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My Experience in PLAB Part 2 OSCE Exam on June 28, 2006

Author: aq2006, Posted on Tuesday, July 11 @ 16:06:54 IST by RxPG  

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PLAB Part 2

1. Bimanual examination (procedure explained and consent taken).

There was a feeling of cystic swelling at the opening of cervix and I found it difficult to palpate for fornices; uterus was retroverted (that is what I think). I forgot about KY jelly. Examiner was asking about Differentials but I was occupied by the cervical finding and kept telling him about cervical swelling. He was not looking happy.

2. Talk to a lady who is 4-6 weeks postpartum with low mood.

I forgot about exact wording of the station. Patient was not making eye contact; she was looking depressed. The history was typical of postpartum depression. But when I probed she was suicidal and having thoughts of harming baby too. So I said baby and mother need admission.

3. Take a history from a nurse about a constipated patient.

Although it looks like an easy station (during preparation I always thought it is easy and didn’t practice it actually) but I performed worst here. After initial few questions I was stuck and was thinking how to proceed? I kept quiet for about 20 seconds and then I started again and tried to rule out emergency and malignancy. I knew it was the effect of drugs write from the beginning (patient was old admitted with FRACTURE of femur? Was on codeine and also calcium supplements) but wasn’t able to find suitable questions to ask from a third person to rule out other differentials (for which you get more marks then the actual diagnosis). So practice every thing, do not think you can do it in exam.

4. Talk to mother of 18 months old child with a fit.

It was a mixed history and counselling station. The history was of first febrile fit. I spent too much time on history so left with very little time to counsel her. I could just explain that it was a febrile fit and nothing to worry (actually I said it’s normal – and she was looking very surprised with the statement). Telling her what to do next time and the time was over.

5. Talk to daughter of 83 years old lady with ca ovary regarding pain management.

She was sitting quite comfortable with a pen and paper in her hand ready to ask every thing about medications.

6. Suture (procedure explained, consent given and wound anesthetized but not cleaned).

They provided with prolene type suture and it was very difficult to make a knot; the instruments were also not very good. The needle holder was not locking properly and they provided toothed forceps (so I kept on struggling with it and finally dropped it and made a knot with my hand). But surprisingly I could do only one suture. But before leaving the room I dropped my needle in the sharp bin.
7. Talk to a lady 6 weeks post MI with heart failure about medications.

I am not sure but I found out from initial questions that she was not taking medicines regularly (she didn’t get her prescription renewed from GP after 2 weeks). So I started with general advice and then told her about individual medications; she was asking about side effects of every drug. While I was telling her about life style modification and telling her to keep an eye on her weight and swelling in legs I remembered I haven’t told her about frusemide, so before final ring I quickly told her that she will also be given water tablets.

8. Talk to father of a child about MMR

Young guy who was very helpful, I think so as he was speaking continuously and you just had to add few points in between.

9. Talk to lady with suspected ectopic pregnancy and persuade her to stay.

Difficult lady, wasn’t ready to stay. She wanted to go for a job interview. Told her she might bleed and even die, and her life is more important than her job. I offered her telephone and letters from hospital. I asked about family and other children. But she was insisting on leaving. I think I should have mentioned about risk of future ectopic pregnancy and infertility.

10. Shoulder examination

To me it was painful arc syndrome. The examiner was not happy and he was asking me differentials. I heard that it was supraspinatous injury, could be tendonitis but it was not muscular injury at all (patients was having difficulty and pain in abduction after about 90 degrees).

11. Respiratory system examination (PEFR was part of the task).

Couldn’t complete it. Forgot about percussion at the back. Missed face during GPE. But at the 30 second bell asked patient to stand up and got 2 PEFR readings before finishing.

12. Diabetic legs examination

Was checking vibration sense when heard 30 sec warning, told ideally I would like to check reflexes and asked patient to stand up and walk (as I was told that gait is very important in this examination). Patient was having loss of vibration sense below ankles. All other sensations were normal and the gait was also normal.

13. Young lady with abdominal pain. Take history and discuss differentials with examiner.

A young lady lying in right lateral position with her hand over the left lumbar region. She gave history of loin to groin radiating pain. Vague complaints regarding urinary symptoms. She had feverish feeling.

14. Adult CPR

Checked my watch before starting CPR (I was always forgetting it during my practice). I think I didn’t miss anything. Just finished it and the examiner told me next station would be rest station so keep sitting till the second bell.

15. Rest station

16. Temporal arteritis; talk to patient about short term and long term management.

Asian examiner but was nice. The patient was middle aged man. I asked him about his understanding of the condition and then told him about the condition as he wanted to know what is it? And then told him about high dose steroids to save his vision and long term steroids for 2 years. The examiner asked about the initial dose and I said I am not sure I’ll check from the BNF. And then the examiner asked about long term dosage of the steroids.

I just wanted to share my experience. Although it's not very well written as i wanted to but may be of some benefit for new candidates.

Good Luck

Note: Originally posted at http://www.rxpgonline.com/postt53634.html. If you find this article helpful, please do share your own experience of the exam as well with RxPG community.

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