PLAS THIER (3) in a ine Date Booked _ TS e PSS Be tlo™ Joue > _ Plame of Fust name ‘Sumame a” ey hy Mt oats | PeaNA® A@D! viv Ligh | (eamimone cau Tel Number 7 ae ~ 4p DA Pe) CLE OIBNES1OV ny Zainabtatimaabel’ © Yohoo: _ an [ Cowuntry of Unf origin Rakishan PLAB 2 test a \a* Det How did you heat: sbout us Friends. 4 . Course date | yp MRO Sey caw . xy (Sie Oe "hy ‘Wock test | Full Mock | Ral eck pee [tee A dates Mock a bamonarpard J . Lrref a, fe thn o& Booked by + Soke Diwa She en be spits ha ely; ey mii de Spt il cao d 4 iene LEB IEC carey rs O whar [oka / Madera 29 “@ Pow Chie. B lecouers” 3 wee oF fa) o: A De ey ’ ate Co) crm oes a WorphJ Oe Oe Ve OO, rr bee abe Yr t thal we TY Ke, m2 FO vale QA tye kame de bit (Po fa Bes vis 1. Or \ ‘ BO Nae WD j roy cervort wr lis a. <4 to, V@ep He Am 29 Car) BAK | 62. Wher Beonmntef 4b VYron'’« Oe ON aig PRE PSone pale pee (Seni meePLA SWAMY }2 GUIDE A COMPLETE UPTODATE GUIDE FOR YOUR SUCCESS IN PLAB 11 EXAM WRITTEN BY THE EXPERIENCED AND GREAT TEACHERS OF PLABTRAINER. ye ‘tiny AG ADDRESS: Balfour House : 390-398 High Road _« ford, Essex IG11TLPLAB TRAINER, (SWAMY) HANDOUTS for PLAB 2 Please note that this is only a handout to help you in passing the PLAB 2 exam. Contents of this may not be authenticated to use in the hospitals. Candidates are Strongly advised to refer to the standard text books and follow hospital protocols once you start working in the NHS Course organiser ; Mr K S Ramaswamy, FRCS (UK ) Address : 390 -398 High Road, Tel: 020 8478 6100 (from within UK) Ilford, 0044.20 8478 6100 (from outside UK) Essex. Email: plabtrainer@google.com (may change. Please verify by phoning us.) 1G] 1TL PrefaceIn the recent years the General Medical Council exams have changed in different manners. To meet these changes and challenges, we decided to design a course to help the doctors to the PLAB 2 exam and named it as PLAB TRAINER course. In this course we guide and teach foreign graduates to meet the criteria of GMC exam. In Ten days all the topics related to PLAB II exam; History & Counselling, Clinical Examination, Advanced Trauma Life Support, Manikins, Dose Calculation and Viva Stations will be taught. To really help you get a feel of GMC before your actual exam, right here in PLAB trainer we conduct Full Mock, Manikin Mock and which will make your training complete. At the end of it all we hope that you will be ready to face the real test and walk down the rest of the path to success. We strongly suggest candidates to use this book only along with other standard PLAB 2 books and not depend entirely on this book. This book will constantly be updated according to GMC exam. We advise candidates to use the latest handouts. We sincerely hope that this handout will prove to be straightforward and readable and will provide the necessary knowledge in an integrated form that a foreign graduate requires for passing the PLAB 2 exam. We