PLAB 2 Cookies by Dr.

Varshil Mehta

Remember these things in every case:

1) ICE & Dx, 2) Ix, 3) Treatment of presenting complains, 4) F/U and 5) Red
flags/Complications
2) Before you enter make 3 differentials
 PLAB 2 Cookies by Dr. Varshil Mehta

Medicine
1 Arrythmia Questions: 1) Loss of Consciousness, 2) Chest Pain, 3) Racing of
(Chest Discomfort): Heart, 4) Hyperthyroid questions, 6) Coffee, 7) Stress, 8) Light
headedness 9) Family Hx 10) Medical Hx
D/D: 1) Arrythmia, 2) Hyperthyroidism, 3) Coffee drinking, 4) MI,
5) Heat Failure, 6) GORD
Ix: 1) Vitals, 2) ECG, 3) Holter, 4) Echo, 5) CXR, 6) Blood
Investigations like Cardiac enzymes and CBC.
Mx: 1) Refer to Cardiologist 2)
Cardioversion/Ablation/Medication
Redflags: 1) Loss of Consciousness, 2) Chest Pain, 3) Leg swelling
2 Pain & Aches: Questions: 1) Pain Questions, 2) Joints stiffness (RA/OA), 3)
Family Hx, 4) Fever/Infections (Septic), 5) Prv Hx, 6) Malar Rash
(SLE), 7) Urine problems (Reiters)
D/D: 1) RA, 2) SLE, 3) Sjogren, 4) Scleroderma, 5) Osteoporosis,
6) Osteoarthritis, 7) Septic Arthritis Aspiration
Ix: 1) Blood test, 2) ESR/CRP 3) RF, 4) Anti CCP antibodies, 5) X-
Ray of bones, 6) Synovial fluid, 7) Thyroid Function test
Mx: 1) Pain Killers, 2) Prednisolone for two years, 3)
Bisphosphonate (for steroid S/E), 4) Calcium and minerals 5)
Refer to Rheumatologist. Give Steroid Card.
Redflags: 1) Fall down and extreme pain
3 Orthostatic HTN w/ Hx Questions: 1) Headache, 2) Light-Headachness, 3) N/V, 4)
of frequent falls: Tinnitus/Ear/fullness discharge, 5) Racing of Heart (Arrythmia),
6) LOC/Weakness (Stroke), 7) Seizures, 8) Bone Pain (OA), 9) Prvs
Medical Hx of HTN, 10) Prv Medication, 11) Family Hx, 12) Stress
13) Why was the medication changed? (if changed), Visual
problems
D/D: Orthostatic HTN, 2) Arrythmia, 3) Stroke/TIA, 4) BPPV
Ix: 1) Vitals, 2) BP at sitting and standing, 3) Glucose, 4) ECG, 5)
CBC, 6) Echo, 7) Carotid Doppler
Mx: 1) Request the GP to Change Medication
Adv: Avoid change of the position quickly, 2) Don’t let her go
home if she stays alone, 3) Wear support stockings, Increase
fluid intake, F/U GP
Redflags: 1) Weakness in one side of the body, 2) Chest/leg pain,
3) Breathlessness, 4) Swelling in your legs
 PLAB 2 Cookies by Dr. Varshil Mehta

4 Constipation: Questions: 1) Did you observe a mass, 2) weight changes, 3) N/V, 4)

Diarrhea, 5) Confusion & fever, 6) Any operation done recently and how is
she now, 7) Medication 8) Diet Hx, 9) hemorrhoids/anal fissures 10) Is she
mobile, 11) Bloating, 12) PR bleeding, 13) Passing of gas (Intestinal
Obstruction)
Ix & Ex: Rectal Examination, Abdominal examination if not done already
Mx: 1) Lactulose (Laxative), 2) Senna (Laxative), 3) Bisacodil (Laxative), 4)
Sodium picosulfate (stimulant), 5) Rectal Enema, 6) More water intake, 7)
Fruits and vegetables
RedFlags: 1) Confusion, 2) Low BP, 3) Fever, 4) LOC/Fits
5 Vestibular Questions: 1) Dizziness and what does it mean acc to you, 2) Tinnitus, 3)
Neuritis: Fullness of ear, 4) Room spinning, 5) Fever and Flu, 6) Weight Changes, 7)
(Dizziness w/ Ear ache/discharge, 8) Weakness in limbs, 9) Dizziness on changing
fall down) position
D/D: 1) Vestibular Neuritis, 2) Labrynthitis, 3) Acoustic Neuroma, 4)
Menierre’s disease, 5) BPPV, 6) TIA/Stroke
Ix & Ex: Vitals, Ear Ex, Neurological Ex, MRI (on referral to an ENT specialist
by a GP)
Mx: Self help therapy (Drink more water, rest more when you have
episodes, avoid driving, working in noisy atmosphere and top
floors/places). Your GP may give you medicines for this as well, but it
doesn’t help much. They are anti-emetics (for N/V), benzodiazepines (for
decreasing the signals sent to the brain)
Redflags: Double vision, Slurred speech, Gait disturbances, weakness
6 Acute Red Mx: Don’t use goggles
Eye Redflags: If you have same pain in other eye
(Glaucoma)
 PLAB 2 Cookies by Dr. Varshil Mehta

