Med and surg

1.X ray smoker patient with rt white lung ( except upper lobe) interpret ix and DD and
further management--mostly effusion vs mass ( exclude malignancy)

2. Difficult urination DD no examination findings were given -- most likely prostate

3. Trauma with L rib fractures + splenic laceration the decision was conservative treatment--
went to the ward severe pain and the nurse called you to see the patient

Obs chart was given the BP trending down and HR trending up-- explain to the patient and
management

4. Chest pain-- pericarditis

7. Infective endocarditis Lady with H/O tiredness and fever with chills. Was told long time
back she had heart murmur.Take history. (Had tooth taken out recently only if you ask on
history )Ask Examiner PE (photo of splinter hges only if you ask ) Discuss prov diag and
reasons.

8. SVT - Man with regular HR.History P/E findings to examinerRelevant invest to examiner.
Prov diag and D/Ds

MI on ECG, crepitation present • Ask PEFE and examiner gave sheet • Ask for ECG & interpretate
it- Anterolateral ST elevation • Explain DDx & reason • No management

4. Diabetic woman 22 yo wants to be pregnant, comes in for counseling, random blood glucose
6-8 • Hx (2-3 minutes) • No COCP, on condoms before • Pap done before • HBA1C normal •
Never in hospital before • No hypo attacks • Risk to baby • IUGR/ macrosomia •
Polyhydramnios • Miscarriage • Risk to mother • Worsening DM/ high risk pregnancy • PROM/
PPROM • Pre-eclampsia

5. 47 yo, on metformin + glicizide, adjusted by GP and put on insulin, feeling dizziness/feeling

funny • Hx (4 minutes) • Ask for breakfast • Happened previous? • Denied complications • Lack
of exercise • Ask for specific office test • Urine normal • BSL=3.5 • Tell her how to prevent
further episodes from this happening • Mx + counseling • Offer glass of juice? • Reduce insulin

1. Radiculopathy, mid 30, tennis player, office worker, golfer, complains of right shoulder and
neck for 1 week • Hx • Index Finger and thumb- tingling and numbness (C5-C6) • PEFE • DDx •
Mx

. Upper left back 2 cm lesion, 42 yp had it for a while, recently become itching recently, punch
biopsy done shows superficial spreading melanoma, deep & lateral margins are not clear, 0.6
mm depth • Explain results
11. 32 yo woman, abdo pain, bloating and constipation, colonoscopy, upper GI, coeliac screen all
normal, thyroid problem, had reflex- IBS • Hx (4 minutes) • r/o other causes • Patient anxious •
DDx with reason • Dx • Mx

Non-tender lump on right side of testis for 3 months • Scrotal Exam on dummy + actor next to
dummy • Right varicocele- snail like • Left side- larger testis • DDx & reasons

The recall u asked ... here it is..

Middle age lady with sob n weight loss. ... n now having hemoptysis.... came in emergency .... n now do urine dipstick ...
tell result to pt n your diagnosis n mananagement

Samreen Hashmi uds had 3 plus proteins and sputum was blood stained,,,hope it will be helpful to all of u

Could be a collagen disease, as in Goodpasture syndrome ut not sure if that's too complex for AMC

does anyone know the complete scenario and tasks of urine dipstick perform in pnuemonia
patient(todays recall)
guys who appeared yesterday plz help with this case,,what was it??

There's no such thing as just plain urine dipstick test for pneumonia unless atypical type like legionnaires where to be
confirm by PCR assay in urine...
Yes probably they want to exclude other source of infection if the case was sepsis

10 may
1) uticaric rash .. dx,ddx and mx
2) perform urine dipstick (this case most of us not sure wat they want coz it seems nothing was positive ).
Then u have to arrange further inv based on dipstick.
3) abdominal aortic aneurysm, indigestion, non compliance in HTN,
4) Med:
SOB(Heart failure)
Itchy Skin rash(Scabies)
Hoarseness of voice

Hoarseness pancoast tumor typical karens

Quincy typical karens. Picture of throat was shown on exam.

