PLAB 2: Jan 07 2014 recall

Discussion in 'Plab 1 and 2 forum' started by samuel, Jan 11, 2014.

  1. samuel

    samuel New Member

    JANUARY 7th Stations
    [1] Examination of Abdomen- Middle aged man with history of 30-35 units alcohol weekly,since many years. His abdomen is distended. Do the examination.

    [2] Osteoporosis. 57 year pld lady is diagnosed of osteoporosis,her Dexa scan was done. Address her concerns

    [3] Simman- Acute exacerbation of Asthma

    [4] Crying child- 4 month old baby was examined by the consultant yesterday and blood test was done,everything was normal,so the consultant discharged her. Mother came today again with same complaint, advice her .

    [5] Young Lady 32 weeks gestation is referred to you by the midwife as her BP was 145/100, and her urine protiene +++. Her booking BP was 110/80. Convince her why she has to be admitted.

    [6] Middle aged man with sudden chest pain while watching TV, Take history,see the ECG,give differentials to your examiner

    [7] Sexual history taking - young man had histiory of UPSI two weeks ago in abroad. Don't counsel or don't advice regarding HIV

    [8] Ophthalmoscopic examination

    [9] Fluoxetine counselling. Patient is on Fluoxetine for depression since two weeks,he has lots of questions to ask you,talk to him

    10] IV cannulation
    11] Take history from the mother of 9 year old girl who collapsed in the school,give your diagnosis to examiner

    12] young man collapsed outside the pub and was unconscious,take history and give diagnosis to examiner

    13] MMSE..75 year old man was found wandering and brought by the Police,check his Cognition

    14] Suturing

    15] Talk to the daughter of a man who is being treated in the hospital for Terminal cancer,he has considerable pain relief with Codiene+ Paracetamol. Talk to the daughter who wish to take him home,address her questions

    16] Take history fro 75 year old lady who is having headache and give diagnosis to your examiner [GCA]

    17] REST....
  2. samuel

    samuel New Member

    [1] Examination of Abdomen- Middle aged man with history of 30-35 units alcohol weekly,since many years. His abdomen is distended. Do the examination.

    What the examiner is looking for, dear Shangeo? Is this station about checking the signs of cirrhosis?

    [2] Osteoporosis. 57 year pld lady is diagnosed of osteoporosis,her Dexa scan was done. Address her concerns

    Do they have the scan in the cubicle? What were the lady's concerns?

    [4] Crying child- 4 month old baby was examined by the consultant yesterday and blood test was done,everything was normal,so the consultant discharged her. Mother came today again with same complaint, advice her .
    Was this station about infantile colic or about distressed mother? Is this station about history taking and councelling?

    [7] Sexual history taking - young man had histiory of UPSI two weeks ago in abroad. Don't counsel or don't advice regarding HIV

    What the examiner is looking at this station?

    12] young man collapsed outside the pub and was unconscious,take history and give diagnosis to examiner

    Was this an epilepsy or use of recreational drugs?

    15] Talk to the daughter of a man who is being treated in the hospital for Terminal cancer,he has considerable pain relief with Codiene+ Paracetamol. Talk to the daughter who wish to take him home,address her questions

    What were the daughter's concerns?
  3. samuel

    samuel New Member

    [1] Abdominal examination- the question didn't ask particularly for looking for signs of Liver failure,but mentioned that patient is got abdominal distension.
    on general examination I found palmar erythema,but was confused because white people's hands are always red,however I commented on it. Abdomen was not vividly distended ,and there were no other positive signs except Flank dullness on percussion. Asked for stethescope to auscultate bowel sounds,examiner said assume it is normal. That completed my examination but was very confused whether to give a normal diagnosis or alcoholic liver disease,and I said palmar erythema and ascites present,all other features normal. I had tme left.so I asked can I say one more thing and the examiner said,''now its over'', I thought he was a bit rough to say that ,bcz the whole 5 minutes is for the candidate.I messed up this station with diagnosis.

    2] Osteoporosis - very lovely lady,she was worried how she can prevent further bone loss. Dexa scan report was not there in the station. Adviced her on medications, diet,exercise,as per her concerns. I was happy with
    this station and patient was happy too.

    3] Simman - Acute exacerbation Asthma. His SpO2 was 88,so I kept Oxygen, bag and mask,he said feeling better, SpO2 came to 92,during examination his saturation again fell to 88, then I told examiner I will start Salbutamol Nebulisation,she asked me the dose,I told,I continued ,there was wheeze in all lung fields,she asked me what else you would do, said I will give Ipratropium Bromide,she said,not available,I said Hydrocortisone 100mg . said all investigations and completed the station,when I was leaving Simman told me ,I am feeling better,thank you doctor.

