Now, I would like to share my exam experience. I started with respi/abd station. My respiratory patient was a young, well-built, white man who did not have any respiratory signs except finger clubbing and a chemoport. I struggled while giving differential diagnoses until the examiner reminded me again to look at the questions – “ This patient presented with recurrent, chronic cough.” It was cystic fibrosis, and the chemoport was there as the patient is expected to need multiple courses of antibiotics. There was no time for other questions because I only told the correct diagnosis at the very last minute. 1 examiner passed me while the other failed me in this station. So, bear in your mind the diagnosis of cystic fibrosis when you sit for exam in UK, especially in young patients.
In the abdominal station, I saw a middle age lady who had lapratomy scar and RIF scar. The question was “ This lady presented with diarrhea for 2 weeks”. The only differential that I was thinking was inflammatory bowel disease as there were no other positive signs. I was asked what the 2 scars were for and I tried my luck by saying the patient could have intestinal obstruction and a temporary ileostomy was done which has now been reversed. The examiners seemed happy with the answer and continued to ask me how to assess the patient whether she is in remission. I passed this station.
In the counseling station, I was asked to counsel a patient who was just diagnosed lymphoma and would like to talk to the doctor regarding treatment. There was a hidden agenda – the patient wanted to know if he can still have children after chemotherapy. He only asked me about that when I asked him whether he was married and whether he was planning to have children. I was expected to talk about alternatives including sperm storage before commencing chemotherapy but I did not have enough time. However, when the examiner asked me what should I offer to the patient, I mentioned sperm storage and both the examiners nodded. I got good mark for this station.
The CVS /Neuro station was confusing for me. I thought I got the correct diagnosis for CVS but I did not get good marks, most probably I missed some important findings. The diagnosis I gave was aortic regurgitation and the examiners asked about investigations and management. My neuro station was facioscapulohumeral muscular dystrophy. I found typical weakness for muscular dystrophy with facial weakness but patient did not have winging of scapula. I saw scars at the scapular region instead. I mentioned all my positive findings including the scars and gave a list of differential diagnoses and I told the examiner the most likely diagnosis is FSH. The examiner then asked me why there was no winging of scapula, I told him that a corrective surgery could have been done for the winging of scapula and he said yes. After that, I was asked how to investigate and manage. I scored well in neuro station.
The two station 5 patients were simulated patients. First was a patient with amaurosis fugax and I asked questions to rule out increased intracranial pressure and explained to patient the likely diagnosis and what I would do next. I was only asked about the physical examination that I would do and was not asked to perform. The 2nd patient had symptoms to suggest peripheral neuropathy, he has underlying ankylosing spondylitis as well. I did physical examination for AS but did not get to perform examination for peripheral neuropathy, the examiner stopped me and asked me for differential diagnoses and investigations. After that, he asked me whether I could correlate AS with peripheral neuropathy, I told him I do not know and he accepted it. I still score well even though I did not answer that question.
The history taking station was a bit complicated. There was a lady who presented with generalized swelling, frothy urine and she has history of multiple episodes of chest infection. I could not correlate these two but I told the examiner my differential was nephrotic syndrome/ right heart failure with underlying bronchiectasis. The examiner asked me to correlate nephrotic syndrome and bronchiectasis but I couldn’t. My mark was still quite good despite of that.
Overall my score was not too bad even though I struggled in respiratory station and did not do well in CVS. One point that I noticed is that most patient already received corrective surgery / treatment for their problems in UK. Therefore, the signs might not be very prominent but the scars could give you a clue. Another word of advice is to forget what you have done in the previous station and proceed to the next station with full attention. Last but not least, DO NOT create signs, just tell what you find and try to generate a good list of differential diagnoses; the question itself is also an important clue. Good luck to those sitting for the coming exam and hopefully my experience is useful to some of you.
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