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PLAB 2 History Taking Secrets

PLAB 2 Exam secret methods of history taking   
            

When you have come thus far, I can well guess that you are a doctor from overseas United Kingdom and already cleared the first hurdle of PLAB 1. Now you are entering into the second round of the exam, i.e. PLAB 2, which is also known as OSCE (Objective Structured Clinical Examination). Passing PLAB 2 is not so easy my friend, and yet it is not so difficult either! You must be thinking I am cutting you a joke. No my friend, I am here to help you in passing this test. Being a successful candidate a PLAB 1 and PLAB 2, I felt the urge to help my fellow doctors across the world in clearing the examination with flying colours. There are some secrets which need to be addressed to get a pass mark in PLAB 2. I shall discuss my secrets here.

In PLAB 2, you will have to face the real patients. You will be examined in a way to assess that whether you are capable in eliciting important clinical aspects from the patients. You should be familiar with the common diseases occurring in the UK and have general idea about the epidemiological aspect of the diseases also. It will also be evaluated how you communicate with the patients.

The minimum criterion to pass PLAB 2 is at least 10 ‘C’ with not more than 1 ‘E’ in the entire examination process where C is regarded as marginal pass and E is marked as severe fail.

My first secret will be not to lose your cool in the entire process of the PLAB 2 exam. To pass the exam in a better way, you need to remember the negative aspects of the exam also. This should come in your mind that even if you fail in 4 different stations, there is still a fair chance to pass in the aggregate score. If you consider that your performance was not good in a station, there is another 13 chances to make it brighter. Thinking positive is the only way in passing the PLAB 2. If you continue pondering it over and over again about the dreadful station, there is high chance that you may do more mistakes in the subsequent stations as well. Maintain your focus and you will definitely win.

Let me give you an idea what is considered as ‘Fail’ in PLAB 2.

  • Generally scoring D is considered as fail in any station. But don’t worry; you can still conquer the PLAB 2 even if you score D in up to 4 stations.
  • The poorest performance you can have is an E. It is considered as severe fail. Again there is grading in E. 1 E is considered as pass. Any score less than 1 E is a fail in PLAB 2.

See, it is very difficult to fail in PLAB 2. I mean, to get 4 Ds and 1 E (i.e. any score less than 4 Ds) and 5 Ds or 4Ds with 1 E or 2 Es (you are marked E in a station if you make any gross mistake) is really hard. If you get this petite score, you were never prepared well to sit for PLAB 2 my dear friend.

Let me share my secrets as to how you should take history in PLAB 2. Just go though the lines and you will find the useful ways to take history nicely in a shortest period of time.

I am sure you all know how to take history. You must have also noticed that there is a specific outline to take history. Let me tell you the essential items that you should not miss during history taking –

  • First things first, rule out the life threatening diseases.
  • Ask leading questions about the diseases that are common in the UK. This will help you in making the differential diagnosis. I know, asking leading questions in history taking is not strictly by the books; but you are taking an exam my friend. You can go by the books later when you pass the exam with flying colours.
  • You must proceed in a specific pattern –

Ask about GRIPS

The chief complaints

The duration of the disease

Any other associated complaints

Significant past history (do not bother about single attack of flu 5 years back)

Personal history including history of allergy (never forget to note down this, your examiner will eagerly await whether you miss this)

Any relevant Family history

Any known side effects of medication

Memorise this pattern. This will help you to recap all the points even if you miss any point by any means.

Let me give you a clinical example. This will help you better in memorising the facts.

Case Study:

A 25 years old young lady presented herself to you with headache. Take the history and note down the differential diagnoses.

Again I would like you to refer the pattern I have just furnished. According to the list, the first thing is to be done is to rule out the diseases that may be life threatening. You can well guess the probable differential diagnoses – SOL (Space Occupying Lesion) or SAH (Sub Arachnoid Haemorrhage). Then you should think about the common diseases like diminished vision, migraine, Glaucoma, tension headache and depression. You must take proper history and can ask leading question to elicit the diagnosis.