21 april

A man presents to you who is a new patient and stepped on a rusty nail yesterday. He is going
to move to your area and wants to become your regular patient. ( this case was similar to karen
notes but the patient was not a case of copd in my opinion because he denied any physical
symptoms and was quite healthy and took no medication, had stopped smoking and no alcohol
intake... but maybe I have missed that 😔 )

24 april
2. 6/8 years old Tom came with his mother with right knee pain , refuse to walk for 1-2 days.he
was very active playful boy, got a history of injury 1 week before at school,his granny got arthritis,
Task: history, p/e, diagnosis n differentials, management In p/e: right knee was ok, restriction of
movement of right hip,

March 2017

Med/Surg

8. Pericarditis
9. Iron deficiency anaemia in 57yo woman
10. Bilateral breast pain
( In this case there was another lump consistent with fibroadenoma so I send for us+fnac )
Cyclic mastalgia ok this case again young girl,27. pain on bilateral breast, worse around period,
relieve by wearing bra. Mum has hx of breast cancer. I said sorry about that. is she feeling
alright now? she said yes. she is taking OCP for 5 years but she is not sexually active? I said why
who prescribe it for you? do you have any problem with period? she said no in case if start any
relation. okay the examiner handed paper of examination typical for cyclic mastalgia ( multiple
fibro cystic I think bilaterally ).

I said I know you are concerned about breast cancer lump in the breast could be cancer the
patient face sad or fibroadenoma but from the hx and examination most likely cyclic mastalgia
but again it could be related to pill I want you to stope the pill, wear supporative bra, NSAIDs
and hot pad and see you again. As I remember the patient on ocp but not sexually active so I
advised her to stope the pill, wearing supportive bra and take NSAD for pain and reassure her is
it a normal condition. ( EPO, Vit E, Bromocriptine ).

11. Post pneumonia Xray

The patient had pneumonia admitted to hospital. she had IV antibiotic for 3 days and discharged
on oral antibiotic. I asked if any investigation done she said she can't remember what is the
name of antibiotics? she said hard doctor to remember.

Task hx and risk assessment post pneumonia 3 X-ray, the old one and 2 new after recovery it
looks better one AP venues and other lateral

12. AAA 3.8cm, before travel. Smoker.

13. Acute R/Ab pain renal colic
14. Diabetic with right calf pain, PVD.
very long stem I couldn't finish it outside. patient on insulin well monitor, Lipitor and atenolol
finding- no pulse from foot only femoral positive. I asked about carotid and cvs exam normal.
complaint- pain on calf increase in walking improve with rest

Task: 1. Take history 2. Advise management 3. Discuss long term and regular( periodic) health
advice that you will give him( completely different from karen case )
A middle age man who is having chest pain on activity, heart racing, pain radiating to arms and
shoulder and had episodes of bright blood in stool....
Task: 1. Talk to him and gain consent for examination
2. Do abdominal examination
3 do DRE
4. Explain the most likely diagnosis with patient( maybe mesentric ischemia but I missed it)
5. A young man who had a lump in front of thyroid recently underwent Ultrasound and FNAC
which showed a papillary thyroid cancer.
Task: tel him the result and discuss management
Med Sx
12.ECG anterolat.MI-H,explain ecg, Invx, mx
13. Lt lower abd pain- constipation+, examination normal. Dx
She had constipation, blood on toilet paper, slight weight loss, no fever, no stress at life..
Examiner told every examination finding is normal. Asked probable dx and dds
Chronic constipation,diverticulosis,rectal polyp colon ca...
14. arm swelling- DVT
15. recurrent uti. Dx of prostatecancer- explain results& mx
Every ix was given,msu ecology,cystoscopy, PSA 6, radioisotope bone scan, Ct, proctate bx-
adenocarcinoma
16. Asthma in 32yr old, recent uncontrolled.- findout the cause & further mx(smoking positive)
03.03.17

1.Middle aged lady present with tummy pain, loose motion and vomiting a few times containing
food materials. Stool was dark brown no blood. No recent travel H.
Task :Assess dehydration status of the patient,tell examiner about your findings.
Perform abdominal exam, Mention pdx, ddx to patient.

(positive findings : skin turgor sluggish, cap refill normal, BP normal, no sunken eyes, no dry
tongue, patient feeling thirsty a bit. Abdominal examination deep tenderness present on whole
abdomen, no signs of perforation, hepatosplenomegaly absent, PR and VE Examination normal,
bowel sound normal, even did fluid thrill also negative) Mention Gastroenteritis,Typhoid, non
specific viral diarrhoea :p,

2.55 year old lady with hoarseness of voice.