wish you all the very best of luck in your exam and future endeavour. QoS ia PLABTRAINER TEAM.Acknowledgments This handout has been prepared by the teachers who have taught at PLABTRAINER in the past and has been kept up-to-date by the current teachers and myself, The information in this handouts is mainly gathered from the candidates who appeared in the PLAB exam, without their help this would have been a impossible task. This handout has been the most popular guide for the PLAB 2 test where even the candidates doing the other PLAB courses too depend heavily on this handout to pass in their exam. We are extremely grateful to all those who have contributed for the preparation of this handout. Ht is very difficult to mention each and every name of contributors. But special thanks to all of those teachers who were and are teaching in PLAB TRAINER. Their contributions in PLAB TRAINER management and teaching deserve the best, because they are the best. And we da remember them, they were and they are part of PLAB TRAINER Team and Family. ‘A special thanks to Dr Sagib Siddiq and Dr. Atif who helped a lot in compiling this notes. c tact oboae ah, ee batt chronce Ay PLAB TRAINER (SWAMY)CONTE: ‘No Topics Page numbers Past GMC questions 10 days of course is divided into 2 paris of 5 days each. | PARTI 1 | Introduction ATES 7 | Oe ne Manikin teaching = section-1 a ea G Manikin teaching - section ~2 & Dose calculation 3 History and Counselling PART2 f —_——— 1 | Medicine _ For4 |__| OFTHE [2 _| Surgery and Orthopaedics a | days eae course {3_|OBG = (Days) |4 diatrics — } - — 5 [Psychiatry 6 | VIVA, Drug prescriptions, MRSA, and other 1 day | Ltopies. a PLAB TRAINER PAST OSCE STATIONSas a | MEDICINE (H&C means combination of history taking and then counselling HISTORY rT COUNSELLING Diagnoses which were in kept in the past GMC exam were written within the brackets: T | ANEAMIA (Bowel Ca, ete) 1 | ASTHMA —14 yr oid boy smokes — explain risks of smoking and advice to quit smoking. (boy said his grand dad has been smoking for yrs | and had no heath problems #0) 2 | ABNORMALTFT (H&C) 2 | ALCOHOLISM(H &C) ( Pt. posted for Herjorthaphy or ingrowing Toe nail removal- blood test shows Low Hb and high MCV ) 3 | BREATHLESSNESS (ASTHMA) 3. TBLOGD TRANSFUSION 4 | CHEST PAIN ova PE, Pneumonia) 4 | Chronic renal Failure (Low Hb, High Urea and Creatinine) | 5 | CHRONIC FATIGUE SYNDROME 5 | Diabetes Mellicus. Importance of maintaining Diabetic Dairy. 6 | CONSTIPATION (Pts on codeive or 6 ‘Morphine ~ drug induced) ) 7 | Young pt. chronic (3 months)DRY 7 | DIABETIC RETINOPATHY (pt is worried about COUGH, BREATHLESSNESS,WT ‘going blind) LOSS (PT is homosexual boy friend is FIV +), sek for rereatioal drags eee sizing) RCP) 160 yr oldman with cough with sputum 8 | EPILEPSY — young lady bas been diagnosed a (Ca Lang, Bronchiectasis) idiopathic epilepsy one week ago started on treatment — she goes to