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Father came to your GP clinic, his 18 months daughter has just been diagnosed with
Asthma. Now, she is discharged from hospital and on a puffer.
1. as! relati#e history
$. chec! spacer with mas! techni%ue
&. asthma action plan
'. long term management

*hen did she ha#e been diagnosed with Asthma+ A few days ago

*hat symptoms did she ha#e+ ,ough, whee-ing and a bit fe#erish, no accessory
muscle using

.s this the first time+ /es

0oes she need to be admitting to .,1+ No

(ow did she get this+ 2he had a cold

(ow did she be treated in the hospital+ Puff and symptom was reli#ed, no need for
oral medication. 3)aminer said" she did not admit into ward just be treated in 30

(ow is her general history before+ Good

.s she allergic to anything+ No

Any history of ec-ema, hay fe#er+ 2he has ec-ema before but now is 45

Any family history of ec-ema, hay fe#er or asthma+ Auntie has asthma

Any one smo!e at home+ mother is a smo!er but not smo!e at home

Forget to as! pet or carpet clean

Father demonstrated the spacer techni%ue and . found three mista!es"

Not sha!ing the puff then connected with spacer

Not put the mas! tightly with face but just put in front of face

Pressure 6 puffs at one time not separately

Father as!ed" how to clean the spacer+

Put it into warm soapy water, do not brush and rubber it, and lea#e it air dry to
pre#ent static electricity.

4therwise the medication could stic! on wall of spacer

Father said" doctor, you are #ery good, could you please e)plain asthma action plan
for me+
Asthma action plan" 0oes not need to write just tal! but . only finished two parts

*hen the child is well" there is no symptoms during day time and night time, no
e)ercises induced asthma symptoms and she does not need to puff more than &
times per wee!, she need blue puff as re%uired. . also mentioned she need pre#enter
because she has been admitted hospital, but e)aminer said that she was only be
treated in 30 not admitted in ward. 2o . said that then she does not need pre#enter

*hen she is unwell" there are asthma symptoms during day time and night time,
she has e)ercises induced asthma symptoms and she needs more than & times puff
per wee!. 2he needs to double the puff dosage and to see GP as soon as possible.

hen bell rung, so . did not finish the tas!

AMC feedback: Explain, demonstrate and check use of Bronchodilater MDI
metered dose inhaler and spacer (passed
7ery surprise, . passed this station888
!orsion of !estis 9e)actly same as pre#ious recalls:
,ountryside, forgot is in GP or 30, 8 years old boy was complaining of pain in right
groin area, #omited twice, pre#iously healthy. (e was riding his bicycle before the pain
started. he pain started & hours ago. Father is #ery worried about this.

a!e history

As! e)amination findings

al! to worried father about management


*hen did it start+ & hours ago

.s sudden onset or gradually onset+ 2udden

Any injury+ No

.s the first time+ /es

(ow se#ere is the pain on the scale 1 to 1;+ <=8 out 1;

(a#e you used any medication to relie#e pain+ No

0oes the pain tra#el to other part of body+ No

Anything ma!e this better or worse+ 0o not !now

Apart from pain, any other symptoms+ 7omiting twice, no blood or mucus

(a#e you found any lump+ No

*hat about water wor! or bowel motion+ Normal

(ow is his general health before+ 7ery good

Any complications from pregnancy or deli#ery+ No

.s his immuni-ation up to date+ /es


GA" no pallor or jaundice but patient in pain

7ital signs" all normal

As! e)aminer focused on abdominal" no mass or distension, low abdominal

discomfort but not pain, tummy is soft, no organ enlargement.

Groin area" normal

2crotal" no redness, no tender

2o . as!ed testis" then e)aminer said" right testis is tender and swelling

his is torsion of testis, emergency case if lea#e it untreated could be dangerous

Admit to hospital

2urgical treatment within 8 hours

Fi) two side to pre#ent further recurrent

Pain !iller
Father as!ed"

0oes it will affect his se)ual life in the future+ No, if we treat early

*ill he be infertility in the future+ No, if we treat early

*ill it happen again+ ,loud be, so that is why we need to fi) two side
3)aminer did not as! any %uestions
AMC feedback: !orsion of testis (passed
Breathe holdin" attack 9e)actly same as pre#ious recalls:
An an)ious father came to 30 concerning about his $=year=old son?s condition. (is son
was crying and lost consciousness for few seconds after his finger has been injured by
the car door. 0uring this time, his s!in became to blue and his two hands were twisted.