By asking questions about the life threatening diseases, you can prove yourself to be a safe doctor before the examiner and that will help you in building your impression.

I am giving you what I faced in my exam. One of my patients was an elderly lady having painful menstruation. She was in early menopause and my provisional diagnosis was Menorrhagia. I made my diagnosis with few questions and oh boy, I was relieved. But I had to think about other differential diagnoses also. You know, there is a long list for the causes of menorrhagia. I gave her an open question, whether she wants to tell any other information. She told me – “Doctor, one of my relative has cancer Uterus. Is there any chance I may suffer from this?” Bells was ringing in my head and I asked a few questions related to CA Uterus and CA Cervix (CA Cervix is very common in the UK). I gladly noticed that my examiner was nodding in affirmation and putting a tick mark as I was clarifying the patients to rule out CA.

2. I was supposed to clear out the common d/ds next. By taking epidemiological history you can catch the disease better. I asked about family history of migraine as it is common in the UK than sinusitis. You have only 5 minutes out there for history taking. So better to prioritising the questions and asking only the relevant ones is the better idea. Noting down the duration and severity of complaints will also help you a lot. It will give you an insight to important d/ds. If any patient says the headache he is suffering is the worst in his lifetime, you can easily think of SAH.

3. Next you should ask about any associated symptoms as well. Vomiting is associated with migraine and history of hypertension or injury to the skull is the clue for SAH. Patient suffering from glaucoma will have visual disturbances.

4. The important of past history should not be emphasised much. It gives you vital information to reach a diagnosis. A case of Herpes Zoster will definitely have an episode of Chicken Pox in his childhood. If any patient gives you similar history of headaches in the past, the probability of migraine is high as it is episodic in nature.

5. Personal history like smoking, drinking and drug abuse has to be taken according to the relevance of the disease. The current status of hypertension and Diabetes may be asked. If any person is suffering from long standing unstable hypertension, he be a case of SAH is there is severe headache.

Always ask about any allergy including drug allergy. Allergy is quite common in the UK. You will make an impression before your examiner that not only you practice safe medicine, but you know the subject also.

6. Most of the people are on a medication. Therefore, it is imperative to take history of medication. Please do not ask “Do you take drugs?” as this means whether he is a narcotic abuser. Ask him/ her “Do you take any regular medicines?” If the patient is taking Contraceptive pills for a long time, there is chance of headache. If you miss it, you are missing an important triggering agent of headache.

7. Keep all the psychiatric aspects of the diseases in mind. Let me give you examples – depression can precipitate insomnia, stress can precipitate headache and anorexia may precipitate weight loss.

As you can see from the example mentioned here that following a specific pattern will help you to keep in mind all the important aspects of history taking. It also carries good impression to the examiner and help you in scoring higher grade in exam.

Let us recapitulate the important points of history taking once more. Do not forget three vital points as per given order while calculating the important differential diagnosis as you are offered a station –

  1. First, exclude the life threatening diseases.
  2. Rule out the common differential diagnosis
  3. Proceed in a specific pattern and never forget to inquire about history of allergy and medicinal history.

Lastly, complete your history taking by asking “Is there any other thing you wish to tell me?”

Remember my fellow aspirants, passing history stations with flying colors is not a game of a child. You may get 2-3 such stations in PLAB 2. It may become a nightmare if you don’t know exactly how to proceed methodically. Also remember that history taking is such a station you cannot concoct anything if you have no idea about proper clinical methods. I have seen a few well prepared candidates are getting mental blocks and roam about the relevant questions to be asked.

At the end of this discussion, let me wish you all the best in your PLAB 2. There is nothing better than a hard work and success is not achieved if you don’t have the guts for hard work.

 

 

How to pass MRCP UK part 2 written exam

Hello to all MRCP hopefuls out there. I’ve decided to share with you my experience while studying and sitting for the written portion of the MRCP part 2 exam.

