PE:

1.Scrotal exam

2.Thyroid exam

3.Headache in the stem asking for head examination ( not sure what it was)

4.Unsteady gait ( neuro examination) all the cerebellar signs were positive

10 th may
PE:
Ankle
CLD
Acute Abdomen
Scaphoid fracture

Lic scaphoid fracture pe typical karen

10. Achilles tendonitis pe patient riding bicycle having pain on the foot.
11. Liver pe alcoholic with raised GGT. Liver function assessment and explain the liver status to
patient.
12. Pid PE abdominal exam severe tenderness in lower abdomen and bilateral adnexal
tenderness.hen sclerosis

21 april

A young man with unilateral hearing loss....

Task: do relevant examination and tel him the cause and what you are doing( on otoscopy of
dummy there was cholesteatoma)
10. A young man who was taking anabolic steroid presented with bilateral breast enlargement
Task: 1. Do Examination
2. Tel the patient the cause

2017March

7. Post MVA, exam regard to blurred vision.

Ok trauma case beautiful young girl she had MVA and complained from blurry vision. Tasks- to
check the vision I asked if the patient has any pain. look she sit comfortably, no sob, no change
in conscious then I inspect the head, eye, nose, ear, neck then I explain to her what I need to do.
today I start with VA, Pupil, VF, color vision – all normal. then I hold the ophthalmoscope I asked
to dim the light the examiner said we can't do that then I said I will adjust the light and start
the examination. the examiner said okay examination done. and the finding there. he gave me
beautiful picture of fundoscopy and said read it to me I said here is the nerve, arteries, vein and
fovea all are normal there is no bleeding, no cupping then I said I need to do eye movement the
examiner didn't said anything it was normal too. he said talk to your patient I said look I am
happy all the eye examination went normal but because you have problem in your vision inform
the specialist who will come and check you again and might be do further Invx such as ct scan.
02 March 2017 recalls

PE

1. Scortal examination

Scrotal examination.Acute pain in 22 yrs old .Penile discharge ,Erythema ,tenderness,Prehns

sign positive.Case epidydmitis.Tell the pt diagnosis---credit to Huma nadeem

Non-tender lump on right side of testis for 3 months • Scrotal Exam on dummy + actor next to
dummy • Right varicocele- snail like • Left side- larger testis • DDx & reasons----another one

2. Amuroxis fugax . relevant PE only

3. LMN facial palsy+ otoscopy in a manikin

25 year lady present with repeated ear infection, unilateral deafness Task:Perform Examination
(present findings to examiner) , mention dx explain with reasons
(examiner ask to wear gloves at the start of Examination, unilateral conductive deafness,
external ear normal, ENT clear, tuning fork 256 & 512 provided, Weber laterlization, Rinne
bone>Air, Otthoscope on dummy, but have to tell patient while doing on dummy, pulled ear and
use respective orthoscope used, tympanic membrane not visible, filled with wax like materials,
mention cholesteatoma and wax

Abdomen PE & Dehydration exam

colesteatoma, ear exam

9. 30yr old male with foot painTask: hx, Perform pe with running commentary to patient, Dx
and ddx Pain in top of foot over second and third toe. Worsens as day progresses. Didn't say
whether it was relieved after taking the shoe off. Has joined walking club lately. Test for
Morton's neuroma positive

10. 55 yr with uncontrolled diabetes. Hbaic 11% . C/o burning pain in legs. Task: perform
sensory neurological examination with commentary to patient Most likely dx and ddx
L4-S1 cotton and pinprick lostSole monofilament lostVibration at tibia, Joint position lost 11.
27 yr old female with maculopapular non blanching non pruritic rash in the lower legs. Viral
URTI last week. Task : perform pe with running commentary to examiner Tell likely dx and ddx
to patient Axillary epitrochlear cervical negative Had to check throat with spatula no findings,
Abdomen no organomegaly 12. 55 yr old came after FNAC of right neck lump. Chronic smoker
for a long time. Has noticed some weakness of right hand Task: perform focused upper limb
neuroPerform focused examination to find the cause of the mass
young teen with bilateral knee pain..perfom PE ( Osgood Schlatter’s, pain in tibial tubercles
bilat )
OSD. Positive findings: bilateral tenderness on palpation of tibial tuberosity r>l; bilateral
crepitations on passive ROM.