ta!e rele#ant history from the father

0) and e)plain to the father


*hen did this happen+ A few minutes or hours ago

(ow long did he loss the consciousness+ A few seconds

(ow did this happen+ (e injured his finger in the car door

0id he bite his tongue or wet pants+ No

*as he well before this happen+ /es

.s this the first time+ /es

Any fe#er recently+ No

Any complications from pregnancy or deli#ery+ No

Any head injury before+ No

Any se#ere infection after deli#ery li!e meningitis+ No

(ow is his general health+ 7ery good

Any family history of epilepsy+ No


his is called breathing hold attac!, not a epilepsy and this will not cause any brain
damage. hen . see e)aminer gi#e me a big tic!

his could happen again, ne)t time" clear surrounding sharp objects, do not put
fingers to his mouth and put him on his side, if this longer than @ minutes call ;;;

his %uite common for child at this age, do not worry, it will go away when they
grow older, please do not punish him or award him
Father as!ed"
*ill it happen again+ /es
3)aminer did not as! any %uestions.
AMC feedback: Breath holdin" attack (passed
# $ %
Meconium &tainin" 9similar as A>, boo! case 1$@ but modified:
$@ years old primigra#ida in early labour with greenish and stic! li%uid out, the
pregnancy is o#er date. Pregnancy up to now was une#entful, GA2 of #aginal swab at
&' * was positi#e.

Bele#ant history

P3 from e)aminer


*hen did water brea!+ (alf hour ago

0o you ha#e any abdominal pain+ /es

.s this li!e contract+ /es

(ow often do you ha#e this+ 3#ery &=' minutes and last for '@ seconds

Any #aginal bleeding+ No

*hen will be the due date+ 4ne wee! ago

(ow about baby !ic!ing+ Normal


GA" normal

7ital signs" normal

As! e)aminer focus on abdomen" fundus height is &' cm, baby presentation is
cephalic, baby heart sound is 1&; beatCmin.

7aginal e)am" to e)clude cord prolapse 9=:, baby head at ; station, the cer#i) is &
cm dilated

. tal!ed e)actly as A>, boo! but . forgot to mention GA2

he role player as!ed me Ddoctor, do you thin! my water is greenish due to

bacteria infection+E

2uddenly, . rechec!ed the stem and said Dyes, . noticed that your #aginal swab at
&' w was positi#e, it will not cause the water colour is green and no harm for
yourself but it could be danger for your baby if #aginal deli#ery. Now your water is
bro!en, so we will start AA4 for you, are you allergic to anything+ Patient said"
No. hen . said we will start penicillin for you

3)aminer said" you finished your tas! and you can go out
AMC feedback: Meconium stainin" (passed
Primar' amenorrhea 9similar as A>, boo! case &8 but modified:
18 years old girl ha#e not started her period yet and she is #ery worried about this. GP

As! rele#ant history

P3 from e)aminer



3#erything was same as A>, boo!, the only differences were her breast and pubic
hair start grow when she was 11 or 1$, she does not !now when her mother had her
first period, and e)aminer told me that she is thinner.

. as!ed her" can you tell me what is your A>.+ 18

hen . as!ed" recently, ha#e you loss weight+ 4r you always li!e this+ 2he said"

. still as!ed" how is your diet+ 2he said" #ery healthy

*hat do you mean #ery healthy+ 0o you eat red meat or fish+ 2he said yes.

0o you do e)cessi#e e)ercises+ . li!e bas!et ball but always play as usual

hen . e)plained to her" usually, the period should be coming $ or & years after the
breast or pubic hair growth, but it can be indi#idual, you do not !now your
mother?s first period age, may be she is also late so could be family reason. /our
A>. is 18 and a little bit lower than normal range" 1F to $@, but you always li!e
this and recently you did not loss any weight, your eating is good and no e)cessi#e
e)ercises. .t is not caused by eating disorder. 2o we can wait for another one year,
today . will order some tests 9ordered e)actly as boo!: to confirm my diagnosis. .
will re#iew when . get the results. After one year, if your period still not comes
please come to see me, . will rechec! your hormone le#el and refer you to a
specialist. .s that o! with you+

