,hx of constipation,Lmp 3 weeks back.. max intensity to left side (ruptured
diverticula with peritonitis)
Other cases:
4. 3 years old child with unprovoked seizure..hx of 2 episodes of febrile convulsions Marwan 148
5. 5 years old with bedwetting.. dry during the day — Alan
6. 7 years old with headache(Headache in child one day have sore throat & inflamed TM)
7. Ocps request Contraceptive counselling, 17 year old girl
8. MS in pregnancy mid diastolic radiate to left fateinl??)
9. Mania
10. MSE..GAD plus borderline personality disorder
11. Temazepam repeat prescription
12. Pt on warfarin,atorvastatin,perindropril..for elective hemicolectomy — Marwan 277
13. [Link] esophagus..hx of longstanding Gerd. ( Wt los 6 kg in 6 weeks) Marwan 79
14. Hay fever
15. Neck pain. Cervical radiculopathy Marwan 51
16. Chest Xray, pleural effusion. Pleuritic chest pain (pneumonia, pnenothsia??, pleural effusion).Marwan ۱۳۶

8th sept 2022 FTF

1. 40 years old female presented with on going headache. Has previously diagnosed asTension headache and also undergone
MRI Which was normal
Presenting several times with different pains. No past medical historyToday also coming ,with headache
1. History
2. Discuss the diagnosis and DD
3. No examinations or management

2. 65 years male coming with cough and recent LOW. No other past medical conditions
1. Do Respiratory examination
2. Discuss the DD with the patient

2. 47 years old mother who is on Diazepam 15mg tds from 6 months. Started as her child has diagnosed with Leukemia but
now on remission. Worried about the dose andneed to stop that. No other medical conditions
1. Brief history
2. Discuss the whether can stop and of so plan of cessation

3. Nurse comes to you with history of excessive vomiting of 2 days old baby in the nursery. Coming with an Xray (X-ray dilated
small bowel loops)
1. Brief history from the nurse
2. PEFE
3. Describe the X-ray finding to the nurse
4. Discuss the diagnosis and DD
2. MSE of 17 year old female, Coming with behavioral change and poor [Link] in by father and it was admitted
18 months ago for Scizophrenic relapse.
1. Observe the Video
2. MSE to the examiner

3. 22 years old male coming with throat pain and difficulty in swallowing. Not had anything from the mouth for past 24hrs
1. Do relevant examination
2. There is a model of ear if need to do relevant examination

4. 47 years old female mother of 3, last child is 17 years old. On OCP for 17 years and now she wants to stop it. No other
medical conditions
1. Relevant history
2. Discuss about the contraceptive method options

5. Post op 67 years old male. SOB breath for 6 hrs. Long history. Surgery done for colonCA and there is no complications on
that. Post op chart has given.
1. Interprit the Post op observation chart
2. Relevant PEFE from the examiner (R/s Lowelr lobe reduced air entry withcrackeles)
3. Describe the diagnosis and DD to the patient

6. 22 years old female coming with bleeding rectum. Not associated with stools. Severalepisodes. Had a trip to Bali and
developed a diarrhea where she was started with antibiotics. Father diagnosed with CA colon recently and she is scared
that she is having a CA
1. PEFE from the examiner
2. Describe the possible diagnosis to the patient
3. Counsel regarding further follow up if needed

7. 32 years old male. Presented with R/S Leg pain for one day
1. History
2. PEFE
3. Explain the diagnosis

8. 22 years old female. Postpartum 6 weeks. Had instrumental delivery and tare. 4.12 kgbaby. Otherwise normal. Tried sex
recently and was painful and also experiencing passing urine when coughing. Coming for postnatal check up
1. Relevant examination
2. Explain possible diagnosis to the patient.

9. 54 years old male, Presented to check the BP to the GP clinic. BP normal and he is only on one antihypertensive and having
hyperlipidemia. Complains that he is feelinglethargic and tiredness for some time
1. Relevant history
2. Explain the diagnosis and DD for the patient
10. Mother of 12 month old child coming with sudden onset seizure like episode whichwas lasted fr 2 to 3 minutes. Resolved
and now the child is drowsy
1. History
2. PEFE
3. Explain the diagnosis to the patient and what to do next time

11. 20 week pregnant lady, First pregnancy and all the investigations and pregnancy up tonow was normal. Coming for a
consult
1. Take relevant history - (Describe a itchy, mild painful rash in the vulva)
2. PEFE
3. Explain the diagnosis

12. 50 years old male coming with Upper abdominal pain for 2 days. No other pastmedical history
1. Take history ( says R/s upper hyperchondrial pain and says taking Marjuana
2. PEFE
3. Explain the diagnosis

8th September 2022 passed feedback

Candidate 1 (C1): is in chocolate (recall was from Telegram).

Candidate 2 (C2): is in blue. I collated these questions and provided a more detailed stem info.
Candidate 3 (C3): is in green.
Candidate 4 (C4): is in red (recall from AMC clinicals)

STATION 1: HEALTH CHECK (OSA) -- PASSED

1. Middle aged man, came in due to tiredness and lethargy. He is usually seen by your colleague but he is on a holiday. He is a
known case of HPN and hypercholesterolemia on which he takes medications. BP is 135/80.
Tasks:
1. Hx for 5mins.
2. Explain Dx with reasons and DDx to px.

54 years old male, Presented to check the BP to the GP clinic. BP normal and he is only on one antihypertensive and having
hyperlipidemia. Complains that he is feeling lethargic and tiredness for some time
a. Relevant history
b. Explain the diagnosis and DD for the patient

Hx, PEFE, D and DDx

Not sure what it was…
Does not look like heart failure or COPD, possibly hypothyroidism but very active and strong character Good mood, sleeping well
Some stress on work as recently changed jobs Good relationship with wife and a son
Good appetite
Positive history was that he has gained weight by 7-8Lg recently Had a feeling of psychiatric problem but , not sure…

Px is a cheery man. Cooperative and answers questions very quickly. This is also my first station. Started with open ended
questions then asked the patient to describe “tiredness and feeling lethargic”. Described as if he has not rested well and
has been going on the past 6mos.
Asked for anything significant that has happened the past 6 mos - has he been sick then and was fatigued afterwards? (No)
although he recently changed jobs (works as a Parking attendant).
Any graveyard shifts? (No, I start work at 7am onwards. A bit stressed from work because of this feeling tired.) Went straight for
HEMIFADOC questions but not all was assessed.
(No noted skin discoloration - yellowing or tanning of skin. No weather preferences. No LOW, LOA, LBs. Speaking of weight Dr, I
even gained weight - around 7-8kg in the past 6mos! **Followed up asking his diet** At night, eats mainly fruits and
 better food but at lunch time, usually just takeaways as he cannot leave his post. Not been sick lately just tired.**In the
middle of this, the RP gave a long big yawn which I took as a clue and asked about his sleep and that he seems sleepy with
the big yawn (as I’m trying to establish rapport) - he thinks is fine as he sleeps from 10pm-6am so he can get ready for his
7am work. He snores and his wife complains a lot about it and now, the wife sleeps in another room. No increase in thirst
and he thinks his appetite is okay. No changes in stool and urine.)
Followed up quickly with his HPN and Hypercholesterolemia background. (He has been compliant with his meds and follow up
with my original GP and his GP, your colleague, has been happy so far with recent workup results)

I then quickly explained that what he has is OSA and that it’s evident with his wife’s complains of his loud snoring. It has been
more prominent as well because he has gained weight. Correlated that we need to manage his OSA as it can greatly
increase his CVD risk as he already has some risk with his HPN and hypercholesterolemia. No management here. I went
through my other DDx and time was up.

STATION 2: SHORTNES OF BREATH (Post op hemicolectomy chart explanation) -- FAILED

2. Elderly man, day 7 post op hemicolectomy, presents with shortness of breath. (Very long detailed stem). A post op chart
starting from day 6- day 7 is provided.
Medical Hx of the px is provided. Previous heart attack 5 years ago and on maintenance meds (list and dosing ). (From another
candidate’s recall: Pt background with HTN and something… Was on furosemide and aspirin and some antihypertensives
but those have been off since surgery. Currently on prophylactic enoxaparin - Clexane). Px is now eating regularly.
Tasks:
1. Request PE from examiner.
2. Interpret the chart provided to the examiner.
3. Explain the findings to the px and what Dx/DDx you’re considering

Post op 67 years old male. SOB breath for 6 hrs. Long history. Surgery done for colon CA and there is no complications on that.
Post op chart has given.
c. Interpret the Post op observation chart
d. Relevant PEFE from the examiner (R/s Lowelr lobe reduced air entry with crackeles)
e. Describe the diagnosis and DD to the patient

SOB day 7 post hemicolectomy, middle aged man

There was an observation chart of vital signs for the last two days (day6 and day7) on stem monitor Pt background with HTN and
something
Was on furosemide and aspirin and some antihypertensives but those have been off since surgery Currently on prophylactic
enoxaparin
Task was
1. PEFE
2. Comments on the chart for normal and abnormal parameters
3. D and DDx to patient
Interpreted to examiner: Low grade temp but otherwise stale vitals, SpO2 95-96 on room air Chart – HR was uptrending
Low grade temperature BP 140- 150
Urine output – has not taken (examiner) Body weight – not available
ECG – not available

Positive findings on PEFE was only ‘decreased air entry on right basal area with dull percussion’ Abdomen soft
I said – atelectasis which may or may not associated with pneumonia….
Greeted the patient and asked if he is in any pain and that if he needs pain relief prior to proceeding to the first task and excused
myself. (He said pain relief was already given but he’s having SOB).
I asked if the px is hemodynamically stable prior to starting and requested for vital signs. (vital signs given as per chart). I did ask if
there are any surgical report (none given).
I was thinking of the 5Ws (post op reasons for fever: wound, water (bladder), walking (if already ambulatory), wonder drugs
(anethesia meds, pain meds, PRN and regular meds given post op), wind (breathing problems - atelectasis/pneumonia
etc)) as my main guide + PMHx of the px.
Started from the hands - any IV fluids (no more). Checked peripheral cyanosis, palmar erythema, cold clammy hands. Then
checked for pulses and radio-radial delay. Checked for arms for scratch marks, IV marks - new and old. Then requested for
BP. Checked for CVS system (JVP normal, s1, s2 heard, no murmurs, no carotid bruits) and Respiratory system (what do
you want to know?) - air entry, if there is any chest lag, any wheezing and adventitious sounds --- (some dullness and
crepitations on the base with ** can’t remember if just one side?!?).
Are there any I/O chart. Any urinary catheter attached? Any colostomy attached? (Not available. Only as per the chart). Asked for
the wound site, Is it hyperemic, swollen, pus discharges, tender to touch and Renal angle tenderness? (no signs of
infection, abdomen is noted to be non tender with good bowel sounds)
Requested for DRE with chaperone and px’s consent. (Unremarkable).
Requested for ECG, Urine Dip, BSL (whatever is given Dr)… *I forgot I was in the Hospital ward setting*
Requested for examination of the legs, if there is swelling edema, redness and distal pulses of the legs (some bilateral swelling,
pulses intact, no redness).

Proceeded with the chart. Day6 - 7 post op.

The chart was easy to interpret. I basically explained the trend within the two day marks.
Px breathes in room air (RA). O2 sat initially at roughly around 97-99 but decreased to 95-94% in RA. HR also increased from 80s
to 98-100 bpm.
Temp also from 36.5C to 38.5C
RR also increased from 19 to 24 per min.
BP also increased (can’t recall the median range) No I/O

Correlated this to the px. I initially told him the possibilities of his SOB on which I initially tried to rule out any infections from
either his wound site, urine or stool but I don’t have any data of input/output but it’s good that he’s tolerating eating and
his wound site is healing well. There is swelling in both legs and correlating it from previous heart attack, it could be that
your heart is unable to fully compensate with the present situation although it is not fully failing (no increase in JVP). I am
still suspecting that there could be a possibility of the him having a starting lung infection (left lobar pneumonia), made
worse by his less compensated heart function.
**This is one of those stations that I thought I did okay but clearly it’s not. I am unsure as to why I scored so low with Dx/DDx -
clearly I guessed wrong and was in the wrong direction. I am so unsure what exactly they want. Maybe add more DDx?**

STATION 3: REST
STATION 4: CONTRACEPTION (Px on OCP, other possible contraception) -- PASSED
4. 47yo lady came to your GP practice for advice in regards to contraception. She is a mother of 3, with her youngest now
presently 17yo. She has been taking COC pills since she gave birth to her last child and now would like to stop the pills and
switch to other options.
Tasks:
1. History from the patient.
2. Discuss to her possible options for her request.

47 years old female mother of 3, last child is 17 years old. On OCP for 17 years and now she wants to stop it. No other medical
conditions
f. Relevant history
g. Discuss about the contraceptive method options

OCP counselling 47 yo female

Has 3 kids with the youngest already 17 yo Still having regular and light period
Husband not cooperative to contraception (does not want to use condoms and not wanting vasectomy) Asking for other options
for contraception as she has been sick of taking OCP
Task
1. Hx
2. Relevant PEFE
3. Counsel

*This is a very cooperative patient.*

Upon greeting the px, the px opens up right away “Dr, I am hoping you could help me with my pills.. wondering if there are other
options other than the pills.”
Addressed the patient’s concern and went to asking questions. I did tell her that some questions may be sensitive and that all will
be confidential. She’s good with it.
Why would you like to switch to other contraceptive methods? (It’s been such a long time I’m taking the pills. It gets tedious and
at times I forget. Hoping there are other options that are not as recurrent or tedious than the pills).
Since when are you taking the pills (Since after my last child was born. He’s now about to go to Uni as he’s now 17!) Did you have
side effects of the pills that you didn’t like? (not really Dr.. It’s just really difficult to take it daily.)
5Ps (regular monthly period still although now less in amount; never had mid-cycle bleed; no note of sudden change in amount of
bleed; no unusual discharge down below; no unusual rash/itching down below. 3 pregnancies, no miscarriage, all NVD.
Happily married; ??unknown of any STD. Regular CST done with normal results, recent CST was N)
Breast complaints (none). Mammogram done (N? *unsure if not done or Normal.. can’t clearly recall now but from what I can
remember nothing significant*)
PMHx:
Any past incidents of blood clots or problem in the blood that runs in the family (none) DVT, stroke, MI, PVD, DM (none) *forgot
to ask thyroid DO*
Changes in skin color like yellowing? (none). Dx with liver disease? (none) MIgraine or severe headaches (none) Fhx of Breast or
cancer from down below? (none)
Any surgical hx in the past? (+ Ovarian cyst before that resulted to surgical removal or R ovary.. no problem since then) Smoker
(none), Drinks alcohol (very seldom) *forgot to ask recreational drugs*

Advice: opened options and explained accordingly.. Implanon - (she listened but declined)
Mirena or IUD - (again she declined)
*In both occassions, I emphasised that this does not protect you from STD* Barrier methods such as condoms (husband doesn’t
want this..)
Opened surgical options: Vasectomy (she declined and thinks her husband will not be up to this)
Last option, Fallopian tube (FT) ligation (she becomes interested).. explained to her that it’s usually a one day admission in the
hospital. They will take your FT and either cut it completely or bend/tie it (*I think I explained it so off*). On very rare
occasions, some women may still get pregnant but these are rarity. Offered reading materials with all the options so she
and her husband can discuss what they would want. I have referred her as well to OBG for further assessment and advice.
 Times up!
*Forgot to let her know of abstinence, withdrawal method, and 3monthly hormonal injections*

STATION 5: Febrile convulsion -- PASSED

5. A 12 month old child was brought in by her mother to your GP practice due to a 2-3minute seizure episode. Child is now stable
although appears to be drowsy. Mother is worried of the child’s seizure episode and has consulted you.
Tasks:
Hx for 4mins.
PE from examiner.
Most probable Dx and advice the mother.

Mother of 12 month old child coming with sudden onset seizure like episode which was lasted fr 2 to 3 minutes. Resolved and
now the child is drowsy
h. History
i. PEFE
j. Explain the diagnosis to the patient and what to do next time

12 months baby
Mum brought the baby after? Convulsion
1. Hx
2. PEFE
3. Dx and management

Low grade fever but not particularly unwell baby Normal development
Immunization up to date
Mum said: She suddenly became stiff and turned blue, then some shaking movement

PEFE – stable at the moment, pink, reactive, temp 37.8 , examniner said ‘neurological examination was normal’

Upon greeting the RP, she straight away opened her spiel, “Doctor please can you tell me what happened to my child? Why did
this happen? I’m very concerned how she will be?”
Reassured the mother and asked for the mother’s name and her child’s name. Addressed them accordingly and assured the
mother that her child is much better now albeit just seems tired and drowsy from the ordeal. I then did asked her
cooperation for questioning.

Pertinent (+)s from the mother: She was changing the nappy of her child when all of a sudden the child stiffened, whole body was
jerking with her eyes rolling upwards. As she does not know what to do, she just held her child all throughout making sure
she does not fall off her arms. Once the daughter stopped shaking, she went straight to GP practice. Prior to the incident,
the daughter has had some colds 2 days ago, then on the day of consult, daughter was just feeling warm. Temp not taken
(no thermometer at home).
Appetite went low and less active. No noted changes in urine/stool other than less frequent. Tummy of her daughter was soft
and was never felt hard/rigid. No episodes of vomiting. Antipyretics not given.
BINDSMA: U/R pregnancy and birth hx. Immunisations at par. Diet (? not asked directly) but was feeding both milk and solids.
 Mother happy with daughter’s development. No noted allergies/asthma in the child.
Mother and husband have no FHx of seizures or epilepsy. No FHx of blood disorders or hereditary conditions.

On PEFE: Px is alert, not crying but clingy to mother, is hemodynamically stable but looks exhausted. No signs of dehydration.
Present Temp: 37.8C. Rest of VS given (except BP) and are within norm range.
Growth chart all within 50% correlates with previous visits.
CVS, Respiratory, Neurovascular and Abdominal exam was normal.
Office tests: Urine dipstick, Stool exam - no data. BSL - within normal range.

Explained to mother as Febrile Seizure episode. Requested that she be given thermometer prior to leaving the practice and to
take note of the daughter’s temp. Explained about the immaturity of her brain to handle sudden changes in body
temperature hence comes out as seizure reaction. Reassured that this is common for their age. Antipyretics given either
oral or PR. Advised on what to do if it happens again and red flags to watch out. Given reading materials and to follow up if
repeat seizure incident happens and if more than 5mins duration.

Station 6 - PILOT
22yo F, Rectal bleed (came from Bali), father had rectal ca at age 52yo.
6. 22yo lady came to your GP practice due to noted blood in the stool. Blood in stool is described to be fresh, bright blood, not
mixed with the stool. No mucus in stool. She recently just arrived from her Bali trip on which she also had diarrhea
episodes and was treated with antibiotics. She is concerned if this symptom could be cancer as her father at age 52yo was
diagnosed with Rectal Cancer.

Tasks:
1. PEFE from examiner
2. Advice the px of your most probable diagnosis and your reasons.
3. Initial management to the px.

22 years old female coming with bleeding rectum. Not associated with stools. Several episodes. Had a trip to Bali and developed
a diarrhea where she was started with antibiotics. Father diagnosed with CA colon recently and she is scared that she is
having a CA
k. PEFE from the examiner
l. Describe the possible diagnosis to the patient
m. Counsel regarding further follow up if needed

22 yo female with rectal bleeding Frank blood, only when defecating

Worried because her dad was diagnosed as colon cancer recently
Went to Bali 4 weeks ago when she had mild diarrhea and treated with antibiotics

Task PEFE
D and DDx
Discuss management with patient
Only findings on PEFE (or I missed to ask something important) Abdomen non remarkable
DRE – anus looking normal, no fissure, no hemorrhoid Examiner said ‘soft brown stool and no bloods on gloves’

Upon greeting the px, the px opened up right away with worry-some face “Dr, I have blood in my stool and it has been happening
more frequent lately, do you think this is cancer just like my father’s?”
Addressed the concern and have told her that I will need to examine her and maybe a few questions and we can both check what
could be the reason and how we can address this. Excused myself to speak with examiner.

PEFE:
GA: pallor? (some paleness) BMI (N). Hemodynamically stable? (VS all within N, no fever). Quickly touched on CVS and Respi
(U/R)
Abdomen: U/R
(I personally requested with consent and chaperone) DRE: No rashes/fissue outside. No masses/nodularities palpated with no
tenderness. On the examining finger: some fecal staining with no blood.
Proctoscopy: (+) 3 hemorrhoids with erythematous base and *fissure (**as I recall now, I am unsure if there was any fissure.. I’m
sure there was hemorrhoids given)
Other office tests: Urine dip, BSL (not done?? Can’t remember now)

Advice: Have told her that there is a big chance that the blood in her stool is due to her (internal) hemorrhoids and could be due
to the more frequent passing of stool. Other possibilities could be due to her recent antibiotic use as an additional factor
to her present symptoms. Other things that I am considering but maybe unlikely: IBS, IBD, Travel infections (Giardiasis, Typhoid
fever, Cholera etc) -- I then asked, have you consulted your GP prior to travelling for any travel advice (no doctor), Food
intolerance, malabsorption syndrome. Adviced that on next travel to have travel consult to prepare some kits or vaccines
to have extra protection for any travel infections. Requested for stool MCS to check for any of these infections that may be
present.

In regards to her concern (rectal ca), it is still a consideration as she still has a higher risk compared to other pxs with no family
history but most probably unlikely for her present symptoms although still opened to request for baseline colonoscopy to
check for her lower gut; this wll also r/o my other differentials that I have discussed previously. Times up!

Station 7 - PILOT Insect bite - leg pain

Middle aged man (30s?) presents in to your GP due to leg pain. You have not seen this px before.

Tasks
1. Take History from the px.
2. PEFE
3. Explain your most likely diagnosis and DDx.

32 years old male. Presented with R/S Leg pain for one day [Link]
[Link]
[Link] the diagnosis

Middle aged male Sudden onset of leg pain Task

1. Hx
2. PEFE
3. Likely Dx and DDx

History reveled it was right knee pain Sudden onset from morning
Unable to walk
Also complaining posterior neck pain, described ‘spasm’

PE – no remarkable other than ‘neck tenderness’ Examiner said ‘it is not stiffness’ Photo – looks swollen medial knee- with ? bite
with surrounding cellulitis

Pertinent (+)s in Hx: Px went camping with friends and it was a “chill night”. No alcohol drinking made. Eats everything, eats meat
in moderation.
First time that this has happened. No LOW LOA LBs.
Px described pain as severe (PS 8/10) on the one knee (can’t remember if L/R), very red and unable to move the knee. No Hx of
trauma. No back aches but he feels very achy in all joints and muscles most especially his shoulders and neck. No tingling,
numbness or weakness of the legs.
(?) Sexually active but no changes in urine/stool. Denied penile discharge. Have always been sexually active with a stable partner.
Denied STD (though not tested previously). Does not use condoms.
No hereditary medical condition. Not taking any maintenance medications. No noted allergies.

