1-RA councelling

2-Thyroid nodule
3-Cough turn to be asthma dx and ddx
4-Scrotal examination(which examiner confuse me i think didnt do well)
5.Eye examination (silver wiring and nipping)
6.Hand exam post thyroid
7.Large for date ut
8.Uterovaginal prolapse with candida plus cyctocele and rectocele and having hight bsl obese (but she was very thin
RP)
9.Unresposive baby and now normal
10.Dental carries turn to be bulimia but i didnt give much ddx
11. MSE examination on OCD pt but they play video ) so am not sure if i mentioned everything :()
12. Arrythiams i think was Af plus other ddx pt tab on irregular )
13.acute abdomin( irregular pulse,high temp. Decrease bowel sound, bloody diarrhea)
I said mesenteric cause irregular,perforation yes could be due to diverticulitis, she had 2scars of previous op so i said
could obstruction as will , and unlikely due to colangitis or heart like MI and others.
14.STI screening (casual partners , shared needles many years back and now having nothing, completed gardasil
vaccine but not HBv so i offered and she was doing pap smear regularly , i advice safe sex plus bring partner to check
and i list what i will do so clamydia ,gonorrhea then syphillis hiv hpv plus hcv cause sharing needle ( i dont remember
if i ask occupation or not ) but from hx she was willing to start new relation thats why requesting)
:(

15.abdominal migraine in 10 yrs old hx dx and ddx (mother have migraine)

16.SOB in old lady

Hand examination post thyroid what symptoms have

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Maiss Hanna Was post thyroidectomy pt had painful hands and tingling numbness sensation , this wt i remember
was long hx.
Perform pe and tell likely dx and ddx

1st june
Just short memo from my mind
Will wirte detail recalls later..
1.shoulder pain case
Came with h/o fall.., likely rotator cuff m/s injury
2. Periorbital cellulitis
Picture showed only upper eyelid swollen, fever 40·
3. Sterilization
47 yr on OC pill, no problem with it. BMI 29 counsel and choose mgt for her
4. PV bleed
Amenorrhoea 6 weeks, hcg not give
Explain further investigation
5.shoulder and neck pain
Examination fidings given by cards when ask, history and ddx
cervical spondylosis
6. Pregnancy induced hypertension
BP 150/100 no proteinuria, no oedema
7. Counselling of Down syndrome
Best actinh role player, crying a lot 😃

8. 4 months old fever,

Don't want to go hosp:, bevause of social worker issue
9. Scrotal exam ( notice swelling in left side)
I saw herpes lesion on penis
Hard mass on left testes, think testicular tumor
10. Tingling and numbness examination (2 weeks after post thyroidectomy)
 Need to perform trousseau sign
11. OCD
Best acting role player too, Walk around when he heard 'king' word
12. CT showed brain atrophy, sister came and gave h/o that pt has abnormal behaviour 1 week,
H/o mania 5 years ago, was controlled and not on meds
Task h/o, dx and ddx to examiner
13. CT show big haemorrhagic mid line shift present
History of hypertension and also taking aspirin,
Taks outcome of condition and explain ct
14. Chest pain radiate to left arm
No underlying casue for MI, heart sound gave noisy heart sound
Dx pericarditis
15.haemato examination
Already gave inguinal lymph node enlargement. Don't need to do inguinal LN check again
Perform other examination, and explain finding to pts.
16. Cxr showed rt pleural effusion , i saw mass on lateral cxr.
Chronic smoker, stopped for 20 years. Other history is unremarkable
Task h/o, ddx
Hope these will help u guys....
I got a lot of help from these group as well..
Sharing is caring.. Cheers!
Now I am praying

1. Placenta previa in 34 weeks pregnant lady

USG was done earlier
She lives in Rural area – 300 km away from hospital.
Repeat USG – grade 4 PP
Plans ??

2 MSE
OCD video

3.Compliance with BP medication

History
Patient said I am too younge to have medication + I have financial problem as well.
Counselling

4. Lady suspecting that she is pregnant . lithium councelling

She is on 900 mg Li for bipolar disorder
History for 4 minute and counselling
Blood level was within therapeutic range

5. ANC – 8 weeks
What screening you would like to do for her .
She is in GP practice
Antenatal visit
6. Threatened abortion – 8 weeks , primi
Mild bleeding
History
PEFE
Diagnosis

7. 16 yr boy coming with abdominal pain – upper abdomen. Wt loss +. Sloppy

diarrhoea. Pt sais that he has scratch type of rashes in limb.
?? Coeliac disease .
History + DD + likely diagnosis

8. 3 yr old girl
Recurrent infection of ear + child is snoring
History + PEFE + management
Tonsils are enlarged but not meeting in midline.