8- gynecomastia pt using anabolic steriods perform relevant examination

reg case of gynecomastia with anabolic steroid use. Apart from Vitals, abdominal ( central
obeisty, striae, moon face and upper back hump) and breast exam( unilateral/bilateral,
tenderess or no,masses, discharge and FH of Ca) .
Other dds of gynaecomastia: CLD, Drugs s/a anabolic steroids, Digoxin, Cimetidine, etc,
Klinefelter syndrome, testicular tumours
what additional points shall we stress in exam of this pt

9.fall from tree. do upper limb neuro exam and further relevant exam.
10.ear examination
11.Acute abdomen

16 march 2017.

1.Footdrop lower limb examination.

( Common peroneal Nerve palsy, )

1)common perennial nerve entrapment :

pt was strawberry picker noticed pins needles in foot ..

Task=
Examine patient , tell your most likely diagnosis and differentials ..

Positive findings
Patient had foot drop while assessing gait ,inability to do eversion and dorsiflexion , loss of
sensation in the web space between big toe and second toe.

2.Lt side abdominal pain examination

3.Tibia fibula fracture examination 4.Female with 7 wk pregnancy rt side abdominal pain
examination
5.TIA examination with lower limb examination and relavent ex.

5)Tia/stroke physical examination

patient with weakness in right lower leg,upper limb neurological examination and gait normal
and cranial nerves are normal .patient has high blood pressure160/90
Task

physical examination of lower limb and examination of relevant system

Positive findings

tone increased on right side , power decreased on right side , reflexes normal, sensations and
coordination nornal ,, normal examination of heart and no carotid bruit , no Afib.

7)open fracture tibia fibula

post Mva patient .. X-ray given .. patient has bandage on and you are not supposed to remove
it ..vital signs bit deranged but yet stable ..

Task
examine the patient and explain X-ray and tell diagnosis and management .

Positive findings
on inspection= bandage blood stained , patient teary
can only wiggle toes , sensations and circulation normal.

8)acute abdomen physical examination

pt having pain in left iliac fossa ..
Task
physical examination
diagnosis and d/ds

positive findings
1)tenderness right iliac fossa and rebound tenderness .temp=38

9)female patient with pain in right iliac fossa for one week ,now got worse ,, her pregnancy test
is vaguely positive and 7 weeks amenorrhea.

Task
1)physical examination
2)tel most likely diagnosis

positive findings
tenderness right iliac fossa
uterus enlarged and retroverted , adnexa tender ..(CERVICAL EXCITATION /CMT IS NEGATIVE)

17/3/2017
1- Cardiovascular examination
2-Scrotal examination
3-Parkinsons disease exam
11-Colles fracture / ? Buckle # it is # distal end of radius non displaced one. history nphysical
findings from examiner n advice inv n management. Positive findings on examination were
swelling.tenderness painful wrist movement and other pulse and nerves were intact. once u tell
the pt have to do x ray he will provide u the x ray. XR was very clear.

PE :
1.Carpel tunnel syndrome ,PE,and Dx
A factory worker is coming 50 something,with complaint of tingling in hand,so on findings he
gives you decreased sensation on median nerve,prayer sign and reverse prayer sign's
positive,no issue with movements of thumb,

2.CLd inch tape and torch given

An alcoholic is here,he said that he will quit alcohol last time but hasn't been able to i
guess,drinks 8-10 SD daily,do CLD examination and explain what you have found to the patient
in the last.during examination,findings to the examiner.

3.Breast exam right upper outer q mass

same case,but i don't know why the examiner didn't seem happy with my examination.mother
had hx of CA. :-(

4.Ear exam ? Wax ?cholesteatoma

so need to know how to use otoscope.deafness on left ear.

PE :
Carpel tunnel syndrome
CLd inch tape and torch given
( Chronic liver disease
Tape : liver span
Torch : eyes for pupil reaction and kf ring , oral cavity.)
Breast exam right upper outer q mass
Ear exam ? Wax ?cholesteatoma
1. PE.
Peripheral Neuropathy.
Hb A1C and B12 normal.
Positive Alcohol plus macrocytosis in history.
Task. PE
Diagnosis. Roomberg plus all sensations lost over both feet.
Said Alcohol Neuropathy.
2. Haematological exam.
Young female going for nasal surgery. Had history of low platelets before.
Tasks.
PE. Only pallor was positive.
Explain condition.
I said will do further investigations to rule out the cause.
3. Hyperthyroidism
Nervousness, irritability and restlessness
Tasks.
PE. young pt pretended to give all positive signs of hyperthyroidism.
D/D. Told all D/D of nervousness.
4. Ears exam.
Forgot positive history points. Might be hearing loss and discharge.
Tasks.
Take history all positive for conductive deafness.
PE. Same as for conductive deafness plus dummy showing tympanic membrane like
cholestotoma./ Discharge over TT.
D/D please do tell other d/D as well for conductive deafness.
5 ankle pe - plantar fascitis dint give pain on palpating sole .. on stretching great toe pain to
heel