PEFE: febrile (can’t remember if significantly high but it is elevated), slightly elevated BP and HR, in distressed/pain
On inspection: Examiner will provide a photo of the knee, Swollen, very red with a noted bite. There is erythema and a noted
border of the affected site. + Tenderness and warmth to touch. + restricted ROM on the affected knee and unable to bear
weight on that leg.
U/R Neuro exam of the all extremities - Reflexes unable to be done on affected knee. Sensation intact. (?) SLR done due to ROM
restricted.

Concluded that my concern is spread of infection from a seemed insect bite or cut on the skin and that could be the possibility of
Septic Arthritis or Osteomyelitis although I am also considering other more localised infection such as Cellulitis. Explained
that they all just vary in the level of infections (Cellulitis, more superficial; Osteomyelitis, involves muscles and bones;
Septic Arthritis, systemic spread of infection from a joint involvement) -- still will need to be treated with antibiotics. DDX:
Reactive arthritis, OA/RA, Lumbar radiculopathy, DVT, PVD, Gouty arthritis, Malignancies..
Station 8 – rest

STATION 9: POST PARTUM CHECK UP (Post partum PE post 6wks) -- PASSED

1. G1P1 middle aged lady came in for her 6 weeks postpartum check up. Her baby is all well and she is purely breastfeeding.
Sexual act has been started but she complains of discomfort. There is also note of minimal passing of urine at times.
Patient delivered her baby (~4.2kg?) via assisted vaginal delivery with forceps and episiotomy was done.
Tasks:
Do relevant PE to the px for 6mins.
(Another task, I cannot remember as I ran out of time. Another candidate said its Dx/DDx).

22 years old female. Postpartum 6 weeks. Had instrumental delivery and tare. 4.12 kg baby. Otherwise normal. Tried sex recently
and was painful and also experiencing passing urine when coughing. Coming for postnatal check up
n. Relevant examination
o. Explain possible diagnosis to the patient.

6w Postpartum regular check up

For regular check up but patient complaining some strange feeling during sexual inetercourse and occasional urine leakage
Delivery was instrumental and baby was 4.2kg, episiotomy – required sutures in theatre
Task
PE – (real + from examiner about pelvic exam) D and DD

I started from vital signs, like PR and BP – manually measured BP – I did this first time in > 10 years! Anyways
Examiner skipped CVS and resp
Did actual examination on abdomen – commented no tenderness, and did not feel uterus
Pelvic exam - non remarkable, but some urine leakage on straining (I said I put gauze over vagina and get the patient to strain),
no prolapse on this

This is such a weird PE station.

Reading time: I’m thinking of the “B’s” of postpartum (Baby, Blues, Breasts, Birth canal, Bladder, Bowel) that I need to assess.
Taken note of the delivery complications and present complains of mild stress incontinence and dry vaginal wall which
makes sexual act uncomfortable. Need to check how much the episiotomy degree of tear is as well..

Upon entry, I looked right away for a manequin dummy - there was none. I saw the RP fully clothe.
I did my usual greetings to the examiner and RP. Hand sanitised and wore gloves and explained PE and gained consent. On GA,
described accordingly the px. Then I asked the Examiner for VS, temp was afebrile. That’s all that was given.
When asking for pulse rate, I was handed a timer. Took pulse for 15secs and did calculations with estimations of PR in a minute.
When asked for BP, I was given the BP app. I thought I’d just do the initial spiel (BP cuff needs to be the right size, at least 40% of
the px’s arm diameter and at least 70-80% arm’s length) then wrapped it unto the px’s arm, snug with one finger
tolerating and was about to pump the cuff with my steth diaphragm on the Brachial artery -- I pumped once and when I
 realised the examiner not stopping me and giving me BP readings, that’s when it kicked in that I need to do the whole
thing.
I stopped and went back to my commentary -- “to accurately check for the BP, I will need to get an initial SBP reading by
estimating it - pumping the cuff and checking when the radial pulse will diminish. Once noted of the initial SBP reading, I
will then place my steth on top of Brachial Artery and inflate the cuff around 10-20mmHg above my initial reading and
slowly deflate until I hear the 1st Korotkoff sounds and the last Korotkoff sounds which gives the SBP and DBP readings..”
By this time, my time is so short now.
I went straight to face: eyes for pallor if evident and if there are signs of dehydration. Thyroid exam (Examiner: normal)
CVS and Respiratory (Examiner: normal)
Abdominal exam: RP automatically lie down and exposed her abdomen. Normal on inspection. I just quickly palpated superficial
then deep (all normal). Have commented that as px just gave birth, I’m assuming that the uterus is still partially an
abdominal organ as it descends back to the pelvis. Missed bowel sounds and percussion.
Pelvic examination: commented for any rash, swelling outside in the vulvar area and if the episiotomy is healing well. (Examiner:
No lesions outside and episiotomy is healing well with no signs of infections).
Speculum exam: (Examiner: some dryness on the vaginal wall. No CMT).
Bimanual exam: (Examiner: commented on uterus size to be within the norm. No masses or tenderness. Still no menstrual bleed.
No other d/c).
Requested for DRE: Normal.
I forgot to do Cough impulse in pelvic exam so I requested but time was up. Have not touched 2nd task.

**This was a LUCKY pass. As you can see, I have not finished the tasks. I was still not finished with the first task and I have NOT
touched the 2nd task. I believe that the main reason of me passing was my commentary and me making sure that I perform
the tasks they asked (pulse and BP). Despite me not being able to reach second tasks, I was dropping DDx in my comments
(eg. Is there any dryness of the vaginal wall as I’m thinking of postpartum atrophic vaginitis as px is purely breastfeeding or
Px had episiotomy, I would like to take note of how the wound is healing and the degree of the tear considering that the
baby delivered was heavy in weight etc..)

STATION 10: HEADACHES (Somatisation DO) -- PASSED

2. 42 year old lady is presently back to the GP practice to discuss her recurring headaches. She has been seen by the
neurologist on which a cranial MRI was ordered with normal results. These headaches are being treated as ‘Tension
headaches’.

She is known to the practice for more than 10 years presenting with different pains in her body. She has also been seen
previously due to “nonspecific abdominal pains” as well as having on and off urinary symptoms with full work up of
unremarkable results.
Tasks:
1. Take history from the patient
2. DIscuss the probable reason as to why she is having these symptoms.
3. (No PEFE or management)

40 years old female presented with on going headache. Has previously diagnosed as Tension headache and also undergone MRI
Which was normal. Presenting several times with different pains. No past medical history Today also coming ,with
headache
p. History
q. Discuss the diagnosis and DD
r. No examinations or management

Greeted the px. In any pain? Offered pain killers. RP declined. (Concern of headaches.. Why this is happening?)
Ensured the px that what she’s feeling is real and that I will need further information so that we both can come up with a plan on
how to tackle this.
(+s in history).. Pain is more persistent and progressive the past 6months. She’s new in this place so no social support (just a few
friends). She has moved here since her recent relationship broke up 6months ago (**I was empathizing with her on this
part**). Moved to a new place for a new start. There are days she needed to be off work due to the pain. Described the
pain to be more of a “banding pain in the forehead and scalp and extends to neck and shoulders”. No N/V, aura,
photophobia etc..
Asked for triggers but she can’t pinpoint specific triggers. Affect sleep? (no attacks on sleep)
How is overall quality of sleep? (Able to sleep full.. no mid cycle awakenings although at times she sleeps late.. but most of the
time can sleep through the night)
Mood? (it’s okay.. not really low.)
Appetite? (still okay..) *I remember asking if she has lost weight but can’t remember her answer..*
Still enjoys going out or the things she used to do? (when she’s not in pain.. yes, she still enjoys going out and wish to have more
social activities..)
I then quickly asked about her abdominal pains and urinary symptoms (she still gets it from time to time but no changes in stools
or urine)

Advice: First explained that thorough investigations were made in regards to her headaches and her other pains and the good
news was that no note of something physical that could cause her pains but ensured that her symptoms are real.
Explained it as Somatisation DO -- the brain is the physical aspect of the mind.. the mind is a strong force that at times,
when it’s difficult to emotionally cope in a significant event, it can manifest as a physical symptom which is still true and
valid but us clinicians are
just unable to find a physical cause. It does help to alleviate the symptoms when patients like you (RP) have someone to speak
about it like in a talk therapy with a specialist like a psychiatrist or a psychologist.
Then described other DDX: Conversion DO, Adjustment DO, Depressive episodes -- explained why unlikely.

STATION 11: COUGH (COPD? - Respiratory PE) -- PASSED

3. 67 yo man, presents with shortness of breath on walking. (Stem was quite detailed with present BP and temperature). Px is
a chronic smoker with 20sticks/day since he was 20 years old.
Tasks:
Do Respiratory PE with running commentary to the examiner. Explain Dx and DDx to the patient.

2. 65 years male coming with cough and recent LOW. No other past medical conditions
a. Do Respiratory examination
b. Discuss the DD with the patient
Respiratory PE
Middle aged obese guy Presented with SOB on walking Smoking history +
Task
1. PE
2. D and DDx to the patient Did a formal respiratory PE
No positive findings but I said likely COPD and other DDx

** As you can see, I don’t have feedback for this because I was actually expecting to fail this. This was a badly made PE for
Respiratory. I HAVE NO IDEA HOW I PASSED. The RP is a maybe obese I patient pretending to cough. He is hunched with
(maybe) pretending to have barrel chest which I have said in inspection. This is mainly a respiratory examination as when I
tried to do quick CVS, the examiner stopped me and asked me to “stick to the task.” The bed is against the wall and there’s
no seat (maybe there is, I just didn’t ask) for the RP to sit so I was doing the whole exam on the bed on which when I
touched the back of the RP for chest expansion, I cannot fully best grasp and assess because the wall is restricting my arm.
Anyway, I was able to assess crepitations on the base of the lungs. My examination is also haphazard.

Please do a better RESPIRATORY PE than what I did. Again, another lucky pass. I have no idea how I did it.**

STATION 12: VOMITING (XRAY Interpretation -- BOWEL OBSTRUCTION) -- PASSED

Obstructive bowel - 2 day old has not passed meconium.
12. You are an intern in a hospital and a 2 day old baby was referred to you by the nurse on duty due to vomiting episodes. The
baby was initially in the ward was now transferred to the Nursery and was given NGT decompression as ordered the the
doctor on call. While the doctor on call was on his way, the nurse on duty is also here to let you know of the abdominal XR
requested. You are now to speak with the nurse of duty in regards to this
baby’s condition.
Tasks:
1. Take Hx from the nurse on duty. He will then provide the Abdominal XR for
you to interpret.
2. Request for PEFE
3. Explain your most probable Dx with reasons and DDx.

**This is the closest Abdominal XR that I can find from what I can recall.**

When I greeted the nurse, he spoke to me right away about this baby and gave me
straight away the XR printout (it was not the clearest printed photo.)
**Because the XR photo was given to me right away, this gave me tunnel vision
and unfortunately have not asked a more detailed Hx.**
How is the baby now? (Nurse - N: Baby is stable although very irritable.)
Does the baby looked very hungry? (N: I’d say more of irritated because of the
vomiting)
**XR given and I thought right away of Hirschprung’s dse… Unfortunately had ‘tunnel vision approach’ on this..** Was the baby
born term or preterm? (N: term)
Anything remarkable during birth? During pregnancy most esp during USG scans (N: None) Has the px passed meconium stool?
(N: No, not yet)
How was the baby fed prior to the vomitng? (N: breastfed) Tolerated feeds prior to vomiting? (N: yes but now cannot and will
just vomit)
Was the pregnancy remarkable? (N: none accdg to mother).
**if I can correct myself, I would have asked further more about the vomitus characteristics.**

PEFE: stable neonate but appears very irritable with no signs of dehydration Growth chart within 50%
Gender: female (baby girl)
Quickly asked for CVS and Resp: U/R
Abdomen: No swelling or obvious lumps. No guarding or rigidity although the abdomen is distended. No swelling or LAD in
inguinal area.
DRE: anus is patent and intact.
*forgot to ask: any facies or deformities. Forgot to ask for Abdominal percussion and auscultation*

Concluded this as t/c Hirschprung’s dse vs toxic Megacolon. DDx: volvulus, malrotation, ileus
*Unfortunately, I feel I could have done better on this. Mgmt was not the task but I finished earlier than time and can’t expound
it further. Went back to explain the XR as to why I mainly thought this is more of colon than Small int - smoother wall, less
haustra, sacrum area is white with no air-fluid levels.*

*THIS can definitely be improved. PLEASE Please have a very good focused History taking. Some questions that can be added but
are not limited to --- Ask for any abormalities during the USG taken antenatally. Ask for the vomitus Hx (CCVO + associated
symtoms like what feeds given - pure BF or with bottle. Did the baby tolerated the first day of feeding? Was the vomiting
only on the second day? Was it immediately after the feed? Did the baby look very hungry after the feed? Etc..) On PE:
look for facie deformities linked to Down’s Syndrome (there is 30% risk for DS babies to have hirschprungs dse).. again
another lucky pass for me. I actually thought this was a mess but I guess they liked how I interpreted that XR film!*

Nurse comes to you with history of excessive vomiting of 2 days old baby in the nursery. Coming with an Xray (X-ray dilated small
bowel loops)
c. Brief history from the nurse
d. PEFE
e. Describe the X-ray finding to the nurse
f. Discuss the diagnosis and DD

2 day old baby boy

Nurse called you because baby is vomiting
Baby was transferred to nursery for ongoing vomiting
Task
Hx from nurse
PEFE (xray will be given) Discuss xray findings with nurse D and DDx with reasons

Hx
- Term baby, no issues during pregnancy or right after birth
- Started vomiting after the first feeds – initially miky and became green for the last couple of times
- Has not passed first meconium

PEFE
Hemodynamically stable No signs of dehydration No dysmorphic features No limb deformity
Abdomen distended, tender and tense No abdominal wall erythema or edema Testes both in scrotum
No inguinal hernia
Anus looking normal and located normally and patent

Xray
Multiple loops of dilated bowel – likely distal small bowel obstruction

D and DDx
I said – Hirschsprung disease or distal small intestinal atresia Or intestinal volvulus, ileus due to sepsis

STATION 13: REST

STATION 14: HEALTH REVIEW -- FAILED
Diazepam wants to stop
14. 47yo lady presents to your GP practice for your advice regarding stopping Diazepam. She started taking Diazepam 15mg/day
(5mg/tab PO 3x/day) during the time that her son was diagnosed with ALL 6 months ago. At the moment, her son is now
on remission. She wants to stop her Diazepam as per advised by her friends. She has full support of her family and friends.

She has a background of Panic Attack diagnosis when she was 19yo and generally an anxious person (?).
Tasks:
1. History from the patient and assess whether she is ready to stop her medications.
2. Advice accordingly and answer her concerns (Mgmt?)

47 years old mother who is on Diazepam 15mg tds from 6 months. Started as her child has diagnosed with Leukemia but now on
remission. Worried about the dose and need to stop that. No other medical conditions
g. Brief history
h. Discuss the whether can stop and of so plan of cessation

Diazepam counsel Mid aged female

Wanting to stop Diazepam
Has been on diazepam 15mg per day (TDS) for last 12 month (6 months on stem but the patient corrected to 12months ‘actually
it’s 12 months’)
Started Diazepam when she was depressed because her son was diagnosed as Leukemia at that time. However now he is in
remission.

Hx of panic attack when she was 19 yo

Greeted the px. (RP: I was hoping you could advice me on how I can stop my diazepam intake Dr..)
Asked her reason why? (RP: Well.. it’s because lots of my friends have adviced me that the dose I’m in is high..)
Prior to you taking this, are you aware of the medications side effects and the possibility of tolerance? (RP: it’s been a while ago
already.. I think this was discussed but I can’t remember anymore..)
How long have you been taking the Diazepam? (I’ve taken it for 12mos doctor..) Just want to clarify as the notes say its been
6mos? (I’ve been taking it for 12 mos but the past 6 mos, I’ve taken it to that dosage..)
Asked if she has been regularly taking her meds accordingly as adviced.. (RP: yes doctor.. I take it as how it’s advised) Followed up
with: any chance that you have either not taken your meds like a missed dose or have taken an extra dose? (well.. there
may be some situations that I may have taken an extra tab or so.. it’s to help me with my nerves) How often was this?
(This was during when my son was on treatment.. not recently anymore. I’m much better.)
This must be a relief for you that your son is now on remission. (yes doctor. Very much. I am much better now..) Assessed sleep,
appetite, mood, social interaction with friends and family -- all much better and has improved. RP also confirms that she
gets full support from friends and family in regards to stopping Diazepam.
Suicide? Any thoughts of harming yourself or others? (None..)
Any episodes that she was too drowsy and had accidents like driving or at work? (none)
*forgot to follow up on her panic attack hx*

Advice:
Concluded that she’s ready to stop Diazepam but this will need to be in a controlled environment. Explained that Diazepam is a
long acting anxiolytic medication and that it needs to be done in tapering dosage. Dosage will need to be taken in the
 clinic more frequently -- 1-2 days follow up to take her dosage and to as well assess how she is coping. Lifestyle
management (diet/alcohol/smoking/phys activity etc). Advised on meditation techniques and sleeping etiquettes will help
in calming the nerves etc.. Reading materials. Family meeting to ensure there is support..

**I must be far off with this management case. Please follow passed feedback for this. Must be my wording in advice was
wrong..**

STATION 15: Assessment of change in behaviour (MSE schizophreniform lady, 4mins) -- FAILED
15. Typical stem.. 19yo lady, initially admitted 12 months ago for a few months due to odd behaviour and was then diagnosed
with Schizophreniform is now back for reassessment as px is behaving odd again. Px was initially treated but was non-
compliant to treatment and follow up. (Another candidate said that stem says that px is oriented to 3 spheres - time,
place, persons. Another candidate solely relied on the video and was unable to check stem again when constructing the
MSE)
Tasks: Watch MSE for 4 mins and present MSE to examiner.

Watched video for 4 min Present MSE to examiner

Lady with previous diagnosis of ‘possible schizophreniform illness’ – 18 months ago, admitted at that time Recently changing
behaviors, non-compliance to medication
Looked recurrent schizophrenia
Showing auditory hallucination and delusion of grandiosity

**This is more or less the MSE I presented. I have NO IDEA what exactly they would want me to say. I can’t accept that my score
is actually this low.**

We have here a caucasian lady brought in by her father due to complaints of unusual behaviour. She is a known
Schizophreniform px who was not compliant to her medications.
On Appearance - she is unkempt with disheveled hair although her clothes look clean, it looks inappropriately partially worn. She
is also wearing large dark colored sunnies (sunglasses) on which I am unable to assess her eye contact. Despite this, her
behaviour is erratic and she clearly looks disturbed although she is cooperative in answering most of the questions. She is
sitting on her chair although she is clearly looking disturbed and looking around.
On Speech, there is normal tone and volume with good rate and she answers all questions in english.
When asked how is her mood, she answers in exact words “It’s okay.. a little bit pressured but you know, this is exciting” and I
believe this is congruent to her affect.
On Perceptions, the patient agrees that she hears voices which is apparent for auditory hallucinations. I am also suspecting for
possible visual hallucinations as she usually turns her head in different directions.
Her thought form is tangential with some loosening of associations and for her thought content I have not noted any suicidal
ideations. Her main preoccupations is for topics of “quantum theory and of parallel universe and that she was recruited
for this mission to help the rest of the world.” In her own words she “needs to be selective of who are worthy for the said
mission” and that the interviewer is “clearly not cut for this” so she cannot give anymore information. She has delusions of
control, grandiosity and reference and there are notes of thought insertion on which she says she “gets the secret code
from the television commercials and the radio signals.” She has also strong beliefs that her “sunnies (sunglasses) are
important instruments to see these secret code and only worthy people can decipher this.”
When asked, her insight and judgement is clearly not intact.

As per the video, her cognition and orientation to at least 3 spheres were not asked. -- **this is the only thing that I was UNABLE
to correlated with the written stem. Another candidate said that written in the stem that the px is oriented to 3 spheres
(time, place, persons)**

In regards to her risk, I believe that she does risk herself in getting hurt as her judgment is not intact. She has limited rapport to
her interviewee and I believe that she is reliable although a secondary history from a carer or a family member close to
her can give further history to strengthen basis of her sudden odd change in behaviour.
*NO diagnosis or management in stem*

**In seeing my score, I seriously am unsure what exactly do they want. My MSE is long because the video is only good for 4mins
so you have enough time to compose and relay your MSE.

What could I have done better?

-when you enter and after the examiner greets you, you have 15 secs to compose yourself -- USE THIS WISELY. I thought I did but
clearly not.
-during this 15 secs: write your mnemonic guide (which I did) and it was more of a tickbox for me that’s why I was able to have a
detailed MSE (still clearly NOT enough).

- KEEP THAT PRINTED STEM CLOSE TO YOU -- make sure that prior to telling your MSE, you review quickly the stem and
incorporate that in your MSE.

STATION 16: ACUTE FEVER (Otitis media + pharyngitis PE) -- PASSED

16. Young man comes in to your practice due to throat pain with painful swallowing.
Tasks:
1. Do relevant examination
2. Explain your diagnosis with reasons and your DDx.

22 years old male coming with throat pain and difficulty in swallowing. Not had anything from the mouth for past 24hrs
i. Do relevant examination
j. There is a model of ear if need to do relevant examination

Young male with sore throat for 2days. With high temperature Unwell for 1-2 weeks
Now difficult to swallow

Task
PE with a patient and ear exam with mannequin Dx and DDx

Patient lying on bed

Looks unwell (could see the patient is acting ‘unwellness’ with deep fast breathing) Only reply to questions with gestures (cannot
express voice)

Examiner showed a photo of throat when I said I am going to exam mouth. Examiner also asked how I do mouth examination
(tongue depressor was there)

Ear exam with mannequin – looked inflamed membrane.. I just described findings Photo was a classical infectious mono type
 bilateral welling of tonsil with plaque

Greeted the px (px can’t speak and will only nod, grimace or thumbs up or down). Did WIPE + consent. Gloves on.
**I then looked around and saw that there is a half face mannequin so I knew there will be an ear exam.** Px is in pain and asked
if he wants pain relief and if with allergies. Gave pain relief as px requested.
Requested for VS (I can’t remember of the VS given.. I think temp was high and HR tachy..)
Started with hands then arms then face. RP is wearing a mask. Asked for the eyes to check for pallor (conjunctivae are pink) I
then asked the px to put down his mask so I can check for his mouth (Examiner / E stopped me and asked what I wanted
to check).. I wanted to check for his lips, is it cracked which will make me think of dehydration, or if there are any lesions
on the lips.. (E: lips are dry but not cracked. No lesions)
I then grabbed a tongue depressor **wrongly mentioned it as a spatula** and have told the examiner that I would like to use this
to examine the back of his mouth (E: How exactly would you do that?)
”I will ask the patient to first open his mouth and from here I will first check his dentition -- are there any dental carries, swollen
gums, bleeding in gums, swollen tooth that would make me think of secondary infection from his tooth/teeth. I will also
check the tongue and oral mucosa for hydration status. From here, I’ll then ask him to stick out his tongue and say aaah --
this will lift his posterior palate and I’ll be able to see his tonsils and his uvula and I’ll also be able to see his posterior
pharynx.” (E: handed me a photo of what I’ll be able to see and asked me to describe it.)