9. Cough for 6 months – 12 years old girl – Honking cough

Treated for Asthma

In History - Parents divorced 6 months ago.
PEFE + Investigations

10. SVT in EGG

alcoholic , ex smoker
PEFE + explain

11. Rt arm pain and swelling ( 26 or 27 years old girl )

She was painting the wall few days ago
History 2-3 minute
PEFE

12 Scaphoid fracture
X ray given – difficult to see fracture
Examination of hand
Explain to the patient

13. Focussed Abdominal exam + DRE in Mannequin

Bleeding PR , could feel haemorrhoids

14. Lower limb examination

Alcoholic neuropathy
B12 , folic acid was normal
GTT – deranged
Megaloblastic anaemia +

15. Lady in ED , nausea + once vomiting

 buzzing in left ear , Vertigo
deafness conductive / sensoryneural ???
Eye problems as well ( eye movement picture was shown in Ipad)
Other cranial nerves are normal.
( I Forgot to ask the task – I think It is PE station + DDs )

16. Grade 2 spleenic trauma

laceration in spleen , vitals were ok outside
Inside - O2 sat were going down 88% , BP going down , Pulse going up.

7.6.17
Have just received from a friend ..remember her in prayers
1. 47 yrs old lady complaining of tiredness and weight gain for last few months- task- hx, PEFE,
tell dx to patient
2. PE- 57 yrs old lady have noticed lump in rt breast. Task- perform PE (on mannequin) tell dx
and dds to pt, next inv to pt (findings- fard fixed lump in upper & outer quadrant)
3. Middle aged man had shoulder surgery in his rt side and behaving odd. Long stem outside,
don't remember all.but positive finding was urine keyone +. Task- perform MSE, tell examiner dx
and dds ( pt was pointing to cockroaches on the floor, throwing things to it and continuously
complaining of the hospital being dirty-- Delirium)
4. 27 yr old mother of 6 wk baby complaining of her baby is irritable and crying a lot. He visited
gp before but she was reassured nothing is abnormal with the baby. Now she came to you.
Tasks- hx for 6 mins, then tell dds to pt ( nothing wrong with the baby, mother is teary because
she doesn't have any support, most of the features of depression were positive. No intention to
harm baby, as far as I remember she didnt have any suicidal ideation. So gave dx of postnatal
depression and other related dds)
5. 4 yr old boy, developed puffiness around eye. Tasks - hx from mother, PEFE, dx and dds to
mother ( child has an attack of sore throat few days back. Urine output is normal, no fever/
breathlessness, no tummy pain/jaundice/allergy/bee sting. PE - dont quite remember the vitals,
but pallor+, some crackles and diminished air entry in one lung, urine dip stick protein +++, no
hematuria)
6. Pt has severe Pneumonia. Task - fill up medication chart with IV ceftriaxone
7. baby has rash for 3 months. Photos shown maculo-papular rash on face and crack like
ulceration behind ear with rash. Task - hx from mom, dx and mx ( mom was saying flakes come
out, no itchying/fever/allergy. Child's granddad has asthma)
8. 15 months baby suddenly had noisy breathing. Task - hx, pefe, dx to mother. (Mom played a
sound on mobile which seemed like as wheeze, childs father has asthma. Pe fever, signs of resp
distress present, but lungs were clear and no added sound !)
9. Lady have severe lower abdominal pain, constipation with distension. Task- perform physical
exam, PEFE and tell dds to pt
10. 36 wks or so pregnant lady came with upper abdominal pain. Task - hx, PEFE, dx to pt and
immediate mx ( headache, blurry vision present, bp 180/110, proteinuria +++)
11. A young lady with grey, foul smelling vaginal discharge for 3 months or so. Had doxycycline
and antifungal but didn't work. Task - hx, PEFE, dx, mx
12. Middle age man has painful urination. Task - hx, tell dx to pt ( has frequency, difficulty in
passing last few drops, has mild discomfort and pain in lower tummy, no h/o Std/Dm/fever)
13. University student with knee pain. Task - hx, PEFE, tell dxs to pt and further mx ( no H/o
trauma , no fever/redness/swelling, she was hockey player, on pe tenderness over patella )
14. Young man with features of Asthma. Task - perform relevant exam, demonestrate pt how to
do peak flow, interpret the peak flow record and tell pt the interpretation
15. Pt with dm, htn, atrial fibrillation going to have hernia surgery. Long stem dont quite
remember all but dm, bp was in control, he's having atonolol, metformin slow release and
warfarin ( inr 2.5). Task- relevant hx, tell examiner what further management you want to take
Dont remember the other one.
Just came back after the exam, few minutes back.
For now, I am just writing down the topics for those who have exam tomorrow.
I will post detailed ones after a day or two.
Recalls 7/6/17
1. Pre eclampsia
2. Acute abdomen
3. Spirometry
4. MSE acute psychosis
5. Breast examination
6. Caesarean section
7. Croup
8. Seborrhic dermatitis
9. BPH with UTI
10. Hypothyroidism
