6.7.

17
Station 1.You are a rural GP. Next patient is 3 yr old girl brought in by mother because of
persistent skin rash for 3 months. (5 photos of skin rash were given,2 on elbow flexure,2 on legs
and 1 on back. All photos look like typical eczema rash)
Task:history(3min),ask PE finding,explain dx and ddx,management
AMC feedback:Eczema(passed)
Global score:5
Approach to patient:5
History:5
Choice and technique of examination:4
Diagnosis/Ddx:5
Management plan:5
What I did: Greeted examiner and roleplayer who looks frustrated due to this problem,ask history
by analyzing the symptom and focused on atopy history,family history,contact history and
aggrevating/trigger factors. Got positive atopy history and rash was really itchy even have to
scratch a lot at night,family history of atopy but couldnt find out any trigger factors. Asked PE
finding about temperature,rash,lymph nodes and organomegaly. Gave eczema as Dx and
contact dermatitis,allergic dermatitis,viral infection as Ddx. Mentioned emollients,low potency
steroid cream and educated on finding out and avoiding trigger factors,wrote down all these facts
in brief,also mentioned regular followup, review and redflags.
when asking PE finding i didnt ask much about the rash like scaly?oozing? Etc. i should have
added scabies,seborrhoeic dermatitis as Ddx. And i gave steroid cream only after roleplayer
mentioned it has been for 3 mths and not relieving at all. Should have given reading materials.
Station 2.You are a GP. Next patient is 28 yrs old lady who gave birth a baby 10 days back. She
complaint of bleeding per vagina this morning which soaked 2 pads.
Task:History(5min),ask PE finding,explain most likely condition,management
AMC feedback:Vaginal bleeding(Passed)
Global score:4
History:4
Choice and technique of examination:4
Diagnosis/Ddx:4
Management plan:4
What I did: Greeted examiner and roleplayer who looked fine. Checked vitals first and got clue
that patient has fever. Made sure that patient is comfortable and congratulated her. Asked history
to analyze bleeding and fever,delivery history and breast feeding,waterwork,motions and leg
pain. No significant findings apart from bleeding and fever after delivery,and delivery was totally
uneventful.Asked PE findings focusing on uterus condition and perineum,also checked breast
and legs for dilated veins to rule out Ddx of fever. Got lax and tender uterus as positive finding.
Explained about endometritis and also mentioned retained pieces of conception/placenta. As for
Mx,referred her to hospital and mentioned they might give oxytocin and antibiotic,arrange USG
and E&C depending on USG result.
I was in a rush bcoz i knew it's a long case,forgot to ask smelly vaginal discharge,placenta
completed or not,and a lot of things. Got into trouble while asking for PE bcoz examiner dont get
my accent. As for Mx,totally forgot to mention fluid replacement or blood transfusion.
Station 3.Rest station
Station 4.You are a HMO at ED. Next patient is 22 yrs old male patient who recently got left
sided chest pain suddenly while playing football. It get worse with deep breathing. Vital signs
provided(all normal). Patient is given oxygen via facemask.
Task:perform relevant respiratory examination(6mins),ask for CXR from examiner,explain CXR
finding to patient,explain most likely diagnosis and other possible causes
AMC feedback:Chest pain(Passed)
Global score:4
Choice and technique of examination:3
Accuracy:4
Interpretation of investigation:4
Diagnosis/Ddx:4
What I did: Greeted both examiner and roleplayer. Asked for consent while washing hands.
Performed respiratory system examination,also included trachea and apex beat. Did all PE from
the back and side and mentioned I would like to perform again anteriorly. Examiner didnt give
any findings and i said everything as i can see. Then asked for X ray and got normal looking x
ray. But when i looked carefully,i think there is tiny fluid collection on affected side and trachea is
slightly shifted. Explained what i saw and mentioned pneumothorax and time ran out.
As this was 1st PE station,kinda excited and examination didnt look smart. Should have counted
respiratory rate even though it was given bcoz he was with 02. I was expecting obvious x ray
showing pleural effusion or pneumothorax but it was not a typical clearcut textbook x ray. Wasted
a lot of time looking at it and couldnt mention other Ddx as time ran out.
Station 5.You are a HMO at ED. Next patient is 4 yrs old boy brought in by mother because of
limping.
Task:take history,ask for PE finding from examiner,ask for investigation from examiner,explain
findings to mother,discuss management plan to mother.