Photo looked very similar to above, Described it with white pus discharge and tonsils were enlarged and very swollen red. I
disclosed this as Tonsilo-Oropharyngitis with pus discharge (*should have added, probably bacterial in origin*)
I then asked to palpate for facial tenderness on the sinuses (E: none noted)
Then went to the neck. I tried to palpate for LAD (RP is lying down on 45deg bed.. I should have commented that palpating for
these should have been best with the px sitting and with me palpating it from behind. Unfortunately I wasn’t able to
comment on this). Have told all the branches of Cervical LNs. Px was grimacing and I was actually able to palpate enlarged
nodes?!?
Unsure if this is just positional..
I then moved to the ear exam. Examiner led me to the otoscope and asked me to assemble it.
**This is the good otoscope type (Welch Allyn brand) so should be easier for candidates to assemble. There were two cups of
speculum but I was unsure if they were different size. I assumed they were the same and don’t really have the time to
check. Picked one without checking..**
On the mannequin (L ear to test): Prior to going straight to otoscopy, I first inspected the outside ear, checking for any swelling,
redness or rashes. On palpation, I pressed on the tragus to check for tenderness. I also palpated for the mastoid for any
swelling or tenderness as I am checking for mastoiditis. All throughout, the examiner was beside me checking every move.
I was commenting on every move. I was also checking the px and asking him that I will be tugging his earlobe up and out
(using my R hand) as I was about to check the inside of his ear. I also made sure that I was holding the otoscope with my
left hand like a pen.
Described what I saw… **It literally looked like a salami lol!**

Very Erythematous base with white specks of I’m unsure if these are the ossicles or if these are discharge. I am unable to
appreciate the cone of light as there’s no reflection from the otoscope light which makes me think that the tympanic
membrane has been fully perforated. I see a clean erythematous border with no cone of light and no obvious discharge
leaking so I have a strong suspicion that the TM is fully perforated. I am concluding that this is OTITIS MEDIA with full
perforated TM.

Discussion with the patient: **I don’t know why I said it like this but wth..**
Have told the px that he has pus discharge and swollen tonsils in his mouth which correlates with his ear infection as there is
*eustachian tube dysfunction* between the two (*what I wanted to say was there is connection between the two and infection
have spread between two areas due to this connection*).
STATION 17: HEALTH REVIEW (Recurrent falls - bradycardia) -- PASSED
17. 65yo man, referred to you by the nurse due to recurrent falls. The nurse addressed the man’s wound from his recent fall
incident. The nurse is worried as this is his second fall incident within a month.
Tasks:
1. Take Hx from the patient (5mins?)
2. PEFE
3. Dx/DDx

Recurrent fall
Mid aged male came to your clinic for wound check up which he sustained on a recent fall. He is worried because this was the
second time for the last few months that he fell.
Task Hx PEFE
D and DDx

History sounded like syncope to me because he only remembered that ‘he was sitting after a fall’ PE unremarkable – ecg normal
(verbal), no murmur

Greeted the px. Asked if he’s in any pain (the nurse has addressed that). “The nurse is concerned of my fall incidents Dr..
Unfortunately, this grazed my leg this time.. should I be worried?”
Appeased the patient and have told him that we both need to talk about it and see the reason as to why this has been
happening.
In Hx, I specifically asked of what he was doing before, during and after the fall. Any witness? First time? Etc..

Pertinent (+): Recent fall: Was in his lounge sitting then stood up but just fell off. No LOC. His leg hit the coffee table. No trauma
to the head. No shaking or jerky movements like in seizures. He is well rested and has eaten well prior. No chest pain or

funny racing of the heart. Lasted for a few seconds only. He’s not shaken when the incident happened -- not cold clammy. No
N/V. Not lightheaded. No spinning of surroundings. No loss of balance. No vision problems (uses reading glasses only). No
stairs or slippery floors around. No witness this time but during the first fall, his daughter saw him on the floor..

First fall: He was on his bed about to go to the toilet and when he stood up and was about to get his first to second step, fell off.
Daughter saw him. Felt a bit dizzy but after a few mins sitting on the floor, was good to stand up.

U/R PMHx, FHx. No smoking. (+) occasional drinks, nothing in a daily or weekly basis. No surgical hx. No maintenance meds or
supplements or OTC.

On PEFE: BP (lying) 120/85, BP standing 115/80. HR 62 (*another candidate says this is 52!* I missed this because it wasn’t clearly
said!!!), regular. Afebrile, RR 19, room air.
BMI - N
CVS, Respi, Neuro, MSK -- Everything was NORMAL!!! BSL - 4.5
U/A - U/R
ECG - pending

Because I MISSED that big factor in the PEFE, I just explained of the other things that could have been the problem. I did say
though that we will have a thorough investigation to note of what the causes may be. I still gave all of my differentials that
the time may permit.

STATION 18: REST

STATION 19: ABDOMINAL PAIN -- PASSED
Cholecystitis
7. 55yo man presently in the ED due to progressing abdominal pain.
Tasks:
1. Hx from the px (3-4mins?)
2. PEFE
3. Explain your most probable Dx to the patient and your DDx.

50 years old male coming with Upper abdominal pain for 2 days. No other past medical history
k. Take history ( says R/s upper hyperchondrial pain and says taking Marjuana)
l. PEFE
m. Explain the diagnosis

Middle aged man with upper abdominal pain

1. Hx
2. PEFE
3. D and DDx Hx
Sudden onset of RIQ pain which radiates towards back, constant Nauseous but not vomiting
PMHx of hypothyroidism with medication PEFE
Temp 38.5 Distressed in pain
(I forgot to ask jaundice..)
Murphy’s sign positive – examiner ask how to do it when ask ‘is Murphy’s sign positive?’ Renal angle no tenderness

D and DDx
I said cholecystitis without obstructive stones given sudden onset
Or CBD stone, cholangitis due to other cause of obstruction such as panc or bile duct cancer

This set up was a bit weird..who knows and what to expect with AMC.. oh well..
Upon entry, you will see a man writhing in pain on the bed. The examiner will greet you and do his spiel to you. He will
specifically ask you then to be at a certain spot -- there is a chair between you and the bed of the px. Examiner will
specifically ask you to maintain that distance and not go near the px. *There was once a time that I touched the chair and I
was abruptly stopped by the examiner.. weird.*

Greeted the px. Px responded but was in obvious pain. Asked if he’s in pain (YES.) Pain killers offered (That would be helpful dr.)
Open question given -- (I’m in pain just below my right ribcage..)
Pertinent Hx:
Pain is progressive (PS 7-8/10), just constant pain (*he denied colicky pattern*). Non-radiating, just staying at RUQ. No N/V but
no appetite. Can’t decipher if food related. Didn’t take any alcohol prior to the pain. No changes in color of stool/urine. No
yellowing of the skin. This is the second incident -- first incident was 6mos ago with similar features but the pain went
down after 3 hours and didn’t recur until now. No follow up made because he was lost to f/up and never thought it would
recur.
I have also asked other things in regards to my DDx.. all denied. (*Please see above feedbacks as I have missed a few*)

PEFE: Asked for BMI (cant recall but I think px is overweight if not obese) and VS (partially febrile, and in pain) No jaundice. No
rashes.
CVS and Respi are U/R
Abdomen: soft abdomen. Sensitive on the RUQ area. No rebound tenderness.
*for some reason, I have forgotten to call Murphy’s sign but I did ask it from the examiner on which the examiner did explain*
“There is tenderness on deep palpation on the RUQ upon full expiration”
Negative Renal Angle Tenderness. U/A and BSL requested -- pending

Concluded as Acute Cholecystitis possibly from GB stones.

DDx: Pancreatitis, Cholangioma, Cholangitis, Hepatocellular Ca, GB Ca, Atypical Pneumonia, MI, PUD/GORD, AAA, Appendicitis

STATION 20: ANTEPARTUM CARE -- FAILED

Antenatal check 20 weeks aog with tingling down below
20. 20week old G1P0, came in to your GP practice for regular antenatal checkup. She has been a regular patient being seen in
your practice for her antenatal care. Previously done investigations were normal and have all been recorded digitally in
your clinic but at the moment, all systems are down and are unable to retrieve data.
Consult her accordingly for her concerns.

Tasks:
1. Hx from the patient and address her concerns
2. PEFE
3. Explain Dx to the patient and DDx

20 week pregnant lady, First pregnancy and all the investigations and pregnancy up to now was normal. Coming for a consult
n. Take relevant history - (Describe a itchy, mild painful rash in the vulva)
o. PEFE
p. Explain the diagnosis

GA 20w pregnant for Regular antenatal check up

She has had first visit check up but results cannot be seen as the system is down today… (on stem) Tasks:
1. Hx
2. PEFE
3. D and DDx to patient
Complaining irritability around vagina for 3 days
She said she took bloods on first visit but not sure about the result and she said she didn’t do STI screening! PEFE – vesicles on
right side of vulva, no discharge

*Cooperative px* Greeted accordingly. No opening lines. First pregnancy? (Yes)

Is this a planned pregnancy? (yes dr.. looks very happy) Congratulated the new mum. Have you been regular with your follow
ups? (yes)
Have the recent scans been done? (yes Dr. I have done my 10-12 week scans and bloods and recently just had my 20 week scan.)
Have they noted anything unusual in the scans (like what Dr?) Any abnormality that they’ve told you in the initial 10-12 wk scans
in conjunction with your blood tests? (none Dr.)
How about the recent 20 week scans, any abnormalities they’ve told? (None Dr.) Is it just one baby or multiple bubba? (just one
Dr.)
During the initial bloods, was there anything prominent -- like any STDs or infections? *I’m trying to refer on TORCH and Syphillis
+ STD screens* (None that they’ve told me Dr)
Are you taking your Iron and folic acid supplements (Yes Dr.. I have taken them regularly) Are you taking your regular intake of
milk? (yes)
Are you feeling your baby move now? (yes dr.. it’s very exciting)
Any severe headaches? (none) Noted swelling of your feet? (none that I’ve noticed) Did the nurse ever told you if your BP was
high during visits (I don’t think so Dr..)
Changes in stool or wee? (no problem with my stools although it’s a bit stingy when I pass urine) Any fever recently (none) loss of
appetite / LOW /L&Bs? (none)
Are you still sexually active? (yes) In a stable (sexual) relationship? (yes). Is your partner the father of your child? (yes) Any
problems with the act, like discomfort or pain? (not really.. it’s more of outside)
Any discharge or rash or skin lesions down below? (I can’t really see Dr although it feels tingly outside of my down below most
especially when I pass urine) How long has this been happening? (less than a week, few days but progressive).
First time to consult this? (yes).
How are your vaccinations, like were you given any vaccine this pregnancy? (yes, I got my flu shot).. How about when you were a
child? (I guess whatever was given to me when I was a kid..)
Have you ever had chicken pox before when you were younger (No.. not that I know of). Childhood vaccines were given (I guess
so Dr.)
*time prompt heard*

PEFE:
GA: Gravid woman, comfortable with no bipedal edema **Requested for weight and I think the examiner gave me one but can’t
remember now**
VS: N, afebrile
Quickly touched on CVS and Respi - U/R
*forgot to ask for thyroid*
Breast exam (can’t remember the results.. I guess U/R)
Abdomen: gravid abdomen. FH = 20cm. Leopold’s: Fundal grip: buttocks, fetal lie/back on the left side of the mother, Cephalic
presentation, not engaged. FHR = 150s
Pelvic exam (with consent and presence of chaperone): *all findings are given verbally. NO photo supplied*
Inspection of vulvar area: (+) erythematous vesicular lesions on the L vulvar side with tenderness/sensitivity to touch. *forgot to
ask if dermatomal in direction*, (+) some tender LAD on the L inguinal.
No noted vaginal d/c.
On Speculum exam: U/R (no vaginal wall lesions inside), cervical os closed.
*I was about to asked for bimanual exam but STOPPED myself* Inspection of the anal orifice: U/R
Office tests: BSL, Urine dip -- both N

Advice:
Explained initially that I am thinking this could be Shingles which is a reactivated chicken pox/varicella infection but because I do
not have a visual, I can’t fully conclude. I am also considering Genital Herpes because of it’s sudden occurrence. Both can
be my working probable Dx but I am leaning more on Genital Herpes as px had no previous recollection of past infection
with chicken pox. Explained that pregnancy can decrease her immunity and make her prone to these conditions to come
up.
**No mgmt in tasks**
**Again, one of those stations as to why I failed?! I will never know.
I guess because my DDx is not enough (add varicella, condylomata acuminata, syphillis, chancroid, HIV rash?, scabies, yeast
infection?)
Also, I have a feeling that my wording was confusing. I should have told Genital Herpes first prior to shingles. I dunno.
Go figure how they score these exams -- this is a history taking on which I failed yet my individual history score is a 5. Check
Station 17 which is a diagnostic case on which I totally missed the diagnosis and yet I passed. In both cases (station 17 and
20) each of them have the same scoring - 6,5,4,3 and yet each has different outcomes. Go figure.**

Good luck everyone! This exam is feasible. Believe in yourself that you can.

13th sept 2022 online

SEHRISH JAMEEL

1- global developmental delay

2- PE - Rash - explain to examiner - eczema herpeticum
3- psych - took pills after fighting with boy friend
4- 6 year old child - headache
5- 27 something female feverish
6- 36 weeks pregnant 32 years old - came for antenatal checkup
7-respiratory PE
8-patient sent by wife for increased alcohol intake
9-67 year old with abdominal pain
10- eye PE - orbital/ peri orbital cellulitis
11- 1 PPH - cord broke
12- explain USG to patient - AAA
13- PE - wrist, history of fall .
14- gout
15- increase size of abdomen 60 something female
16-diagnosed case of breast cancer came with tingling in feet and burning

14th Sept 2022 online

1) Neck lump ___ Neck lump
I said SCC. Hard lump. Hx of oral ulcer and prolonged sun exposure.
Task
Hx DD

2) Abd pain- IBD, __ 17 yrs old boy with abd pain....IBD

Task Dx with reasons

3) COPD- Management --- CXR given

Hx like COPD
I told it pneumothorax or acute exacerbation of COPD
Task
Explain CXR and DD
Immediate mx (I told pneumothorax as dx of cxr.) as trachea was shifted to left and COPD leads to pneumothorax.
Long term mx ( for COPD)
Donno exactly

4) Febrile seizure -- Task Hx Counsel and mx

5) Egg allergy -- Cheek rash baby-egg allergy

Task
Hx
Dx with reasons

6) Ulcer examination -- Early wk pregnancy vaginal bleeding. PT positive at home.

TV us revealed no sac Corpus luteal cyst. Beta HCG 892.
Task
Ask for inv
After checking in there will be card

7) POA 1 week Usg No sac in uterus adenexa clear hcg 869 -- Early wk pregnancy vaginal bleeding. PT positive at home.
TV us revealed no sac Corpus luteal cyst. Beta HCG 892.
Task
Ask for inv
After checking in there will be card
Than mx

8) citalopram for depression × 1 year but stopped after 1 week of prescription because it was not working. Now patient has come
with depression symptoms again -- Major depression non compliantpt. Relapse
Task
Hx Mx

9) whooping cough vaccination counseling in pregnancy -- Preg woman 20 wk came for adv
Enquire abt whooping cough vaccine
Task
Hx Talk abt her concern

10) pyelonephritis pe. Positives given in stem - bph +dm2 -- PE case

Pt came with abd pain. Pyelonephritis case. Also have diabetes and, BPH
Task
Talk to pt in 2 min about exam what u r going to see.
To examiner about steps and why ur doing those exam?

11) breast abcess -- Breast lump Mastitis

Task.
Hx DD

12) Poor school performance

Task
MSE Present to examiner
DD (acute psychosis-delusion of reference, persecutory delusion, auditory hallucination, poor insight and judgment, lives alone)

13) Incidental finding of fracture in CXR. Pix not given. Pt came to discuss abt it.
Osteoporosis with wedge fracture
Task
Hx Dx with reasons

14. Long case....pt came with TFT report There T3, T4 high. Pt had symptoms of nervousness.
Task
Hx DD

12)
 20th September 2022 F2f
RUMANA AFROZ,

[Link]
[Link]
3. ge reflux 4 months
[Link] illness relapse
[Link] p.e sbo/ lbo
[Link] p.e bitemporal
[Link] deafness ear p.e
[Link] 2 episodes arrythmia
[Link] abruption with iud
[Link]
[Link]
[Link] traveller hepatitis A
[Link] dependence
[Link] spirometry n explain mx
[Link]
16. Endometriosis

20th SEPT 2022 f2f

Hi everyone, will write down whatever I remember. Sorry cannot remember full stems. Hope it helps. Best wishes.

Station 1 GER
Mom came as her 4 months old child with Hx of vomiting. (GP setting)
Hx(3mins) Dx & DDX, Mx plan

Hx:
Introduction. Open ended Qs. Asked her concern. Asked baby’s name. (wrote both her and baby’s name in paper provided)
st
Vomitting qs- since when? CCVO? Blood? Projectile? able to keep anything down? Getting worse? 1 time?
Feeding Hx- BF or bottle? Introduced solids? Hungry after vomiting?
Bowel qs: Diarrhoea, Bladder qs: wet nappies, crying while peeing and changing nappies, change in color and smell?
Fever? Tummy distension? Noticed lump in tummy and groin? Lump while feeding?
Child active, irritable or drowsy? Sleep? Appetite? Anyone in family e same problem? Personal or Family hx of bowel issues?
Any issues during preg or after birth? Medical or Surgical hx? Enough support?
Positive findings: Hx of vomiting few times, esp after feeding, non projectile, just whitish milk, BF baby, mom concerned, no other
findings.
PEFE card was given after Hx bell rang. Everything was fine, no dehydration, nothing. Growth chart was also given which was on
th
50 percentile and was progressively increasing.
Dx/DDx: gave Gastroesophageal reflux as Dx. Drew diagram and told it is due to the lower end of food pipe poorly developed
which is common in babies esp this age group. I understand ur concern, told PE was all normal and baby is also growing
well and gaining weight according to GC so please try not to worry.
DDx: Pyloric stenosis, Gastro enteritis, Intusussception, Strangulated hernia, UTI but unlikely. (just mentioned the names)
Mx: Usually improves over time esp after intro of solid food. Sometimes by age of 1 year. I will give you some advices: give your
baby small more freq feeds, let the baby burp after feeding, do not keep ur baby to lying position or to sleep immediately
after feeding, raise the head end of cot, can give milk thickeners like Gaviscon which I will give RM how to prepare, if not
improved may need to involve specialist who might give some medications like acid suppressants. Is it understandable for you?
Meanwhile look out if baby excessively vomiting, not feeding, irritable, drowsy, decreased wet nappies. Gave RM. Any
questions? (anything else I should kw doctor?)

Station 2 Mittelschmerz
Middle age female patient came with Hx of right sided lower abdominal pain. Pain every month in middle of her cycle. Blood test
prev done mentioned all normal.
Interpretation of Ix Dx & DDx
Counsel and Mx the pt (GP setting)

Introduction. Wrote down her name in paper provided. Asked if in pain right now? No.
As you were having tummy pain so we did USG of your tummy, the reports are here with me, I will explain it to you, before that
do you have any specific concerns? Yes doctor, is the pain because of my appendix? I will address your concern, lets see
the reports together, please ask me if you do not understand anything.
USG findings: Both the USG written report and the USG film was provided. (outside and inside the room, inside the room it was in
the table and displayed in the big screen also) While explaining the examiner even came to see what I was explaining from
the scan provided but I just drew the picture and began explaining so, examiner went back.
USG showed maturing follicles in the right ovary, minimal fluid in POD, stones in gall bladder, GB wall not thickened and no signs
of inflammation, appendix not visible, (no appendix inflammation: mentioned in the report itself).

I drew the diagram and explained one by one (serially as mentioned so I won’t miss anything) like this is your ovary, it produces
multiple follicles each month of your period cycle out of which one matures and breaks
open to release the egg that goes to your womb and waits for conception, we call it ovulation & it is a sign of fertility and normal
occurrence, in your case it is happening on your right sided ovary. Small amount of fluid can be released during breakage
of follicle and spillage can happen in your tummy esp in space between womb and gut called POD, which we can see in
your cases, this fluid can irritate your tummy and cause pain, we called it mid cycle pain or mittelschmerz.
Then there is GB which sits behind your liver and stores bile, there are some stone in the GB which can happen due to bile
precipitation, we call it cholelithiasis, pain character different so unlikely, no wall thickening so unlikely of cholecystitis.
Patient kept on asking is it coz of my appendix multiple times even after I explained USG mentioned though not visible but it said
no inflammation. Then, I said very unlikely coz in appendicitis pain is persistent, not cyclical, can have non-specific
symptoms like fever, vomiting, and your blood test are also normal. Patient was then calm.

Dx/DDx:
Just mentioned the names as I already took time in Ix explanation.
Dx: most likely mid cycle pain or mittelschmerz
DDx: Other things that comes in my mind is cholecystitis, cholelithiasis, appendicitis, ovarian cyst but unlikely.

Patient counselling: For your pain will give you painkillers Panadol or NSAIDS. If not improved can give u OCP as well and involve
specialist gynaecologist. (I don’t kw y but I asked are u planning for pregnancy and she said not now but in future wud
definitely love to, so I said at that time we will consider to stop your OCP and pt smiled and said she loved the idea).
You can use hot packs or hot water bottles which u can buy from pharmacy.
For Gall stone it was most likely incidental finding, no relation with pain, will refer to gastro-enterologist for further opinion. keep
an eye if severe upper abd pain, vomiting, come to ED.

Station 3: Rest
Station 4 EYE PE
Old aged male pt had problem in vision, no HTN, no DM.
Perform Eye Examination mentioning the findings to the examiner, Dx & DDx to pt.

Failed this station so cannot give proper feedback.