Psychiatry
1 Colleague • Greet and ask day to day life, classes, whether he enjoys talking to
coming late the patients?
• Ask him if he knows that why have you called him?
• Tell him that you are concerned about his time keeping skills? Say
that you noticed that he came late today as well? Any reason? Also
say that your colleague has noticed the same. Any particular reason
why he comes late often now?
• Is everything okay at home?
• How far is the house? If far, he can talk to supervisor for an
alternative work place which can be near his home. Or else try to
find a rental nearby the work place.
• Explain about the importance of being punctual, as a patient may
need you at a crucial time.
• Also, it is important to show that you are capable of coming on time
to your staff member, so that they can rely upon you.
• Also, it would be a great idea to attend a time- management course.
All including me can learn a lot from it. They teach to maintain
priorities and schedule task more effectively.
• Furthermore, do you keep alarms? It shall be great if you can do it.
• Also, explain that coming early helps to learn more as the morning
rounds are very important.
• Advice to inform your supervisor before he comes to know from
some one else and next time he becomes late, he should call his
supervisor as well.
2 Cocaine • Greet and ask day to day life, classes, whether he enjoys talking to
Colleague the patients?
• Ask him if he knows that why have you called him?
• Nevermind, I saw you at the party yesterday. Did you enjoy the
party?
• Actually, I am bit concerned because you were drinking a lot
yesterday.
• Okay, did you take anything else other than drinking? How about
recreational drugs? I am talking about it because our colleague saw
that you were agitated and hyper excited.
• Actually, I saw you taking something? I may be wrong but it looked
like it was cocaine. if you don’t mind telling me, was that cocaine?
• When did you start taking it? Any particular reason behind taking
it?
 PLAB 2 Cookies by Dr. Varshil Mehta

• Did you take it during work hours?

• As the colleague saw that you were agitated today, don’t you think
that it has affected you already?
• Mood?
• Family and friends support? Relationship with them?
• I am sure that you know taking cocaine is not good for health as
well. It can lead to over confidence and you may prescribe or take
risk with the patients life which can compromise the patients
health. It is against good medical practice and it may affect your
value as well as a doctor.
• Also, it can lead to S/E like seizures, stroke, coma, heart attacks.
• Any incident that may have occurred so far due to your habit? Have
you ordered any ix, or tx any patient today? I am sorry but I have to
now review those patients to see if everything is fine, as patient
safety is important. Please give me the list of the activities/names
of the you did/managed so far.
• I am afraid that I need to inform the seniors too so that they can
take care of the situation. You may have to take a test and
depending on the results. they will take the decision.
• Also pls avoid taking care of the patients until the seniors come with
a decision and pls take care of yourself.
• Also assess how would he go home? Avoid driving and ask him to
take GP advice which can be confidential as well.

3 Alcohol Same as cocaine

Colleague
4 Suicide Inspection: See if there is any trauma/bandage and ask about it.
Questions:
• What happened and offer confidentiality of she is hesistant,
• Offer sorry,
• Ask about cuts if any (How much deep, when did she do it?, Was
there any one at home?, did she inform any one?, did she leave
a note? What did she do after cutting herself?),
• Ask about tablets (when did she take it?, how much? Where did
she find the tablets from?, any symptoms now?
• would she like us to inform her parents?
• How does she feel about the incident? Bad? Will she do it
again?,
• Mood and its scale?,
• Alcohol and Drugs,
• Family, friends, finance, occupation and relations with them
 PLAB 2 Cookies by Dr. Varshil Mehta

• boyfriend (age, where did she meet him, how long was the
relationship),
• offer to call mom,
• tell her that psychiatrist will see her first and then after talking
to mom (if she agrees), to assess her safety, you can discharge
her.
Ex & Ix: Examine her wound, GPE, vitals, chest and tummy. Send blood
for pregnancy, CBC, levels of the drugs that she consumed.
Mx: Keep under observation and Psych referral.