Task:H/o 4mins, Ask PE, explain Pdx, Investigation to patient
(Positive findings: Second time, first time after viral infection, now no fever, school teacher need
to use more voice recently, smoking history positive, no Surgery, no swelling, no features of
cancer,Physical examination all normal except reduce air entry on left side with, dullness, I
check for bone tenderness, and features of cancer but negative, exclude ddx:thyroid, Surgery,
tonsil, infection, indirect laryngoscope she said not available)
Mention about base line test, laryngoscope, CXR, followed by Broncos copy and biopsy
depending on imaging results. Patient is calm afterwards..

75 man present with 12 hour tummy pain . Task :h/o, Ask pe, mx
(typical urinary retention case with bph symptoms, urge to urinate present on pressure, bph
symptoms +, examiner provided all answers and I didn't need to ask any, last station, explain
about catheterization and patient ask when to remove it, arrange urologist and admit
8.55 year old lady present with chest discomfort for a few months duration. Task :h/o, Pecard
provided with answers, tell ddx
(patient chest discomfort, 3/10,worse on activity, no radiation, no associated features :f,
sweating, SOB, she thinks she has reflux, no stool change, no travel, no underlying medical, only
positive finding pain worse on activity, ABCDEFS normal,)

Family history positive and BP slightly elevated. Mention angina and heart cases first, lungs,
bowel,...

massExplain dx to pt C8T1 power reduced, Respi exam normal I said I want to check vision,
examiner gave me pic of Horner's. 13. 55yr old female came to get invx results. Lump on left
breast for which bx was done. invasive ducal carcinoma, Receptor status given I can't
remember, No vascular or lymphatic spread -explain results, Mx, Implications of dx

14. 60yr old female with severe headache for past 2 weeks. Now worse. Task : hx, Explain dx
and ddxLeft side temporal area pain. Throbbing. No visual disturbances no vomit no Low, no
gait issues or vomit, Has difficulty and pain chewing and opening mouth Fmx of migraine15.
Lady 30yr feeling feverish. Task: hx, PEFE card, Dx and ddxUnwell with fever night sweats
3/12LOW positive, No flu like illness, sexual history good, no rashes tummy pain. Pruritus +,
Examination card pallor, no jaundice, 2 enlarged cervical LN firm, scratch marks on chest and
abdomen, throat normal.
16. 30 yr old lady wants to quit smoking after bout of bronchitis Task: assess her nicotine
dependence Mx

pain in the base of big toe picture of sweeling patient on diuretics and drink beers/alcohol. ask
for exam findings and the examiner gave u a picture. brief ho and mx.
10-young teen tired.. Glucose 34

- 30 years old guy motor vichle accident.. Giving a chest CT..explain to patient with mx
14- yound lady anxity palpitations.. Cant stand hot weather lost weight
15- acute abdomen.. Pain on epigastrium raditaing to the back.. Improving in leaning forward pt
heavy alcoholic and smoker... Investigation and inform the patient about the diagnosis
16 - hypertension old guy tired sleeping problems may be sleep apnea------------

MEDICINE/ SURGERY
12.Medication chart . MOrphine
13.Lymphedema
14.Atrial fibrillation
15.Hypoglycaemic attack
16.Rectal bleeding

11.Pt indigestion -black stool +, D & DDx.

12.Pt, chest discomfort -Sob on exertion.
13.Confusion in 85yr old man-talk to doughter – hyponatrimia.
14.
16.IDA with blood film
----------------------

2)chest pain

Task

Take history
ask physical examination findings that will be given to you on card .
most likely diagnosis

Positive findings
chest pain after meals on walking uphills , took mylanta and no response .. smoker
on examination all normal except high blood pressure
diagnosis ;

Stable Angina

3)non organic abdominal pain ..