VA: There was Snellen chart, examiner said to use it as 3 metre distance chart. There was no marking on the floor. Pt was wearing
glasses, checked VA one eye at a time. Pt was able to read the lowest line as if he memorized it before.
Color vision: asked for chart, examiner said assume it is normal.
VF: I thought there was problem in visual field, but thought I did not explained pt well so repeated 2-3 times, (totally forgot about
the bitemporal hemianopia case).
Light refex: direct, indirect: normal
Accomodation reflex: normal
Forgot about mentioning pupil.
Fundoscopy: Examiner gave the fundoscope. Told need to dim light and put mydriatic eye drop. Had difficulty in turning on the
light, took time, the examiner said u already turned it on, then only saw it was on. When I comment on red reflex then
examiner gave the fundoscope finding picture and said to explain to her. It seemed normal fundoscope picture. I had no idea wat
to say for Dx/DDx as I did not performed PE well so got no positive findings. Just said it cud have been coz of HTN, DM
retinopathy but no Hx and no findings on fundoscopy, Eye sight problem but VA is normal, so will involve eye specialist for
further evaluation. Knew will sure fail this station.

Station 5: Pilot

Station 6
Failure to conceive
Female pt having difficulty in becoming pregnant.
Trying for last 1 year. Worried. (GP setting) Hx, Mx

Hx: Introduction, Wrote down her name in paper provided, Open ended qs.
Confidentiality statement.
5P hx- everything was normal, no period issues, no menorrhagia, no dysmenorrhoea, no hx miscarriages, was on OCP 1 year
before, no STI hx, asked is it ok to ask if her partner had prev partners- yes, and if any child from prev relationships- no. No
pelvic heaviness. Gave confidentiality again and asked how often intercourse? She said 2-3 times/week. I asked is it every
week of the month? She said no, only one week a month as her partner comes home only for 1 week in a month coz of
work.
Past MHx like thyroid, DM, HTN, joint prob, FHx of same problem or miscarriages or birth defects.
Sx esp pelvic Sx SADMA
Counselling: explained that not able to become pregnant most likely coz of less no. of sexual intercourse. Sud have atleast 2-3
times a week every week unless on periods but u are having for 2-3 times for only 1 week which is insufficient. (Then
remembered about fertile period) and asked do u have any idea abt fertile period? No. Actually it is the time during which
if you have intercourse, more chance of pregnancy. There are diff ways to kw abt it like: using ovulation kit which u can get
from pharmacy, Basal
body temp method where u measure ur body temp every morning after waking up and b4 getting off ur bed, Cervical mucus
method where secretions from neck of ur womb is thin, more and lubricative. I understand it must be too much
information, I will give u RM about these and teach u further as well.
Other conditions also comes in my mind like thyroid problems, fibroids, endometriosis, hormonal issues so need to do further Ix
st
like: FBE, ESR/CRP, UCE, TFT, most importantly will do mid luteal hormone assessment ie 21 day [Link], others
hormone levels like FSH, LH, oestrogen, progesterone, pelvic USG, Urine MCS. And for your partner may need to do Sperm
analysis.
I understand it must be difficult your partner has to leave home coz of work but it is also imp to have freq sexual intercourse and
know abt fertile period. If you want we can arrange meeting with your partner and see if he can arrange his work or work
nearby house so he can spend time with you. We are hopeful it will work out but if not then still there is other options like
IVF. Once you miss your period please come back. Are you taking folic acid? No, ok so I will start you on folic acid. RM.
Review after test results.

Station 7 SCFE
Dad came coz his 10 yr old son was having leg pain. X ray also done. (GP setting)
Hx, PEFE, Interpret Ix to dad, Dx & DDx

Hx
Introduction, asked son’s name, wrote down, Open ended qs.
Pain qs, pain on leg. (Rt or left leg I forgot), pain on Rt knee and Rt hip. Diff to walk, he is limping since few days, not able to bear
wt on rt side, Plays games (football?) in school, pain started after the game, no Hx injury, 1st time, left leg no pain.
No fever, no redness, no swelling, no deformity, no viral illness Hx, no personal or Family Hx of bone
disease, no bone Sx, no any other medical Hx, no medication Hx. Enough support.

PEFE: Have to ask examiner one by one. All hip movement restricted esp abduction and IR, BMI: weight very high compared to his
height. Others all normal.
Ix: Pelvic Xray way given showing Rt sided SCFE. Rt Knee Xray was also given which was normal. (I think Xrays given outside and
inside the room) Explained in layman term. Examiner came to see how I was explaining Xray.

Dx: Gave SCFE as dx. Said head of thigh bone is supposed to be inside the socket of hip bone but in your son’s case it is slipped
from its position, so that’s y he is having this pain. Pathology is actually in his hip not his knee, but the same nerve supply
so hip pain is referred to the knee. Being overwt as found on PE and being sports person contributes to it.

DDx: Perthes disease but xray finding different, OM, OA, SA but no fever, Transient synovitis, Bone # but unlikely.

Station 8: Rest

Station 9 MMSE
Middle aged male patient heavy alcoholic.
Explain MMSE Perform MMSE
Tell about positive and negative findings

Sorry can not give proper feedback as I failed the station.

MMSE Chart was given. Did not asked question accordingly.

My mistakes:
th
When I asked abt date I thought I heard twenty two (It was 20 on my exam day) so when I mentioned about it later the patient
th
seemed to be surprised. I don’t kw maybe he meant 20 and I misinterpreted as twenty two.
For registration there was no mention of wat 3 objects to ask so I wrote down and asked on my own. It was affected.
For attention, it was mentioned as ask pt to count from 100 backwards subtracting 7 each time and if pt not able to do ask pt to
spell the word “WORLD” backwards. Here pt was not able to subtract 100 so asked to spell world backwards. My mind
completely gone blank when he was replying so had to ask him to repeat again (biggest mistake), he spelled DLORW Recall
was also affected.
For naming 2 objects: I did not see it mentioning the objects name. so saw clock and water bottle on the table and asked to name
them. But after finishing all the tasks, when checking if I missed anything, saw it was mentioned: clock and pen. So asked
him to name these objects and said sorry for earlier.
Station 10 (my starting station) Diazepam Dependence
Middle aged lady came as she was concerned that she is taking diazepam for long time( 1 year). (GP setting)
Hx, Counselling

Hx: Introduction, Confidentiality, Open ended qs, asked her concern.

Pt was concerned abt her diazepam intake, initially prescribed by GP, started when her son was dx with ALL, said sorry to hear
and asked how is her son now. Son is fine, doing chemos and now in remission. She was increasing dose herself now
taking about 30mg daily. She was constantly saying because of some problem she was taking the diazepam. I asked is it
coz
of stress of ur son’s health, she said yes and other stress. I asked wat other stress, she said she is a single parent so difficult to
manage esp not able to go to work as she has to take care of son and sometimes financial issues. So addressed then and
there as I might forget later that I cannot imagine it must be a difficult situation for you but we have centre link support to
provide financial help and single mother support groups too to provide you help which I will tell u later. Had withdrawl
symp whenever stopped taking. Forgot to ask about motivation level. Her sleep was affected so increasing the dose
herself, no nightmares, no early awakenings. Mood was ok. No depression, no hallucination, no delusions, judgement &
insight good. No support, single mom. SADMA negative.

Counselling: Said I really appreciate you coming to see me and all the empathy words. Seems like you are having Benzodiazepam
dependence. It means that u are dependent upon the medication diazepam that are taking for your sleep. Usually have to
be taken for short term but if u take it for long tym then u can develop dependence. I can say this coz u are increasing the
dose to get the same effect as before and u are having withdrawl symptoms wen u don’t take it. But I really appreciate
that u are concerned abt ur health and came to see me.. thank you so much for coming. I can help you with this. We will
make a good plan for
you. We will gradually decrease the dose of your diazepam over few months of time. Will give you a weekly prescription that u
have to take it from pharmacy on daily dispensing manner. This way the chances of severe withdrawl symp is less but if u
have extreme sleeplessness, low mood, ideas of self harm u have to come to ED asap.
Along with this, LSM like yoga, meditations can help you with your stress as well as your sleep.
Can arrange family meeting if u give permission. Don’t bottle up things, try to relax.
I will give you RM on sleep hygiene which will be of extreme help in long run. (didn’t had time to explain so just mentioned this
way)
Support groups, Centre link.
If needed will involve psychiatrist as well. (forgot abt psychologist and talk therapy)
Station 11 Abdomen PE
Old age patient’s relative was there to talk to you about pt’s condition. In stem was mentioned, pt has long term hx of
constipation and all, no LOW, no LOA, no blood on stool, everything pointing towards bowel obstruction. Vitals normal, no
pallor, no jaundice.
Examine just the abdomen
Explain Abdomen X ray to examiner (I think Xray was available outside too)
Dx & DDx to relative

Examination: Only the section of abdomen dummy was there as a patient. There was loud bowel sounds throughout whole room
from the machine inside the dummy. Pt’s relative was very concerned and asking lots of questions esp while telling abt Dx
& DDx: wat is that? Wat do u mean by it? I don’t get u at all. Can u explain again? Say wat u said again.

Sanitize and gloves Introduction, Guardianship.

Inspection: no scar, no cullen’s and grey turner’s sign, umbilicus central and inverted, abd seems little bit distended.
st
Palpation: Examiner 1 I wud like to make sure no tummy pain. Then light palpn and deep palpn all 9 quadrants. Examiner, the
abdomen feels tense to me.
Palpated for hepatomegaly and splenomegaly, both absent. Checked shifting dullness and fluid thrill for which the relative helped
with positioning and all. For bowel sound, I said present and seems increased in intensity.
Examiner, I wud like to examine inguinal area for any mass or swelling for hernia esp incarcerated & strangulated hernia: normal.
I would like to finish by doing DRE e pt’s consent & presence of chaperone: Not done or normal I forgot.

Then examiner gave abdomen Xray: It was xray of volvulus showing coffee bean sign. (Right now I don’t remember if it was
sigmoid volvulus or caecal volvulus but I mentioned which one during the exam. If cleft of coffee bean pointing towards
left: sigmoid, If towards rt: caecal)

Dx: Sigmoid/Caecal Volvulus: twisting of the large gut leading to bowel obstruction so that’s y constipation and all that was
mentioned in the stem. Plus abd seems to be distended, BS seems to be increased and X ray finding pointing towards it.
DDx: Caecal/Sigmoid Volvulus, Inguinal Hernia (pt kept on asking wat is that so said part of gut or fatty tissue may come out of
tummy and can lead to bowel obstruction), Diverticular disorder (pouch like formation called diverticulosis, may lead to
stool
impaction and can cause infection causing diverticulitis), Bowel cancer (relative seemed to be concerned and said really it is
cancer?
unlikely coz no LOW, LOA bt as elderly so have to keep in mind), Small Bowel obstruction but unlikely.

Throughout the station relative seemed to be concerned and dis satisfied with the explanation.
Station 12
Hepatitis A in traveller
Middle aged patient came coz of feeling unwell, tummy discomfort. Had travel hx. Safe sex hx. No I/V drug use. Had done blood
Ix, came for report.
Ix was showing derranged liver enzymes, bilirubin also increased, other Ix were normal. (don’t exactly remember the numbers)
PEFE, explain Ix result to pt, Dx & DDx

Patient seemed to be concerned and saying I am not feeling well. Wat happened to me? I said u are in safe hands we will try our
best to kw wat is wrong and try to help and mx u well. Are u in any pain? No. Is it ok if I talk to my examiner and examine
you? Please excuse me. (Whenever I had task of PEFE or talk to examiner in between, I excused myself from pt in similar
way and turned back towards the examiner and thank the examiner after finishing and again turned towards the pt).

PEFE: Had to ask one by one.

When asked abt Jaundice examiner said no so, asked specifically if there is yellow discoloration in eye, examiner said yes.
Liver was little bit enlarged. All other normal.
Office test: asked about UDT: bilirubin was present I think.

Ix: explained whatever was given, like we checked ur liver function by enzymes like so and so which seems to be increased and
all.
Dx: said most likely Hepatitis which is inflammation of liver which is organ in right side of ur tummy. As ur liver enzymes are
affected, yellowish color of ur eyes,
liver enlargement on PE, plus travel Hx. Any tym u had outside street food or unbottled water? Bottled water but street
food as was travelling. So most likely can be Hepatitis A or E.
DDx: Other things comes in my mind, cud be Hepatitis B, C but unlikely coz safe sex and no I/V drug use, HIV but safe sex and
unlikely, Gastroenteritis: bacterial like salmonella, shigella or viral like rotavirus, other travel related infections like
malaria, dengue, typhoid, tb, CMV, toxoplasmosis, nasty growth anywhere in body but unlikely. (While saying DDx bell
rang, examiner said to leave, but still I rushed and said these DDx, as I was heading outside, the roleplayer said u still have
1 min time so again listed all the DDx)[
Station 13: Rest

Station 14
Abruptio placenta e IUD
Pregnant women in last trimester (forgot exact week) came coz of tummy pain. ED setting. She seemed to be in pain & very
concerned.
Hx, PEFE, Dx, Mx

Hx:
Introduction, Open ended qs, Checked HD stability one by one with examiner: he said pt is stable for now, Offered pain killer
after pain scaling and ruling out allergy.
st
Pain was since last few hours, suddenly started, severe constant pain, 1 time, not relieved with pain killers.
st
No trauma Hx, no vomitting, no fever, no vaginal discharge, no bleeding, regular ANC, was also not feeling baby kicks. 1 preg,
no miscarriages, partner supportive, Blood group: she said don’t know. SADMA negative. No past medical Hx or Sx. No FHx
of miscarriages. Took folic acid, not on any medication.

PEFE: asked one by one.

FH was more than GA, No uterine contractions, Abdomen tender on palpn, no vaginal discharge or bleeding. FHS not heard.
Dx: Most likely you are having condition called abruptio placenta. Drew diagram (examiner came to
see the diagram) and explained this is womb and this is placenta which connects u to ur baby and carries O2 and nutrients from u
to ur baby, separation of placenta from the womb before the labour. So bleeding happening inside your womb. It is
actually emergency situation for u and ur baby. As u are bleeding inside so the baby can have life threatening effects and
unfortunately, I am sorry to say most likely ur baby is not alive. (Pt started to seem irritated and said wat do u mean by not
alive doctor, wat do u mean by it? She was showing facial expressions of disbelief) I explained as u are not feeling baby
kicks and on PE I cannot hear baby’s heart rate so most likely ur baby is dead. (Pt started to act sad and disoriented) I
cannot imagine what u are going thru ryt now, I am extremely sorry for this news. But we still need to do USG and CTG to
confirm. (forgot to say concealed abruptio placenta as no vaginal bleeding and FH>GA) (did not gave any other DDx as in
question did not asked for ddx)

Mx: Need to Admit you. Call my seniors and Obs specialist. In the meanwhile monitor your vitals, attach u to monitor, Open 2
wide bore I/V cannula, take basic blood samples esp for Hb, BG and cross matching, may need to give antiD if negative BG,
USG, CTG as mentioned earlier, LFT, KFT. May need to do C/S or Induction after confirmation and decided by specialist. Do
u want me to call anyone?
Station 15: Pilot

Station 16 Endometriosis
Middle aged female pt came with dyspareunia. Hx, PEFE, Dx & DDx

Hx: Intro, Confidentiality, Pt had pain on deep penetration, dysmenorrhoea also present, no dysuria, no pain on defaecation. no
bleeding after intercourse, no vaginal discharge, no LOW, no LOA, no pelvic heaviness, no wt gain, no trauma, no pelvic sx,
no pregnancy or miscarriage before, using condom I think. No fhx of similar problem.
PEFE: asked one by one. There was nodularity in uterosacral ligament. All other things normal.

Dx: Most likely Endometriosis. Drew diagram and explained like the inner lining of the womb called endometrium is deposited in
other places like FT, ovary, ligaments surrounding the womb. Exact cause unknown but might be due to menstrual blood
backflow. On PE, there is nodules on ligaments surrounding the womb so leads to pain during intercourse due to pressure
on ligament and pain during periods due to scars and adhesions.
DDx: Fibriods which is benign tumor of womb, PID, cervicitis, Infections like candidiasis, trichomoniasis, cervical ectropion, cervix
cancer, womb cancer all unlikely.
Station 17 Pertusis
Dad came as his son (young child, forgot age) having cough since few weeks/ months.
Hx, Explain X ray to dad, Dx & ddx to dad

Hx: dry cough since few weeks, prev had flu, occasionally gets flu, now fine from flu, cough cough and vomits afterwards, fine
between attacks, no SOB, no noisy breathing, no chest pain, active alert, no pale or bluish discoloration, doesnot go to CC,
elder sibling who goes to CC has similar cough which started before the pt, upto date e vaccination, no travel hx, appetite
and sleep good but last night freq wake up coz of cough, no personal or fhx of allergy, asthma, hayfever, no pets, no
carpets, father smokes sometyms but not inside house, no LOW, no past hx or fhx of lung, heart disease, preg and birth hx
normal, heel prick normal, enough support, happy family.

X ray : I think was given outside also. This is the x ray of chest of ur child from front view. These white shadow u can see are the
chest bones called ribs, this greyish shadow in centre is heart, normally borders sud be well defined but here it is not well
defined so we call it shaggy heart. On both sides of ur heart, u can see black shadows which are the rt and left lungs as it
has air so black in color, in the upper areas here u can see we call this as perihilar areas where the blood pipes and airways
enter the lung, in here there is some swelling
ie infiltrates so little bit white in color. This is the windpipe which is central in position, and this is dome like struct called
diaphragm which separates chest and tummy. Is it understandable to u?

Dx/DDx: Most likely Pertusis which is infection of airways by bug called Bordetella pertussis leading to inflammation, swelling and
narrowing of airways. (dr by bug do u mean bacteria? Yes it is bacterial infection) as has hx of cough cough and vomit and
cxr findings.
Other things comes in my mind: pneumonia, viral URTI, post viral cough, asthma, allergic rhinitis, covid infection, croup, GERD.

I think no Mx but still mentioned nasopharyngeal swab for confirmation and 5 days of AB as bacterial infection, notify DHS.
Station 18: Rest

Station 19 COPD
Male patient with long hx of cough. Spirometry done.
Explain spirometry to examiner, Dx to pt, Mx to pt.

Spirometry: explained step by step, defined FEV1, FVC, TLC, RV. BMI was also high. Pre and post bronchodilator values given.
FEV1, FVC, FEV1/FVC all reduced. Irreversible obstructive pattern finding so gave COPD as Dx. Dx/DDx: Most likely COPD,
explained. Gave ddx as asthma but unlikely coz findings are of irreversible pattern, lung cancer, bronchiolitis but unlikely.
Mx: Explained as COPDX

Station 20
Relapse of Schizophrenia
Male patient came with some behavioral changes.
Hx, Dx & DDx, Counsel and Mx pt

Hx: Intro, Confidentiality, Open ended qs. Since few weeks/months having auditory hallucinations as he is hearing conversations
between top secret high authority ppl about parallel universe. No visual or tactile hallucination. Pt seemed to be
distracted and looking here and there so I asked again is it coz u are seeing someone that u seem to look at different
directions? He said no, he was not seeing anyone but was moving his head so he can hear the conversations better. No
commands, no thought insertion, withdrawl or broadcasting. Pt kept on telling he is important person as he can hear
conversation. I think there was delusion of grandiosity. Mood was ok, not low not high, sleep ok but has to wake up to
listen, affecting social life and ADL due to time spent on listening. No suicidal tendency. Known case of schizophreniform
disorder, stopped taking medication himself coz symptoms were controlled, no f/ups. Insight lost.
Judgement and cognition I think was ok. No financial stress, no lifestyle stress, no head injury, no weather preference, No fhx of
mental illness. SADMA negative.
Dx/DDx: Most likely Relapse of acute schizophrenia. It is mental health problem where there is loss of touch with reality, as u are
having auditory hallucinations since u are hearing voices and conversations, and mentioned all positive findings. I see you
were diagnosed with schizophreniform disorder and stopped taking medication leading to relapse. Other things comes in
my mind are Bipolar disorder, Mania, Substance abuse, Head injury, Thyroid disorder, Brain infection but unlikely.
Mx: Admit to hospital, Need to do basic blood test, TFT, LFT, KFT, toxicology screening. Psychiatrists will start antipsychotic
medications that u need to be compliant with. Psychologist for CBT. Family meeting if give consent. LSM, yoga,
meditation. RM.

Non Scored Stations:

Ear PE
Perform Ear Examination Dx & DDx
(RT/Left sided Conductive hearing loss due to cholesteotoma, DDx: Impacted wax, AOM, COM, serous OM)

Male pt with hx of fall

I think task was Hx, Dx and DDx.
No pre syncope danger signs and no post syncope features, no dizziness on position change, LOC +nt for few secs, no epilepsy
nd
features, no witness, this is the 2 episode, no stroke features, forgot to ask missed meal, no DM. Pt was complaining of
pain and swelling on back of his head, no bleeding, known case atrial fibrillation, HTN, was on 3-4 medications (brand
names, don’t remember), none of them was recently started, no dosage change, complaint and regular f/up.