5 Homosexual Inspection: Appreciate the sad look on the face of the patient and offer
man w/h/o help/confidentiality clause if necessary
PCM Poisoning Questions:
• Listen more, speak less.
• Ask about tablets (when did he take it?, how much? Where did
he find the tablets from?, any symptoms now?
• Mood? Scale?
• Will he do it again?
• Any particular reason he did? Homosexuality: he will say
• Convince him that there is nothing wrong in being homosexual
and he should be proud of himself.
• Family, friends, and with whom does he live? How are the
relations with all of them?
• Occupation and financial status?
• Sexual history & partner/bf Hx
• Smoke, Alcohol and Recreational drugs
Ex & Ix: Vitals, GPE, Abdominal and Chest. Send blood for LFT, RFT, PCM
levels (at 4th hour)
Mx: Give NAC if the levels are above. Will have to admit if the levels are
above and tx will continue for 21 hours at least. Reassessment after that
and dx if he is fine. Offer support/ call his mom or anyone for support.
6 Anorexia Questions:
Nervosa • weight loss questions – How much weight loss? Intentional?
Reason behind the loss? Does she know the ill effects of the
weight loss?
• Hyperthyroid questions, light headedness, hungry
• Diet plan and exercise schedule
• Vomiting (Induced)
• Menstrual Hx
• Occupation Hx
• Medical Hx (Mental)
• Mood and sleep
 PLAB 2 Cookies by Dr. Varshil Mehta

• Friends, family, financial support? How is the relation with them.

• Smoking, Alcohol, Drugs
• Did you ever tried to harm yourself
D/Ds: 1) Anorexia Nervosa, 2) Bulimia, 3) Hyperthyroidism, 4) Tumor
Ix & Ex: Vitals, Abdomen ex, GPE, Blood reports including thyroid, RFT,
LFT, Urine E, Weight and height, Scan bones (osteoporosis chance),
Mx: Psych referral, CBT, Diet advice, Family therapy, medications that
will make your bones stronger, Ca and minerals prescribed by your
doctor. Admit for now.
7 Psychotic 1) Involve Homeless service and social service, 2) Hallucination, 3)
patient Concerns? 4) Safe in hospital, 5) Mood and self harm
2) Mx: Inv and CNS, CVS examination. Anti psychotics. Referral to
psychiatric. Admit him.
8 Alcoholic 1) Health in general, 2) Mood, 3) alcohol hx, 4) any symptoms that
dependency she gets when she doesn’t drink, 5) CAGE TDW, 6) Work, 7)
Family including children, 8) Friends, 9) Finance, 10) Trouble with
the law, 11) Self harm
2) Mx: Medical (Acomprosate, Naltrexone, Benzodiazepine) and
Non medical (AAA, CBT, Diary, family therapy)
3) As she doesnt have any life risk, we do not need to admit her

9 Drug 1) Drug hx, Any other drugs, if yes, we will talk about it later if time
dependency permits, 2) Needle sharing program, 3) Offer HIV test, 4) Mood
and self harm, 5) family including children (both take drugs then
involve social service for the child safety), 6) friends, 7) Finance,
2) Mx: Non Medical (Anonymous group, CBT, family), Medical
(Brupronorphine, Methadone)
10 MMSE 1) Time Orientation- Year, Season, Month, Day, Date (5)
2) Place Orientation- Country, County, City, Street, Building (5)
5535-321- 3) Registration- Say Three words and ask to repeat. Also say that
3111 you will again ask these three words so please remember.
Apple, Table and Penny (3)
Talk to 4) Attention: Spell 5 letters word (eg. WORLD) backwards (5)
examiner at 6 Or
minutes end Can you count backward from 100 by subtracting 7 every time
5) Recall: Could you please repeat those 3 words which I had asked
you to remember? (3)
6) Language: Please pick 2 simple things and ask the pt. to name it
(Paper, Pen). (2)
7) Repetetiion: Ask to repeat a phrase: “No ifs, ands, or buts” (1)
8) 3 stage command: “Take this paper in your right hand, fold it into
half and put it back on the floor/table” (3)
 PLAB 2 Cookies by Dr. Varshil Mehta

