2011:

CVS exam pt. with murmurs, quizzed on types of murmurs & signs ENT exam Exam Ear otoscope + Rinnes & Webbers, then Q's around pics of ear drum MDEMO Rheumatology exam hands/ GALS screen CNS exam lower limb, explain findings Ophthalmology read words from inside (5 mins) +Blood Pressure Paeds hx from mother about lack of progression with speech (check for other developmental delays, ask about hearing, behaviour etc) GP Station feeling tired all time (exclude hypothyroid, diabetes, sleep problems, depression etc. Ix plan) Drug chart station pneumonia/PE Vascular exam dopplers and qus Clerking Portfolio review Discharge Summary Palli/Onc Explaining to daughter that mothers condition has worsened, pmhx breast ca, new mets and increased tumour markers Venepuncture On manikin, fill out form, decide tests and into correct bottles

2010:
1) A discharge summary and discharge letter to write back to a GP after an admission of their patient. Tip is to flick to the back of the notes and they have a summary of management there 2) A prescription correction station where one has to highlight the doses and incorrect format of a patient's prescription chart 3) To write a prescription for the acute management of asthma 4) To counsel a woman who's mother was terminal and try and get her to agree to a DNAR 5) A portfolio station reviewing all the clerkings you had undertaken that year 6) A set of false eyes with numbers in the back of them for you to record and write down 7) Taking a blood pressure 8) Doing a PR examination on a bust and asked to write it up as a formal document with the pedunculated polyp described just inside the anal canal 9) Taking blood from a prosthetic arm for a patient's digoxin levels. Knowing which blood bottles to use (U&E, K and Digoxin level) and then writing it up on the blood film 10) Talking to a visually impaired patient about doing an MSU and then walking her to the loo to demonstrate you could do this 11) A gals examination and knee examination on a patient who had had bursitis removed from both knees. Asked what this could be caused by and eventually got around to psoriatic arthritis even though there were no psoriatic signs. Asked what the specific management was for psoriatic management of the knee other than drain effusion 12) An upper limb neuro on a patient with goodness knows what disease. Mixed upper and lower motor neurone signs that wasn't motor neurone but asked to look at the patient's nails which were all stained white. None of us had a clue what this was but I will email Prof Levy to try and ask as the consultant said he was not allowed to tell us 13) A woman with a CABG scar and saphenous vein harvesting and also an S1 metallic valve sound consistent with a mitral valve replacement. Also a lobectomy scar and in AF with a BP of 152 / 92 mmHg. Asked what valve she had had replaced and what the long saphenous vein harvesting was for 14) An ear exam on a patient with a conductive hearing loss. Asked for causes and then a picture with what looked like an ear effusion (it had bubbles in it) and asked questions

about what this was, what causes it and management. Apparently this question was also given last year 15) Woman with a cough for 3 months and a positive reversal test with salbutamol so asked to counsel her on diagnosis and management 2009: - Explain peak flow to a person with visual impairment - guide them to chair. Peak flow done standing up and take best result out of 3. - Venepuncture on model and fill out blood form, decide what tests needed to request and which correct bottles - Palli Onc station explaining to patient post-mastectomy the various treatment options (radiotherapy, chemotherapy, hormonal treatments) and the side effects of them - Cardiology examination - patient with aortic stenosis. asked what can give an idea of the severity of the stenosis - ophthalmology - look at eye models - blood pressure - clerking portfolio review - psych station - take brief history off guy describing voices in head - important to ask about things like alcohol/drug use (present and past), past psychiatric history, suicidal thoughts, were voices telling him to hurt himself/anyone else etc - GP station - angina history described by patient, had to decide plan of action for them - discharge summary - focus on getting easy marks first putting their details, GP details etc - ENT examination and then a few questions based around a picture of an ear drum. none of us really had a clue at all what the picture was, though perhaps was ?acute otitis media - rheumatology examination of hands. asked what thought it was. actually slightly unsure what it was. I thought RA but consultant quizzed me on other features of examination which lead me to think it may be OA, but then consultant lead me in questioning towards systemic sclerosis, but then lead me back to an RA diagnosis!! all very confusing for me and thought I had really messed up the station but passed it apparently! - abdo examination - purely wanted us to do the stomach, not the whole hands, neck, face etc. told us what we found on examination - what was differential, what investigations did we want (importantly wanted amylase and erect CXR as differentials were acute pancreatitis, bowel perforation, gallstones etc) 2008: 1) Sexual history secondary syphilis 2) Palliative care talk to daughter of patient, explaining about syringe driver, and breaking bad news (mother short period left to live). Actress palliative care nurse. 3) GP station: Diarrhoea post trip to Egypt; patient on OCP; worried about job related to catering. Asked to give differentials, and advice. 4) Phlebotomy: take blood from plastic arm (all tools provided, can ask clinician where to find equipment!), fill out blood form for dig level and bloods for person in renal failure (marks deducted for unnecessary tests) 5) Discharge summary photocopied notes. Conceptually amusing as admission was in 2005 (which presumably was the 'current' admission) so patient had been in for roughly 3 years... 6) CVS examination: CABG and AS. 7) GALS:GeneralisedOA 8) CF with liver transplant: best to be honest if you don't recognise something 9) GP/psychiatry history: Memory loss + motor problems. Asked to take history, then give differentials 10) ENT examination: a) Examine patient's ears b) answer 2 or 3 questions on a photograph of an ear