3)aminer said" you finished your tas! and you can go out
AMC feedback: Primar' amenorrhoea (passed
Abdominal pain ( PID 9this is my last station and . did #ery badly, . totally forgot that
this is station 11 and it should be 4GG station, . thought it was medical or surgery
A $@ y.o woman comes to the A G 3 department complaining of acute abdominal pain
on the right lower abdomen.
)our task is to:
91: a!e a focused history.
9$: As! physical e)amination findings from e)aminer.
9&: 4rder necessary in#estigations
9': 0) and >)

*hen did it start+ wo days ago

(ow se#ere is the pain+ 6=< of 1;

*here is the pain+ 1mbilical and right lower illic fossa

0oes the pain tra#el to other part of body+ No

(a#e you ta!en any medications+ No

.s the first time you ha#e this+ /es

*hen the pain started+ 2tarted at umbilical and lower abdomen and constant there

Any thing ma!es this better or worse+ No

Are you se)ual acti#e+ /es

Are you in stable relationship+ Hust ha#e a new partner a few days ago 92tupid
me, . did not as! how many partner before and any #aginal discharge:

(a#e you e#er had P.0 or 2.0 before+ No

*hen was your last period+ & wee!s ago

.s there any possibility you are pregnancy+ 0o not !now 9did not as!
contracepti#e method:

Apart from pain, any other symptoms li!e nausea or #omiting+ Feel nausea and
#omited one or twice

Any fe#er+ Feel hot but did not chec! temperature

*hat about bowel motion or water wor!+ Normal

Any colour change in stool or urine+ No

(ow is general health before+ Good

Any surgical treatment before+ No

Are you allergic to anything+ No


GA" normal

7ital signs" &<.@ otherwise normal

As!ed e)aminer focused on abdomen" no mass and distension, tenderness in

umbilical and B.F, no rebound pain and tummy is soft. Percussion is normal and
bowel sound normal. >acAurny point pain 9do not !now:.

PB 9=:

2tupid me, forgot to as! #aginal e)am

ell patient 00)"


3ctopic pregnancy


4#ary cyst torsion or rupture


Benal colic

. will do .n)" FA,, 1rine dipstic!, urine pregnancy test, did not mention 2.
screening at all
3)aminer as!ed me >)"

Admit to hospital

.7 gi#e AA4

Pain !iller

Be#iew by surgeon 9. belie#ed this is a surgical station:

3)aminer was not happy and as!ed me out, . !new . will fail this station.
AMC feedback: Abdominal pain (lo*er (failed Not surprise
Ps'chiatric (totall' t*o ne* cases
Case I
2e#ere depressi#e patient had been in#oluntary admitted hospital before. his time, she
has been #oluntary admitted into hospital. 2he will need 3, treatment. 2he gi#es her
son consent to tal! with you. Forgot is a hospital setting or GP setting. 9here is an

al! with the son about 3, indication, ad#antages, disad#antages, procedure

Answer his concerns

After greeting with the son, . mentioned that from the stem your mother has gi#en
you the consent to tal! with you, he said yes

(ow will . help you today+ >y mom will ha#e 3, treatment, what is the
indication for this+

.ndications" se#ere depression, acute psychosis, and medications not wor! well

*hat are ad#antages+ Iuic!, effecti#e

*hat are disad#antages+ . am sorry, . am not a professional in this area can . loo!
up to my medical boo! then get it bac! to you+

(ow will it be done+ 2orry again, . do not !now but . can loo! up to my medical
boo! then get it bac! to you+

.s it safe+ /es

Aefore this, does the patient need sedation+ /es

,an my mom gi#e consent to do this+ *e will assess her capacityJ if she has
insight and adjugement, she can gi#e the consent.

his time, she has been #oluntary admitted into hospital, can she gi#e the consent+
.f it is a case, she ha#e the insight so she can
AMC feedback: EC! procedure, indications and effects (failed
Case II
GP clinic, one of your patient feel depressed for %uite long time but she does not ha#e
any sucial idea.

a!e history for 6 mins

3)aminer will as! what is the cause of her problem


Greeting with the patient

(ow are you feeling today+ Not happy and the patient read her stem for about half
or one minute

(ow long ha#e you felt li!e this+ Ne#er happy before

(ow is your mood+ Not good

*hat about your sleep+ 4!