9) Reading: Write something on the paper (Close your eyes) and ask
him to follow the task written on the paper. (1)
10) Writing: Please could you write a sentence on me? (1)
11) Drawing: Draw two pentagon intersecting each other on the
paper and ask the pt. to copy it (1)

25-30: Normal
21-24: Mild cognitive impairment
10-20: Moderate cognitive impairment
Below 10: Severe cognitive impairment

If the MMSE is not completed by 6 minutes, tell the examiner: I would

like to complete my Mini Mental State Examination.
From my assessment, MMSE suggest ___________ Cognitive
impairment.
To examiner: My Mx plan would include taking full medical hx (Full
medical hx includes medical hx, social, drug and family hx), perform
examination (Full examination includes cardiac and neuro examination),
order routine blood test, referral to psychiatric and neuro psych team
once the patient is medically stable. They may involve social service and
homeless team as well.
Will also need advance cognitive assessment. Will send further
investigations like FBC, U&E, LFT, Ca, Vit B12, TFT, and RBS.
 PLAB 2 Cookies by Dr. Varshil Mehta

Pediatrics
1 Febrile D/Ds: Febrile convulsions, Sepsis, Meningitis, Encephalitis, Epilepsy
convulsions Questions: How long the fit lasted for?, how many episodes, vomiting,
Shaking, rolling of eyes, tongue biting, wetting her pants, did she hurt
herself, what happened before, at, after the fit, Rash, pain while her neck
is moved, any ear problems, cough, Any medical illnesses like epilepsy,
Prvs similar episodes, Birth Hx, Wee and Poo, Recent jabs, Red book,
allergies and who looks after her
Ex: Measure her vitals, tummy, neurological and ear examination.
Ix: Blood routine, ESR, CRP, Blood culture if she still has fever.
Mx: Paracetamol and observe for now, only give antibiotics if the fever
last for more than 4 days.
Explain about Febrile convulsions (6 months - 5 years), difference
between epilepsy and febrile convulsion,
Safety nets: (Recovery/sideways posture, Removing any sharp objects,
loosen clothes around her neck), main thing is to reduce the temperature
as it can lead to a fit in this age group, give paracetamol etc. No need to
worry as these convulsions goes by the age 5 years.
Red flags: Pls bring the child back, if she has fever, LOC, fits lasting for
more than 5 minutes, stops breathing, rash, neck stiffness. We can give
her some medicines which reduces the fits and fever doesn’t resolve by
4 th day.
2 Epilepsy (pt is Opening line: Glad to say that the pt is getting dx today, however, I am
getting dx) here to give you some important information so that you can take care
of her better at home.
Epilepsy knowledge
• Access her understanding for epilepsy,
• Explain if she doesn’t understand,
Triggers:
• Why does it occur: Triggers like excessive computer/TV screen
play time, lack of sleep, exercise, dehydration, loud sounds-
always ask if she has/does any of the things at every step.
• What to do: Let the coach, teacher know about the condition,
swim in shallow water with some one who knows above the
condition, avoid places with heights, sharp objects, loud noises,
drink lots of water and do not skip meals. Use showers instead of
bath tubs.

Medication:
• Epilepsy medication importance: prevents the seizures if taken
regularly, DO NOT STOP without consulting the GP,
 PLAB 2 Cookies by Dr. Varshil Mehta