AMC feedback:Acute limp(Passed)
Global score:4
History:4
Choice and technique of examination:4
Interpretation of investigation:5
Diagnosis/Ddx:6
Management plan:4
What I did:Greeted both examiner and roleplayer. Asked history by analyzing symptom and also
asked injury,recent viral infection,etc. got history of fall while playing. Couldnt quite catch what
roleplayer was saying. Asked PE finding focusing on all joints but didnt have findings, so asked
for bone tenderness and it was present on shin. Asked for leg x ray as investigation and it
showed clear cut spiral fracture of tibia. Explained mother about fracture. Mentioned about calling
ortho specialist for cast application and gave some advices for prevention.
I am not sure whether we should inform to CPA or not as I couldnt explore possibility of abuse.
Station 6.You are a HMO. Next patient is 20 yrs old lady brought in by father because of a funny
turn this morning.
Task:take history,ask for PE finding card from examiner,explain most probable diagnosis and
differential diagnoses to patient
AMC feedback:Funny turn(Passed)
Global score:5
Approach to patient:4
History:6
Diagnosis/Ddx:4
What I did:Greeted both examiner and roleplayer. Asked her how's she doing right now and
asked the event in details (before,during,after event). Positive finding was that she got single
episode of seizure witnessed by father and it was 1st time for her. Asked history to cover Ddx like
epilepsy,CVS causes,metabolic causes,head injury,alcohol and substance abuse. Only finding i
got was that patient had binge drinking before the event. So,i gave that finding as most probable
cause and explained other Ddx by telling points for and against each Ddx.
I forgot to ask about prolong standing,frightening event,etc and didnt mention vasovagal
syncope,postural hypotension in Ddx.
Station 7.You are a GP. Next patient is 58 yrs old male patient,former courier driver and ex
heavy smoker, who came for investigations result. Investigation results are consistent with
moderate COPD.
Task:explain condition to patient,explain your future management,explain about plans to promote
his pulmonary health
AMC feedback:Shortness of breath(Failed)
Global score:3
Approach to patient:3
Diagnosis/Ddx:4
Management plan:4
Patient counselling/education:3
What I did:Greeted both examiner and roleplayer who's a little bit out of breath. Asked if he's
comfortable and he said fine. As all investigation results were given and pointed towards COPD, i
explained COPD by drawing diagram. As for management,praised patient for quitting smoking
and advised to keep staying that way,gave bronchodilator and vaccines. Also suggested referral
to chest physiotherapy for breathing exercise. Told him to keep his environment clean and avoid
all smoke exposure. Said I would arrange regular followups and warned redflags.
I totally forgot to mention about acute exacerbations and antibiotics. I also should have
mentioned briefly about how to use puffer. And I think I should have checked vital signs and
arrange some oxygen for him during consultation. Although i said it's not as bad as CA lung,i
didnt reassure him a lot. I think these maybe the reasons why I failed.
Station 8.Rest station
Station 9.You are a GP. Next patient is 45 yr old professional lady who complaint of pain in right
foot for 4 weeks.
Task:take relevant history,perform physical examination,explain condition with reason to patient
AMC feedback:A painful foot(Passed)
Global score:4
History:4
Choice and technique of examination:4
Accuracy of examination:4
Diagnosis/Ddx:5
What I did:Greeted both examiner and roleplayer who was siting on a couch. Introduced her and
asked how's her pain. Then analyzed the symptom briefly,focused mainly on site of
pain,aggrevating factor,injury history,occupation,underlying medical condition,etc. positive
findings were pain between 3rd and 4th toe worsened by tight shoe. Then i washed my
hands,asked for consent and performed examination in look,feel,move,special test format.
Mulder test was positive. Then I explained about morton's neuroma with diagram and reasons for
diagnosis.
Station 10.You are a GP. Next patient is 57 yr old lady who complaint of headache. She has
been diagnosed with tension headache for 3 years. She also complaint of pain in neck previously
and MRI was arranged which turned out to be normal. She also has previous complaint of
recurrent abdominal pain for which no cause is found,and also dysuria,urine frequency
Task:take history,explain your understanding of cause of her headache and other possible
diagnosis
AMC feedback:Headache(Passed)
Global score:5
Approach to patient:5
History:4
Patient counselling:5
What I did:greeted examiner and then elderly looking roleplayer who looked troubled by
headache,offered painkiller and analysed headache symptom,she described typical nature of
tension headache,quickly ruled out CA and migraine.moved onto explore stressors, she got
mainly problems in relationship and at work,patient became teary as she was speaking so
offered her tissue and reassured her. Then explained about mechanism of tension headache and
its relation to stress. Explained she might have somatisation disorder becoz she has had multiple
symptoms as given in stem. Quickly explained why i ruled out other Ddx.