Task
History
physical examination
diagnosis and management

positive findings
periumblical pain ,
stressor: grandma colostomy tube
Ex all normal .
12)Cbc report (hb low and mcv low ) . and blood film poikilocytosis, anisocytosis

Task
1) .interpret results,, tel her the different
reasons for this and als0 the reason in her case

positive findings
1)postmenopausal but no bleeding , taking ibuprofen)

13)patient with indigestion

Task
history
investigations

positive findings
(heartburn after meals ,black tarry stools, weight loss, smoker )
Post op pyrexia.. atelectasis
5-Leg pain.. chr Ischaemia in 55yo postmeno lady. cant walk even 200m. PVD.it was
PVD..Peripheral pulses were absent.pain after walking 200m.tenderness in legs. femoral bruit.
History , Physical examination findings from examiner,Tell the pt diagnosis.No management
6- Syncope in pt with long term DM.
Hyperglycemia..FBS 8mmole.Poor drug compliance.on metformin.all other was negetive.
I also told like that but after exam i remember my friend got a similar case on last August.18th.it
was postural hypotention due to autonomic neuropathy due to long term dm.i got that point at
last minute.
7-COPD. spirometry done.. pt with spo2 93%.. mildly dyspnoeic.. came to discuss about the
results.. if u can take relevant history for 2 mins.. explain futher management plan to the pt
8-Tiredness / Anaemia, Veg
10.Sti counseling young female Multiple sexual partners
so this lady even doesn't remember her sexual partner count in last year,suddenly her new
partner and she have decide to get tested for STI,use condom infrequently,she never had
gardasil vaccination
Hx, what investigations you will do and why
Advice patient
13.Hemorrhoids grade 1 Karen's case positive Fhx
so this guy had diarhea few months back,no constipation,works as accountant,normal
weight,blood on toilet paper,no pain with bleeding,takes balanced diet.no positive findigns till
proctoscopy where you get haemorrhoids.

14.Post cholecystectomy bleeding counseling consent for another surgery

It's an old case can anyone find it ??? I'm sure it's an old case but need to find it somewhere
so had laproscopic cholecystectomy,shifted to ward,suddenly bp dropped,hb dropped,gave 4
pints of blood,now stable,surgeon thinks that staples came off from cystic artery,so shifted him
back to OT,they have told me to inform partner that they will do it laproscopically but may need
open surgery as well.
the partner had 3 tricky Q
1.why i wasn't informed earlier on about my husband's condition?
2.why did staples came off?
3.what did surgeons do wrong?

I thought she is crying so i offered tissues,but she replied i don't need them,i am fine :-(

15.Young man dipstick blood ++

Protein ++ leuks + and nitirites +
DDx Ix and Mx

this was a weird one,no hx,lab reports as above,no fever,no prostate issue,no tummy pain,no
other finding whatsoever apart from allergy to penicillin
so you had to give your dd with reasons,your diagnosis,and what investigation and mx you
would do for it

16.Female chest pain + sob o2 sats <90

Chest finding : dull
And crackles
Hx Pe Dx Mx
?pleural effusion
?pneumonia

so her condition got worse (As above) after a normal flu.she didn't take flu shots since long time.

Guys i hope this little effort will help you,i would be busy in few things so might not be able to
reply your queries on time.
2 issues which were new in this exam this time
1.tasks were alot,i was able to finish just 1 case before time,in all others i couldn't address the
last tasks completely.
2.where stations were divided b/w groups like 4 min for hx etc,the examiner was not stopping
you at the bell,so i missed the bell in few stations and took time out of next task as well.

Hemorrhoids grade 1 Karen's case positive Fhx

Post cholecystectomy bleeding counseling consent for another surgery

It's an old case can anyone find it ??? I'm sure it's an old case but need to find it somewhere

Can't remember properly, start with 'we are sorry what happened to your husband . then every
operation has its own complications. In lap chole, one is slipping of clip from cystic artery
( given in the stem, you don't hv to know, where the bleeding is coming from) it can happen
even all the precaution hv taken, in a very expert surgeon as well.
pause, let her express her anger, show a empathetic and patient face. then-
I can assure about one thing, he is in safe hand. the next management will be ---- say what is
given in stem like laparotomy, transfution, there complications, recovery whatever the
management.
Even after this she is shouting, tell her, I can arrange a meeting with consultant, we are here to
help- all the fancy dialogue.