• Medication side effects: as it may interact with drugs, so always

say that she has this disease
Red Flags
• Same as above case

Follow up with the GP regularly, he may review the medication and

disease.
3 Otitis Media D/Ds: OM, Meningitis complication, Viral or bacterial infection, Trauma
Questions: DOPEFAAA, Hearing loss, Ear discharge, Trauma, Rash, Fever,
Cough, phlegm, lumps and bumps (parotitis), N/V, Similar episodes,
Medical illness, Jabs, recent jabs, red book, birth Hx, Any one from family
or school had similar complaints, Travel Hx, medication hx, allergies, wee
and poo, feeding problems.
Ex and Ix: Vitals, GPE, Ear examination if not done. No need to monitor
if no fever at present. No need to do blood test as well, if fever is not
more than 4 days.
Mx: Paracetamol and fluids. Ask mom to come back if the fever hasn’t
subsided after 4 days. Give her lots of fluids.
Its most likely virus, so cant prescribe antibiotics
4 NAI D/d: NAI, bone disease, infection
Questions: What happened, any bleeding, any injury, how much time did
you take to reach here, LOC, N/V, any other things you noticed before
the fall and after the fall, shaking, wetting the pants, biting her tongue,
fever, cough, confusion after the fall, rash, ask about the father (whether
biological, relationship with the child), who takes care, relationship of
the person who takes care, if she alone takes care of then how does she
manage, any more kids, relationship with them, finance, Similar episodes
in the past, Medical illness, Jabs, recent jabs, red book, birth Hx wee and
poo, feeding problems. What does she think that might have caused
this?
Ex & Ix: Vitals, GPE especially for any trauma, eyes, ear and
musculoskeletal examination. He had a spiral fracture which is quite
uncommon when there is a fall. It generally occurs when an external
force is applied. Hence, we will have to observe him and will ask my
senior to examine him as well.
Mx: We will give painkillers to provide pain relief. Will do full body scans
to assess if there are any fractures. We may have to involve Social
service. They will come and assess your child and may interview you as
well to see that what had happened.
5
PLAB 2 Cookies by Dr. Varshil Mehta
 PLAB 2 Cookies by Dr. Varshil Mehta

New Stations
1 Gender Questions: 1) Why do you want a male child? 2) Menstrual Hx, 3) Medical
selection illness like congenital defects 4) Contraception 5) Prvs Pregnancy Hx
MX:
• Between 18-21 weeks, the USG can be done to see the sex of the
baby but we wont be 100% sure as its difficult.
• In UK, till 24 weeks the termination of the pregnancy done
without any reason, and after that on basis of medical illness like
mental illness in the mother, fatal diseases that can occur in the
child if born. However, sex can not be one of the reason.
• Can go to private clinics where Preimplantation Genetic
Diagnosis is done. PGD can identify genetic defects and improve
the chance of conceiving a baby. But it can be done only on
medical grounds and it will cost 1000-2000 GBP.

2 Rheumatoid D/D: 1) OA, 2) SLE, 3) HLA B27 diseases, 4) IBD, 5) Scleroderma 6) Septic
Arthritis 7) Gout
Questions: 1) DOPEFAAA, 2) LIQRA, 3) any problem in other joints, 4)
redness, swelling, warm, 5) Fever, 6) Stiffness (Morning or night), 7) Pain
or stiffness increases or decreases with the activity, 8) Urine/Bowel
problems, 9) Vision problems, 10) any rashes 11) Hands turn blue in cold?
12) PAMHUGSFOSSWA 13) Has it affected the work
Ix: Vitals, examine the hand. Some initial ix like blood test. ESR, CBC, Uric
Acid, Rheumatoid factor. Tell the Dx.
Advance test like Anti CCP antibody, Xray of hand and wrist
Mx: Pain killers and refer to the Rheumatologist.
He may give steroids in the beginning, DMARDS (Methotrexate) for
controlling the disease and monoclonal antibody if the first tx didn’t
work. Physiotherapist and occupational therapist shall be involved as
well.
S/E of the drugs: Methotrexate: Sore mouth, diarrhoes, hair loss, N/V
Redflags: Pls come back to us if loss of function of hand, fever.
3 Colorectal Sigmoidoscopy was done and it showed polyp. Now the patient is called
Poly back for Colonoscopy.
Ask routine questions (Dopefaaa, Pamhugsfosswa).
Ask what she knows about her condition and explain if she doesn’t know
(Non-cancerous growth in the sigmoid colon). Tell her that this is a
different test involving a different section of the gut, since she has polyps
there is a possibility that she might have it in the other parts as well. So
it is done ad if present, they can be removed as well. Otherwise these
may turn cancerous.
 PLAB 2 Cookies by Dr. Varshil Mehta

