Cases collected from several posts for April 21st retest; Unable to find passed Recurrent

miscarriage and Cardiology cases. Anyone has them, please modify this file.

1. Copd- 62 year old female patient recently admitted in the emergency dept due to sob and
been discharged. H/o sob on walking a flight of stairs and on exercise. Was prescribed
ventolin in the ed. Past h/o bronchitis. Smoker from 20 years of age. Father had heart and
lung problems. Recent admission and Dr told she had bad lungs.
Task. History . Probable diagnosis. Differentials. Investigations from the examiner. Examiner
gave an X-ray of chest which showed hyperinflated lungs.

Station 2 Shortness of Breath

Bad lung case, recent admission, Dr told pt she had bad lungs. After pt was discharged, she
came to your GP clinic

In Hx, I asked SIQRAA qx for SOB, and DDx qx for PE, Angina/heart failure, chest trauma,
exercise tolerance, PMHx, SADMA

Dx: COPD, explain the condition

No PE required

Ix: Spirometry and CXR; CXR film given to me only when I asked examiner for it. No
spirometry results.

I could not finish explaining CXR but still got a score 5

Approach to pt: 5

Hx: 4

Choice and technique of exam, organisation and sequence: 5

Dx/DDx:5

Interpretation of Ix: 5

Global Score: 5 pass

2.post op pyrexia. Patient had recent laparoscopic cholecystectomy and is having fever on
pod 1. Task history. Pefe. Diagnosis. Differentials and management. 
There are hospital charts outside the room showing pulse ( with a spike) RR mildly increased
spo2 95% temperature( increased to 38.5) and blood pressure. 
Patient is completely asymptomatic on history and had reduced air entry and mild left lung
basal crackles on examination.

Station 4 post op complication

Post op complication:

D1 post Cholescystectomy, a obs chart given, Temp 38.8

Pt felt fine. I asked qx re SOB, chest pain, rigors, infections(cough, sputum, vomiting, nausea,
diarrhoea, dysuria, frequency, wound pain/discharge); all negative; long term heavy smoker

PE: vitals all in obs chart, right basal creps, other all normal

Dx: Post op atelectesis

Mx: I mentioned CXR both pt seemed suprised, Chest physio, deep breathing, adequet pain
control, monitor, no abx

Approach to pt: 4

Hx: 5

Choice and technique of exam, organisation and sequence: 4

Dx/DDx:4

Interpretation of Ix: 4

Global Score: 4 pass

3.OCD- university student referred to gp because he had falling grades and worried about the
word KING. Father history and diagnosis. Differentials. Answer patients questions.

Station 5 Behavioural complaint:

King case.

Confidential statement.

I asked "Could you please tell me what happened", then pt started to tell but I did not
understand much (too nervous).

Then I started to ask ASPECTICJ MSIGCAP HEADSSS questions then OCD questions and
anxiety questions.

Dx: OCD +/- anxiety

Answer pt's questions: what would you do to my school coordinator?

My answer: with your consent, I will send her a letter to explain your condition, also I would
like to arrange a meeting with you and your coordinator to discuss what we could do to help
you.

Approach to pt: 5

Hx: 3

Choice and technique of exam, organisation and sequence: 5

Dx/DDx:5

Pt counseling: 5

Global Score: 5 pass

4.CVS examination.
Patient had a high blood pressure recording of 170/90 and fundoscopy picture was given
along with the stem. Tasks
Perform cvs exam. Tell the examiner the findings. Interpret the fundoscopy( it showed AV
nipping and silver wiring) explain your finding to pt.
Station 6 Periodic health review

Cardiology PE

Need to measure blood pressure, two cuffs given, not sure need to change cuff, but I did not

I could not finish all steps in PE and examiner asked me to proceed to Fundoscope
interpretation, I told nipping and silver wire. Then times up. So no time to explain, I just
mention “you had hypertension”before I came out of door.