Station 11.You are a GP. Next patient is 25 yrs old lady who complaint of sorethroat. She is your
new patient.
Task:take history,ask for PE finding card,explain diagnosis and differential diagnoses,explain
management plan to patient
AMC feedback:Sore throat(Passed)
Global score:4
Approach to patient:4
History:4
Diagnosis/Ddx:4
Management plan:5
What I did:greeted both examiner and roleplayer. Patient started by telling she has had similar
sorethroats previously and she think antibiotics really work for her and asked if she can get any.
Then started history about current sorethroat,previous attack,skin rash,smoking,vaccine,contact
history,etc. findings were all suggestive of common cold. Asked for PE card which state inflamed
tonsil and no other significant finding. Explained she juz might have some flu and other Ddx like
bacterial sorethroat,EBV infection,etc and why they are less likely. Reassured her that it will go
away and antibiotic are not necessary and explained risk of antibiotic resistance if used
improperly. Gave her ibuprofen,saline gurgle and lozenges,adviced ample fluid and bed rest,also
to get flu shots. Warned her about redflags and called for review a week later.
Station 12.You are a GP. Next patient is 35 yr old lady who complaint of changes in urine colour.
You have never seen this patient.
Task:take history(6min),ask for PE finding card,explain most likely diagnosis and differential
diagnoses
AMC feedback:Health review(Passed)
Global score:5
Approach to patient:5
History:5
Diagnosis/Ddx:5
What I did:greeted both examiner and role player lady. Only symptom is change in urine
colour,so clarified what kind of colour and she said reddish brown. Asked if it was first time and
she said she has had similar problem previously but colour was milder. Started asking about
hematuria like change in colour at start/through/at the end of stream,UTI symptoms,recent viral
infection,stone history,injury,chemical exposure,medications,family history of cancer,etc.
Findings i got are that she has viral infection a wk before and she is worried about bladder CA
because of family history. Asked for PE finding card which show raised BP,mild tonsilitis,mild
oedema and RBC in urine test. Explained about APSGN as main dx and other ddx like IgA
nephropathy,stone,UTI,meds induced,CA,etc by drawing. Reassured her that it is very" less
likely to be CA.
Station 13:Rest station
Station 14.You are a HMO. Next patient is 19 yrs old girl brought in by father because of
behavioral changes. Patient has had previous psychotic episode for which she was admitted for
10 days and diagnosed as schizophreniform disorder. Father said she is not taking medications
regularly.
Task:perform mental state examination(6mins),present MSE findings to examiner
AMC feedback:Behavioural change(Failed)
Global score:3
Approach to patient:4
Choice and technique of examination:4
Accuracy of examination:3
What I did: greeted examiner and roleplayer who was wearing sunglasses,she was kinda
cooperative,well orientated but having auditory hallucination and sometimes talking to herself.
She has good judgement but poor insight,mood was ok. Did MSE in ASEPTIC format,ruled out
organic causes like thyroid problem,alcohol,substance abuse. Presented to examiner in
ASEPTIC format again. I had problem in listening to roleplayer,tbh i dont have a clue about half
of the things she said,i should have asked her to repeat. Maybe i missed to present some
important finding to examiner.
Station 15.You are a HMO. Next patient is 10 days old baby brought in by mother for routine
followup as suggested by community nurse. Baby's weight,height,head circumference given.
Task:take history regarding pregnancy and delivery,perform examination on baby while
explaining what you are examining and why,summarize findings to mother.
(Fundoscopy and paediatric sthethoscope given)
AMC feedback:Health review(Passed)
Global score:4
Approach to patient:4
History:4
Choice and technique of examination:3
Commentary to examiner:4
What I did:greeted examiner and congratulated roleplayer,asked briefly about pregnancy and
delivery both of which were uneventful. Asked for consent to examine baby mannequin.
Commented general appearance,facial feature and performed fundoscopy for red
reflex(roleplayer switched on the light for me) then listened to CVS and Respiration with baby
stethoscope. Assessed muscle tone,no hammer was given but i used stetho as a
hammer.(maybe it led to poor mark) did ortholani and barlow test. Checked umbilical stump too.