It was already said on the stem that the wife had the consent, for me she was very anxious at
first but when I reassured her that the partner is stable and in safe hands she calmed down and
we had a chat I told her that unfortunate incidents may happen all the times and I'm sorry that it
has happened in your case, then she started to cry and then I offered the tissues and the water
And asked her if I can do something to make her feel better and she said no dr thanks I feel
relieved right now then I talked about the things that happened and what we are going
afterwards and as soon as he is out of the OR I'm going to arrange for her to meet him.

Young man dipstick blood ++

Protein ++ leuks + and nitirites +
DDx Ix and Mx

Female chest pain + sob o2 sats <90

Chest finding : dull
And crackles
Hx Pe Dx Mx
?pleural effusion
?pneumonia
Medicine and surgery.
1. Epigastric pain.
Task.
History.6 minutes.
Alcoholic. Off and on pain from last year. No pain at this time.
Most likely diagnosis and other D/D.
Pancreatities and told other D/D of epigastric pain.

Rule out cardiac causes for any chest discomfort. The most likely causes for epigastric pain would be GORD and
peptic ulcer disease. Chronic blood loss could happen in peptic ulcer disease and lead to anaemia, which is one
of the contributing factor for angina.

2. Acute SOB. Since 3 hours

Tasks.
History. Was jogging. Felt SOB. Nothing else positive.
PEFE. Auscultation reduced breath sound left lower zone. Percussion not done.
Investigation. Cxr given poor quality.
I initially mis judged xrays. Said pleural effusion. But I was confused. said sorry
my apologies. It is pneumothorax. Need to admit and chest drain. Could not judge the response
of examiner. observe and do serial CXR

3. Osteoporosis.

62 year old female. Bent to pick up something. Had upper chest and lower back pain.
Tasks.
Explain xrays.
Immi date management.
Long term management.

Again poor quality xrays. But could see a fracture. Unable to guess which lumbar level.
Explained initial and long term management.

12acute pancreatitis - hostory n investigation given clear raised lipase .. further history
managemnet

67. Pre op medication reveiw - dm , htn on warfarin

6 lumpin nat traingle of neck moves with swallowing .. dx ddx

medical chart complete- pneumonia , give ceftriaxoneChart it was only young girl
Weight 60
Vital signs given
No allergy, no pmh, no drug history
Complete the chart and write the ceftriaxone order

Yeah, you should write it in regular medication

I have an idea but i'm not sure, i think the reason was when i asked the examiner is VTE assessment done or not and
then the examiner told me whatever you need is mentioned in the stem and instead of leaving it, I ticked the VTE
prophylaxis not needed.
Like
· Reply ·
1
· 17 April at 21:40

Khalilullah Arefi Cuz you shouldn't tick it unless you have done the assessment yourself, when i didn't do it I
shouldn't have touched it.
Chris Villacorta So for Ceftriaxone, you fill it out on the regular medicine portion of the chart. Dose/frequency 1g
mane write the dates for today then for a minimum of 4 days, to review after that. Then cross out the dates after so
the nurse would know it's only up to that date. So for example 29/7, 30/7, 31/7, 1/8-----------------. Very important to
note of any allergies, none for this case though. But write something on it even so. To add, treatment should be
greater or equal to 2 days after symptom resolution. *MIMS

I have passed this case and got perfect 7 in each with out any idea what i did
In dose I mentioned 500mg B.D because i got cautious when they mentioned about GFR.
Rest of the things were just filling the form.
Furthermore, I didn't even put the dates right.

I had written ceftriaxone in regular medication AND filled out only regular medication part because they had
mentioned thatceftriaxone is going to be a regular medication in the statement.
Creatinine level was given which i overlooked because it is used to look for the admission of a pneumonia patient.
I had filled rest of the form with name of the patient , weight because they had given it, route I/V, No allergies because
it was mentioned and 500 mg B.D because I got cautious about eGFR.