(ow is your appetite+ 4!

(a#e you lost weight recently+ No

(ow is your home going+ Not good

*hat do you mean not good+ (ow is relationship with your husband+ *e li!e

Any conflict or financial problem+ No

1sually, how often do you and your husband tal! to each other+ Not often

*hat about your !ids+ (ow many !ids do you ha#e+ &

(ow is the relationship with your children+ hey mo#ed out+

*hen did they mo#e out+ $ years ago

(ow do you cope with this+ . feel empty

(ow does your husband cope with this+ (e coped #ery well, he has lots of mates

*hat do you do for li#ing+ . am a housewife

. understand that you feel not happy, ha#e you e#er thought the li#e is not worth
li#ing+ No

0o you ha#e any thought to !ill yourself+ No

Are you a ner#ous person+ No

0o you worry a lot other people not worry about+ No

*hen you feel not happy, ha#e you e#er had heart beat fast or sha!ing+ No

(a#e you e#er feel that you will loss control when you lea#e home+ no

0o you smo!e or drin! alcohol+ No smo!er but drin! sometime, not increase drin!

At this time, e)aminer as! me to tell what is the cause of her problem

. said that . understand you feel not happy, you and your husband not tal! often,
may be this is your problem. 0o you ha#e any friend to tal! with+ No

Aell rung

After the e)am, . tal!ed with other candidatesJ they said this lady had hysterectomy
1; years ago, no se) with her husband after the surgery. 2he immigrate to Australia
when she was young and she has no friends
AMC feedback: +oneliness (passed
Ph'sical exam
,ip exam
'6 years old man with right hip pain for 6 months
as!" do e)am 9no history ta!en:

Gait" patient wal! with limping at the right leg with wal!ing aid

redenlenberg test" positi#e on the right side

.nspection" right leg with fle)ion posture

Palpation" pain on the inner side of right leg

>o#ement" limitation on all mo#ement

homas test" fi)ed fle)ion on the right side

ell e)aminer" this is 4A, e)aminer as! 00" . forgot

3)aminer also as!ed" is there any other e)am+ . said power, refle) and sensation"
all normal. Any thing else+ . said that . finished so e)aminer said go out

Aut just when . close the door, suddenly . remember . did not measure the leg
length 9 feeling was so bad, . want to hit myself :
AMC feedback: %ait and hip examination (passed
-espirator' exam
@;=6; years old man who has smo!ed for many years, he smo!ed 1@ = $; cigarettes
e#ery day.
as!" do e)am 9no history ta!ing:

After physical e)am, . said this patient ha#e ,4P0

3)aminer as!ed what you will do for the patient. . said lung function test. (e was
not happy, and as!ed bedside test, then . said spirometrey. (e was still not happy
and said bedside lung function test. . said pea! flow meter.

After the e)am, the morning candidate told me that they had been as!ed to let the
patient to blow the pea! flow meter
AMC feedback: -espirator' examination (passed
IBD 9e)actly same as pre#ious recall:
$@ years old computer analysis had diarrhoea for three wee!s,


P3 from e)aminer



*hen did it start+ & wee!s ago

.s first time+ No, this is third episode

.s sudden onset or gradually onset+ 2udden

Begarding the diarrhoea, is watery or loose+ Koose

Any blood or mucus in stool+ /es

Any abdominal pain+ 0iscomfort

(ow is your appetite+ 4!

(a#e you noticed any weight loss recently+ /es, lost &=' !g o#er & wee!s

Any fe#er+ Not notice

Any bowel motion change" sometime diarrhoea or sometime constipation+ No

Any eye problem+ No

Any s!in rush+ No

Any joint pain+ No

Any one who you contacted with ha#e same problem+ No

(ow is your general health before+ Good

Any family history of same problem+ No

Any family member is on special diet+ No

Any tra#el history recently+ No


GA" normal no pallor or jaundice

7ital signs normal

,er#ical lymph nodes 9=:

As!ed e)aminer focus on abdomen" 9=:

Kump or lymph nodes in groin area 9=:

PB" blood on glo#e


ell the patient that . understand you ha#e chronic diarrhoea with blood and mucus
in your stool and also weight loss, most li!ely is .A0 91,: but we also need to
e)clude other conditions" infection 9giadiasis:, coelic disease and malignancy

