Diet 1/2023

(Collected from telegram groups and candidates)

Station 2 History taking

1. ST 2- young female with diarrhea for 3 months Hx of travel with Thailand 3 and 1/2
months back. Stool - watery and semi solid
2. St2) - C/o chronic diarrhea in a 24-year-old lady. History consistent with celiac and
there was a recent travel history

3. ST 2 - Mr.X is a 50 yr old male has dizziness for 3 days and chest pain. Hx of MI
6 weeks ago. Dizzy spells in pt with recent MI on questioning "SOB, melena, heart
burn"

4. St2 - 45 yr old lady - sudden dizziness, spinning on neck movement, only once
happened today morning, having high stressful job for 20 yrs, having anxiety +
depression, drug only sertraline 50 mg for 1 yr, ..f/h/o-CVD. Her BP - 160/ 90
mmg.... I said, drug induced, Vertebrobasilar ischemia / TIA, cervical spondylosis

5. Station 2-63 old lady complaining of headache..more in the morning.. Past history
of Stoke and weakness. Viva on SOL. (Px with past history of stroke and
depression on treatment with pressure headache symptoms)
6. St 2 History: MG with morning headache

7. St-2 - 47y man with peripheral sensory neuropathy for 4m. Now having wt loss,
loose motion Takes 20units alcohol weekly, H/O unsafe casual contacts, h/o taking
metronidazole 6m back and works in a metal company but no direct exposure.
 Told DD HIV, alcohol. Examiner was unhappy for not exploring metal company job
further.

8. St 2 – fever, loss of weight, loose motion (non-bloody), nausea, vomiting In -Low

WBC, Low plt, raised AST, ALT, Normal pancreatic level …HO renal transplant for
congenital renal ds 20 yr ago now on Tacrolimus, mycophenolate, ? Post tansplant
lymphoproliferative disorder 10 years ago not sure about diagnosis

9. St2 - low back pain due to celiac and post menopause

10. St2. back pain with history of trauma, inflammatory type pain. Ankylosing
spondylitis (History- 30 yr old female, back pain and stiffness, Inflammatory back
pain, buttock pain, no other joint pains history of minor trauma..ph of IBS and
appendectomy. fh of psoriasis in father..using iucd..no other positive data..job
digital marketing maping..discussion about ankylosing percentage of positive
HLAB27 and negative and how job affecting her)
11. Station 2 back pain in 61 years old male, history of chest cancer received
radiotherapy, for last 10 days he is complaining of back pain
12. Station 2 - back pain Ca: 2.2 ALP: 117 (History Mechanical Back pain in 55 yrs old
lady with high ALP and low normal Calcium Inside mechanical back pain with hx
of Uncontrolled celiac early menopause wt loss unbalanced diet wt loss low exp to
sun DD osteoprosis with fracture OA and all TOPS)

13. St 2 Known case of type 1 DM presented with recurrent vomiting (I thought

Addison, later turned out to be gastroparesis)
14. Station 2 - Type I diabetic erratic life style recurrent DKA admission
15. St2----breathlessness, RA,mtx (OHT , Middle aged lady with RA on MTX 7.5mg
weekly coming with exertional SOB for 3/12. She has wheeze too. Both SOB and
wheeze more in the morning. Marked improvement of symptoms with 1 week
course of inhalers. Past hx of similar episode 5 years back, improved completely
with short course inhalers.)

16. station 2 - fever.sweating. wt. loss.lumbs and pumps - discussion on lymphoma

17. St 2 – recurrent fall

18. Station 2 - 25 year/ F smoker - sudden onset giddiness - BPPV /TIA

19. station 2:sabacute thyroiditis

20. St 2 30 year old female with syncope

21. Station 2 45 year old female with intermittent headache since 1 month and panic
attacks and stroke left sided hrniparesis since 6 months

22. St2 Chest tightness in known case of anxiety with glycosuria and erratic rise BP.

23. Hx morning headache feeling Hot if asked there is neck stiffiness "meningitis"

24. Station 2Pt , 50 y , hematuria , Cr 150 mmol FH : adopted , biological father died
at 35 y ( berry’s) DD ADPKD Thin basement membrane GN UTI Cancer Asked
about how frequent u screen for PKD in children I saif if above 20 y - every 3-5 y
25. History- 30 y old male with Episodes of LOC In the histrory no hard evidence for
Seizuers. Gv a history of One episode recover after sweet DD -seizure,
Hypoglycemia, cardiac