    4] Crying child's mother- station was a sort of counselling but she was very annoyed,as she tried everything. I took a brief history ,there was nothing positive,previous day the consultant examined and blood test were normal too. I kept on reassuring her,that this condition is very common in the age group and they will outgrow soon. She should be happy that all the test are normal,and there are no serious symptoms . Mother remained not very happy. I said if she likes to talk to some one senior i can arrange,she didn't say anything to that. [​IMG]

    5] Primigravida 32 weeks,with BP 145/100, convince her on admission. She was easily convinced when I explained regardin BP control, monitoring the mother an d Baby,and if not admitted and traeted chance of developing Eclampsia. She was convinced.

    6]Chest pain ,history and dd, he said first episode,pain while watching TV,lasted for 20 min,radiating to left jaw and shoulder, ruled out other conditions,. Examiner showed me ECG,there was no ST elevation, he asked me is it normal,I said there is bradicardia otherwise no changes ,gave DD,he asked me what will I do,I said management,he asked which are the cardiac enzymes. If cardiac enzymes are negative now ,when will you repeat,I didn't know that answer,otherwise it was ok, hope he will not crucify me for that,later on I thought I could have said it could be even a NON ST elevation MI. [​IMG]

    7] Sexual history taking- task specially mentioned not to advice on HIV, not to do counselling. Just took a detailed sexual history,he had UPSI with a prostitute when went abroad 2 weeks ago. No symptoms of STI, asked the route of sex ,gender of the partner,asked any previous history of same,asked about his partner ,whether he had sex with her after the
    episode UPSI, and General health. I was happy with this station.

    8] Ophthalmoscopy- first checked red reflex in the simulator then proceeded to fundoscopy. My diagnosis was Proliferative retinopathy. Slide was very clear,examiner told me you have to examine both eyes.

    9] IV Cannulation - I did ,but didn't get blood,so I asked examiner can I repeat,he said go ahead,,unfortunately didn't get blood even second attempt,but verbalised the procedure,and the time was up. [​IMG]

    10] Take history from the mother of 9 year old girl who collapsed. Girl fainted during school assembly, first episode,recovered soon,she had breakfast in the morning,not epileptic.not diabetic,no head injury, my diagnosis was Vasovagal syncope.

    11] Talk to the daughter of man with terminal cancer,who is on treatment with Codeine+ Paracetamol,having considerable pain relief.she has lot of
    questions to ask.
    First she asked me can I take my father home, I asked her is there any one to look after him,she said she will.
    she asked me if his pain get more,what will you give- I said in that case we will start him on Morphine

    She asked me can you tell more about Morphine,I have only heard about it- so I told routs of administration,including PCA, benefits and side effect quickly
    She asked me besides pain what else he will have- I said loss of appetite and the time was up,I had to leave the station.......

    12] Take history and give diagnosis, man collapsed outside the pub
    he said he had two pints of alcohol,no epilepsy,no head injury,not diabetic,not on any medication,no recreational drugs,quick recovery after the fall, no confusion. So I gave diagnosis as Hypoglyceamia due to Alcohol. But after leaving the station I remembered that I didn't ask for any Cardiac arrythmia, felt very sad that I missed the diagnosis.....sometimes mind get very blank !!


    13]Suturing- Assistant was provided, I managed to put two sutures and still time was left.

    14] Fluoxetine- patient on treatment with Fluoxetine for depression,talk to him.
    I asked him how can I help him? he said Dr. Iam taking this for two weeks and I cant feel any better. I told him it will not work straightaway but takes atleast 4-6 weeks to see the difference,so pls continue and don't stop.

    he asked is there anything I should worry about... I asked him if he has any suicidal thoughts,this medication initially can increase such thoughts,if that happens pls contact your GP soon.
    He asked me what side effects can I have, I told him a few.
    He asked me how long will you give me this medication, I was not sure, so I said ,I am unable to tell you correctly,but I will ask the consultant and get back to you before you leave. Asked if he has any more querries, he said no. He was happy, and said thank you my Love

    16] Headache , take history and give diagnosis to examiner.
    A lovely old lady 75 year old, worried about head ache,near the temples,pain while eating,severe scalp pain when she combs.

    My diagnosis was GCA.

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