2o . would li!e to order some tests to confirm diagnosis" FA, for anaemia and
infection, 32B and ,BP, stool cultureCmicroscopyCsensiti#e, coelic disease
screening test if positi#e then small bowel biopsy, colonoscopy with biopsy 9role
player as!ed what colonoscopy is +: . said it li!e a telescope through your anus to
big bowel and loo! for any lesion and ta!e some tissue out for confirm diagnosis

Bole player as!ed me if it is .A0, what will be the treatment. Aell rung and
e)aminer said it is not the tas!
AMC feedback: Diarrhoea (recurrent (passed
Infecti.e endocarditis 9e)actly same as pre#ious recall:
'6 years old ba!er who feels fatigue for three wee!s 9when . read the stem, . feel happy
but . pretend not !now this case:


P3 from e)aminer


00) to e)aminer

*hen did this happen+ & wee!s

0oes this start suddenly or gradually+ Gradually

.s it getting better, worse and stay same+ *orse

.s first time you ha#e this+ /es

(ow is your appetite+ 4!

*hat about your mood+ 7ery good

2leep problem+ No

(ow is your appetite+ 4!

(a#e you noticed you lost weight recently+ /es, 1=$ !g

0o you prefer hot or cold weather+ Normal

0o you feel thirsty or want go to toilet so often+ No

Any fe#er+ /es, but did not chec! temperature

Any flu li!e symptoms+ No

*ater wor! or bowel motion+ Normal

(ow often do you do your pap smear+ (alf year ago which was normal

Any abnormal #aginal bleeding+ No

Any bac! pain+ No

(ow is your general health before+ Good

(a#e you done any surgical treatment before+ No 9he he:

Any dental procedure+ $ months ago 9(aha:

(a#e you had any AA4 when you ha#e the dental procedure+ No

GA" loo!s tired but no pallor or jaundice

7ital signs" &8.@ otherwise normal

,er#ical lymph nodes 9=:

,hest 9=:

. want to focus on heart 9 e)aminer smile and said what are you loo!ing for:" heart
beat ape) displacement 9=:, heart sound and any murmur" systolic and diastolic

Abdomen" any mass 9e)aminer as!ed me what mass: so . said that . want to !now
any organ enlargement especially spleen 9yes:

Any lump or lymph nodes in groin area 9=:


ell patient that you had dental procedure two months ago, now you de#elop fe#er,
fatigue and my physical e)am showed high , heart murmur and spleen
enlargement, all support you ha#e infecti#e endocarditis but we also need to
e)clude other things li!e" depression, other infection li!e 1., endocrinology
disease 9 hyperthyroidism or 0>: and malignancy but they are unli!ely

Admit to hospital for in#estigations li!e FA, for anaemia and infection, 32B and
,=reacti#e protein, 1rine anlysis, blood culture, 3,G and echocardiogram

*e will start AA4

3)aminer as! me for 00) so . repeat again

AMC feedback: / of undetermined cause (passed
-eflux 9e)actly same as A>, boo! case 1'$:
AMC feedback: %astro(oesopha"eal reflux (passed
Post operati.e (e)actly same as A>, boo! case 1@;
AMC feedback: Post operati.e (passed
#steoporosis 9e)actly same as pre#ious recall:
GP clinic, <; years old lady who li#e alone came with bac! pain. /ou ordered lumber L
ray showed compression fracture. Aone density scan showed score is =&. but FA,,
32B and other test 9cannot remember: all normal.



*hen did you feel bac! pain+ A few days ago

(ow did it happen+ Any injury+ 0o not !now, but no jury

.s the first time+ /es

(ow se#ere is the pain+ &=' out 1;

(a#e you ta!en any medications+ /es, panadol and it wor!s well

Bole player #oluntary said that . drin! @ cups of coffee e#ery day

0o you smo!e or drin! alcohol+ Pre#ious smo!er but stopped 1$ months ago, no

0o you li!e mil!, cheese or yougut+ No, . cannot tolerant it

0o you physical acti#ity+ No, e#en no gardening

0o you e)posure sun light e#ery day+ No, fear of s!in cancer

*hen was your last period+ 1@ or $; years ago

(a#e you e#er used (B+ No, because no menopause symptoms

(ow often do you do your pap smear or mammography+ (alf year ago, all normal

(ow is your general health before+ Normal

Any family history of ,a or early onset osteoporosis+ >om had osteoporosis when
she was 8;