university) 9 | DIARRHOEA & VOMITING (H&C) EPILEPSY (POORLY CONTROLLED) —-H&C_ (food poisoning ) Tig. DOPLOPIX To FOOD POISONING [ir BzaNEss TI | Post Stroke Advice T2 [ EARACHE (ARO TRAUMA (eave i, 12 [ HEADACHE: (pasthist. ofmigraine now demands ‘OMS EXTERNA, Otis media) CT scan or MRI scan) 13 | FEVER (MALARIA PNEUMONIA, TB, PCP) | 13 | Pe wants HIV TEST 4 i4 iS /HEMOPTYSIS (1 & C ) (7B, PE.Ca, 15 | MESOTHELIOMA (BREAKING BAD NEWS ) Brower) 16 | HEADACHE (Ai) Explain 16 | NON PHARMACOLOGICAL TREATMENT OF mahagement to patient. HYPERTENSION 17_| HOARSENESS OF VOICE, T7_ | MULTIPLE SCLEROSIS (weakness in Ie eg and aa had loss of vision 4 yrs ago) 18 TR | MORPHINE FOR SPqNAL SECONDARIES | Hlas side effects — what to do 2?19 | HYPOTHERMIA IN ELDERLY 19 | TERMINAL CARE ~PT.DOESN'T WANT LADY. Take history ftom her son and MORPHINE (ASK HIM WHY HE DOESN'T counsel WANT AND ALLAY HIS CONCERN ) (2? Elderly abuse) cE 20 | LOSS OF CONCIOUSNESS 20 | PT.ON MORHINE FOR SECONDARIES, BUT PAIN NOT CONTROLLED WITH MORPHINE. 21 | PALPITATION 21 | Consultant stated pt. on morphine for secondaries athis back ~ pt. isa teacher ~ worried about work ~ can I teach ? ~ won’t be silly infront of kids 72) 22 | PANIC ATTACK 22 | PEFR - EXPLAIN THE CHART and plot the reading on the chart 23 | RED EYE - (Glaucoma, Ankylosing 23 spondil 24 RISK FACTORS FOR CVA 24 | Elderly lady came to hospital with ankle injury — no x-ray was done in her first visit — pt. came back again with pain ~ x ray done second time revealed facture in ankle. Pt. is very upset that X ray was not done — counsel. Pt. just needed POP cast as ‘treatment. Ths tests your communication skis for revealing hospital eror. 35 | WEIGHT GAIN ‘GUM clinic — urethral discharge (Gonortheoa) ins (HYPORTHYROIDISM) male after unprotected intercourse. (H &C ) 26 | WEIGHT LOSS (Hyperthyroidism) Post Mortem counselling 27 | SORE THROAT (Infectious ‘SMOKING explain risks and advice to quit Mononucleosis, Tonsillitis.) 28 Gaint cell (temporal) arteritis 30 | STD -You are in sexual health elinie - take history from a man who is anxious about contracting STD (only history no counselling) SURGERY aac HISTORY COUNSELLING 7] | HEMETEMESIS ] | APPENDICECTOMY (Ifthe patient has been vomiting dehydration should be corrected before the surgery) 2. | HEMATURIA 2. | HEMICOLECTOMY & COLOSTOMY 3__| PR BLEEDING 3 ‘| MALEANA (elderly lady with maleana—ptis | | 4 | LADY POSTED FOR NEPHRECTOMY FOR taking voltarol(diclofenac for rheumatoid RENAL TUMOUR — COULSEL HUSBAND arthritis) 5 | TESTICULAR PAIN 5 | VASECTOMY 6 | SCROTAL SWELLING [6 | HERNIORRHAPAY -GA ORLA (ANEASTHETIST DECIDED GA - CONSULTANT IS ON WARD ROUND — HE WILL COME LATER AND TAKE CONSENT FROM PT.