11. Post partum blues
12. Bacterial vaginosis
13. Osgood schlatter disease
14. Nephrotic syndrome
15. Pre anaesthetic medication
16. Medication chart
Today’s Recall – 8.6.1027
All the stems were really really long. In few stems , I had to read the questions again inside the
room because of long stems and so many tasks. I cant recall any of the stem completely .
Now when I look at the cases they all look simple and old recalls but it was not like that., They
were long confusing stems and I had dig deep for getting information. 2 minutes was not enough
time for thinking outside.
1. Infective Endocarditis – Patient was having fever and night sweats since 6 weeks . Had a dental
procedure as well ( he gave this information after sometime when I asked him if he is on any
medication . He took panadol for pain relief ) had positive findings for infective endocarditis.
Now when I think , patient had fever and night sweats ( Long history ) – Could be hodgkins +
Infective endocarditis.
2. Major depression - Patient was on fluoxetine, was feeling axious . Take psychotic history , she had
suicidal ideation with plans . D/d and likely diagnosis.
3. Serotonin syndrome – patient was on Mirtazapine and fluoxetine .
4. Hyperemesis gravidorum
5. Scrotal examination - Hydrocele
6. Examination of a 10 weeks pregnant lady with micocytic hypochromic anaemia . There was a ldy
lying on the bed , i asked for vitals , examianer said – check it yourself – I took pulse and RR ( did
waste my time ) . Couldn’t finish the exam.
7. Examination of thyroid for a hyperthyroid patient.
8. Child abuse – 4 years old female . Old recall.
9. A young patient feeling unwell since 4 days - History and D/D .
The role player was very sleepy, was not interested in giving history .
Had runny nose and difficulty in breathing. Had inhaler for that from his girlfriend. Had history of
Asthma , but off inhaler since 5 years.
10. Adenocarcinoma colon – Counselling
11. Hodgkins lymphoma – I don’t remember the stem , wt loss + sweating
12. Amaurosis Fugax – had to do fundoscopy – Examiner gave me a picture ( A big one ) , explain the
changes to examiner , it was a very clear obvious picture of silver wiring , AV nipping, no soft or hard
exudates . No pappiloedema
It was long stem with loss of vision , for eye examination .
13. A 10 years old boy had abdominal pain since 10 days and today it is sudden severe pain in
tummy . History , examination , D/d . It was some critical care case , couldn’t diagnose it .
Tahycardia , ketonuria ++, Blood sugar was 4.2
No postive finding in history.
Examination – epigastric tenderness + bruising in epigastric area . No rashes .
I don’t know what did I miss.
14. Irritable child with Lump in groin - Inguinal hernia in a 10 weeks old girl . On PEFE – he gave a
picture and hernia was reducible.
15. Patient with malena and palpitations ( book case for gastric ulcer )
16. Perimenopausal lady feeling hot during the day. History and D/D.
I hope it helps .
I didn’t do good anyway ..
8/6 recall from friend.
Physical examination:
1- amaurosis fugax ( eye examination)
2- thyroid ( hyperthyroidism)
3- scrotal examination ( hydrocele)
4- serotonin Pe
Psychiatry
5- major depression start on paroxetin 2 weeks ago, not feeling well suicide thought!!!
Gyn and obstetrics:
6- 10 weeks pregnant woman with blood test showed low hb explain the test and reason for that and
also further investigations.
7- 47 year old woman with hot flush no other symptoms, had irregular period, it was uncomfortable
for her and she wants to know the cause.
8- early pregnancy with nausea and vomiting not able to eat or drink. Ketone positive in urine. Most
likely hyperemesis gravidarum.
Paediatric:
9- rash on the vulva parents separated from each other 6 months ago. The mother is very suspicious
of sexual abuse and ask you to do something so that her partner won't be able to see her daughter
again.
10- inguinal Hernia baby was crying for 3 weeks now and irritable. If you asked the examiner will
show you picture?
11- 10 years old boy with acute abdomen tenderness in the epigastric area. There is hx of trauma 3
days ago!
medicine and surgery:
12- endocarditis, feeling dizzy, Osler nodes and hx of dental procedure.
13- Breaking bad news, moderately differentiated adenocarcinoma in the large bowel 4 cm.
14- feeling tired with weight loss and there is night sweating on examination there is 2 cervical
lymph nodes enlarged with scratching marking on abdomen.
15- asthma with runny blocked nose and wheezy sound
Hx, explain the cause to the patient.
16- young man with racing heart there was no ECG it happened while climbing the upstairs. Now the
patient okay, stable with no complain
Got from a friend
Scrotal examination on a dummy hydrocoele
Thyroid examination
Hb low, relevant examination
Depression
Serotonin syndrome
Hyperemisis gravudarum
Adenocarcinoma of colon
TIA