26. History 18/12 back delivered since 3/12 weight gain,poor libido,malaise Past
history pph,only once menstruation 10/52 back Dd_shehan
,hypothyroid,pregnancy

27. St2 60 male presented with first partial seizure a week ago

28. St : 2 30 male presented with recurrent collapse in last 8 month Gp did hb : normal
Mcv 102 RBG : 4.2 mol ( normal 3_6)see advise In side recurrent collapse 2- 3
mints with loss of consciousness and sweating some times relieved with sugary
content Alot of stresses in job and home wife has depression Job working in a
factory dealing with machine and driving Stop driving and occupational worker
advise DD : hypoglycemia Alcohol related hypoglycemia because he drink 4 bottle
of whisky a week Conversional disorder Epilepsy Syncope

29. St 2 Outside - Dysphagia and Dysarthria Dx - MG, LEM, MD

30. St2 Scenario mr x with itching for 4 weeks but no rash.only positive findings wt loss
1 Stone in last 3 weeks,night sweat

31. Station 2: chronic cough for 3 month

Station 4 Communication skill

1. ST 4 palliative care with advanced COPD and type 2 DM with empyema and sepsis
(St4: palliative care with advanced COPD and type 2 DM with empyema and sepsis
Any COPD +multiple comorbidities + recurrent admissions +frail person Think about
Palliative care ....)

2. ST 4 - 37 yr old lady known to have psoriasis, and psoriatic arthritis was on

methotrexate since 3 yrs. Before 3 days had UTI and was given trimethoprim
developed pancytopenoa today her cbc shows pancytopenia hb 9 wbc 1.1 plts 30.
My Task is to explain to her what happend and discuss a plan

3. St4 -End stage alcoholic liver disease e renal function deteriorating. Treating team
doesn't think liver transplant would work now. Want to carry on with ongoing mx. No
invasive procedures to be done. .councell regarding resuscitation mx + other
concerns.. (Both british examiners, asked me in one question, do you practice that in
India? I said, i am from Bangladesh Mam, i have no idea what happens in India ,
then they laughed)

4. Station 4.,,Diabetic elderly patient age 80,having hearing issue ,secretary call for
telephonic consultation. Talk with daughter. Daughter tell ,no telephonic call was
received. She wants to take live consultation instead of telephonic one.

5. Station 4 - Explain to pt she has MGUS not multiple myeloma, Mgus patient concerns
of cancer. Now only IgG increased up to 3.4 Dx made MGUS Plan discharge and
monitor Follow up blood test, IG G 3-4 monthly/ first year then 6-12 monthly in next
years
6. St 4 – Covid 19 pneumonia -pt. is post kidney transplant for 10 yrs admitted with mild
covid infection, he is candidate for escalation of management if deteriorated c/o SOB
seen by consultant he is vitally stable spo2 96 % on air pt. is anxious .. talk to him
concerns... *I am worried as i witnessed deaths in the ward because of covid

*Am i going to die?

* Can i live a normal life ... when does this covid will end

*My antibodies for covid are low despite vaccination ... examiner

commented that i should reassure that Ab level normally drop some

duration after vaccination

7. St4) Explain diagnosis of Multiple sclerosis to a medical student

8. St4 lumbar puncture after CT brain normal in case of SAH

9. St4: incidental diagnosis of Lung mass- talk about further Mx plan

Lung cancer with cerebellar metastasis for bronchoscopic biopsy

10. St4----post MI, post PTCA no tiredness and bruisabilty (st 4 common senario of post
pci 2 month ago started on many medications worry about side effect easy bruicing
and tierdness to councel him Patient had MI and presented with frequent collapses
and need for inserting ICD her son says that she is forgetful a lot. Your task is to
check patient capacity.
I think before entering how to check capacity! Check patient if she is able to retain
information given. If she can ways the risks and the benefits for the information given.
 I’ll give her some information an address and phone number to recall later. I will ask
her some social questions about where she lives who she came with what did she
eat yesterday for dinner and today for breakfast
I started as I think, asked her what happened why you’re here today and she told me
they need to put some device in my chest. Then I told her I will explain little more
about your condition and device in simple way. I started explaining that your heart
electricity is not working properly due to the heart attack you had previously and we
need to put device called ICD abbreviation for implantable cardioverter-defibrillator, it
is simply will monitor your heart electric action and if it stopped for longer than usual
it will start to give the heart signal to start immediately.
Now can you tell me what do you understand and recall from what I said. I repeated
the information many times and asked her to recall and give her my address and
phone number where she forgets to give me back. Recall then 6 minutes passed.
Examiner first question
How do you assess the capacity of the patient? I answered as thought, I’ll give him
information to check if she can ways the risk benefit ratio of situation and she can
recall information and ask some social questions to assess her ability to recall.
Second examiner question - What is the ethical issues in this situation? I answered-
Autonomy patient has the right to take decisions for himself, Beneficence to do good
for patient, Non maleficence not to harm the patient, Justice patient has the right to
be treated irrespective of her gander religion or ethnicity.)