24 april

Middle aged man Damien came with all feature of hypothyroidism. He gained weight, felt cold,
had constipation. His Mother had autoimmune disease. Task: perform physical examination ,
probable diagnosis . ( patient got cold n Sweaty hand. Rest of the things were normal. Don't
forget jerks. Patient kept himself exposing to get his jerks examined . Biceps triceps ankle knee
jerks were good. Examiner came closer to check during ankle jerks.).
10. Acute abdomen. Middle aged woman( forgot the age. One candidate remember she was old
enough) came with tummy pain. Task: examination. Possible causes . ( there was generalised
pain all over abdomen, maximum intensity to left side, epigastruc point, mc burney , Murphy all
were tender, though there was no distension or no rigidity girding. I asked per vaginal( though not
sure it was relevant / not, examiner told me bilateral Adnexal tenderness present. Cough impulse
tender but no herniation. )
11. An old man came with shakes. Shakes aggravated in stress n problem in manual tasking.
Worried about perkinson as he had someone in his family with perkinson. Task: examination of
upper limb for tremor, n additional examination. Possible cause.
13.old woman with blurred vision. Task: Hx, examination from examiner, causes. (It happened
for3 times over last 1 week . She felt a curtain dropped down from above blurred her eye. In
examination there was carotid bruit )

14. Middle aged Mark came with Epigastic discomfort n heart burn for lady 6 months. Task: hx,
possible causes ( patient feel better if he eat small meals frequently, sitting up position, there was
feeling of good coming up).
15. 25 years old man with sore throat. Task : hx , examination findings sheet from examiner.
Cause n manage. ( patient got no travel history, not sexually active, worked in architecture farm.
Wanted antibiotic. mild fever,no runny nose, tonsils were enlarged but no exudate ).
16. Old lady came with back pain for 2 months. Previously she was treated with panadol by
another gp. (X-ray of lumbar vertebral region showed wedge fracture. The X-ray film was good.
Patient was in menopause. Stayed indoor, caffeine for 6 cups a day, didn't like dairy.pain started
after lifting shopping bags 2 months ago, movement, walking straining coughing aggravated the
pain) in Task: history, explain X-ray, possible causes
From one of my friends : 1 Ques couldn’t be remembered….dn worry for that…

. A man presents to you who is a new patient and stepped on a rusty nail yesterday. He is going
to move to your area and wants to become your regular patient.
Task: 1. Take history 2. Advise management 3. Discuss long term and regular periodic health
advice that you will give him
He was heavy smoker and stopped 2 years ago