— YOU COUNSEL FOR OPERATION & FOR GA ) 7 | DYSPHAGIA 7] POST HERNIORRHAPHY WOUND INFECTION 8 | DYSURIA (ENLARGED PROSTATE) 8 | POST HERNORRHAPHY PAIN HIST & MANAGEMENT MANAGEMENT9. | PAIN ABDOMEN (APPENDICITIS, 9. | HERNIORRHAPAY CANCELLED DUE TO ‘TWISTED OVARIAN CYST), ANEAMIA (PT. ON ASPIRIN) (MAY HAVE (THINK OF MIIN ELDERLY MAN WITH. ‘TO TAKE LITTLE BIT OF HISTORY) EPIGASTRIC PAIN EVEN IF HE IS ON TRIPLE ‘THERAPY FOR PEPTIC ULCER DISEASE) 10 | PRE - ASSESSMENT FOR OPERATION 10 | POST MASTECTOMY 1] | PRE- ASSESSMENT FOR OPERATION— || 1] | POST OPERATIVE PAIN MANAGEMENT ASSESS SUIATABILITY FOR DAY CASE ‘SURGERY (PLANNED FOR PIN REMOVAL FROM ANKLE) eer 12 165 YR OLD MAN WITH Lif PAIN 12 | ENDOSCOPY (ELECTIVE AND (DIVERTICULOSIS) EMERGENCY FOR HEMETEMESIS) ‘Chronic ulcer on the back history B | NA CHILD AFTER TEA (EEA FEMUR discuss DD and further management Reis An COUNT NG eae with the patient 14 | PROSTATIC HYPERTROPHY WITH UTI (MANAGEMENT OF UTI AND PROSTATECTOMY) Telephone conversation- Xray ofa patient was | | 15 | MOLE REMOVAL ket inside the cubicle. Patient had CVP line for total parenteral nutrition early that morning, Patient developed shoriness of breath by evening. Chest XRay was done. Discuss the XRay finding and management of this patient with e examiner 16 | ULCER OVER THE BACK - GP THINKS SINISTER (HEC) 17 | POST HEMICOLECTOMY COLLAPSE ~ TEL CONVERSATION 18 | POST HYSTERECTOMY — UNSTABLE VITALS - TEL CONVERSATION 19 | OBSTRUCTED INGUINAL HERNIA — TEL CONVERSATION PAIN ABDOMEN - ALL INVESTIGATION | LIKE BARIUM MEAL, COLONOSCOPY | ‘NORMAL (IBS) (HIS UNCLE DIED OF BOWEL CA) - COUNSEL (7? Irritable bowel mdrome) ‘LOCAL ANAESTHESIA 22 ‘Spinal Anaesthesia TOOTH EXTRACTION CANCELLED DUE TO OBESITY - BIOCHEMISTRY RESULTS ‘NORMAL - COUNSEL ORTHOPAEDICS HISTORY COUNSELLING 1_| KNEE PAIN (Reiter's syndrome) 1_| ANKLE SPRAIN 2__| BACK PAIN: 2 | RHEUMATIOD ARTHRITIS 3 | CARPEL TUNNEL SYNDROME 3. | GOUT (PT. ALCOHOLIC AND THIAZIDE (TINGLING AND NUMBNESS IN HAND) DIURETIC FOR HTN) | OSTEOPOROSIS F_T OSTEOPOROSIS 3 ELDERLY LADY HAS PAIN INKNEE— '5_ | TOTAL HiP REPLACEMENTPHOSPHORUS - HISTORY ONLY (OSTEOMALACIA, OTHERS 7OSTEOPORORIS, RHEUMATOID ARTHRITIS, OSTEO ARTHRITIS) BLOOD TESTS SHOWS — HIGH ALKALINE PHOSPHATSE, LOW CALCIUM AND LOW 6 |/55 year old fady with tingling numbness 6 | TOTAL KNEE REPLACEMENT in her hand. (Is a typist for 6 years - ? Repeated stress syndrome) i 7 7 | HEMI-ARTHROPLASTY OF HIP. PAIN MANGT ALREADY BEEN DISCUSSED. TALK TOT. _ | oF OTHER MANAGEMENT. i OBSTETRICS AND GYNEACOLOGY | HIsTORY [ COUNSELLING 1 | HYPEREMESIS (HIST & MANGT) ]__ | ANTEPARTUM HEAMORRHAGE, | 2_| URINARY INCONTINENCE 2 __| GA CERVIX— BREAKING BAD NEWS 3 | IRREGULAR 7HEAVY MENSTRUAL, 3_| DMINPREGNANCY : BLEEDING 7) ANENORRTOER F_| DOWN SYNDROME 5. | PREMATURED RUPTURE OF 5 | DYKARIOSIS - ADVICE COLFOSCOPY MEMBRANE _ 6 | LADY WITH STD GUM CLINI) 6 | DYMENORRHEOA [7 WAGINAT BLEEDING 7 [ECLAMPSIATEL WITH CONSULTANT 8 | ABDOMINAL PAIN 18 | ECLAMPSIA-TALK TO HUSBAND FOR. LSCS 9 | OCP SUITABILITY 9 [ECTOPIC PREGNACY - PATIENT WANTS TO ATTEND INTERVEIW IN THE NEXT ONE HOUR. [To [Pee accaersa