21st Sept 2022, F2F

1-mother concern about her daughter watching pornography
Counsel and management
2- 67 year old male has done cholecystectomy last year now presenting with lost of appetite and losing wight
His Liver showed multiple metastatic lesion explain ct scan , invx
3-man has done hernial surgery 6 hours ago now has pain abdomen, PE on maneuquin ( bladder enlarge nit sure)
4-pelvic exam 67 lady with spotting Every thing was normal
Ddx and abdominal exam
5-mse 19 year lady wearing sunny
With commandary auditory hallucination , unkempt hair, keep pretending talk with phone
Thought disorder grandiosity
I missed the cognition part I told examiner , present mse
6-peaky eater with normal growth chart hx and counselling
7-hyperemesis gravidarum , hx, ask pe, ddx
8- Sob in 55 year old lady, first ask pe and initial management fever , shock low blood pressure , xray chest given, right sided
consolidation and inc vocal fremitus, dull air sounds on right side,
9- pneumonia or atlectasia ??? chest X-ray and management fever after surgery few hours, dull in percussion. Crackle in
auscultation on right side
Increase in vocal fremitus(not sure)
Cxr consolidation right lower lobe, chart given outside( fever in range of 37??)
10- Burn in 3 year old boy came with his nephew hx and mx burn less than 10 percent, no bruise on child
11-55 man with irritability for a while taking ssri 10 mg , history of 1 yr depression, taking ssri for 6 months, on history was non
complaint, only took for 1 week
Counselling and mx
I found during history has problem with wife and drinking alcohol
Hx .mx
12-50 y lady with tingling and numbness of arm and hand for 2 weeks , drinking wine every night
On exam T1 sensory loss
Upper neurological exam
13- hypercalcemia in hypothyroid lady who is on levothyroxin, ask investigations, history management
14- seizure in 3 yr child, 37.1 fever, previous 2 febrile seizure history
15- SOB on middle age lady, on walking uphill, orthopnea , no oedema of legs, non smoker, taking 3 medication htn, statin and
for afib.
Ddx, history
16- warfarin counselling for elective colorectal carcinoma

September 21 feedback!
Hey guys I went into this exam thinking YOLO! Whatever happens happens. But I passed. Still shocked. Thought I share my
feedback for some ppl that were asking. Please dont message me directly I will have to block you. :(

__________________________________________________________________________________ Station 1 - Pilot station

I do not remember this station details. There was chest X-ray that was shown on request. And it showed consolidation in the
middle lobe. So u had to explain to the examiner ur finding.
_______________________________________________________________________________________ Station 2 - fussy eater

Child is a fussy eater. Mum is worried. Take history, PEFE from examiner.
The child was exclusively breast fed. Then when started on solid he refused everything. Only eats yogurt. Development all normal.
Did full BINDSMA history. Everything normal. When asked about any concerns for growth she pulled out baby’s growth chart and
said she brought it from Maternal child clinic for me to take a look. Child weight and height was all normal above 50th centile and
growing normally.
Asking PEFE from examiner - all systems was normal. No office tests available.
I don’t know why I failed Thi station or what else I could have asked in history. :/

_____________________________________________________________________________________
Station 3- Rest _____________________________________________________________________________________ Station 4-
Pornography
Mother comes in to see u because she saw her daughter watching porn on her laptop.
I started by telling her that she did a good thing by coming to see me today.
Then I asked her to explain to me what happened.
I asked about the girl’s school performance, her friend circle, her behaviour at home.
Then I asked details of the home situation. Who lives there, anyone at home smokes/drinks/ does drugs.
How is everything at home.
Then I asked details of the mother’s relationship with the girl.
Then I counselled her about the risk of watching porn how it leads to insecurities about her body and false expectations in her, and
how watching porn can lead to addiction.
I also asked her if she thinks her daughter is sexually active. She said no, we are a believing christian family. (LOOOL) I told the
mother to have a friendly chat with the girl. Ask her about the incident and why she was watching the video.
I also said times are different now. If she ever does decide to become sexually active it’s important that she knows about safe sex
practices to prevent sexually transmitted diseases and unwanted pregnancies. So it’s important she have the talk with her girl. I
also suggested to her

that if she and her daughter consent and are happy they can both come in together and we can talk together. I can talk to her
about safe sex practice.
I also told her about parental locks and controls she can install for her internet and on her kids devices. I told her to call “geeks2U”
from Officeworks and they can come to u on the same day. Then in the end she asked - do u think I am a good mother? I told her
we all try very hard and the fact that you care about your daughter and are seeking consultation about this shows how much you
care. But it is a difficult age and very challenging. You’re doing great.

______________________________________________________________________________________
Station 5- Burn
18 month Child came in with a burn from hot drink on chest. Take history from carer, PEFE, Consult

When I entered I first introduced myself then told the role-player to excuse me as I want to make sure the child is
hemodynamically stable. I then told the examiner I want to know the vitals of the patient. Examiner said all normal u can proceed
with history.
In history there was a guy he said he was on the phone and had his coffee on the table. The child then pulled the coffee and spilled
it on him.

I asked him if the coffee was hot and freshly made? He said it was made 4-5 minutes before the incident and was still kinda hot.
I asked what he did immediately after? Was any first aid done for the burn? He said he removed the child’ clothes and put him
under water for 5 minutes and called the ambulance. Ambulance arrived within 5 minutes. I said wow that’s really fast response
and u are lucky to be tended to so quickly by the ambulance. He laughed and agreed. I also told him he did the right thing by
applying water to the burn.

Then I asked about the child. The extent of the burn. He showed the front and upper area of his chest area. I asked if the child had
any breathing difficulty? He said no. I asked about how the burn looks. He said it is red. I asked if there is any blisters or fluid filled
sacs? He said no. Then I did full BINDSMA history. The child’s parents are separated, so the father is not in the picture. the mum
goes to work and he takes care of the child. I asked about his relationship to the mother and wether he was her partner? He
laughed and said the mother is actually his sister. I asked about his relationship with his sister and how they get along, all seemed
normal.
In PEFE everything was normal. All vitals normal. Child was happy and quiet now. All system review was normal. There was a
superficial 1st degree burn of 10%

I told him the child looks well and happy now. And the extent of the burn is 10%. Usually when the extent of burn is 12% or more
we admit the child. But in this case we can send him home with dressing instructions. We can use hydrocolloid dressing and zinc
creams for faster healing.
I asked him if the mother was informed. He said yes and she is on her way.
I said we will not discharge the child just yet. We will have to talk to the mother as well. And I will also have the opinion of the
consultant too.
Then I asked him if he had any concerns.
He said I am just worried that the scar will be there longterm. I said it doesn’t seem like, because it’s just a first degree burn. So his
skin should heal just fine.

_____________________________________________________________________________________
Station 6- Hyperemesis Gravidarum
-Take hx -PEFE -ddx
Pregnant lady complaint of vomiting. She had a vomiting bag next her and acted like she was vomiting 2 times while I was taking
history.

In history I asked her about her LMP, whether this was a planned or assissted pregnancy. She said planned but not assisted. I
asked all questions about her period history, her past medical and surgical hx. Also asked about twins history in the family.
Then I asked about all first trimester screening questions like blood group, STI screen and rubella and varicella. Wether she started
iron, folic acid and other multivitamins.
I also asked about dating scan if she did one. She didn’t.
Then I asked about down syndrome scan and if she did it or was told about it she said she didn’t so I quickly told her about triple
test and NIPT. Just brushed through and told her to come see me another time if she needs to have it done.
Then I asked her about pregnancy symptoms like sore breasts, vomiting, any abdomen pain, any discharge or bleeding. She said
for past 1-2 weeks she can’t keep anything down. And she keeps vominting. I asked about color, content, volume and frequency of
her vomiting.
In PEFE I asked for vitals - all normal
I asked about CVS, Respiratory and abdomen.
In abdomen exam - any tenderness, masses? And is uterus size appropriate for gestation age? Yes uterus corresponds with
gestation age.
In pelvic exam everything was normal.
Office tests available? Examiner asked what do u want to know? I said any urine dipstick? He said yes what u looking for? I said
any protein, leuokocyte, nitrates or ketones?
Yes ketone positive on urine dipstick.

Then I turned to patient and told her my ddx

It’s normal for some ppl especially in 1st trimester, Twin pregnancy, molar pregnancy, infections like UTI and gastroenteritis.

___________________________________________________________________________________
Station 7- UL neuropathy
62 y woman, long time smoker. Comes with numbness, tingling, weakness in her right hand. Do Upper limb focused neuro exam.
Give ddx.
I went in asked for vitals. Examiner said all normal. Then asked patient if she had any pain before I start. She said no.

Inspection looking for any fasciculations, wasting, redness, swelling and scars. I commented on both sides. Then the remainder I
did only on the affected side to save time.

I did tone of wrist, arm, elbow and shoulder muscles all seemed normal.
Power- I did the myotomes and commented on each one. She did show weakness in C8 and T1 myotomes.
Then I went to reflexes - examiner moved close to see where I place the hammer. I did biceps and triceps.
Sensation I did fine touch with cotton wool. I did the dermatomes and found dermatome loss of T1 so I mentioned to examiner
that.
I told the role player that I found some nerve compromise in C8 and T1.
I gave differential diagnosis as Pancost tumor, cervical radiculopathy due to masses or disc prolapse, any other mass putting
pressure on brachial plexus or at the cervical exit, Trauma to the brachial plexus or the neck. Etc.....

_____________________________________________________________________________ Station 8 - rest

________________________________________________________________________________ Station 9 - Unprovoked seizure

Hx, PEFE, dx
3 year child came with episode of seizure. I asked her before, during and after the episode questions. All answers showed that the
child had a real seizure.

The child had no fever, no signs of infection anywhere, no ENT, respiratory, abdomen or UTI signs. Nothing.
And all BINDSMA. Everything normal except In past medical the child had 2 previous febrile seizures.

In PEFE everything was normal. Office tests of urine dipstick and BSL all normal.
I told mother this was an “unprovoked seizure”. As there was nothing that could have triggered the seizure. And it would require
further investigations.
I also told my ddx that it could have been a febrile seizure due to fever, or infections anywhere, or due to hypo or hyperglycaemia,
or any other electrolyte disturbance. It could also be a first episode of seizure due to a condition known as epilepsy.

_________________________________________________________________________________________________________
______ Station 10 - Short ness of breath
62 y woman complain of SOB. She is farmer’s wife and is unable to carry out routine works at the farm due to her SOB. Known
case of HTN and DM.
I asked all relevant history of SOB. Ruling out all ddx including URTI, ACS, PE, Infections, Trauma, COPD (smoke hx), asthma hx, all
negative.
When asked about past medics history and medications she brought out her prescription and it showed that she was on glicazide,
ramipril, and metformin.
I gave her all ddx of SOB :D
I literally thought I’d fail this case :D
____________________________________________________________________________________ Station 11- post operative
complication
Lady who was post surgery. Vitals graph was given that showed upward spiking of temperature and upwards spike of hearts rate.

Task: 2min hx, PEFE, ddx

She was feeling a bit hot but no other problems... Urgh I have no more to say about this case. I failed this one.

___________________________________________________________________________________
Station 12 MSE video.

____________________________________________________________________________________ Station 13 rest

_____________________________________________________________________________________

Station 14 - CT liver shows multiple metastasis lesions. Long time hx of indigestion. And blood test showing anemia.
Task - explain results to patient, hx, further investigation.
I first start with asking him how he felt since last appointment. I asked him if he wanted anybody to be with him today. He said no
he is ok.

Then I explained blood results to him first telling him he has anemia. Which could be bcoz of reduced production, increased blood
loss. Or reduced absorption.
I also showed him CT and said this looks like a picture of metastasis from somewhere else.
I asked his history like symptoms of cough, bloody sputum, urinary symptoms like dysuria or dribbling. I also asked him about
melena and constipation/diarrhea or blood in stool. He said he had dark stools.
I also asked about weight loss, night sweats, bone pain anywhere. He said he only noticed unintentional weight loss.

For further investigation I said we need to do iron studies, endoscopy and colonoscopy, PSA, Tumor markers, Bone scan, chest,
brain and abdomen CT scan. (I might have forgotten one of these coz I scored low)

____________________________________________________________________________________ Station 15 - Results

review
Patient known case of hypothyroidism on medication.
Came to review her blood results. Results show high Calcium. Normal T3.

Task take hx, ask further investigations from examiner, explain results and ddx
I start by asking her about symptoms of hypercalcemia - ask about tiredness bone or muscle weakness and constipation? All
negative.
Then I asked about her hypothyroid - how long she was diagnosed, how often she follow up and what treatments she take.
Then I asker her about other past med history or surgical history and wether she takes other supplements. She said she used to
take vet D supplements but stopped coz since last few appointments her Calcium level was high.
ThenI also asked if she was ever diagnosed with kidney diseases, or ever had bone fracture recently or any trauma. Or ever
diagnosed with a malignancy. She said no!
I asked examiner that I wanna do FBC, UE, repeat free T3, Parathyroid hormone, vit D levels, Kidney function test (creatinine and
GFR) and LFT.
Examiner handed me Investigations showing everything normal and PTH elevated.
I explained to patient that usually elevated calcium is due to primary causes or secondary causes. In her case I draw the thyroid
and parathyroid. And said they are next to each other and usually one affects the other so the parathyroid gland which is
responsible for Calcium level regulation is dysregulated or playing up. (I used Get Z terminology :’D)
I said I was also thinking about secondary causes like excess vitamin D or Calcium supplement, kidney disease, Trauma, fracture,
malignancy that can cause hypercalcemia.
_____________________________________________________________________________ Station 16 - rest
_____________________________________________________________________________________ Station 17 - abnormal
bleeding

70 year old woman with abnormal brown spotting.

Task - get consent, do pelvic exam, ddx
I started by explaining and getting consent it was so weird coz there was a mannequin but the role player was sitting next to the
mannequin. So I would explain each step and when I do the speculum exam she would moan and say it’s so uncomfortable. I just
kept telling her to bear with me.

Anyways first I start with abdominal examination. Examiner said what u looking for. I said I am looking for any tenderness and
masses. She then said normal.
Then I went for pelvic I looked at inspection and there was a lot of lubricant on the vagina. I said I can see clear discharge, the
examiner said it’s just lubricant, move on. Ok then I went for speculum I said I want to look at walls of vagina for atrophic changes
or trauma. and I wanna look at the cervix for any abnormality. But I didn’t see anything so I said I can not appreciate any
abnormality.

Then I removed the speculum and told examiner I wanna go for bimanual examination she said skip all normal.
I told her my ddx - atrophic vaginitis, cervical cancer, cervical ectropion, cervical polyp, endometrial hyperplasia, endometrial
cancer, fibroid, DUB, bleeding disorder.......

______________________________________________________________________________________
Station 18- rest ______________________________________________________________________________________ Station
19 - warfarin case pre op- I failed This so not gonna even attempt remembering what I did here and re traumatise myself.
_______________________________________________________________________________________ Station 20 - Abdomen
exam.
Man 6 hours post op- did hernia surgery. Now complaint of abdomen pain.
Do abdomen exam, tell ur ddx

I start by explaining and getting consent. Then I asked for vitals. Examiner said all normal
I explained general appearance role player was sitting comfortably but seemed in pain.
Then I did inspection. There was a dressing in the RIF and it was clean. Examiner said dont touch or remove the dressing. I started
superficial palpation. Felt a mass in the lower part of abdomen. Went for deeper palpation. There was a pass in the mid lower
abdomen of the mannequin. Then I did persuasion from diploid downwards until it was dull 2-3 cm below the umbilicus. I
commented on that. I then auscultated for bowel sound OMG Holy Moly!!! there was a speaker in the mannequin that mimicked
bowle sounds. So I said bowel sounds present.
I thanked patient, covered the mannequin and told examiner I also want to do a DRE. He said all normal.
Then I gave my ddx. I remember saying urinary retention, UTI, fecal impaction forgot what else I said. But I said a lot haha.
According to the feedback - Only 3 was acceptable!!!!
 21st sept 2022 Combined feedback from morning and evening

1. Video 19 y o female schizophreniform disorder, We have to leave to another planet

Calculations ,Powers, Waiting Orders for harm other people
MSE x

2. 50 y lady with tingling and numbness of arm and hand for 2 weeks, drinking wine every night
On exam T1 sensory loss. Upper neurological exam
(neuro exam x)

3. (Pelvic exam x) pelvic exam 67 lady with spotting Everything was normal
Ddx and abdominal exam
Menopause 15 y ago
Not sexually active
Dx with different
Atrophied vaginitis

4. 67 y o m Post cholecystectomy D1 with and pain, Chart

Abdominal exam x
Suprapubic pain
Urine retention
Dx and Mx

5. Fussy eater x
10 month baby picky eater
Hx from mom
Dx
Mx plan
Hx delivery developement nl no fever
Wt normal
Standing now
Started to feed at 8 months
She says he picks on Broccoli
Tried vegetables not eating
Likes to eat yoghurt

6. (Atelectasis)
Post op lady

7. (Depression)
Male diagnosed by GP depression citalopram 10 mg 2 months ago
Complaining of restlessness
Hx from pt(Taken for 1 week and stopped bcz of no response
Low mood
Sleep disturbance
LOA
No anhedonia
No suicidal idea)
Dx
Depression
Mx

8. SOB
Hx
PEFE
Dx with reasons
(Heart failure)
Lady 50 y o working in a farm
Orthopnoea
Dry cough 3 months
HTN
Hyper cholesterolaemia

9. Lady admitted for respiratory complaints pain over the lower part of chest
Hx
Fever
Hypoxia
Tachycardia
Tachypnoea
(Pneumonia sepsis)
PEFE
Dehydration
Hypotension
Restriction in right chest expansion
Right respiratory crackles
Right Dull
Immediate Mx
Ix
CXR AP and Lat(right lower lobe pneumonia)
ABG
Cultures
Explain diagnosis to the patient
Show the x ray

10. Burn pedia

7 y o child , Uncle caretaker, Chest 10 percent burn
Mx

Hyperemesis

11. Female hypothyroidism on thyroxine

Ix : Hypercalcemia
Focused Hx
Ix specific TFT nl pTH high RFT Vit D nl
Dx with reasons
12. Old female dyspepsia wt loss 4 months , Hx of cholecystectomy , Liver ct scan contrast(with liver metastasis), Ix Hb low
MCV low
Explain CT
Dx with reasons to the patient

Seizure

13. 70 y o CA sigmoid colon with a prosthetic valve awaits surgery 2 weeks

Hx
Preop on warfarin INR nl
Enalapril
Atorva 40 mg
PEFE
BP 140/90
Mx
Warfarin to heparin
Check and start warfarin in

2--67 year old male has done cholecystectomy last day now presenting with lost of appetite and losing wight
His Liver showed multiple metastatic lesion explain ct scan , invx)

1- 15 y o girl mother concern about her daughter watching pornography

Counsel and management

3-man has done hernial surgery 6 hours ago now has pain abdomen
4-pelvic exam 67 lady with spotting Every thing was normal
Ddx and abdominal exam
5-mse 19 year lady wearing sunny
With commandary auditory hallucination , unkempt hair, keep pretending talk with phone
Thought disorder grandiosity
I missed the cognition part I told examiner
6-peaky eater with normal growth chart hx and counselling
7-hyperemesis gravidarum
8- Sob in 55 year old lady after surgery , fever , shock low blood pressure
9- pneumonia or atlectasia ??? chest X-ray and management fever after surgery dull in percussion. Crackle in auscultation
Increase in vocal fremitus
Cxr consolidation right lower lobe
10- Burn in 3 year old boy came with his nephew hx and mx burn less than 10 percent
11-55 man with irritability for a while taking ssri 10 mg
Counselling and mx
I found during history has problem with wife and drinking alcohol
Hx .mx
12-50 y lady with tingling and numbness of arm and hand for 2 weeks , drinking wine every night
On exam T1 sensory loss. Upper neurological exam

27th Sept 2022 F2F

[Link], lower abdominal pain with multiple sexual partners, hx, pefe, dx,
2. UL neurological PE
[Link] exam
[Link] and Dizziness: AF, hx, pefe card, ecg, dx
5. SOB, parapneumonic effusion: hx, pefe, dx
6. [Link]: pefe, dx n ddx, Mx
7. Mse with mmse
8. immunization counselling: address parents concerns
9. Bartholin abscess: hx, dx n ddx pic given
10. HTN counselling with ambulatory bp measurements provided
11. Obs exam: ? Normal Pregnancy
12. Croup: hx, dx n ddx
13. Normal Grief: hx, dx n ddx
14. Nephrotic syndrome: hx, pefe, dx and ddx
15. PV bleeding, hx, pefe, ix
16. Cervical radiculopathy with breast cancer case

28th sept F2F

1. PE Station: lumbar radiculopathy
2. Haemorrhoids PE DRE and abdomen examination
3. MSE mania case video
4. Inevitable miscarriage: history pefe and diagnosis with reasons
5. AAA explain CT, management/ counselling and implication of diagnosis Marwan 100
6. Hyperthyroidism in 17 year old: pc anxiety and palpitations. Marwan 193
7. Generalised skin rash: looked like hives in an adult Marwan 106
8. Giddiness PE: had nystagmus patient did not come out of couch
9. ?Sepsis in a 14 month old baby. Handbook case114
10. Anaemia In a 4 year’s old. Contra slide 43
11. Acute UR with fibroids
12. ANC counselling BMI 31 42 year old
13. Antenatal care breastfeeding vs formulae
14. 22 year STI explain results and management Chlamydia positive
15. Difficulty in swallowing ? Ca oesophagi? History and diagnosis with reasons.
16. Postnatal depression history diagnosis management.

29th sept 2022 F2F

1) HSP Rash examination and DDx to patient
2) Neonatal PE
3)Urine dipstick performance and bloody sputum examination and DDx to patient
Sputum Test, (Phlegm Analysis), Sputum Culture, Sputum test, Sputum Analysis - Bing video
4) Pelvic examination and CST
5)patient coming with lethargy-OSA
6) Meningitis Hx and DDX and Mx
7) Scarlet fever HX and implication
8)RS PE and Pneumothorax XRay
9) Sepsis in a 9 month old -Hx and DDx
10) POA 35 asking for IOL because husband is going on a business trip in a week
11) Tension headache and somatic symptoms disorder Hx and DDx
12)back pain Hx and DDx. Marwan 114
13) Heametemesis 1st episode Hx and DDx
14)Cellulitis with many comobidities Hx PEFE and Mx. Marwan 90
15)Endometriosis Hx and DDx
16)Delirium case. Mother has pneumonia and features of CHF. Now delirious. Explain the condition to daughter

October
5th October online
6th October online
Station01:
37 year old breast lump
Tasks:
1. Hx for 6mins- was breast feeding, 3rd baby, delivery 6 wks back, no fever, firm in consistency, non tender, had hx of milk
engorgement, FHX of breast cancer, 1st time
2. DDX

Station 02:
GP, Pt came for flu vaccination, Nurse checked BP twice 10 mins apart. It was 170/100 and 165/105. Has hypercholesterolemia as
well. Blood cholesterol was 7mmol/L.
Was on telmisartan 80 mg.
Tasks:
1. Hx for 6mins
2. Counsell regarding flu vaccine and cvs risk

Station 03: REST

Station 04:
GP, Alzheimer disease counseling

Station 05:
GP, Mary, 67 year old will undergo knee replacement surgery for rt knee OA. Pre-anesthetic check revealed COPD, IHD, Mild CKD.
Anesthesiologist said surgery is risky. Sent pt back to you. List of medication given which she was taking for COPD, IHD,
CKD.
Tasks:
1. Hx regarding Knee osteoarthritis.
2. Hx regarding other diagnoses
3. discuss risks & benefits of surgery.
It was specifically mentioned that do not talk about alternate mx of surgery.

Station 06:
GP, Breast ca pt, after having 6th dose of chemo( Paclitaxel) now complaining of sensory problem in feet, which should be the
side effect of this treatment and pt was informed regarding that.
Tasks:
1. Focused Hx for 3 mins
2. Describe sensory PE to examiner
3. Tell what findings you will look for

Station 07:
GP, 4 month old child BIB mom due to vomiting
Tasks:
1. Hx for 5mins
2. PEFE- all normal
3. Dx with reason
4. Mx

Station08: Rest

Station 09:
Gardasil vaccine counseling

Station10:
GP, 3 year old boy had otitis media 2 weeks back. At that time you heard murmur but failed to examine properly as he was crying
a lot. You asked to come later. Today they have come back for a checkup. He is smiling today
Tasks:
1. Explain steps of examination to father
2. Explain what examination you will do to examiner, you need to finish task 1 and 2 in 6 mins then PEFE will appear with
relevant examination. Pansystolic murmur at left lower sternal edge.
3. Explain most likely dx and ddx
Station11:
Sara BIB by parents at ED had funny turn. Friend witnessed the event.
Tasks:
1. Hx 5mins
2. PEFE all normal
3. DDX

Station 12:
GP, 8 yr old dental problem. Presented with facial swelling. 2 pic given. Current one showing rt. sided facial swelling, old one
normal. A medical student was there with you. Vitals were given temp was 38.4C
Tasks:
1. Explain relevant PE to MS.