A middle age man who is having chest pain on activity relived with rest. heart racing, pain
radiating to arms and shoulder and had episodes of bright blood in stool....
Task: 1. Talk to him and gain consent for examination
2. Do abdominal examination
3 do DRE
4. Explain the most likely diagnosis
. A young man who had a lump in front of thyroid recently underwent Ultrasound and FNAC
which showed a papillary thyroid cancer.
Task: tel him the result and discuss management
Breaking bad news
A lady who was recently back from holiday from cambodia, presents with tiredness.
Task: 1. Take history and ask examiner of examination for 7 min ( all normal but reduced
breathing sounds and dullness in the base of the left lung was present)
2. Tell the patient the likely cause of her tiredness
14. A young lady who is a known case of T1DM since many years ago, is going to become
pregnant in 6 m.
Task: take relevant history and counsell the patient
15. An elderly man presents with recurrent falls recently and wants to discuss the cause...
Task: 1. Take focused history( on history he mentioned DM history and was on metformin but
because he lost his wife couple of months back, he was forgetting to take tablets...he had pain in
knees as well...but all other systems were normal)
2. Ask examiner for examination on a card( showed features of DM neuropathy)
3. Discuss with patient the likely cause of his falls
16. A middle age man who is known case of diabetes for many years on insulin ( a very long list
of his insulin were given) presents with pain in his calf( leg).
Task: 1. Take history ( typical features of PVD) 2. Ask for specific examination you need( dorsalis
pedis pulse was absent on left side and ulcer was present on left foot)
3. Tel him the likely cause of the pain, severity of the problem, the risk factors for this condition.
21/04/1017
2. Copd case spirometry findings given and explain it. Same book case. Examiner
gave findings again he gave to hand when I asked towards copd. She was smoker
and worked as a courier person..she quited smoking and retired now I appreciated
for it . But initially she was coughing and like breathless she behaved I asked
examiner vitals he asked wat u want I said mainly o2 saturation 93% but she was
behaving same so I said examiner I would like to give o2 to my patient 1st I want my
patient to be comfortable them he said ok and I explained spirometry simply Fvc is
the air wat u have inhaled and fev1 is amour of air u expelled and TLC is increased a
that means the amount of air ur taking is in lungs it's basically problem with air
exchange air ways has got narrowed and that's y u have sob.. then examiner gave
findings and said her wat has already has damaged we can't do anything and from
now we will take care of u I will refer u to pulmonary rehabilitation centre and there
we have specialist and they will teach u exercises and make u learn how to cope up
with the situation.. I should have gave her steroids and admit. And came out she was
not so happy.. thanked both of them and came..please do like in handbook
5. DVT case- results she came its dvt we have to explain her y she got it. She
travelled to Europe 28 hrs flight.she was sleeping for 10 hrs continuously I asked her
u went to gp she said yes.. and asked about family hx she said Mom have clotting
problem. Said sorry for that. No ocps use,No medical illnesses..I said because of
long travel when u stay in one place circulation won't be proper and draw a picture
for her and said clot has formed in the leg that's wat u have swelling and she don't
have any symptoms like shortness of breath .. I said will refer her to specialist they
will give u anticlotting medications heparin she was tensed I said it's manageable we
want to treat it otherwise it can travel to heart and lungs other parts of the body and
stopped and said should do thrombophila screening its like for all clotting factors test
if it's positive should use one more drug called warfarin life long.. but don't worry it's
because of travelling u will be fine..she said u want me to tell anything I said I
anytime u feel difficulty breathing or swelling gets big u should come here thanked
and came out.. I should have told her next time before travelling walk in
between..move ur legs and come to me I didn't say.. and reading material..
8. Chronic asthma- 4 th attack for a child 2 yrs old preventer medications also
finished..father came I should ask focused hx, explain spacer and
management..when I entered he asked explain this puffer how to use .. I said ok will
ask u some questions he said ok asked binds, allergies family hx, soft toys, smoking
- he said he smokes will talk to him I said..so many things in the table mask and all I
was confused initially fixing it they were looking at me and finally I fixed it and said
there r so many things I am not used to them then I explained make the child sit in a
quiet place shake the puffer to ensure medication is present and attach spacer and
place in child's mouth and seal..spacer is always gud as medication can be used
completely and it won't get wasted..child can take normal breaths and no need to
hold breath..he felt gud..and started telling about action plan and time finished
thanked them and came said will give u material and came ..only station time
finished before task as I wasted time fixing it..

9.Chest pain case- hx - she said pain always there near apex offered pain killer and
didn't do much in that case. Findings should asked some - he said inspiratory
crackles present . I said about pneumonia..not sure about this case..she is not so
cooperative examiner as well..
10. Head collision- hx- boy had collision when playing football.. so asked any
injuries anywhere else she said no..did he lose consciousness she said yes how
long she said less than 10 mins wet his self - no, he remembered event afterwords-
yes but little he forget .. how is his school performance- he is doing gud is
said..home situation is gud happy family..Pefe: asked GA: active, bruise on head he
said..vs: wat u want he asked bp, pulse then he was telling slowly.. asked bruises
anywhere else- no, cranial nerves examination- all gud.. was asking soon he said
slowly u have to tell and more specific I asked cardiovascular exam -
normal..neurological exam - tprcs- normal. Then talked to her after talking to u and
examination findings from examiner ur son is doing well no prob but as he has bruise
and loss consciousness will admit him and will inform specialist and will do ct scan
for him to make sure everything is fine with him.. and once he is fine u can take him.
Don't worry he will be fine..Thanked and went out.

Herpes zoster- picture given same hb case hx- severe pain.. gave pain killer .. no
other rashes .. stable partner.. Pefe: no other rashes.. told its shingles rash it's
herpes infection and as u got it first time it's very painful.. this virus stays in the body
and comes out when u have fever or any infections he asked oh it stays I said yes
but don't worry Will give painkillers and creams for rash .. no itching he said..antiviral
drugs I said and offered vaccination for his wife.. he said it will be gud.. u will be fine I
said.. thanked and came. That's all I remember guys. All the best for all of you..I just
did wat I know.. and didn't scar if I made a mistake just left that part went on to
further leaving mistakes back no more thinking of them.. hope it helps
1-in ED setting your has hand over a 24y/o lady with SOB after five
days of viral illness and clear rhinorrhea. She has chest Pain which is
aggravated by breathing. T=38.1/ tachycardia(cannot remember
exactly)/ the patient has been given painkillers.
Task:
1- ask further investigations and physical findings that you want
from examiner
2-explain the most likely diagnosis and other possible diagnosis to
patient.

