1- Child with Chickenpox T

● Same as before
● 3 year old child with rash and fever
● Mother's concern is the rash and fever and cab child go to nursery or not
● Some doctors asked about feeding , child is not able to drink or eat orally so mother
is adviced to bring the child to hospital .
● Rash picture is in the cubicle.
● Mx. 1- Stay away from school, nursery, or work until spots crusted.
2- Plenty of Fluids.
3- paracetamol (not aspirin).
4- anti-scratching measures.
5- bathe in cool water.
6- be away from pregnants , newborns , and people with weak immunity.
7- safety net about complications of chickenpox like pneumonia and
encephalitis.

2- Lesbian for cervical smear T

● Stem says :- female going on holiday , had her vaccine , nurse found out that she did
never done pap smear before.
● No risk factors , no bad experiences about it.
● She doesn't think that she need it
● Her partner had sex with men before
● Can i travel for vacation now or not ?
● Mx. 1- explain to her the importance of pap smear.
2- explain the possibility of aquiring the HPV for homosexuals.
3- explain the hazards of cancer caused by the HPV.
4- schedule her appointment.
5- advice about R/F.
6- safety net her about symptoms of cervical cancer.

3- Rejected Tonsillectomy T
● Very angry mother ( deal with caution )
● Her child with 5 episodes of tonsillitis , referred to ENT for assessment , tonsillectomy
rejected , doesn't meet the criteria.
● Mx. 1- Appreciate the mother's emotions , be empathetic and sympathetic,
when she talks stay calm and silent.
2- explain to her about the reason of tonsillectomy rejection.
3- explain to her when the surgery can be done.
4- safety net about complication of recurrent tonsillitis.

4- Consultant son of a mother with ct-scan T

● He wants to know his mother's ct scan results
● He wants to help in management plan
● Ct scan results are not disclosed to mother yet
● Same as before
● Mx. 1- Praise him and appreciate his willingness and care about his mother's
condition (Rapport).
 2- tell mother first (mental capacity + consent).
3- patient's confidentiality and medical ethics.

5- Dementia mother with wt loss T

● The mother is admitted becuz of wt loss
● Unable to eat due to dementia
● Daughter concerned about her mother's wt loss
● She wants to know how is her mother's condition cuz she's been unable to visit her
for sometime
● Mother was decided to be put on end of life care ( no aggressive management)
● Daughter wants to take her back home with her
● Mx. 1- things done in hospital
2- cause of not eating is dementia itself
3- no benefit of staying in hospital
4- no aggressive treatment
5- support , dietician , carers

6- post-partum Depression T
● In stem , pt with insomnia
● During analysis of insomnia , pt gave a hint of she's on maternity leave
● Pt with low voice tone , so ask about mood , exclude red flag ( psychosis )
● Insomnia is just a symptom here , focus on the depression in management
● Mx. 1- self-help measures
2- CBT
3- Antidepressants
4- safety net about post-partum psychosis.

7- Bell's Pulsy
● Female complaining of facial drooping since 2 hrs back
● She gave birth recently (rapport)
● Exclude red flags ( stroke , SOL )
● Her concern is stroke
● Psychosocial and mood
● Reassure her (brain ct !? )
● Mx. 1- steroids for 10 days
2- lubricating eye drops
3- eye pads at bedtime
4- full recovery within 9 months
5- if no improvement within 3 weeks , go back to GP (surgical!)
6- if low mood >> CBT

8- Misdiagnosed Pneumonia
● Pt was strangely not angry !
● Mismatched x-ray picture with another pt
● Antibiotic s/e :- diarrhea is +ve
● Bnf is present
● Medical error scheme , cooperative pt
● Mx. 1- explain the error happened
 2- Apologise about what happened
3- manage the diarrhea
4- incident form , complaint

9- Hematuria
● Painless hematuria , male pt
● No signs of prostatism
● He is not sure about wt loss
● O/E , prostate is enlarged
● Best case / worst case scenario
● Further assessment
● Pt concern is cancer
● Mx. 1- referral to specialist for further assessment
2- Ix :- routine , abd x-ray , ct scan , cystoscopy
3- safety netting about cancer

10- BPH
● Difficult accent
● Coming for PSA results which is normal
● Pt complains of all symptoms of prostatism
● O/E , prostate is enlarged
● FLAWS is -ve
● Mx 1- referral for further confiatory tests
2- lifestyle changes , less fizzy drinks , less alcohol , less fluids at night ,
double voiding … etc
3- Meds , Tamsulosin and finasteride
4- surgery , TURP .. etc
5- safety net about UTI and cancer.

11- Optic Neuritis

● Female pt with sore eye
● Other symptoms , blurry vision , pain while moving eye
● O/E , low visual accuity , something with optic disc
● Concern is MS , her mother had MS
● Mx. 1- ADMIT , steroids
2- ophthalmologist referral
3- fundoscopy
4- brain scan (MS)
5- safety netting about MS

12- Postural Hypotention

● Pt complaining of fall
● His wife adviced him to go to doctor ( praise her )
● Pt hypertensive on amlodipine and statins
● Pt says fall while sunddenly standing from sitting position
● O/E , significant difference of bp on standing and sitting
● Mx. 1-fall due to P. Hypotention
2- ADMIT , Ix to rule out DDs
 3- referral to specialist , adjust/change meds
4- prevent future falls ( pt safety) , home visit … etc

13- Alcoholic Liver ( combined )

● Male pt with tummy swelling since weeks
● All hx -ve except alcohol
● O/E , huge ascitis , all abdomen is dull on percussion , liver is impalpable
● Management , explain dx and further assessment , talk about alcohol
● Mx. 1- ADMIT Pt
2- Ix to confirm Dx and for underlying causes
3- specialist
4- lifestyle >> ALCOHOL
5- Safety nettinh about complications of alcoholic hepatitis and cirrhosis

14- Blood Culture

● In stem , don't take Hx
● Difficult to withdraw blood , mannequin not good
● Regular station.
● Mx. 1- labelling and sending to lab
2- change Abs acc to results.
3- safety net about anaphylaxis and inf complications

15- Hematemesis (Simman)

● In stem , pt vomiting of blood
● Inside , the simman , the crash cart , the vomited blood beside him
● Pt just done endoscopy and vomited blood after that
● Pt not feeling well
● ABCDE APPROACH
● Pt gets better after starting blood transfusion
● If no blood transfusion is given , simman dies !
● Mx. 1- ABCDE Approach
2- O² , Fluids
3- Ix :- routine including blood group and cross match , giving blood once
available after senior consultation
4- specialist involv , further assessment and management.

16- Back pain (multiple myeloma ?)

● FLAWS is +ve
● Nocturia
● Symptomes been for a while and getting worse
● All examination is normal
● Mx. 1- urgent referral to specialist
2- further inv to confirm and assess including bone marrow biopsy , ct
scans , chest x-ray , bence jones in urine and routine blood .
3- safety net about worsening of sympt