Station 13: REST

Station 14:
Women at 34 wks of gestation came for ANC. Midwife is concerned. Two charts given showing SFH is 30 wks now. Antenatal hx
details given. Everything was normal.
Tasks:
1. Focused Hx
2. Tell what inx you want to do
Finish 1 & 2 in 5 mins
Then invx result will pop up. 4 charts was given. Baby’s wt, Amniotic fluid, 2 more chants. All indicating towards IUGR.
3. Tell dx, risks, further mx

Fundus less than dates: Consider:

• oligohydramnios—liquor volume usually <500 mL
• small baby
• intra-uterine growth restriction
• wrong dates
Oligohydramnios is associated with conditions such as fetal abnormality, prolonged pregnancy, kidney disease, pre-
eclampsia, congenital infections (CMV, toxoplasmosis), PROM and placental insufficiency.

Most likely diagnosis is small for date baby. Have you heard about it? Let me please tell you more. It is the condition most
likely due to small baby however other causes for this condition should be assessed starting with correct date, less
fluid, any viral etiologies, placental issues and baby malformations. We therefore needed to confirm this with USG
abdomen, CTG , viral antibodies and complete blood workup. I will refer you to Obstetrician and would follow you
up in high risk clinic. We will take care in a multidisciplinary team approach. Delivery would be arranged around 38-
39, depending upon the baby and the womb conditions, methods would be advised by the specialist possibly CS.
Please also, be aware about babys kick, any passing of fluid, early contraction, in which case you needed to contact
to the emergency ASAP. Let me provide you some reading material about this condition.
Handbook case133

Station 15:
Heroin pt feeling unwell
Tasks:
1. Hx for 5 mins
2. PEFE
3. DDX

Station 16:
Young female sent by uni counselor. Detailed hx given regarding orientation- N, SADMA-nil +ve, PMedHx- nothing, Family is
farmer, Lives in uni residence, No friends, Plays video games
Tasks:
1. Do MSE in 6 mins
2. Explain MSE to examiner
Station 17:
31 wks pregnant lady with BPV.
Tasks:
1. Hx for 5min had trauma due to physical assault by partner.
2. PEFE: SFH was 29wks, mild tender abdomen, and CTG was given baby was fine.
What other investigation will you do?
3. DDX

Station18: REST

Station19:
Abd pain in Ed-
Tasks:
1. Hx for 5 mins
2. PEFE Irreducible inguinal hernia
3. DDX

Station20:
Young female at Ed, Talk to friend. Was feeling unwell. Now moved to resuscitation cubicle. Vitals were given:
BP- 90/70
Pulse-112/min
T- 36.2
Spo2- 97%
RR- 20
Tasks:
1. Hx for 5mins
2. PEFE-
No lip swelling, wheeze, bee sting, cold calm periphery
3. DDX

18th October online

1) A 27-yr-old boy was detained by police under a mental health act after being assessed by the crisis assessment team (as he is
threatening? a shopkeeper and customers)
tasks: h/o, answer mother's questions (procedures of MHA and reasons for using? MHA)

5. Binge alcohol caught by police, admitted acc to MHA, history of behavioural change for 6 months. Parent wants to know
about Mental Health Act. ( wht are the task please , 30 june )

Once again
Safe limit of Alcohol
Explain what is intoxication
Parents are to be informed that According to LEPRA he was detained by police due to breach of peace in public place.
According to Mental health Act 2014 and AOD 1974 He is give involuntary treatment for his mental illness (not sure if we
should say mental illness or mental disorder)
Once he is recovered he will be explained about the treatment option rehabilitation and support to him and he can make
his own choice in regards to the tratment. Support will be provided to his family as well according to this Act.
Plus 4Rs
Any person with mental illness and unable to give consent, to ensure the safety of that person as well as the community,
authorised personnel like doctor can activate MHA ( mental health act ) to initiate involuntary treatment. Process of
initiate treatment====
Admission order (AO) given by GP or by HMO in hospital which is valid for 24 hours
>> in ED, there is ECAT team and they will follow this AO
>> within 24 hours, psychiatry consultant will see this patient
>>> He will give TTO ( temporary treatment order) and can keep the patient in hospital for up to 28 days, or he can
discharge the patient after assessment
 >>> If more time needed or parents not agreed , he will send the case to MHT ( mental health tribunal) consist of 3 people,
psychiatrist, retired judge and lawyer
>>> With in 2 weeks MHT will hear the case; if agree with consultant, they will issue TO( treatment order) for involuntary
treatment in community or in the hospital. This order will be valid for 6 months as well.
All AO, TTO, TO are for both community and hospital treatment.
CAT team will ensure treatment in the community.

Mental Health Act-your son will be seen by the CAT team, they will admit your son to the hospital under the Mental
Health Act.
They will do organic work up (Key point) FBC, UEC, LFT, TFT, ESR, CRP, blood sugar, Urine MCS, Toxicology screen of blood
& urine.
Then, your son will be assessed by psychiatrist and they give temporary treatment order (antipsychotic).
They will form mental health tribunal which consists of new psychiatrist, lawyer& community person.
If your son is safe they will discharge your son voluntarily, or they might give inpatient treatment order, or community
treatment order (he should come for follow up with mental health tribunal) with support of family member and
friends
Mental Health Acts - comparative tables ([Link])

2) ?A middle aged guy comes to the GP for ?check-up (was taking telmesartan for HTN), but BP was elevated two times 180/?
no hypercholesterolemia, ?blood sugar is fine
tasks: h/o, management
(non-compliance for 2 months because he is busy picking up meds)
(find out other socioeconomic needs)

3) MMSE

4) OA hand examination (special tests with rp, the rest techniques with examination and tell the ex the findings you are looking
for OA)

5) old aged pt come to the clinic to review pre-op assessment for right hip replacement
Thoracic spine X-ray shows ?lesion suspecios of cancer
tasks: brief h/o, explain the condition (?need to approach breaking bad news), explain immediate implications of right hip
surgery

6) a lady who just gave birth and nurse has concern about her mental condition everything regarding taking care of the baby was
done by her husband
Bottle feeding
delivery and baby is uneventful
tasks: psychosocial history, ?tell the examiner the risks and reasons

7)A 27-year-old boy recently collided to the head by his friend while playing ?rubby/football
LOC for a few seconds/minutes
imagined tests were not significant
he is about to be discharged
you are ?intern and not in a duty while he was admitted yesterday
tasks: h/o (3 mins), explain the condition, further management for concussion

8) 9-year-old boy c/o right thigh and knee pain (months)

X-ray and PEFE will be revealed after 5 mins
tasks: explain X-ray and diagnosis with reason
?SUFE

9) 4 months old baby just came back from Malaysia presents with cough and high fever 38.?
covid-19 PCR was negative yesterday
tasks: h/o (6 mins), ddx

10) cervical screening tests

tasks: h/o (3/4 mins), explain the procedures, ? explain the condition (forget the last task)
 pap smear test vs cervical screening tests
[Link]

National cervical cancer screening program

- Cervical cancer 12th most common diagnosed cancer in Australian women, – 1.5% of cancers in Australian women
- Since 1991 – 50% decrease in mortality due to cervical cancer, largely due to NCSP
- 80% of women with cervical cancer had not had a pap smear or cervical cancer screening in the previous 5 years –
- Pap smear is obsolete from 1st December 2017
- A lot of migrants come here – so we need to know how to deal with women transiting from pap smear to CST

HPV the common cold of the genitals

Up to 80% of people are infected in their lifetime
14 oncogenic types – 16,18 carry the highest risk of cervical cancer
- Other than 16,18 will be cleared by human immune system – within 1-2 year – thatʼs why you repeat CST within 1-
2 year in HPV non 16/18
- Usually asymptomatic infection
- Subtype 6/7 cause warts but not oncogenic
- >99% cervical cancer linked to oncotenic HPV subtypes
- Penetrative intercourse not strictly necessary – no penetration needed to be infected
- Transmission via genital skin to skin contact, vaginal, oral and anal. It can also transmit in patient with:
o Transgender with cervix
o Lesbian also needs to do this – skin-skin contact Low risk – 6, 11, 40, 42, 43, 44, 54, 61, 70, 72, 81
High risk 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 66, 69, 73
- They more likely to persist – 70-80% cases in cervicalcancer
- HPV 16/18 are associated with cellular abnormalities that are less likely to regress and more likely to progress to
high risk lesion compared with other oncogenic HPV genotype
NCCSP
- All women who have ever been sexually active will be invited for screening at 25 years old
o Even though not active at the moment – as long as there was a hx of sexual intercourse
- Routine screening carried out every 5 years for women with no symptoms or hx suggestive of cervical cancer
- Invitation and reminders will be sent by the national register to eligible women
- When do we stop? Between 70 and 74 if regular screening test have negative
results and if there is a negative exit results Transition from pap tests (pap every biannually)
- Women aged 25 to 74 will be invited for a CST two years after their last pap tests (new migrants and refugees) – if
due, then CST will be done
- Difference between pap and cst
o Cervical cancer is usually associated with infection by cancer causing human HPV
o Pap smear started by 18 years old age and was done every 2 years if the previous results are normal or 2
years after the sexual activity whichever is later
o CST starts at 25 years irrespective of the sexual activity and is done every 5 years if the results are normal
o Pap take the sample from SCJ – smear at the slide only tested for cervical cellular changes alone and not
for HPV infection
▪ So even if patient has HPV infection, it was not detected
▪ HPV can present in the cervix without any symptoms
▪ 30% false negative rate
o CST we take the sample from SCJ – we put it at transport media the lab will look for oncogenic HPV –
then they will do reflex LBC to look for cervical cellular changes
▪ Looks for HPV infection and if oncogenic HPV detected, the lab looks for cervical cellular changes
and then for the management is done accordingly
▪ So the chances of prevention of cervical cancer progression is better than pap smear
▪ 2-3% false negative rate
- Women overdue by 2 years or more and > 30 years old will be invited to screen and self-collection is an option
- Women under surveillance for an abnormal pap tests – specific guidelines
 - How do we make transition – whatever the test results
o If <23 years old – ask them to come by 25 years old
o If >23 years old – do the CST at 25 years old

Why do we do the screening at 25 years and not younger? Cervical cancer is very rare in young woman
Screening <25yearshasnot reduced invasive cancerratesordeathsinthisagegroup or in 25-29 years of age
HPV vaccination is already showing a reduction in screen-detected abnormalities in woman < 25 years
History of childhood sexual abuse or early sexual debut (<14 years and prior to HPV vaccination) – consider hpv
tests between 20-24 years
IT IS A RECOMMENDATION NOT A MANDATORY
- Because it takes 8 years from infection to become cancer
Symptomatic women of any age should be assessed with cervical cancer screen – do the test for diagnostic

What is CST
- HPV DNA test
o If positive for oncogenic HPV – completed by RLBC
- Reflex liquid based cytology (RLBC) – look for cervical cellular changes caused by the HPV
- If both done – co-testing
Cervical screening pathway for asymptomatic women under NCSP from December 1 st 2017

11) lump in posterior triangle of the neck

tasks: h/o, dx/ddx with ?reasons

12) you are a GP (?a student is attending virtually at ur clinic)

boy (??27 years) got hit by bicycle handle
pain in upper abdomen
tasks:
explain the steps of examination to the ?intern
do focus abdominal examination and special tests released with h/o

13) 32 weeks pregnant lady

pregnancy is uneventful
just wet this morning (?water broke out)
otherwise well
tasks:
forget h/o or examination (has to explain the med student)
after ?5 mins, CTG finding is revealed
explain the significance of CTG result to the student

14) guy (?middle aged/ 27)

feeling unwell (tell fever, cough, sore throat)
tasks:
h/o
?most possible dx
ddx (with reasons)

15) ?4 months old baby has vomiting for ?months (mother is worried)
tasks: h/o (?5 mins), growth chart and PEFE were shown after 5 mins), dx with reasons
(GC within the range, but just above the red line, not progressing, slightly ?downtrending and plateau)
2017 ka case
4wk old baby with persistent vomiting, initially mother was not concerned but since it is persistent she is concerned and
constantly crying. This is her second child and according to her baby growth is normal as her first child.
O/e there was no lump in the abdomen. Growth chart showed wt gain less than 50th percentile.
 I told her its failure to thrive and needs further investigation like ultrasound and abdominal examination with test feed. I failed.
Please someone who ha
Dx as gerd

DD - GORD, pyloric stenosis, metabolic diseases.... history to clarify whether it is vomiting or regurgitation,,,, vomiting bilious or
non bilious, consanguinity,
examination with test feeds required...uss of abdomen should be offered to see the pyloric thickness...

16) feeling not well

+ve --> fever, sob
tasks: h/o, ddx with reasons

25th Oct 2022 f2F

1. Preeclampsia - 30 wks pregnant women with protein urine 3+ , Hx 3 min, Perform PE (it is not written like this but when
enter the room patient is sitting side of the bed) , Diagnosis with reason

2. Medication chart review ACS Hx patient, talk to son, - recently added diltiazem from cardiologist, on simvastatin,
paracetamol, allopurinol, aspirin, tenazepam
Task: Hx from son 3min, ask the paper from pharmacist advice from examiner, explain to the son
Paper: diltiazem can elevate the simvastatin and could induce the liver damage and rhabdomyolysis, temazepam is
considered to stopped, medication aid could be provided.
Finding: temazepam for 2 mo from sleeping disorder

3. Knee examination - both leg pain from Volleyball trainings, PE knee and Dx with reasons ( not DDx but I told)
⁃ Findings: patella tendinitis on both knee.

4. Greek lady delirium condition, on ACEI, furosemide, pneumonia on antibiotics, fever 37.8’C, blood test is done but no detail I
given, urine culture (-)- Mostly Dx with reason, take brief Hx, Management

5. T1DM 22yo lady wants to be pregnant. Living in rural area, want to labor in near small hospital - Hx 5 min, PE from examiner,
Counselling

6. Mania, 27 yo psychology master degree student - Take psychosocial history, Dx and Ddx

7. Inguinal Lymph node - non tender, mobile, rubbery, night sweat recently, LOW(?), you will continue the examination, you
don’t have to confirm the inguinal LN again, scrotum is normal, UDT and blood exam is done normal, Hematology
examination (PE) and relevant examination Dx Ddx

8. Coughing up the blood, 57/F during the eating the dinner: Hx 5 min, PE from examiner, Dx and DDx
⁃ finding: 2 teaspoons, LOW 4-5kg unintentional, night sweat (+), missionary work in Cambodia to help sick people

9. Painful lump 52/M (didn’t give where is the painful lump on the stem), Hx 4 min, PE from examiner, Dx and DDx
⁃ finding: 24 hr painful lump, lump is 3 mo, no fever, constipation (+), no bowel movement recent 3 days

10. Nose bleeding from 40-50 ish lady with HTN on ACEI, BP 140/90, Manage the nose bleeding, take Hx, Dx with reason Ddx
- finding: she is holding tissue with bleeding, hay fever on nasal steroid spray, no trauma,

11. 7-year-old boy tiredness and not attentive at school. Take Hx 4-5 min, PE from examiner, Dx and Ddx to father
⁃ Finding: aggressive and fight with friend, getting better with sleeping on the weekend, snoring and recurrent tonsillitis Hx, PE
finding Enlarged tonsil

12. SOB from farmer patient who had ACS 1 year ago/ Not following up Dr, Thrombolytics Therapy done 1 year ago in regional
hospital as patient refused to go. Hx 4-5 min, PE from examiner, Dx and Ddx
13. Patient was hospitalized for 3 days from acute urinary retention and need to review. Focused abdominal PE, Do Digital rectal
examination, Dx and Ddx

14. Lump on the downside and rash form 57/F, Take Hx, PE from examiner, Dx with reasons maybe Ddx
⁃ Finding: 2 big babies, no HRT, no urine or stool leakage, reddish rash from groin, PE high blood sugar and glycosuria

15. Vomiting 4 mo old baby, Hx from mother 4-5 min, PE from examiner, Dx, DDx
⁃ Findings: a few weeks now. Vomit just milk, on breast milk giving 10 times a day, burp up and upright position well, Growth
chart is given when asked to patient, Weight is toward to 3rd percentile, PE there is no mass on abdomen, no dehydration,
but irritable and alert
Dx GERD

26TH OCTOBER 2022 F2F

1. Lower ureteric stone CT interpretation and immediate management
2. Threatened abortion 27yr 8 wk pregnant with painless vaginal bleeding - history, pefe, diagnosis and differentials
3. 15yr CF girl with drop in weight pct and FEV1 after 13yr - had 2 graphs. Girl was on medication, stopped at 13 when meds were
to be taken by herself and when parents divorced - explain graphs and concerns of mother
3. MSE video - mania with psychosis and delusions
4. Young male HT CVS exam
5. Lt CHL with ear exam on model - diagnosis
6. Rt foot pain - relevant examination
7. Heroin IDU 1 month back no other details given? Chronic HCV..history pefe diagnosis and differentials
8. Fall from ladder with lower thoracic trauma - history and diagnosis
9. 35 week delivery with baby in NICU on 40% oxygen - relevant pregnancy history and diagnosis and treatment
10. Uni student with Depression after 6wks of breaking up - history, diagnosis and differentials.
11. Interpret Dexa scan and advice management T score of femur -2.38, can’t remember z score
12. 8 wk. pregnant (UPT pos) female with acute right lower quadrant pain - relevant examination, diagnosis and differentials.
13. Pt wants Mirena - relevant history and counselling
14. 6yr girl with headache mother has migraine - history and diagnosis with differentials
15. Chronic diarrhea 2 years, young male - history, diagnosis, and differentials.

1. Ureteric stone. CT scan provided, explain the findings and immediate management to patient. Don’t forget to offer pain relief.
Patient was lying on the bed – grimacing in pain.

2. Threatened miscarriage 27yr female 8 weeks pregnant with painless vaginal bleeding.
Task- history, physical examination findings from examiner (Be specific – you will only get the findings you ask), diagnosis and
differentials. Remember to ask blood group, FBE, Urine pregnancy test, BHCG and USS – intra uterine pregnancy, heartbeat
present. I asked all these and the examiner promptly provided the results – managed to finish all the tasks on time and reassured
the patient.

3. Cystic fibrosis. Mother of a 15years old girl concerned. You will be provided with charts (weight, height, lung function test)
which shows down trending weight, height is within the normal percentile and worsening FEV1. Positive findings in history,
daughter takes medication on her own (not supervised by mum) but mum noticed she is not compliant at times, recent stress –
her brother left to uni (feels lonely) and parents are divorced. Task - explain the chart findings and address the mother’s concerns.

4. MSE video - mania with psychosis and delusions. Task - watch the video and present the MSE findings to the examiner.

5. Young male with hypertension. Task perform - CVS exam. You have to measure the BP and HR manually. The examiner observes
your BP measurement technique. A small timer will be on the table.

6. Left ear conductive hearing loss. Task is to perform the ear examination (otoscope on the ear anatomy model and the rest on
the real patient). During Rinne test, my patient got confused with which ear she had problems, examiner redirected her and I did
Rinne test again to make sure I identify the type of hearing loss correctly. Finished with Weber test and explained my diagnosis
and differentials. During otoscopy, I found impacted ear wax. I finished the task early and examiner asked my Rinne test findings
again. If you are not familiar with otoscope please make sure you practice how to use it correctly and choose the right tuning
fork for Rinne/Weber. Don’t forget to comment on general appearance of the external ear/mastoid area.
7. Right foot pain – perform relevant examination. The patient screamed when I did the metatarsal squeeze test mimicking
morton’s neuroma but on palpation no pain between the 3 rd-4th toes. I mentioned the differential diagnosis instead. Achilles
tendon was normal as calf squeeze (Thompson) test negative.

8. Right upper quadrant pain. Positive findings in history - Heroin use IVDU 1 month back (first time) Task – History, physical
examination findings from examiner (again be specific, tender RUQ, Murphy’s sign negative, urobilinogen in urine dipstick),
diagnosis and differentials.

9. middle-aged female, fell from ladder while cleaning the gutter, with lower thoracic trauma, SOB, pleuritic chest pain.
Task - history and diagnosis. I mentioned differential diagnosis. Positive findings – vasovagal, skipped breakfast

10. Mother who just delivered a baby at 35weeks, anxious and concerned as baby is in the NICU requiring 40% oxygen.
Task - relevant pregnancy history, diagnosis and treatment. It seemed like transient tachypnoea of newborn but I gave
differential diagnosis, she didn’t have GBS swab- delivered vaginally.

11. University student with depression. Task – history (positive findings – recent break up with girlfriend, low mood, poor sleep,
loss of appetite, socially isolated), diagnosis and differentials.

12. Osteopenia case. Stem mentioned he has COPD, smoker, frequent exacerbation requiring steroids. Role player mentioned
his mum had osteoporosis. Interpret Dexa scan and advice management T score of femur -2.38, can’t remember z score.

13. 8 weeks pregnant lady (UPT positive) with acute abdomen (right lower quadrant pain)
Task - perform relevant examination, diagnosis and differentials.

14. Contraception counselling. Patient specifically wants Mirena.

Task - relevant history and counselling. There was a mirena kit inside a small uterus model on the table so make sure you use it
to explain instead of wasting time drawing.

15. Mother of a 6years old girl concerned that she has frequent headaches. Task - history and diagnosis and differentials with
reason. Positive family history of migraine, parents are separated, no bullying in school, no early morning vomiting, feels
better when she rests in a quiet dark room, no specific food trigger.

16. Diarrhoea in a young male. Task- history, diagnosis, and differentials. Positive findings: chronic diarrhea, stress, not lactose
intolerant, denies any gluten allergy, no recent travelling or antibiotics use, no PR bleeding.