- 24 y/o man came to GP.has had a mass in his RT testis .your

colleague has examined and found that there is a 3cm mass, tense,
you can reach the neck of the scrutom but testis and epididymis are
not palpable. The mass has been translucent on transillumination.
The left testis is normal.
Task: talk about diagnosis with the patient.
4- 52 y/o man comes to you because of high blood pressure.you
find that he has been taking his medication erratically.He is chronic
alcohol drinker but in the last 2weeks he has drunk on and off.
Task:
Do the MMSE and explain for the patient about the most likely and
other possible diagnosis.

6- a 47 y/o lady comes to you in GP and complains that she has

something wrong with her nerves.
Task:
1- take further history
2- ask about the physical findings that you want from the examiner
3- explain the most probable diagnosis and other possible ones to
her.
Dx:hyperthyroid state

12-a 22y/o lady comes with 2 days history of red sore eyes.
Task:
1- take history from patient
2- explain the most probable diagnosis for her.

15-A52y/o female comes with severe RUQ pain. The pain has been
8/10 and in the ambulence has been given painkiller and is 5/10 at
the moment.
T=37/ PR= 80/
Task:
1- take detailed history from the patient
2- explain investigations that you want for the patient
37 yr man, send from blood bank as he come to donate, BP 170/ 100. Task examination of CVS. Then
explain patient his condition as well as explain him given fundoscopy findings. ( need to do BP as
well, need to change BP cuff size as it is Paedi cuff, fundoscopy show silver wiring for sure)
Women palpitation and SOB . Got history of smoking alcohol and coffee. PR150. Task history, PEFE,
ECG present to examiner , explain DDx. ? SVT
15yr old SOB left side chest pain. Task history, PEFE, X-ray explanation , Dx to patient . Got history of
something pop in chest, sudden onset, parents coming now, X ray mod pneumothorax.
Got history of post gall bladder surgery, obstructive Jaundice pattern. Patient also have PR of 120.
Patient have problem at work being investigated, friend got action but not him. Happened 3 weeks
ago, having sleeping problem on temazepam. Not helping. Task history only 3 mins, explain DDx,
management plan.
22 years old with breast lump, history given, USG given. Task explain USG, DX, Further invx and
management. USG looks like Simple cyst to me.
30 yr old dark urine 2 days. History of sore throats. Recent. Task History, PEFE give finding card.
DDx with reason to patient.
Hypoglycemia recent infection and not much breakfast and change to gliclazide from metformin.
Task, explain causes, father management plan.
. Moderate alcoholic lady with severe upper tummy pain, not cooperative at all - I think it was
pancreatitis , examination , explain diagnosis to patient

6. Melanoma 0.6mm clarks 2 , explain the biopsy report, and explain to the patient
7. Smoking cessation counselling
8. Chronic dialysis patient with palpitations
Recent change in BP medications , ecg was hyper kalemia. Discuss management with the patient.

25/08/2017
Med/Surg
1) 52 female with pallor and intermittent abdo pain. Patient said weight loss but examiner said no
wt loss. Pallor. PR blood on toilet paper after BO. Diagnosis and differentials
2) AF ECG explain ECG TO EXAMINER. Explain Diagnosis, causes and complications to
patient.
3) SOB on walking, Hb 97 WBC raised MCV reduced. Anisocytosis and Pokilocytosis. Diagnosis
and diff.

Retest 26/8/2017 26 August

Collected from the group ( photo )
1- lady came with SOB & tiredness
Ibuprofen long time use
MCH low
MCHC low
HB low
WBC normal
Task : interpret results
Dgx & Ddgx
2- A man came with epigastric pain , chronic drinker
Pancreatitis ??
Task : hx , Ddgx with .......??
3- SOB , bad lungs >>>> pleural effusion
Task : hx
X ray interpretation
Dgx & Ddgx
4- Back pain PE >>>> Sciatica