11) Surgical: Examine two (fake) forearm lumps. Discuss differentials with 'patient'. Write up in notes. 12) Portfolio review supposedly the 'fireside chat'. Know your portfolio before this chat to make it easier! 13) CNS exam Lower limbs examination. Wheelchair, lesion in spine. No differentials asked. 2007: Venepuncture: Take blood choosing correct bottles for relevant tests. Fill in tubes and forms Cannulation: Set up drip insert venflon connect up drip. On live actor with arm patch Ear exam: picture and write answer, then examine patient with otoscope plus webers and rinne. Suturing: reef knot, then three sutures no hand technique, remove sutures Palliative care: tell wife about husbands pain management (increase morphine manage side effects), discuss fact that not going to get better. GALS: Rheumatology patient discussion, what differential diagnosis are. CVS: exam AS full CVS exam describe findings and present Neuro: Exam lower limbs, all equipment provided, loss vibration sense and UMN signs Sex History: hepatitis screen as presents jaundiced, sex worker Psychiatry: alcoholic pt, take history of habit, how is it effecting physical, psychological and social wellbeing. Give differential diagnosis GP: tired all the time patient, take history and create differential diagnosis Clerking portfolio: discuss some cases what I learnt from it. 2006: 1. CVS examination PSM (?Mitral regurgitation). Asked about clinical features, Ix and Tx. 2. Sexual history from a swinger Hepatitis B/C risk assessment 3. Hand examination rheumatoid hands. Asked about DDx, Tx and potential side effects of DMARDs 4. Neuro examination of legs pyramidal weakness and abnormal sensation (?MS) 5. GP consultation 15 year old girl who wants OCP 6. Pall/Onc consultation r/v post-chemo inpatient with known bone mets - Hx suggestive of spinal cord compression (but pt was eager to go home!). Had to convince them to stay for urgent MRI. 7. IV cannulation and fluids (on manikin strapped to examiner) 8. Measure BP* (NB- its checked afterwards with automatic sphyg) 9. Ophthalmoscopy* following blood vessels and reading letters off back of eye (Ping Pong manikin) 10. Psych/GP consultation Generalised Anxiety Disorder. Asked about DDx with reasoning 11. Clerking portfolio examiners went through two cases 12. ENT examination otoscopy, hearing tests (Rinnes and Webers) on pt with waxy ears and conductive HL. Asked to draw & label normal ear drum and then asked questions about hearing loss 2005: 1. Examining a fake breast with Ca and mets in the axilla and supraclavicular fossa. 2. Phone call to a GP asking him to pass on bad news to a patient about the death of his wife as he is housebound and deaf (thus we can't call him from hospital). The GP was

not there and we had to ask his colleague (another doc obviously) to pass on the message. An exercise in telephone manners if nothing else and confidentiality (i.e. not telling the receptionist). 3. Neurology upper limbs - cerebellar pathology - MS. 4. GALS Rheumatology screen - hands = hands + elbows + ears! Knee effusion causes. Drugs and side effects (thanks!). 5. GP consultation - headache - SAH. Refer to hospital stat. LP - xanthochromia etc. 6. Neck exam - goitre and myxoedema. feel pulse etc. 7. Psychiatry consultation - depression after stopping SSRI. 8. Sexual History - assessing HIV risk in a nurse who worked in Africa and had a needlestick injury. 9. Cannulation and setting up a drip. 10. BP and fundoscopy (ping pong ball eyes with letters that we had to write on a paper) and picture of an eye with glaucoma (cupping). 11. PR exam - rectal Ca. Investigations and management (APR). 12. Palliative care consultation - telling a daughter whose mum has carcinamatosis (she knows) that we cannot control her nausea well enough and answering q's.