4 Abdominal D/ds: 1) AAA, 2) Spodylosis/it is 3) BPH/Prostrate Ca, 4) Trauma, 5) RCC,

Aortic 6) MM, 7) Potts TB, 8) Pancreatitis, 9) Aortic Aneurysm
Aneurysm Questions: 1) DOPEFAAA, 2) LIQRA, 3) Stiffness, 4) Trauma, 5) Out of
country travel, 5) Frequency to the loo/Burning/obstruction while
urinating, 6) Fever, 7) Weight loss, 8) Feeling tired, 9) Racing of heart /
light-headedness, 10) Appetite changes, 11) GERD, 12) Numbness,
Dizziness, 13) PAMHUGSFOSSWA
Ex: 1) Vitals, 2) Back, Abdominal and PR examination,
Ix: 1) CBC, ESR, CRP, Xray spine and chest, USG Abdo (AAA) and ECG.
We may require MRI angio or CT for AAA
Mx: 1) Explain what AAA is (Main artery in our abdomen is swollen at
one of the point just like a balloon and due to its pressure, you are feeling
the pain. Sometimes, the pressure increases so much that it may rupture
and that can be fatal.) Hence we need to control it. There are no specific
causes for it, however there are risk factors like Sex (M), Age, HTN, DM,
Cholesterol, smoking. So we can try to modify the lifestyle and it may get
better. Secondly there is surgery also available.
From 3.5-4.4 cm: Mild (Lifestyle modification with yearly USG)
4.5-5.4 cm: Moderate (Lifestyle modification with 3 monthly USG)
5.5 cm and above: Surgery (Open or Endovascular)
Advice: To make lifestyle modification
Redflags: Back Pain, Headache, palpitations, LOC
5 Cyclical D/ds: Ca,
Breast pain Questions: Breast lump, shape and size, Menstrual Hx, Medicine, OTC,
hormonal therapy, Family hx,
Examination: Want you to undress above the waist, will have a
chaperone for your privacy. I will examine you in sitting, lying and
standing position. Explain the procedure and take consent.

Inspection
While sitting
1) Sit upright and put your hands on your thighs (breast are
symmetrically at same level, no redness, swelling, visible mass,
bruises and scars of any sx. No discharge from the nipples and
peude orange.),
2) Put your hands on your waist and bend forward (No visible mass
on bending forward)
3) hands on back of your head (No fullness on supraclavicular and
axillary area)
4) Lift your breast with two fingers, (No fungal infection in
inframammillary area)
5) Squeeze your nipples with two fingers (no discharge from nipple)

Palpation: while lying down at 45

 PLAB 2 Cookies by Dr. Varshil Mehta

1) Temperature: Compare All 4 quads with the other breast’s

quads.
2) Superficial Palp: Anti-clockwise and tenderness check
3) Deep Palp: Anti-Clockwise and mass check and comment on
mass (Size, shape, regular or irregular, attached to underlying
structures or overlying skin)
4) Peri-areolar palp: with thumb to find out mass
5) LN:
while standing: Axillary LN
From the front: Ant, Med, Apical
From behind: Post and lateral
Supra clavicular

Mx: Pain is related to periods and happens in second half of the cycle
becoming worse at the end. Because some woman tissue are more
sensitive to the hormonal changes and hence they get pain. Not a serious
disease.
Mild: No meds, but
1) Support the breast with well supporting bras,
2) Pain killers and anti-inflammtory medicine (paracetamol)
3) Danazol/tamoxifen/goseralin can help in severe cases but can be
prescribed only bt specialist
4) Evening primose oil can help.
5)
Medicine that can worsen the pain: HRT and antidepressants and BP
meds.
F/U with GP
Redflags: lump, bump, dx from nipple
6 Barretts Questions: N/V, bloating, dysphagia, burps, halitosis, hiccups, weight
esophagous loss, heart burn
Mx: Barium swallow, biopsy (must hv been done already)
Tx:
Non-Medical
1) Smoking, 2) alcohol, 3) weight loss, 4) spicy food, 5) don’t eat or
drink 2hrs bfr going to sleep, 6) have one more pillow that keeps
the acid below
Medical
Drugs that can reduce acid production (PPI). May have to take for short
time or may be for life long
Surveillance
1) Gastroscopy/esophascopy with biopsy every 3 years to see if the
cells have become dysplastic
2) If dysplastic every 3-6 months so that it can be removed sx if
required.
 PLAB 2 Cookies by Dr. Varshil Mehta

7 Cervical 1) Menstrual hx, 2) Contraception hx, 3) Sexual hx including

bleeding after sex, 4) Pap smear in past and result
smear Why do we do PS examination? – To look at the size and shape if internal
and external reproductive organs