gr eCy ECLAMPSIA.) (PT-HAD SEVERE HEADACHE AND BLURRING ‘OF VISION BP -160/110 ~ SEVERE PRE — 10 | GONORRHOEA POSITIVE—REFER TO GUM | CLINIC PRE MATURE MENOPAUSE |-GIOF FLUSHES WIGHT SWEATS). i HRT 123 HYSTERECTOMY CONSENT ll B LAPAROSCOPIC STERILIZATION | 14 ‘MISCARRIAGE 15 EMERGENCY CONTRACEPTION 16 ‘TERMINATION OF PREGNANCY [ 7 PAIN RELIEF INLABOUR 18 HUSBAND HAD SEX WITH PROSTITUTE — COUNSEL WIFE 19 STILL BIRTH 20 [PELVIC INFLAMMATORY DISEASE 21 [OVARIAN CYSTECTOMY 22 IDDM lady wants to be pregnant - counsel Jt Lady diagnosed to be having DVT. She has been commenced on warfarin. She is on OCP, Advise her for alternative methods of contraception. (Barrier methods, safe period method, may be progesterone only pills. JUD may be‘contraindicated when she is on warfarin ) PEADIATRICS HISTORY COUNSELLING ‘BREATHLLESSNESS (ASTHMA) 1 | INCONSOLABLE CRY we CONVULSIONS 2 COELIAC DISEASE (FEBRILE, HYPOGLYCAEMIC, MENINGITIS, EPILEPSY) 3 | DIARRHOEA (H&C) (Tel) PASSED [3TARRITABLE HIP URINE WHILE CHANGING NAPPY 4 | FEVER (UTI also discuss magt with mom) | +4 | DOWNS SYNDROME. 5 | VAGINAL DISCHARGE FB ASPIRATION H&G) 6 | COLLAPSE (VASOVAGAL) 6 | SWALLOWED BLEACHIOCP 7 | DELAYED WALKING (H&G) 7 | MENINGOCOCCAL SEPTICEAMIA 8 | INFANTILE COLIC H&G) C97] MMR - AUTISM 9° | VOMITING (H&C) ‘| NEEDLE STICK INJURY - MOM WORRIED ABOUT HIV INFECTION ‘Mom does not know whether the needle i rested ornot ~ 10 | WEIGHT Loss 10 | PHYSIOLOGICAL JAUNDICE (H&C) 1] | CHILD HAD COUGH 10 DAYS AGO. TL | INTUSSCEPTION NOW LETHARGIC, NOT EATING FOOD BUT DRINKING PLENTY OF WATER. 12 | URT-NOW NOT WELL (mum [12> PEA NUT ALLERGY WORRIED ABOUT MENINGITIS) 14 | HEAD INJURY (H&C) [447 OBESETY — GROWTH CHART chiidhood obesity, (NAD) 13y 01d BM 32kg/sam, about to be cischarged, Talkto Imether about testy and gietary modifiations, growth chart provided, NAT (FRACTURE FEMER/SCALD) NAI(TEL CONVERSATION WITH THE CONSULTANT) = (YOU ARE IN ARE DEPARTWENT,6 YR OLD BABY WAS BROUGHT BY HER MOTHER BABY HAS BRUISE ON RIGHT ARM MOTHER SAYS, ‘BABY FELL FROM COUGH. (Baby hes fracture humerus and rile os facies on bs —X RAYS kept on the table. Mom es agit cut boy fend takes care of avy, 15 [EAR INFECTION— GP GIVEN ABX. MOM WORRIED ABOUT MENINGITIS (TEL) 16 | PR BLEED (Biood in the nappy in Himonth | | 16 | CHILD WITH RASH— MOM WORRIED old child — Intussuseeption) ABOUT MENINGITIS (TEL) 17 | Child with potyarea, polydypsia, cough and | | 17 | Child swallowed one tablet of Tamoxifen (H& C) drowsy ) hist, 2? meningitis, 27 DM ~ Should say you will refer TOBASE or take advise from Poison information centre. Then ‘examiner gave Information about Tamoxifen overdose including complications and treatment). 