6 lumpin nat traingle of neck moves with swallowing .. dx ddx

5. Breast exam

Secondary pph - perform examination cause mx

5 ankle pe - plantar fascitis dint give pain on palpating sole .. on stretching great toe pain to
heel

. 21 april
A young man with unilateral hearing loss....
Task: do relevant examination and tel him the cause and what you are doing( on otoscopy of
dummy there was cholesteatoma)
10. A young man who was taking anabolic steroid presented with bilateral breast enlargement
Task: 1. Do Examination
2. Tel the patient the cause
6. Scrotal exam - and causes for swelling ..no pain in scrotal region I said it's not
emergency as u don't have pain if pain that's testicular torsion we say that's
emergency I said varicocele but other friends said it's hydrocele. I don't think u need
investigations if ur concerned I will order ix like tumor markers and Usg and no
biopsy because if it's tumour it can spread to other areas and less likely in ur case
and was asking some hx ques examiner said no hx... and thanked and came out.

7. Cervical spondylosis case- she was lifting heavy things now neck pain.. its like
dds case..hx- Asked her occupation sitting work with system and use hands
more..examination findings examiner said problem with index finger and thumb I said
radial nerve and medial nerve problem and I think they were expecting to tell about
axillary nerve..I didn't say. Explained her cervical spine and pressure has happened
my dds cervical spondylosis, over use injury, occupational and age related I said..
rest ur hand don't place pressure to hand will give u painkillers .. rest ur hand and do
movements of hands where u don't have pain otherwise stiffness can happen..I said
u will be fine I will refer u to specialist .. thanked and came out..

14. Dm neuropathy physical examination.. it was gud..he is type 2 diabetic he is

cooperative.. only cotton , tooth pic were there no monofilament... reflexes
Normal..vibration sense gone completed with upper and lower limbs.Refered him to
podiatrist and diabetic physician because of diabetes u got this symptoms.thanked
and came out.

risperidone induced tremor physical exam case:Do we check for liver disease
stigmata and thyroid,
or
only do parkinson and UL Neurology and at the end will say:
to conclude my examination i want to rule out thyroid and liver causes??????
Ta
6 Comments
don't think thyroid and liver is imp here. Here our main aim is to check Parkinsonism... so leg wheel rigidity, lead pipe
rigidity in hands, glabellar tap, micrographia, gait checking are important. This case, you will see that the patient will
shake his/her hands...H/O resperidon intake...so clear cut DX. Moreover time is a big issue.
Like
· Reply ·
1
· 29 January at 10:52
guys i think u have to rule out all the dd s of tremors

have heard it from people who passed the case

Also check BP for postural hypotension , i think no need to do thyroid or liver , but check which type of tremor this is .
Like
· Reply · 29 January at 15:23

James Chen Focus on tremor examination(to differentiate tremors caused by Parkinson's disease or Parkinsonism by
risperidon , essential tremor, chronic live disease, hyperthyroidism), other than that I think we don't have time to do
it, just mention in the end of PE. Waiting for Drs to add....
Like
· Reply · 1. General Appearance
Masked face – lack of facial expression
Drooling of saliva
Posture – flexed
BMI – usually increased
2. VS: postural hypotension
Can you please stand up, walk, turn and walk again
Cannot change their direction or stop suddenly
3. Gait:: shuffling gait
Lost of arm swing
4. Upper limbs – Inspection look for a tremor
Pin rolling tremor in both hands affecting both
Fine tremor
Flapping tremor
Finger – nose – the tremor disappears
Distract him. Could you wave using your left hand?
Check the power (wrist)
Check for bradykinesia (2 tests)
Twiddling test – with parkinson’s
they will have difficulty
Finger tapping -
Ask him to write his name and look for micrography
5. Face – tremor of the face or the tongue
* Glabellar tap from the back – normal patient will blink once
Those with parkinsonism – will keep on blinking
Weakness in upward gaze –
Eye movement