11. St 4 – mesothelioma

12. Station 4: DNR and future care plan

13. St 4 Patient diagnosed as ca colon, previously missed on colonoscopy due to

inadequate preparation
67yr old female with COPD and atrial fibrillation came in with distal bowel obstruction
consistent with Colonic cancer. Colonoscopy done 3months prior was inadequately
prepared and consultant requested for a repeat Colonoscopy but the patient was
 never informed and the repeat was not done. The patient is quite upset about the
development.
Task: Discuss with son and further management plan
(Communication- a missed tumour
65 female presenting with bowel obstruction. CT scan shows sigmoid cancer.
LGIE done 3 months ago- poor bowel prep, findings normal, rpt planned-not done
Prior doctor who did endoscopy has left the trust. Ur task is to explain her son the
results and discuss his concerns.)

14. Station 4 ,5 years headache now diagnosed with pheochromocytoma delayed

diagnosis counsel on diagnosis and mx (St4: You are the Dr in MOPC Pt: Mr Ahmad
Ali 42-year old Problem: Delay in diagnosis of Phaeochromocytoma. The patient has
been recently found to have Phaeochromocytoma. He has seen his GP on account
of intermittent hypertension and his GP made diagnosis of panic attack and white
coat HTN and has been on diazepam for 2 years without improvement in symptoms
but other than an ECG and TFT done over the course of symptoms (which were both
reported as normal), he had no other investigations. A recent ECG, ECHO and renal
function test done was essentially normal. However patient had insisted on getting a
2nd opinion to do further investigation and an abdominal CT done revealed a 5cm
adrenal mass with no evidence of metastasis and confirmed to be
pheochromocytoma. He is willing to know if an earlier diagnosis would have made a
difference to his treatment and overall prognosis. He is quite angry about the
perceived delay in diagnosis. Task: explain diagnosis and address the delay in
investigation and other concerns he might have.)

15. St4 Meningococcal meningitis councelling

16. Communication pt on HDU admitted after fits he is cycler and recently took diuretic
Concern about travel

17. Communication- 89 y old patient with mini stroke . Known patient with AF with
recurrent TIA on sub therapeutic level of warfare INR 1.2 Explain the grand sone the
 need for stroke unit admission Other options of anti coagulation Grand son want to
take him home because he afraid that his grandfather will acquire infections from
hospital Other worry is that grand son thinks subtheraputic INR is due to this fault
missing warfarin Other options of anti coagulation

18. St 4 : daughter unhappy as her mother was diagnosed with advanced cancer, she
thinks there was delay in her management ( there wasn’t she presented 2 month ago
with vomiting had endoscopy which showed esophagitis received treatment and
discharged , vomiting didn’t stop so she had a repeat endoscopy which showed
obstruction from out side this time , a subsequent Ct CAP revealed advanced cancer

19. Station 4: 70 yrs old k/c htn and AF on warfarin,, collapsed, found to have
intracerebral hemorrhage,,, INR:1.5 (target 2 - 3)...talk to anger daughter.... Inside:
surrogate wanted to complain the heart doc. For giving warfarin
Examiner:summarize? What will u do next? Will u start warfarin in the future? What
other alternatives? Advantages and disadvantages of novel anticoagulants will we
start warfarin in future??

20. St 4 Active open TB case task advise regarding isolation Pt reluctant because she
want to travel to her sick mom

21. Station 4: Asthmatic, refuse to take steroid inhaler

22. Communication pt after pci refuse his medication because allergic to penicillin and
given to him he lost talk with his wife and address her concern

23. Functional do – dysphagia

24. Station 4 non STEMI had previous allergey from aspirin according to wife (with
questioning was gastritis) explaining to wife and explaining medications

25. Station 4: MND