18 | Child consumed 240mg Paracetamol 78) 2 YEAR OLD CHILD WITH Heo HYPOGLYCAEMIC COMA. TALK TO MOM ABOUT FURTHER MANAGEMENT Scabies 19 | IDDM COUNSEL MOM 1020 | Child with breathlessness — counsel dad ‘21 | Child with fracture ankle — take history from mom regarding assessment for anaesthesia, & tell her that anaesthetist will come and discuss about the anaesthesia ) (Child has IDDM) 22 | Unwell child ~ Dad says child had ear infection before and he thinks it could be the same this time asking you whether he can give the same antibiotics — tell him there is no ear infection — itis only URTI — there is no need for antibiotics. PSYCHIATRY HISTORY COUNSELLING 1_| ANOREXIA T_| PCM SUICIDE RISK 2__| DEPRESSION 2_ | DEPRESSION 3 | Insomnia without depression (pi. on 3. | ANXIETY - PTSD ‘methotrexate nd NSAIDS for Rhuematoid arthritis) history and management. 4_| INSOMNIA (SOMETIMES PT 4 _| DEPRESSED PT, READY TO BE DEPRESSED). (PT ON METHTREXATE DISCHARGED. ASSESS SUITABILITY TO BE AND NSAID FOR RHEUMATOID DISCHARGED HAND) 5__| OCD 35 _| MMSE 6 PSYCHOSIS 6 | MSE 77_| OPIUM ADDICTION | 7_| Obsessive compulsive disorder. <8. [ AMITRYPTILLINE, 8 PANIC ATTACK 97 | PAROXETINE 9 | SCHIZOPHRENIA (pt. brought in by 0 DRUG ABUSE (H & C) Heroin addict. Pi. wants police who has not committed amy crime but to quit. pi. thinks he has committed erime) | 10. | POST NATAL DEPRESSION (HIST & TI | Lady who took 20 OCPs (because she had "| MANGT) | unprotected sex - worried about pregnancy) also slashed her wrists. — assess suicide risk. Pt asked whether she can go home. IT | ALCOHOLHIST AND ADVICE HIMTO™["[I2 [SS QUIT ALCOHOL CLINICAL EXAMINATION MEDICINE 1 [cvs 8 12707 CRANIAL NERVE 2_|RS& PEFR 9_[ 8™ CRANIAL NERVE 3_| ALCOHOLIC FOOT 10 | DIPLOPIA 4 | DMLEG 11, VISUAL FIELD (PT. HAS VISION PROBLEM AFTER RTA) 5_| COMATOSE PATIENT [12 | LYMPHO RETICULAR SYSTEM - 6 | GCS & NEUROLOGICAL | 13 | MENINGITIS PT. EXAMINATION OF COMATOSE PT. (PRIMARY AND SECONDARY ratSURVEY HAS ALREADY BEEN DONE) 7 | LOWER LIMB SENSORY AND MOTOR | 174 | CEREBELLAR FUNCTION EXAMN, 8 15 | HEMIPLEGIA ORTHOPAEDICS SURGERY 1 [Hr | | UPPER ABDOMEN (MURPHY’S SIGN POSITIVE) ~ sometimes pt may have upper ‘midline incision sear. Do not check to look for incision hernia, epigastric hernia by asking the patient to lean forwards without support [Z_[ KNEE 2_| THYROID 3. | ELBOW 3 _| PERIPHERAL VASCULAR DISEASE 4_| WRIST 5 _| SHOULDER 6_| SPINE 77_ | FRACTURE HUMERUS Pis arm was on sling. Had severe pain. You can’t examine for movements or any tests involving movement as be is in severe pain. Don’t forget to check neuro-vascular deficits ~ | RHEUMATOID HAND. MANIKINS 1 | IVCANNULATION ~~ 9 | 36 WEEK PREGNANT (OBST EXAMN) ~~ —— 2 | BLOOD SAMPLING 10 | BREAST 1 3 | ABG w Ti | CERVICAL SMEAR L-7 [4] SUTURING [ * 12 | BIMANUAL EXAMN: 5 13 |-PERRECTAL — _-~ 6 14 OTOSCOPY. ee 7 15 | EUNDOSCOPY 8 16 | SPACER : MISCELLANEOUS 1 | ATLS 5 | SCRUBBING (PRIMARY SECONDARY SURVEY) 2 | NECR INJURY (WHIPLASH INTORY) HAND WASHING 3” | MRSA (LEG ULCER, CEASARIAN DOSE CALCULATION SECTION WOUND infection) 4 | LUMBAR PUNCTURE EXAPLAIN 8 | Medical negligence PROCEDURE TO PT. 12