27th October F2F

1) Ear PE (cholesteatoma, post OM conductive hearing loss)
2) Scrotum exam (hydrocele)
3) Resperidone induced tremor pe
4) Peroneal nerve palsy
5) threatened miscarriage with possible fibroids
6) Pyelonephritis in 10wk pregnancy
7) BDD
8) exercise induced amenorrhea
9) nausea/ vomiting plus confusion was on amlodipine, lisinopril, Diclofenac, furo27semide - probably electrolyte imbalance
hyponatremia,
10) HIV non-compliance with meds
11) facial swelling in the morning 11 y
12) egg allergy
13) neck lump in 11 y old girl (thyroglossal cyst) Hx pefe dx n dds
14) post op discharge plan wants to go home but surgeon wants to keep her for 72 hours, all ok but trace of blood in UDT
15) AF warfarin management plan side effects
16) back pain (protrusion)
28th Oct 2022 Ftf
[Link] PE:delivered baby 10 days ago now fever.
Task: HX, PE
[Link] examination ( lateral epicondylitis) Hx and PE (barista occupation)
3. 42 years female now Anaemia only positive NSAID
Task:Hx,explains dx , ddx
[Link] arteritis steroid
Task: hx, dx, ddx
[Link] baby(crying baby) for 1wk, 6wk chk up was all normal with postpartum blue( no family support, very low mood, now
smoking outside) Task: counselling
[Link] of schizophrenia with low mood : ulcer in foot, hearing voices, muffled, no commands, no visual hallucinations
Task: take hx , present MSE
[Link] ( dull tympanic memb, GC 50%, no smoking, indirect laryngoscopy: not available/ not done, no adenoid facies,
tonsillectomy done, mouth breathing now)
Task: hx, PE, dx
[Link] patient PE ( pt did not wakeup in pressure, only moving hand) GCS: 3
[Link] PR bleeding (accountant, has a dog, pushes the lump back by himself, normal diet, mostly sitting, no pain on
passing stool, no FHX of bowel cancer)
Task: Hx for 6 mins, DX, DDX
10.70 years old woman now on warfarin for TIA, MHX of AF, now bleeding and bruises, son thinks non accidental injury from
carer, new carer came she doesn’t like that new carer , she was confused, no fall, no injuries, no UTI, using a walker
Task: Hx, ask PE( normal), dx
in recent settings u dun admit every patient who has bruises wid INR less than 5.. as k if they are living alone? if yes they
need to b admitted so in case of fall etc they r not at stake..if not tell about the red flags, nose bleeds., blood in
stool, vomitus, blue toes stop warfarin and check INR the next day and once INR is in the acceptable range strt
warfarin wid low dose.. these days role of vit K is contoversial as it shows effect in 2-3 days but u can gv in this
patient.
Id say admit still. Is this patient in acute illness? Taking antibiotics? New medications? Trend of INR? Is it uptrending?
How old is the patient? B/g of patient like previous stroke! History of fall? Newly titrated dose of warfarin?
Traditional chinese medicine use? Repeat ecg reading? Fast af?

Current ADLs? Is the patient independent or dependent? It all falls down on your confidence level that nothing eventful
will happen at home. Does he stay home alone? Who is the carer? Is the carer dedicated or the patient is with
another old patient? How often do you want to monitor? Social set up? Can the patient go for close monitoring.?

If INR is 5 asymptomatic, can still manage at home, omit warfarin doses for a day or 2. But if I am the doctor, ill admit
the patient if patient is at risk of bleeding. No harm actually to admit. Though there is also no harm to observe so
long as the benefit will outweigh the risk

[Link] 42 years old man Handbook

[Link] ligation( OCP, many children) doesn’t want any other forms of contraception
[Link]: headache for 1 day, tonsil enlarged no exudate, Ear pain, no fundoscopy, otitis media positive (Headache- sore
throat and mild otitis media)
Task: hx, ask PEFE dx,ddx
[Link] pneumothorax: man was walking, sudden SOB, no racing of heart, no rash, he is on oxygen, no liver
Hyper resonant, decreased breath sound
Task: Hx, Ask PE, dx ( no ECG)
[Link]: Paediatric . GERD- 4 mos vomiting, everthing is normal
[Link] traveler -- Bipolar travel advise,

8th November online

1. CST Station with bimanual examination
2. Male , Post lap inguinal repair, day 2, with fever counsel, patiebt wants discharge , finding positive for nitrites and blood in Udt
3. 52/F With shakes, hx and ddx
4. 18mo opd woth fever, unresponsiveness and vomiting x 24 hrs Pe( mild erythema tonsils, no rash no neck stiffness) task: hx,
interpret PE, immediate investigation managment in next 24 hrs
5. Hyperemesis gravidarum case, dx ddx management
6. 27/F on OCP with sudden SOB PE Station
7. Elevated bhcg, one week positive PT, tvs: 1.5 right iovarian cyst denoting corpus luteum, no fluid in pouch of douglas, task: dx
and management
8. Chronis schiz patient on risperidone, with persistent tactiale and somatic delutions, complain chest pain. Dx , management
with reasons
9. 22/M patient, post MVA, with left sided bruises and wound, complaining of left sided chest pain, history dx and mgt
10. 12-month-old with complain of non use of left arm. Task: hx inclduing devt history, interpret pe ffindings to mom, inc tone on
left upper lower limb with brisk reflexes, upper limb in fixed flexion and closed fist, lower limb in adducted fixed ext
rotation posn
11. Pe Rash of intellectually diabled patient, dx ddx
12. 62/m complaining of loss of energy and appetite, nasty growth hx dx and ddx
13. Baby with cough and colds , Hx, dx and ddx
14. Patient admitted with fluctuating GCS post ingestion of unknown amt of alprazolam and mdma. Gcs trebd :3/15-12/15-
14/15-12/5. Task: hx from dad, dx and mgt
[Link]
13 april 2021 case any passed feedback please
-Young boy overdose with alprozolam and ecstasy at ED GCS was 3/15 then 14/15 and again 9/15
Ggt raised ,party last night , breakup with GF suicidal attempt
Task
history and management
Can someone help me in this case?
15. Pe deep lacerated wound volar aspect
16. 92/M terminal case, with extensive multlobar pneumonia and respiratory failure. With DNR IN advanced care directive task
explain directive to relative and succeeding mgt

9th November 2022 Online

1) 32 yo female. c/o wrist injury on dorsal aspect. Longitudinal cut. Dressed up well.
a) h/o for 6 min prompt
b) Present MSE including insight, judgement, suicidal risk assessment.
Mood up & down. Feeling I am looking from outside of my body to myself. Cut because she was waiting for friend to turn up at
café, but after waiting for 20mins they didn’t turn up and cut myself. Previous 2-3 episodes of same. Smoking 15 cig since 5 years.
Binge drinking sometimes. Cannabis +ve. Taking counselling from counsellor (didn’t reveal for what). Never had suicidal ideation
2) 77 yo male with abdo pain. Dx as leaking AAA. Explain PE to med student.
3) 42 yo male to GP with restrosternal chest pain. Developed Pain while eating nd relieved after 2 hours. BMI 29.
a) h/o for 4 min prompt
b) ECG will be appeared and interpret it to pt.
c) Explain Dx to pt with reasons.
Tightness of chest. Radiating to jaw. No relation with exertion or rest. Don’t remember previous h/o was there or not. Eating
healthy diet and meat. Alcohol 2 glass at weekend. No burning pain (r/o GERD), ECG was normal I guess but I was having doubt
how can it be normal. I double checked and developed doubt was there QT prolongation or not. Asked family h/o sudden cardiac
death but negative. No SOB, Palpitation. No lump in tummy.
4) Newborn with vomiting. Mother here.
a) h/o for 4 min prompt
b) Order Invest
c) Dx and Ddx
18 hours age. CCVO. Undigested milk. Immediately vomit after feeding. Formula feed. No smell, no blood, not throwing away, no
greenish. No tummy lump or waves. No overfeeding. No fever or neck rigidity. No ambiguous genitalia (Addison dis). No GER(bcz
immediately throwing vomit). Baby passed meconium 8 hours ago.
PEFE. Vitals-dehydrated, No fever, BP 100/70, RR-30 (crying) exact words. DEXTROSTIX (exact word) -3.0 mmol/l. Mildly
distended abdomen.
5) 32 yo/F at GP. c/o chest pain while going to postnatal exercise (4 months baby).
a) Mental status examination prompt 6 min
b) Summarise MSE to examiner
I started taking h/o chest pain a bit, ensured hemo stability. Then asked for mood. Said tensed. I asked anytime high/low. said no.
Asked any SOB, numbness around mouth, feeling edge or about to die. She told yes dr I am worried I am going to have heart
attack. That’s why keeping mobile with me all the time. Asked any thoughts harming yrself/others. Denied. Feel/hear/see that
other’s cant. Denied. Was continuously making weird expression as I am asking wrong que or heading in wrong direction. I went
back to chest pain again. Any relation with food. Previous episodes. Said 3 times. Relieved by self. Asked having fear going in
crowded places. Denied. Worried of consequences of episodes? Said obvio doc I told I am worried I am going to have heart
attack. I asked what about baby. How is he doing. He is good but am worried if I will get heart attack I may put my baby at risk, so
am worried. I continued taking both medical and MSE history. No +ve in ASEPTICJRRR. No spying on you/trying to harm you/u
have superpower. Denied everything. Oriented to TPP. Judgement was intact. Not suicidal. No SADMA +ve.
At the end, I could not understand it totally. What was that case. I was thinking about panic disorder but what to say in
ASEPTICJRRR bcz nothing positive. Very weird pt. Appearance was blonde hair, colourful clothes. Co-operative giving h/o.
maintaining eye contact.
6) 27 /M at GP with hay fever. PEFE given in stem. Boggy mucosa. Prominent inf turbinate. Nasal crease. Runny nose, watery
eyes. Pt has atopic family h/o.
Everything given in stem.
a) Short h/o regarding treatment given.
b) Give immediate mx
Complete both the tasks within 4 min prompt
c) Longterm mx
Pt was taking antihistamine OD. Nose spray(decongestants) BD. Cortisone as well. No relief. No carpets, pets. No SADMA.
Cortisone seemed expensive to pt.
I don’t know what to do in this case. Told about rebound phenomenon of nose spray. So stop. Use nasal saline 20-30 min before
cortisone. Will make sure I will prescribe cheap one. Send bloods. Refer to allergen specialist for allergy tests. Avoid triggers.
Forgot to refer to ENT specialist for inf turbinate removal sx. I don’t know what else to say. Diet sleep exercise. I am going to fail
this one.
7) 2 yo F accidentally pooled hot noodle bowl on chest. Crying a lot. BP-100/70 (crying) Pain- 8-10/10
a) h/o for 3 min prompt
b) Send investigation
c) Immediate mx
Ensured stability. Asked 1sttime. Responded 6 months ago happened same. Confidentiality. Asked home nv. RP was uncle of pt.
RP told her sister(mother of pt) drinking a lot. Living with new BF. Explored more. Risk was abuse I found.
PEFE appeared. Image was given how much area of body involved in burn. Right half of head, chest and abdomen. Right deltoid
area was involved. Image was very detailed. Given image which area represents how much % BSA.
Sent FBE, ESR,CRP, UEC, LFT,RFT. Admit and analgesia. Dressing with silver nitrate. Parkland formula. Involved pedia registrar. I
need to inform CPA.
47 yo M. H/o of GTCS. Now unable to move Right arm and leg. Do Motor neuro of UL and LL to medical student
9) 22 F with pelvic pain. 4 min prompt
a) h/o 4 min prompt
b) PEFE at 4 min
c) Dx and Ddx
Ensured stability. Asked exact location said RLQ. Asked SOCRATES. 4/10. Worst on walking. Relieved by rest. Since 2 days. Gradual
onset. LMP 3 wks ago. NOT SEXUALLY ACTIVE. Stopped asking 5P ahead. r/o appendicitis,IO,dysmenorrheea,IUCD displacement.
PEFE appeared. USG lt and rt ovarian size given. Cyst measurement was given. Cyst collapsed and ruptured. Fluid in pouch of
douglas.
Told dx as rupture haemorrhagic cyst. Ddx ectopic,pid, iucd, torsion, appendicitis, diverticulitis, uti, pyelonephritis.
10) 22 yo M. poor uni performance. Late submission of assignments.
a) h/o for 4 mins prompt
b) Single dx with reason to pt (Exact words)
c) Immediated mx
Pt was good actor. Speaking very low tone. And was distressed and accent I was not able to understand few words. Was speaking
so many things altogether. But was not pressured speech for sure. Just low tone of speech and was acting distressed.
Confidentiality. Since when? 3 wks. Anything happened? So long statements but was able to hear word BREAKUP only. Not more
than that. Some issue with father he said but not properly understandable. Mood? Angry sometimes. Anytime low. He replied
something but couldn’t understand bcz wasn’t just yes or no answer. Asked sleep. Diff towards end of sleep. (I asked specifically
wake up early and difficulty falling asleep? Again said big sentence instead of just yes/no which I couldn’t hear properly. Appetite
decreased? Yes decreased and again big sentence but was able to hear clearly yes decreased appetite. ( I thought atleast I
understood something at last). Thoughts of harming yrself or others. Said sometimes I wish I don’t wake up.
Bcz of the h/o I myself started having depression lol. Whther this pt meeting criteria for MDD or not. And finally I think I took
wrong decision of saying Mild depression. Referred to psychiatrist to confirm dx and then explained about role of psychologist.
Gave sleep hygiene. Reassured a lot. But obviously it appeared that I am lacking confidence giving dx and immediate mx.
Definitely going to fail.
11) Breast PE
12) Telephone review. Young female concerns for left eye.
a) h/o for 5 mins prompt
b) Dx and Ddx
c) Initial mx
Puffiness since 2 days. Gradual onset. Not on & off. H/o trauma? Yes gardening, there was scratch. Fever? Feeling hot & cold
sometimes. Redness? Yes. Associated symptoms. Headache? NO (clearly denied of headache) discharge? No. discharge from nose
ear? No. noticed any blood or reduction in urine? No. frothy bubbly urine? No. recent flu or sore throat? No. Insect bite? No. Any
medication? Then RP relieved yes Ibuprofen. Asked for what? Said for headache. Started taking h/o headache. Pt said it’s there
since quite a few times but nothing related to eye. RP herself revealed this. Asked vision diif? No. Noticed any distinct swelling on
eyelid only? Said swelling there on eyelid and around eye as well.
I gave dx as periorbital cellulitis. DDx as orbital, stye, chalazion, FB, TIA, Temporal arteritis, tumor. Scleritis, conjunctivitis.
13) 12 yo F with mother bcz of persistent cough.
a) h/o 6 min (prompt)
b) Dx and Ddx
Ensured stability. Since when? 6 months. Dry or productive? Dry. Seal barking? Cough cough and vomit? No. Making posture to
comfort? No. Honking? Yes. Sob? No Turning blue or pale? No anyone smoke at home? No. Pets? No. fever? No. relation with
food? No. Sleep affected? No. noticed coughing more at weekend? Yes. School performance? Achieving milestones. Noticed
having cough while surrounded by people? RP couldn’t understand my que asked me to rephrase. I asked u noticed she is having
cough more in presence of people and less while alone? Said I don’t know while going to her father’s home, having cough nd
while with me also having cough. Started asking home environment. Stress? Said yes bcz husband separated 6 months ago. I
asked mood about mother. Said I don’t think so anything is related of my mood with my daughter’s cough. Askd well baby q and
BINDSMA. All normal.
PEFE appeared. All normal. Written skin prick test- allergy to house dust mite.
Asked again. Noticed runny nose, watery eyes? Said no.
Gave dx as psychogenic cough and 2ndmost ddx will be allergic rhinitis bcz having allergy to house dust so regular keep your
house cleaned. Other ddx asthma, pneumonia, ger, parapneumonic effusion, Cystic fibrosis, pertussis.
14) 27 yo F. had CST 1 year ago- LSIL. Repeated now. HSIL and HPV 16 +ve
a) Hx for 4 mins prompt
b) Explain result to pt
c) Immediate mx
No symptoms at all. No post coital bleed, no LOW,LOA, lumps bumps. LMP- currently 2nd of period. No issue with it. Multiple
partner. Only using OCP, no condoms. NO previous STI. Only vaginal. No pregnancy before. SADMA. Smoking 5-10 cig since 8
years. Marijuana-smoking. Not injection. General health, family h/o. all normal
Explained result. Sent for colposcopy and biopsy. As I forgot to ask in h/o- asked for Gardasil here. Not taken. Adviced to take it
asap.
15) 27 F for blood donation. High BP on 3 readings. BMI-23. UDT- normal
a) h/o for 6 min prompt
b) Dx and Ddx
Ensured stability. R/o complications of HTN first. Started asking for TRACKPADS. Nothing positive. SADMA. Nothing there. Taking
OCPs-micro 30. Family h/o- mom dx with HTN. Any sudden cardiac death?
Dx- OCP induced HTN. Gave others as Ddx.
16) 72 M at ED with rectal bleeding.
a) h/o for 6 mins prompt.
b) Dx and Ddx
Ensured stability. Since when? Today morning. Colour? Bright red. Lump? Yes. Staying there or reduced as well? There always.
Pain? No. blood on toilet seat or paper? No. blood on surface of stool or mixed? [Link] hard? Yes. Stick to pan or diff to
flush? No. Anemia qu? No. Low loa lumps bumps? No apart from this one. Alternate diarrhea or consti? No but consti there since
long. Started asking for risk factor. Cough? NO(here said no to me), heavy lifting? No. occupation? Retired lawyer? Longterm
standing or seating? Not as such. Bleeding dis or blood thinners? No. Prev medical condition? Revealed everything altogether.
HTN and COPD. 5 years back had colonscopy-dx for diverticular ds. Immediately asked any tummy pain particularly in left lower
tummy? No. How about HTN and COPD? Under control? Reg visit with specialists? Yes. Family h/o colon ca? yes mother at 54
years.
Told dx as internal piles. Explained. I was confused bcz everything goes for piles but blood mixed with stool doesn’t. Nd asked for
diverticular as well. Any pain in LLQ, denied. Given rest of Ddx. CA,fissure, IBD, polyp, mesenteric ischemia, bleeding ds, blood
thinners.

15th November 2022 online

[Forwarded from WGT]
1. Post op UTI
2. Male uti
3. Mechanical back Pain
4. Recurrent falls-Postural HTN
5. Dementia
6. Sewage
7. Epistaxis , on apixaban
8. Parapneumonic effusion
9. Unprovoked seizure
10. Rash examination( a new weird case)
11. Knee exam
12. Ccf
13. Relapse of Schizophrenia
14. Acute stress disorder ( Dog about to die)
15. DUB
16. NIPT
11week pregnant lady coming to discuss NIPT.

Tasks
Hx and counselling about aneuploidy screening- 5 minutes
NIPT appear at the end of 5 minutes
Explain results to the patient and future plan

25 year old coming because a friend has told about NIPT. First pregnancy. No miscarriages Booking visit and
routine tests have been done. No issue. Has a family Hx of Downs syndrome baby of one of her aunt’s. Thats
not the reason for her to consult. I talked about the test. It's not covered by medicare. Done from 10 weeks
onward so she can do it. Costs about 400- 500$. It's a blood test. Blood is taken from you and the baby's DNA is
checked. It's 99% accurate for Down. Still it's a screening test. Advised on other screening tests- combined and
triple/quadruple test briefly and the time lines. Explained about diagnostic tests. CVB and Amnicentesis, how its
done, timeline and miscarriage risk. But she said, I want to go for NIPT . Told her that deciding on doing the test
is totally up to her.

Results
Low risk of anomalies of genes 13/18/21
Gender XX

Explain results
Low risk for all the genes. However, it is not diagnostic. If you want some other tests , you can go ahead and do,
but I feel like its not really needed according to the report. However, its her decision. Asked if she wants to
know the gender of the baby which was mentioned in the report and she said no, me and my husband want to
keep it secret till [Link] I didn't say it.

16th nov 22 online

[Link],15w pregnant, lower abdominal pain.
2. Preeclampsia

3.62y old lady with itchiness in vulva.

4.19th month old baby can't walk.

5. MI, do relevant cvs PE

[Link] retention PE

7 . UL and LL neurological PE

8.4y old with redness in vulva, others normal, mom is very worried,

9.14y with headache, using some medication, BMI 90.

[Link]

11. Lady with painful lump in the bottom, brown colour, offensive discharge.

12, 87y old with pneumonia and confusion.

13. Psycho, pt with multiple problem, complaints about pain

14, University student, low moods,

[Link] ulcers

16.