Internal examination: examination of cervix, vulva and vagina, uterus

shape and size, any adnexa, performing swabs
external examination (anatomy, lesions, ulcers, discharge)

Procedure
explain the procedure, ask her to expose from below the belly button,
chaperone, consent. Show the position: lying in supine position, with
knees bent and heels brought upwards facing towards the bottom.
Contraindications: bleeding, pregnancy, recent sexual intercourse, active
menstruation, spermicidal cream

Learn the procedure form page 88 of aspire. New stations

8 Vitamin b12 D/Ds: 1) Vit B12, Folic Acid, Thyroid, Anemia, Bleeding, Stress
def Questions: 1) tingling/numbness, 2) weakness, 3) Speech problems, 4)
Sensation loss, bleeding, loss of weight, cold/hot intolerance, loss of hair,
diarrhea, constipation

Ex: blood, thyroid hormone levels test

May be pernicious anemia: we will do advance test to see if that’s the
case. Here the food doesn’t get absorbed and so do vit b12.
Autoimmune.

Mx: At first, you GP will give you injection every alternate day for two
weeks or until your symptoms get better. After that we will see your
blood test to see that if its working. Then injection twice a year may be.
Also, people with vegan diet may have to take every day b12 tablets
between meals as vegan meals do not provide b12.
We will recheck after 8 weeks to see if the treatment was successful.

Vit b12 sources: Cod, salmon and meet. Milk products. Also, cereals are
now fortified. Check label bfr buying.

Folate defn: You have to take for 4 months. Good sources: broccoli, peas,
chickpeas, brown rice.
Gp should check vit b12 frst cos folic acid may hide the effects of vit b12
and you may have cns problems.
 PLAB 2 Cookies by Dr. Varshil Mehta

If it is not pernicious anemia, but non diet vit b12 def: we will have to
give you vit b12 injections every other day for two weeks, followed by
every 3 months for the rest of your life.

If you already have neurological symptoms, we will refer to the

hematologist and you may need injections every two months.
 PLAB 2 Cookies by Dr. Varshil Mehta

Surgery
1. UTI BPH D/Ds: UTI, BPH, Prostatic Ca
Questions:
(Dysuria) 1) Open ended question,
2) If burning sensation, ask more about it (DOPEFAA), or if Pain
(DOPEFAAA LIQRA),
3) Ay fever, N/V
4) change in color of urine,
5) smell,
6) blood in urine,
7) Frequency of urination especially in night
8) HUIDS – hesitancy (do you feel difficulty in starting the
urination?), urgency (do you need to rush to the loo?),
inconsistency (Can you hold your urine before going to the loo?),
dribbling (does your underpants get stained with urine after you
have completed urination?)., Strain, satisfaction and stream: are
you able to complete your urination?, do you need to strain while
urinating and how is the stream?
9) Any lumps or bumps or swelling
10) weight loss and appetite
11) Any instrumentation or surgery done in your pvt parts
12) Past hx, allergy, medication, Social and Sexual Hx
13) Work Hx
14) any other complains and concerns

Ex: Initial-Vitals, examine your tummy and back passage, blood ix and
Urine test.
Start with ICE and Then say the dx and expain it.
Special Ix: First we will also check PSA (a chemical secreted by prostate
gland), further urine culture to catch the bug, USG (scan) or CT Scan as
well. We may to have to take some sample form the gland to rule out a
possibility of a cancer.
Rx: Treat the presenting complain first i.e. pain – painkillers; N/V: anti-
sickness. We will also give some medication that will decrease the size of
the gland (Finasteride) or help in relaxing the muscle of the gland
(Tamulosin). For UTI – give antibiotics (Nitrofurantoin or trimethoprim)
If medications do not work, we may have to do a surgery to remove a
part of the gland. Suggest drinking less tea and coffee and more water.
And bladder training.
F/U & Redflags: If you can’t urinate, pls come back to us.
2 UTI Same as above, except:
Do not ask for hesitancy and dribbling. Ask for frequency and urgency.
Female
 PLAB 2 Cookies by Dr. Varshil Mehta

Medication hx is imp if she is taking folic acid for getting pregnant or if

she is pregnant. Copper T or any other instrumentation is important as
well.
Ask about Menstrual Hx: LMP, any discharge, pain while or after sex.

If prescription pad given write antibiotics

Nitrofurantoin 100 mg BD for 3 days
Or
Trimepthoprim 200 mg BD for 3 days