All PE normal and no positive findings. Explained mother before and at the end of each step of
examination.
Station 16.You are a HMO. Next patient is 30 yr old lady who has headache and stomache. She
passed watery brown motions 4 time this morning. She vomitted old food once. No significant
past medical history. No travel history. No recent antibiotic. Does not have contact history.
Task:perform physical examination including dehydration assessment and abdomen,explain to
the examiner at every step about your finding,explain most likely condition to patient and
differential diagnoses
AMC feedback:Health review(Passed)
Global score:4
Approach to patient:4
Choice and technique of examination:3
Accuracy of examination:4
Diagnosis/Ddx:5
What i did:greeted examiner and roleplayer who was sitting on a couch. Asked for
consent,washed hands,asked for vitals and table clock was given,so counted heart rate,
assessed dehydration status by checking sunken eye,dry mucosa,skin turgor,capillary refill and
cold,clammy extremities, all looked normal to me. Then performed abdominal examination. Only
finding is non specific generalized mild tenderness,no rebound tenderness,didnt perform any
special test apart from Mcburney point tenderness which was negative. Bowel sound was fine.
Explained bacterial GE,viral GE,food poisoning,IBD as Ddx and ran out of time.
Station 17.You are a GP. Next patient is 25 yrs old lady complaint of painful periods for 12
months. She has never been pregnant before. You have never seen this patient before.
Task:take history,ask for PE finding from examiner,explain most likely diagnosis to
patient,explain about management plan
AMC feedback:Menstrual dysfunction(Passed)
Global score:4
Approach to patient:4
History:4
Choice and technique of examination:4
Diagnosis/Ddx:4
Management plan:4
What I did:greeted examiner and roleplayer. Asked about painful period in details,relation of pain
to timing of period,1st time or not,regular period or not,etc. also asked sexual history and patient
had painful sex on deep penetration. She was taking OC pill given by doctor to relieve but it
didn't help. No plan to get a baby. Asked for PE finding focusing on pelvic area. Adnexal
tenderness and some nodularity present. Explained endometriosis as Dx by drawing a picture,
mentioned referral to gynaecologist and explained about stronger hormonal treatment like
depo,mirena,etc. also explained usg and laparoscopy maybe necessary as she hasn't had any
investigation. Gave mefanamic acid and vit supplements for symptomatic relief.
Station 18:Rest station
Station 19.You are a HMO at ED. Next patient is 52 yrs old lady complaint of right upper
abdominal pain.
Task:take history,ask for PE finding card,explain most likely diagnosis and differential diagnoses
to patient,explain initial investigations to patient
AMC feedback:Abdominal pain(Passed)
Global score:7
History:7
Diagnosis/Ddx:7
Choice of investigations:7
What I did:greeted examiner and roleplayer. Asked her how she's doing and she said pain got
better. Asked about pain in detail,which was in RHC area going to back,about 6-7 severity,got it
soon after fatty meal,patient was a bit obese,asked for fever and jaundice,neither present,asked
for gallstone history,alcohol history,injury,past surgery history,regular meds,and ruled out AMI by
asking chest pain,SOB,etc.
PE finding card all normal apart from mild tenderness in RHC. Explained about biliary colic due
to gallstone with diagram,explained ddx like cholecystitis,pancreatitis,hepatitis,gastritis,AMI,lower
lobe pneumonia,etc.
Arranged USG(hepatobiliary),LFT,pancreatic enzyme,ECG as investigations to be arranged. I
wrote down all Ddx and inv on paper to make sure she is clear.
Station 20.You are a GP. Next patient in GP is 25 yrs old lady who has had vulval ulcers for 4
times previously. When you examined currently,no abnormal feature is found.
Task:take history,explain most likely cause,counsel the patient
AMC feedback:Vulval complaint(Failed)
Global score:3
Approach to patient:2
History:2
Diagnosis/Ddx:4
Patient counselling:2
What I did: greeted examiner and roleplayer who started by saying she want to know what's
happening. Asked her about ulcers but she's not having them currently,asked about sexual
history after explaining about confidentiality. She has had some unprotected sexual encounters
in the past. Explained she might have genital herpes,and explained how she might got it and its
nature. Advised her to use condom and if she agree i would arrange STI screening for her.
I might have missed something important in history,and as i missed it,couldn't cover that issue in
counselling.