Approach to pt: 6

Choice and technique of exam, organisation and sequence: 3

Accuracy of examination: 4

Pt counseling: 3

Global Score: 3 fail

5. Acute abdomen examination- long stem, long term moderate drinker, pain in the upper
abdomen and radiated to back. 
Perform relevant examination. Diagnosis. Differentials. 
Station 7 abdominal pain

I ask if pt needed pain killer, pt answered no

I ask examiner if haemodynamically stable, answered stable

I started with checking sign of dehydration, then went to abdo Inspection palpation and
auscultation, during palpation, severe tender epigastric area, Murphy sign positive, did not do
percussion, told examiner that I did not percuss because of pain. After auscultation, I reported
BS present not pitched, examiner did not say anything, some other candidates told examiner
said BS absent. I mentioned with pt consent, I will check scrotum and hernia orifices,
examiner happy and said all normal. When I started to tell PR exam, examiner stopped me
and say normal or no need I can’t remember.

Note: in this case, actually we were required to give findings/commentary to pt not examiner.

I forgot to check jaundice and pallor…..

Dx: I said pancreatitis, giving reasons

DDx: Acute cholecystitis, acute cholangitis, peptic ulcer, renal stone which are less likely

Choice and technique of exam, organisation and sequence: 3

Accuracy of examination: 4

Dx/DDx:4

Global Score: 4 pass

6. Rheumatoid arthritis counselling. All symptoms of RA given outside. Pt saw you last time
and NSAIDs prescribed to control hand pain which was not effective; some blood tests
ordered and results given including anaemia, positive anti-CCP; Tasks
Explain condition and differentials.

Explain the implications of blood tests

And the implications of the disease.

Further management to the patient. 

Station 9 Painful swollen hands

Nothing special, just told patients what RA was and its effect on hand function and her
occupation (pt told me she was a typer). Also explain the blood results.

DDx: RA, OA, arthritis due to other autoimmune diseases

Mx: rest, immediately gave steroid for acute flare up; refer to specialist; Centre link, social
worker

Approach to pt: 4

Dx/DDx: 4

Pt counseling: 4

Management: 3

Global Score: 4 pass

7. 37 year old lady wanting to get pregnant for the past 6 years but has no health related
issues. General, abdominal and gynecological examinations remarkable.
Task take history for 6 mins. Investigations with reasoning.
Thought it was infertility outside but was a case of recurrent miscarriage when asked the
history. Had 3 miscarriages.
Station 10 First trimester complications

I am upset by this case.

When I read the stem, it appeared to be an infertility case, then DDx in my mind:

Female factor: PCOS, Pills, POF, Prolactinaemia, PID, STI, Fibroid; male factor: STI, sperm
quality issue, mumps in childhood etc.

When I sat down in front of pt, I said I understood it is frustrating, let me help, could you
please tell me more about your condition, AND pt replied what do you want to know, doctor.
(after exam, other candidates told me when they asked, pt just told them everything about her
multiple times of miscarriage).
Anyway, I carried on then, I mentioned confidentiality (I am not sure if I mentioned this earlier)
then started to ask relevant questions all about infertility but not in an well organized way.

Mx: blood tests to check hormone, check partner bala bala, pt seemed to be surprised when I
mentioned some tests, anyway, it was not important at all

Another mistake that made me miss this case is that in 5 Ps questions, I did not ask
miscarriage!

I failed this case which was not unexpected.

Approach to pt: 4

Hx: 2

Choice of Ix: 2

Global Score: 2 fail

I feel it was just a bit unfair. But this is AMC. If one did not ask the specific question or make
the specific statement (confidentiality), he/she would not get the answer. One of my tutor and
friend told me in our class that he always made confidentiality before he started to take hx.

8. Osteomyelitis- pain in the right lower limb. Of a 5 year old boy along with fever. He plays a
lot outside but has no scratch marks or bruises. He's not able to bear weight for the past one
day
Tasks examination findings from the examiner. Diagnosis and differentials to mom.
Management to mom.

Station 1 Painful leg

Paeds Osteomyeltis

Hx: As per Karen

Key point in PE: any point tenderness for OM, ROM of joint in septic arthritis, previous URTI
in transient synovitis

Mx: admission, FBE blood culture CRP Xray, IV abx, nonweight bearing

Dx: osteromyelitis; DDx: septic arthritis, fracture, cellulitis

I also reassured parent the outcome was usually very good, then parent appeared relieved
and happy.

Approach to pt: 5

Choice and technique of exam, organisation and sequence: 5

Dx/DDx:6

Mx: 5

Global Score: 5 pass

I saw these (or similar) words many times in the past and now it is my turn to write up my
recalls and speak them: Work hard and pass this exam!