If you have the time, BSL, Urine dipstick 29 January at 16:11

Also you can perform pool test There will be lack of postural instability ... Which is the Hallmark of Parkinsonism
15. Abdominal pain on left side abdomen..he is a farmer .. in hx he said he have
constipation from long time ..take Laxatives.. no other medications..and asked about
bowel and water works.. fine he said .. any blood in bowels .. only on tissue paper he
said .. any pain he said no.. then I thought about haemorrhoids .. Pefe:she said only
finding is appendicectomy scar and I thought it's a diversion so I didn't ask anything
about it.. I told I am suspecting haemorrhoids as u have constipation and straining
and started drawing diagram telling them I am not gud at drawing he said it's ok dr..
said about diverticulitis and diverticulosis.. told will give painkillers.. have more fiber
diet more water as ur farmer.. don't use more laxatives as u can addict.. I will tell all
my patients natural ways than medications. If it get bad they will do rubber band
ligation I said.He asked me u want to tell me anything said will give u reading
material for all the conditions I explained..he said it will be gud.. will see u in 3 days
meanwhile u have severe abdominal pain or more bleeding come back..thanked and
came back .

a 52 y/o man who goes to bodybuilding center, has come with c/o
large breasts.
Task:
1- explain for the patient the examining steps that you want to do
(then the examiner gives you the result of physical examination)
2- explain the most likely diagnosis and give reasons

11- a worker comes to your GP c/o back pain.started suddenly few

minutes ago after lifting a heavy box.has not have any problem
before.

Task:
1-examine him(with running commentary)
2- explain the most probable diagnosis for the patient
Knee pain 1 month, about 18 yrs old. Task, examination of knee and explanation of diagnosis to
patient. Clarke's test positive Lt>Rt.
Fall on hand 1 month, Initially X-ray normal, pain going on, come for check up. Task examination
hand, explain X rays, further investigations. Got scaphoid findings.
Neonatal examination. Task take history for 2 mins from mother, then examination with telling
mother along the way and explain what you are doing and then summarize to the mother
afterwards.
. Headache in 72 year old gentleman ,
Examination, explain diagnosis to patient - giant cell arteritis

10 may
Young female with pain in one ear for 1 week. Hearing problem on left side. Task: perform PE ,
give commentary, tell Dx n DDX
13. Pt fall on right shoulder now having pain. Task: perform PE, give commentary, tell Dx n DDx
Young male soldier( it is from MCQ handbook stem) Come for routine checkup everything
normal. Task perform urine dipstick, tell result to the patient, Dx n DDx, further investigation u
would do

March

Male, severe abdominal pain, feverish, on general apperance no jaundice, PE... Tenderness over right
hypochondrial and epigastric.. Murphy positive.. No other relevant PE finding
No history just PE, diagnosis and reasons I think

27th April what was this case?

24 y/o man came to GP.has had a mass in his RT testis .your colleague has examined and found that
there is a 3cm mass, tense, you can reach the neck of the scrutom but testis and epididymis are not
palpable. The mass has been translucent on transillumination.
The left testis is normal.
Task: talk about diagnosis with the patient.
5 Comments

Station no 4
PE- 42yr old lady co wilt pain in the left lower abdomen..
I did as usual and give
Dx-diverticulitis
AMC's feedback- abdominal pain - pas
Station no 12
Lady with breast lump/on microgynon 30
Stem provided Full breast examination findings + breast USG
Tasks- 1-explains ur diagnosis
2-Explain further investigations
3-Address concerns about Ca
AMC's feedback- breast lump- failed
tation no 15
Thyroid PE
AMC's feedback-health review- pass
Man with abdominal discomfort (burning sensation)
Did my best
But,
AMC's feedback-abdominal pain-failed
Station no 18 (rest)
25/08/2017(August 25, 2017)

PE
1) Thyroid – features of hyperthyroidism. T4 increased TSH low jittery patient
2) 17yr boy with bilat knee pain more on R. Tender on patella tendon but anterior drawers
positive?
3) Respiratory examination post URTI. Do PEFR (3X was650) Non asthmatic
4) Clavicle # - apply triangular bandage. Xray displaced fracture no pneumothorax.
Management.

28 August 27, 2017 retest

1- Scrotal PE