. e)plained that . understand you ha#e bac! pain for a few days, and we did L ray
showed compression fracture. . also order other tests li!e FA, and 32B normal so
do not suggest malignancy. /our PAP smear and mammography are also normal
which also do not suggest malignancy. he bone density scan score was M & that
suggest you ha#e osteoporosis. 0o you understand what osteoporosis is+ Not really

3)plained what osteoporosis is


start Aiphosphnate 9. saw the e)aminer tic! a bo):

reduce coffee drin! 9 e)aminer tic! again:

stop smo!ing" you did #ery well to stop smo!ing which ma!e a big progress for
your health 9 e)aminer tic! again:

. understand that you do not li!e mil! so . can gi#e calcium supplement

7it 0 supplement to help calcium absorption

0o some e)ercises li!e wal!ing e#ery day $; to &; minutes but not now, when you
do not feel pain

3)posure sun light e#ery day $; minute but not get sun burn

. noticed that you li#e alone, . will as! 4 come to your home to assess the home
situation to pre#ent future fall

Befer to physiotherapist for suitable e)ercises to pre#ent future fall

Are you happy with this+ /es, . am #ery happy

3)aminer did not as! any %uestions

AMC feedback: #steoporosis (passed
In.asi.e breast Ca 9Another terrible case for me, there is an obser#er:
@; years old women came with a lump in the right upper %uadrant breast in your GP
clinic. /ou refer her to do FNA, 9or core+: , the biopsy showed" in#asi#e ductal breast
,a 9grade one:, no axillar' l'mph node in.ol.ed. (comment : I think this is a wrong
assumption that lead to the candidate failing this station need to read scenario

3)plain the result


Greet with the patient

(ow are you feeling today+ An)ious about the result

*hat do you e)pect the result+ 0o not !now but an)ious

Area! bad news" . am afraid that the test result is not good

*hat do you mean not well+

2howed empathy" . understand that you found a lump in your right breast, we did
biopsy which confirmed it is ,a 9 patient is smiling:

.s there anyone come with you+ 9patient still smiling and said no:

*ould you li!e me to call someone come here to support you+ 9Patient had more
smiling, . feel angry888:

0o you understand so far for your condition+ And . draw a picture to show what
the in#asi#e breast ,a is and told her that she will ha#e a good outcome because it
is early stage

. will refer her to a surgeon to discuss the treatment" you might need to remo#e
whole breast. 2he also needs radiotherapyJ chemotherapy or hormone treatment but
she need discuss this with specialist. *e also need do some tests li!e , scan of
your chest and abdomen to e)clude distance mastates 9Comment: Refer to surgeon
to discuss surgery breast conserving ie wide local ecision(and radiotherapy) vs
mastectomy. !nd for sentinel lymph node biopsy. If sentinel lymph node biopsy
positive then will need aillary clearance. "epending on histology and hormonal
receptor status may need chemotherapy or hormonal treatment).

3)aminer was not happy and as!ed me how do you !now the outcome is good+
Aecause the biopsy showed grade one and no lymph node in#ol#ed

3)aminer as!ed how do you no lymph node in#ol#ed, . said that from the stem
9 my brain just not wor!ing, . did not remember before the surgery she need
lymphogarm to detect if any lymph node in#ol#ed at this moment but after . go out
. do remember. his is the second time . want to hit myself:

3)aminer as!ed" (ow to monitor her condition+ . said that mammography, ,

scan of chest and abdomen, e)aminer became angry" she do not ha#e breast, how
do you do mammography+ . ha#e nothing to say then bell rung

After . went out, . felt #ery badly about the e)am and . thought that . will fail this
time. 2o . told to myself at the rest station" just does it as a practice.
AMC feedback: Breast Cancer (failed
Kuc!ily, . passed the e)am.
>any than!s to 0r *en-el for your generous help and support during the preparation
>any than!s to 7>PF long course, . learnt a lot from this course and made many
>any than!s to my study partners, you guys are great8
*ithout your help and support, . could not ma!e this.
After the e)am, . feel this e)am mainly focus on your medical !nowledge. he A>,
boo! is #ery important, e#erything came from it. Please read it many times as you can.
%ood luck0'one