Nov 16, 2022 (online)

1. Pre-eclampsia with table of findings. BP 155/95 in 2 readings. Protein 3+. Further history, further PE and explain instruments, investigations
2. UL and LL sensory examination. Patient with some numbness on foot and hand. Explain PE to med student with instruments and expeced
findings
3. Acute chest pain. Central tightness, radiation to jaw, + sweating. Smokes 10 cigarettes/day. Drinks alcohol. Explain PE
4. Emergency Department. Man coming for acute urinary retention. Explain PE
5. Spirometry. Low FEV1/FVC, Low FVC and low FEV1, FEV1 increased by 6% post bronchodilator. Residual volume increased. Explain spirometry
results and take further history in 7 mins, explain diagnosis and reasons
6. 3y/o with genital redness, +bubble baths, mother suspects sexual abuse by father. History, PE given (no bruises, just genital
redness), Diagnosis and management
7. 18month old with difficulty walking. Father and sister also with delay in walking. Delivered vaginally, cephalic. Rest of dev ok. History, xray
shown with PEFE (asymmetric crease, left leg shorter, limited abduction, tight adductors), diagnosis
8. 77/F with itch down below. +taking thyroxine for Graves disease. Previously applied estrogen creams but did not help. History, picture given,
diagnosis, outline management
9. Ulcer on left lateral leg. Sore, only recently became painful because it sticked to a tight gumboot.+hypertension noncompliant to meds.
Smoker. History, PE card (poor pulses on left leg, +wheezes on bilateral lungs) diagnosis and DDx
10. Student referred by counsellor for poor grades. Gives too much attention to details. Likes thing to be orderly. Thinks this is rational. Also
difficulty concentrating because everytime he reads "king" he gets up. Thinks this is irrational. History, Diagnosis
11. Pain in the back. Between the buttocks. + fever, + brown discharge, + lump, +overweight, student with prolonged sitting, + more hairy than
usual. History, Diagnosis and DD
12. 13/F 3 months of headache, all over head, +double vision, +vomiting sometimes, BMI 25, on tetracycline, BP140/90. History, diagnosis and
immediate management
13. Worsening abdominal pain for 2 days in a 15 week pregnant lady. +back pain, vomiting, painful urination, +leuc, +nitrites, +blood. History,
PE card given with UA resulta) Diagnosis, Managament
14. Ulcerative Colitis counselling. Explain diagnosis and implications, Management
15. Dysthymia + passive dependent personality with 20 years history of un happiness and tiredness. Already on antidepressants. History (2 sons
spend less time with her, husband with business, moved to Aus at 11 y/o), explain psychosocial factors which may cause her unhappiness and
tiredness
16. Elderly diagnosed with High risk CAP. + confusion, egfr 50. With allergy to amoxicillin (urticaria). Table on antibiotic guidelines for CAP given.
History. Explain why he is high risk CAP. Explain antibiotic of choice and gain consent
22nd nov 2022, f2f
1. mva at 36th week preg.
Task, hx, pefe, diagnosis. Seatbelt injury.
2. Pertusis, counselling case.
3. Tremors in hand for 2 weeks.
Tasks, Hx, perform pe, diag n ddx. Resperidone induced tremor.
4. Back pain pe,dx n ddx. Sciatica
5. Mennorrhagia for 1 yr. Task, pe, dx.
Fibroid
6. Acute abd pain. Task, pe, xray, dx, ddx.
Int obstruction.
7. Antibiotic induced diorrhea, counselling, inv, dx, ddx.
8. 5 yr kid with lethargy. Fhx of cong heart problems positive.
Hx, pefe, inv from examiner, dx.
Diabetes
9. 27 yr old feeling hot n cold for last 1 mnth. Very weird case . case 9 was already a diagnosed case of HIVpositive patient
his ob’s were all stable except for being febrile 39.6 temp and on his exam/PE- he had white buccal exudate= fungal
infection
10. Bilateral feet pain case. pt had history of alvohol, a bottle of red wine daily for last 4 to 6 yrs and smoking 6 to 8
cigrattes, for past 14 yrs
Weird case, nthng fit with hx, it was not pain, but discomfort n burning, worse on rest.
Alcoholic neuropathy i diagnosed.
11. Bali or nepal returned traveller with change in urine colour. Again weird case, maybe hep a or post chole syndrome. ave
history of having street food, jaundice +be, liver enlarged and tender, mild temp 37.9, LFT - deranged, with bilirubin in his
urine, had history of nausea, vomiting and diarrhoea ever since he came back from the trip, no sex,or drugs and no piercing
and tattoos
12. Reduced hearing pe.
Conductive deafness.
13. Inv admission under Mental health act counselling
14. Dental carries, bulimia nervosa.
Hx , dx, ddx.
15. Recurrent herpes ulcers.
Task, dx, ddx, inv, mx
16. Post cholecystectomy syndrome

23rd nov 2022 f2f

1. Knee examination after squatting having pain all movements were restricted and
Acute Knee Injury - Predominant assessment area – Diagnostic formulation
A middle aged lady presenting with acute knee pain. Task – history, PEFE, DX and DDx to patient.
GS – 4
Approach – 4
History – 4
Choice and technique of examination – 5
Dx and DDx – 4
Intro, offer painkiller (patient was lying on the bed with pillow under her knee on right side)
History – patient was squatting down and when her daughter called her, she stood up and twisted
the knee. Got swelling and pain soon after that. Patient pointed the pain on medial side of the
right knee. Otherwise – unremarkable.
On PEFE
Inspection – swelling +, no redness, fixed flexion deformity +, locked in mid flexion of right knee
joint.
 Palpation – tenderness on medial side of knee
Movement – Restriction of movement +
Special tests – Patella bulge and tap test, apprehension test, anterior drawer and posterior drawer
test, varus and valgus test all negative.
When asked for apley grinding and mc murrey for meniscus, examiner said cannot be performed
because of fixed position and pain, and also patient refused to do it.
Dx – medial meniscus injury
DDx – other ligament injury, fracture, infection, chondromalacia patella, etc

PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION STATION 1

Scenario: Acute knee injury Grade: Fail

Assessment Domain Domain Score (see key below*)
Approach to patient/relative 4
History 3
Choice & Technique of examination, organisation and sequence 3
Diagnosis/ Differential diagnoses 3

2. Egg allergy rash , there was picture of rash on mouth of 9 month baby with history of taking egg in afternoon and one time
also history of same rash when he was 6 month old
Predominant assessment area – diagnostic formulation
A 11 month old baby brought by his father to the GP with a rash round his
mouth( pic given like this with baby’s face)
Task – history
Dx and DDx
History – rash appeared today. Only around the mouth, not increasing the area of
the rash. No fever or SOB. When asking whether he had a new food today, father
told baby’s elder brother has fed him some egg which he has not eaten before. No
previous Hx of rash like this as I remember. No change of soap or creams or
contact with other allergens, drugs or insect bites. Picky eater?
BINDS – NL
Strong family Hx of atopy and eczema
Dx – rash due to egg allergy
DDx – drug allergy, cosmetic allergy, insect bite but unlikely

PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION STATION 2

Scenario: Fever in a child Grade: Fail

Assessment Domain Domain Score (see key below*)
Approach to patient/relative 3
History 3
Choice & Technique of examination, organisation and sequence 4
Diagnosis/ Differential diagnoses 2

3. Unscored

4. Mse of acute stress disorder but no dx was asked

PREDOMINANT ASSESSMENT AREA - EXAMINATION STATION 4

Scenario: Behavioural complaint Grade: Fail

Assessment Domain Domain Score (see key below*)
Commentary to Examiner 3
Accuracy of Examination 3

5. Common peroneal nerve examination he was strawberry picker n wasn’t able to walk on toes
Feedback – PASS
You are a GP and your next patient is male (forgot name) presents to your clinic with c/o pins and
needles on his right foot for past 1 day. He is a strawberry picker by profession. He doesn’t have any
significant past medical history.
• Perform physical examination
• Tell the pt about your most likely Dx and DDx
Two Min: footdrop pe, sensations only Nerve wise
Entered the room, greeted the patient and examiner. “Hello my name is Anish and I’ll be your doctor
today. I understand you are having some problems with the foot, is that correct? yes doc. Ok well I’ll
be doing an examination over your foot to find out the main cause. It will inolve me looking,
touching and doing some tests over your foot. Is that ok? Sure doc. Great could you please expose
the area while I wash my hands.
Mr Jones seems to be likely comfortably, doesn’t appear to have any obvious pain or distress and no
Protective posture
Check the gait- Are you able to bare your weight?yes doc. Would you be able to take a few steps for
me? High stepping gait. Romberg’s sign – to differentiate between sensory ataxia and peripheral
neuropathy. Look (Please lie down on the bed). SWIFT à Swelling, Wasting of muscles, Involuntary
movements, fasciculations and Tremors.I cannot appreciate any stigmata of peripheral vascular
[Link], Skin color changes, Loss of hairs, Shiny skin. Feel- Temperature on both feet normal.
Tenderness- Checked the forefoot, midfoot and hindfoot of both sides- no tenderness. Circulation -
Checked the Capillary refill time of both feet and Checked the pulse- dorsalis pedis and posterior –
tibial. All normal
• Sensation – got the findings for deep and common peroneal nerve.
• TIP à tibial nerve – Inversion and Plantar flexion
• Sensation of tibial nerve is checked on the sole of the foot
• Superficial peroneal nerve – eversion
• Lateral and dorsal aspect of foot
• Deep peroneal nerve – dorsal flexion
• Sensation over the first web space between toe and 2nd toe
Movements Of the Ankle- all normal ( which confused me a little)
• Point them up – dorsiflexion
• Point them down – Plantar flexion
• Move your feet away – eversion
• Bring them together – Inversion
I forgot the special tests
Said what I got to the examiner.
I explained it was Common peroneal nerve injury. After examining you, what you might have is most
likely common peroneal nerve palsy aka strawberry picker palsy. There is a main nerve at the back of
buttocks to the back of the thigh and at the level of the knee it divides into 2 branches- common
peroneal and tibial. I think in your case it is the common peroneal nerve that is compressed at the
level of the knee. Because you are a strawberry picker, you squat to pick the strawberries which can
cause compression of the nerve at the level of the knee. Initially it would pose no problems but since
you do this constantly, repeated irritation of the nerve may cause damage ( I wasted too long
explaining what foot drop is with pictures and drawing etc). Other possibilities are . bell rang ( I was
very upset cause this was a case I should’ve known like back of my hand) but yea idk where the time
went but still passed it

PREDOMINANT ASSESSMENT AREA - EXAMINATION STATION 5

Scenario: Walking difficulty Grade: Pass

Assessment Domain Domain Score (see key below*)
Approach to patient/relative 4
Choice & Technique of examination, organisation and sequence 3
Accuracy of Examination 3
 Diagnosis/ Differential diagnoses 4

6. Scrotal mass with a painless ul;cer on penis was a dummy there

14. Scrotal swelling PE FAIL
Approach 4, Choice & technique 3, Accuracy of examination 3, Dx & D/Dx 3, Global score 3
Q : 20s male who came with scrotal swelling.
Task : PE, take consent from the patient before doing the PE, Dx & D/Dx
Measuring tape, torch and paper were provided
This is my last station and honestly I didn’t practice much on scrotal swelling PE which I regretted
now. Roleplayer was friendly. I think I found some swelling over left scrotal. Also, when I remove the
skinfold, I found some ulcer on penis as well. Again, I failed this case so please look for the pass
feedback.
Another Feedback - middle aged male c/o swelling in testis. something like that. Tasks PE, DDx
PAA-examination - Fail
The average global score for this station was only 3 which is quite low.
Did the usual format, WIPE with chaperone. Inspection all normal. Asked to cough also.
Palpation there was a small lump in bottom pole of right testis i think, i couldn’t find anything else.
Transillumination, cremasteric reflex normal. no LN
Then gave all ddx for scrotal swelling. I was scored down in accuracy of examination. Think coz I have
never practiced on mannequin before i got a little confused.

Scrotal swelling (PASS)

Global - 5
Approach -5
Sequence -5
Accuracy -5
Dx/Ddx -5
A young man with scrotal swelling.
Tasks- perform physical examination, Dx and DDx.
Introduced
Are you comfortable right now?
Take consent from the patient, after explaining the examination steps in details.
The examiner told me not to wash the hands but put on the gloves.
Performed a proper scrotal examination on dummy.
Positive examination findings- left scrotal is bigger than the right
There is a ulcer like growth when retracting the foreskin
Left testis is bigger than normal size and consistency is quite hard compared to the right one
Others- unremarkable (no tenderness, no discharge, transillumination test is also neg)
Dx- cancer but this is just my working diagnosis
Others- epididymo-orchitis, hydrocele, hernia, varicocoele, epididymal cyst ( with reasons)
I also mentioned about the investigations for him to confirm the diagnosis.
(The examiner helped me a lot during transillumination test. He helped me cover the private part
with a blanket. I didn’t have to use all the steps in SPIKE approach because the patient said it’s ok,
I am all right.)
Another Recall (PASS) - Scrotal lump - Young man presents with a painless lump on his testis for
two months. Do PE with running commentary to the examiner.
Consent- I’m S. one of the doctors at the GP gonna to take care of you this morning. I’ need to
carry out examination of genital area including penis, testicles, surrounding area and tummy. Is
that ok with you? Dear examiner can you be the chaperone? Yes. Are you happy for me to
proceed. Yep! WIPE, dummy exam-
Look - On examination of lower abdomen and groin area- there’s no scars, skin changes, masses,
distention. On examination of the penis no obvious discharge, rashes, vesicles, ulcers. On scrotal
exam no erythema, rashes, scars,vesicles, bruising/ swelling .
Feel- any pain anywhere? On retracting the penis there is an erythematous irregular rash, no
phimosis. Non-tender temperature normal. There is a hard lump on right testis, irregular, can get
above the lump. Trans- illumination positive. No pain in epididymis. Spermatic cord nontender
with no masses.
 I’d take the temperature chart , do DRE and through abdominal examination
Dx- there are possible causes for the swelling John. This lump could be a harmless / a lump of
concern with malignancy.

PREDOMINANT ASSESSMENT AREA - EXAMINATION STATION 6

Scenario: Scrotal swelling Grade: Fail

Assessment Domain Domain Score (see key below*)
Approach to patient/relative 3
Choice & Technique of examination, organisation and sequence 3
Accuracy of Examination 3
Diagnosis/ Differential diagnoses 2

7. Women with swelling or arm red in colour with pain mild and painkiller was given by nurse she was concerned dt fever, had
to take pefe but examoiner will give finding inly asked so she had multiple axillary lymph nodes n no fever she had mosquito
bite on history
unscored
8. rest
9. Hrt counselling she was 20 cigrette smoker 47 year old and was having irregular periods and mood changes, recommend she
can start hrt or not

PREDOMINANT ASSESSMENT AREA - MANAGEMENT/COUNSELLING/EDUCATION STATION 9

Scenario: Irregular periods Grade: Fail

Assessment Domain Domain Score (see key below*)
Interpretation of investigation 2
Choice of investigations 2
Patient Counselling/ Education 3

10. DVT

PREDOMINANT ASSESSMENT AREA - MANAGEMENT/COUNSELLING/EDUCATION STATION 10

Scenario: Leg pain Grade: Fail

Assessment Domain Domain Score (see key below*)
Approach to patient/relative 3
History 4
Diagnosis/ Differential diagnoses 5
Management plan 3
Patient Counselling/ Education 3

11. Typical OCD with contamination fear and in hx he had taken loan and his uncle also had hx of some contamination or I don’t
remember some fear tell dx n dds

PREDOMINANT ASSESSMENT AREA - HISTORY TAKING STATION 11

Scenario: Behavioural complaint Grade: Fail

Assessment Domain Domain Score (see key below*)
Approach to patient/relative 4
History 3
Diagnosis/ Differential diagnoses 3

12. Childhood obesity there were two charts to fill in 4 min of height and weight and bmi with Hx of asthma wellcotrolled and
had to counsel father abt obesity
PREDOMINANT ASSESSMENT AREA - MANAGEMENT/COUNSELLING/EDUCATION STATION 10
Another Feedback – Obesity Grade: Pass
Task- plot the growth chart along with the BMI of the patient and explain the results to the
patient’s mom. 13 year old boy, had well controlled asthma and is now sitting at home in front of
the television, not exercising (mother fears that it will worsen his asthma), drinking sugary drinks,
Performance of procedure 4
Diagnosis/ Differential diagnoses 3
Patient Counselling/ Education 4
GS- 4
I plotted the growth chart- weight and height chart- there were BMI readings in one of the charts, I
plotted them as well. The height chart was within normal limits however, the weight chart was in the
97th percentile and it was increasing.
I explained what the normal ranges are and what is happening with her child to the role player. The
role player had a huge tummy, which looked like a pregnant belly to me, and she also had a cola can
in her hand. When I asked about her belly she said that it is just due to the big bones in the family. I
gave her a plan to work on body weight, diet, have nutritious diet, prepare food at home, no sugary
drinks in the fridge, involve whole family, no junk food, moderate exercise, even a small reduction in
weight would improve his asthma rapidly.
I could not say referral to the dietician and exercise specialist as the bell rang.
Another Feedback – STATION 10-OBESITY
PAA-MANAGEMENT/COUNSELLING/EDUCATION
Performance of procedure 6
Diagnosis Differential diagnoses 6
Patient Counselling Education 5
Mother comes with 12 yr? Old child who has been diagnosed with asthma previously. Asthma is
under control now and asthma action plan is good. She wanted to talk to you about his weight. He is
not very active in school and at home. He doesn't play outside for his mother is scared of him getting
an attack. He eats a lot of junk food at home.
Tasks- Plot his growth chart
counsel the mother
So outside I told myself , be very careful to approach the mother about this obesity. She will be
sensitive should not mess up due to nerves.
Went in there was a lady sitting there far away from the table. Told me I spilled my coke thats why
I'm sitting like this. Dunno if it was mistake or acting coz she said that for my friend too. Maybe she
wanted to draw attention to the coke? Dunno AMC is weird.
I told her no problem we can see if it can be cleaned up. I see you are here to talk about his weight. I
really appreciate that is asthma is under good control. You are doing a good job of that. At this point
examiner told me that's enough otherwise you won't have time for the growth chart. He said it very
kindly but it interrupted my flow. So i said ok thank you examiner and turned to the role player. I
told her so we have measured the weight of your son and I want to plot this chart with [Link] said
sure. There was only boys chart for height and weight no need to worry. But its better to check and
confirm that its the right one. I started plotting the chart and I kept the role player engaged. Like so
at this age he was this and at this age he was this. I said stuff like oh these charts have such tiny
boxes I need a microscope just to see it. I had to use a paper to use as scale and mark in the right box
it was really [Link] examiner told me we also have BMI that you need to plot. I said ok thank you
examiner and plotted that too. It was like given in the previous cases -height was good but weight
was in 98 th percentile. Bmi was high. I explained to her what growth chart was. Then I told her the
height was very good. Child is growing well. But in weight he was quite high. Which shows that he is
overweight almost we could say obese. I said it in a low voice rather gently. She was like oh. Then i
 explained I know this is hard to hear and we want out children to be healthy but this is not good for
him because of problems now and in future like asthma attacks and heart disease and diabetes etc.
So we need to organise exercise program and get a dietician. Is there a reason you don't let him
play? For that I can give you ideas of what exercise to do that will be less likely to provoke and also
meds to use before exercise. Here the bell rang I had lot more to say unfortunately could not.( Other
points to say is do it as a family to support him since i see you have coke in your hand, and more
exercise will reduce further attacks and necessity for meds and his lung capacity. Couldn't
say all this at all.)

PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION STATION 12

Scenario: Feeding problems Grade: Fail

Assessment Domain Domain Score (see key below*)
Approach to patient/relative 3
History 3
Choice & Technique of examination, organisation and sequence 3
Diagnosis/ Differential diagnoses 3

13. rest
14. Ear examination with bilateral conductive hearing loss dx n dds
Another Feedback – Middle aged female with hearing problem.
Tasks: Examination, Explain findings to the examiner, diagnosis.
(PASS) (Approach 5, Tech and sequence, organization 4, Accuracy 3, Dx/DDx 4)
Went inside. Greeted examiner
Introduce patient, explained took consent and wash my hands
Asked which ear you have problem she said no idea
Inspection- deformities, swelling, skin changes, discharge
Palpation-
Palpate the pinna for swelling or nodules, tenderness
Mastoid processes tenderness
Feel for nodes (pre- and post-auricular)
Wisper test- she has problem with both ears
Webers test- no lateralization
Rinnes test- BC>AC in both ears
Otoscopy- after fixing the instrument before performing examiner gave me a picture
Its almost like this
I have to explain to the examiner
Cone of light present , no perforation , no bulging, no retraction
middle aged women with Bilateral conductive deafness
I gave my dx – otoscleorosis
Explained what it is.

PREDOMINANT ASSESSMENT AREA - EXAMINATION STATION 14

Scenario: Hearing complaint Grade: Pass

Assessment Domain Domain Score (see key below*)
Approach to patient/relative 4
Choice & Technique of examination, organisation and sequence 4
Accuracy of Examination 4
Diagnosis/ Differential diagnoses 4
15. Bleeding per rectum blood on tissue no pain dx n dds

PREDOMINANT ASSESSMENT AREA - HISTORY TAKING STATION 15

Scenario: Abdominal pain Grade: Fail

Assessment Domain Domain Score (see key below*)
Approach to patient/relative 4
History 3
Diagnosis/ Differential diagnoses 3

16. rest
17. PPH atonic and snapped cord and placenta was inside , delivery was half hr. back, counsel mother

PREDOMINANT ASSESSMENT AREA - MANAGEMENT/COUNSELLING/EDUCATION STATION 17

Scenario: Vaginal bleeding Grade: Pass

Assessment Domain Domain Score (see key below*)
Approach to patient/relative 2
Choice & Technique of examination, organisation and sequence 2
Diagnosis/ Differential diagnoses 0
Management plan 4

18. Rest
19. Patient with dry cough for one year, its just same he said and he woke up at night too and felt better after a sip of water ACEI
& reflux

PREDOMINANT ASSESSMENT AREA - HISTORY TAKING STATION 19

Scenario: Chronic Cough Grade: Fail

Assessment Domain Domain Score (see key below*)
Approach to patient/relative 4
History 3
Diagnosis/ Differential diagnoses 1

20. Threatened abortion counselling she was farmer no assisted pregnancy

PREDOMINANT ASSESSMENT AREA - DIAGNOSTIC FORMULATION STATION 20

Scenario: First trimester complication Grade: Fail

Assessment Domain Domain Score (see key below*)
Approach to patient/relative 3
History 2
Choice & Technique of examination, organisation and sequence 2
Diagnosis/ Differential diagnoses 2
24th november 2022 f2f
PAEDIATRIC
1. DIOS with CF
2. Herpes stomatitis
GYNAE
3. Post partum contraception
4. GDM Counseling
PHYSICAL EXAMINATION
5. Pelvic
6. Gynaecomastia
7. Neurology motor
PSYCH
8. MSE schizo
9. Adolescent -!!
10. Depression headache
MEDICINE
11. Rhinitis medicamentosa
12. Diabetic Nephropathy
13. Ureteric stone
14. Pulmonary TB
15. Ecg MI
16. Neck lump

29/11/2022 f2f
1. GAD- patient is computer programmer 27 years old feeling stressed.
Task : Hx, Dx and DDx
2. Recurrent miscarriage
Task, Hx, Inv with reasons
3. Recurrent candidiasis
Task: Hx, PEFE, Mx
4. BEP, pt 62 years old with blood in urine
Task: Hx, Dx DDx with reasons
5. 12 years old boy asthma with obesity Ht, Wt given
Task: plot in growth chart, explains reasons for the condition, tell about complications now and in future
6. COPD stable, with ankle swelling gets worse at the end of the day, better when raising leg. has HTN taking amlodipin. Has SOB
when walking
Task: Hx, PEFE, Dx DDx with reasons
7. MSE (video) nurse with major depression with psychosis
8. Difficulty in walking, drinking alcohol
Task: PE lower limb neuro exam, sensory is normal, Dx DDx with reasons
9. Alcoholic pt, investigations done, all normal except macrocytosis
Task: PE lower limb neuro exam, Dx and DDx with reasons
10. 62 years old lady with self-detected lump on breast. Menopausal not taking HRT, not sure about family history.
Task: perform breast exam, give Dx and DDx with reasons
11. Brother had CABG, pt is 47 years old come to discuss.
Task: Hx, PEFE, preliminary assessment of risk, inv you want to do to give precise risk of CVD
12. 10 years old having headache. Parent come to talk.
Task: Hx for 4 min, PEFE, give Dx with reasons, immediate Mx
13. 9 months old with 24 hours of noisy breathing with cough, had runny nose 24 hours before otherwise well.
Task: Hx, PEFE card, Dx with reasons, immediate Mx
14. 32 years old 3rd gravida 28 weeks pregnant comes with PV bleeding for 2 hours, 1st was NVD, 2nd was CS.
Task: Hx for 6min, what inv you want ti do further with reasons.
15. Young pt comes with upper tummy pain
Task: Hx for 6min, Dx (acutely pancreatitis) DDx with reasons
16. Pt found semiconscious by spouse, gave orange juice now feeling better. Pt will call you to talk to you.
Task: Hx, give the Dx with possible causes (can’t remember 2nd task properly, my friend said it was Dx with possible causes and
other possibilities)

30.11.22 f2f
1. Picky eater
2. Pancreatitis
3. GORD
4. Abdo exam - some got Pyelonephritis, Appendicitis
5. PE - Pelvic examination
6. PE - Coma
7. Post op - Fluid overload, HF
8. Alcohol intoxication
9. Major depressive with acute psychosis
10. 9-year-old girl - tension headache
11. Mania - MSE
12. Hypertension medication counselling
13. STI
14. Crohn’s
15. PPROM
[Link]