I luckily managed to not only pass the MRCP part 2 exam my very first time sitting for it, but to also achieve a respectable score of about 68%. To put this into perspective, the passing score is 55%. I also managed to achieve this score with only 4 months worth of studying. Here is some of advice based on my own personal experience:

1-What to Read:

At the top of the list of required reading material for the MRCP part II exam is none other than the Oxford Handbook for Clinical Medicine. From my point of view, this book is one of the absolute best books you can use to prepare for MRCP exams as a whole, whether you’re studying for part 1 or part 2. This book actually contains the keys needed to answer many of the exams’ questions. However, it does have a disadvantage, which is its large size that can make it different to memorize for many.

Essential Revision Notes: Of utmost importance for both parts of the MRCP exam. These notes are written in a manner that facilitates memorization and focuses on the key subjects that examiners seem to prefer. Unfortunately, these notes contain a considerable amount of inaccuracies and can’t be considered very up-to-date, particularly when it comes to latest updates in treatment and diagnosis so always keep an eye on other more updated sources when you are reading from this book
Complete Data interpretation of the MRCP: An excellent group of books with phenomenal interpretations.
Radiology for MRCP 2: It is important to realize that approximately 15-20% of the written portion of the MRCP part 2 exam consists of picture-based questions. Over half of these are radiology related, ranging in variety from x-rays to CT scans and even MRI or ISOTOPE SCAN questions. Radiology books in general are rather difficult to study and understand. This book however is easy to comprehend and will help you a tackle a weakness many MRCP candidates seem to have.

Rapid Review of Clinical Medicine for MRCP : Part 2:

While I may not have personal experience using this book in particular, it is highly regarded by many MRCP candidates. It is even considered by many as the most essential book needed to pass the written portion of MRCP part 2 exam. In fact, some of my own personal colleagues have relied solely on this book and have managed to achieve impressive results.

2- Online Tuition Courses:

Recently, online MRCP courses have seen an increased interest for all sorts of candidates. In fact, I personally consider the importance of these courses to be greater than the importance of all the books I’ve mentioned combined. Unlike books which set their limits at 200-300 questions per book, using online courses you will be exposed to an incredibly large bank of questions usually around 2000 to 3000 mcqs. Therefore, these courses will give you a much greater opportunity to study and practice. A second advantage these courses give you is the ability to track your progress compared to other candidates and thus they will help you define the areas where your knowledge needs to be fortified. Never underestimate the importance of the great variety of questions offered by these courses, as MRCP part 2 exams tend to repeat these questions whether with or without modification over the years.
My experience with not one, but two of these courses has been extremely positive. These online courses were onexamination and pastest, with the former offering more in terms of questions likely to appear in the exam.

3- With regards to the picture-based questions in the exam, it is advisable to take advantage of the variety of free medical atlases available online, such as dermatlas that offers several thousand photos you can study. However, it is also advisable not to invest too big a portion of your time in this task because compared to the written questions, picture-based questions pertaining to either radiology or ECG are a minority and answering them doesn’t always depend on having an accurate understanding of the pictures.

4- Last but not least is time management. Proper time management is essential to your success and can make or break your chances of getting though the MRCP part 2 exam. You have to keep in mind that most of the questions are long and take time to answer but you should never take too much time answering a single question while neglecting others. I had to deal with this issue myself and while I ran out of time answering the first paper, I managed to stay afloat for the following two papers by saving the most complicated questions for the very end.

I wish you the best of luck and I hope that sharing my experience will provide future candidates with some important tips to pass the MRCP part 2 exam.

Thank you.

see also

HOW TO PASS MRCP UK PACES Exam

How to pass MRCP UK part 1 exam

How to pass MRCP UK part 1 exam


mrcp uk exam is a huge step in your medical career and it is a difficult exam only if you did not prepare well and it is actually very passable and straightforward  exam if you know how to prepare for it and used the right tools  here is some tips

1- give your self good time for preparation say 4 to 6 months if you are not so busy or 8 to 10 month if are a busy doctor and don’t have ample free time for preparation

2- concentrate your initial reading efforts on philip kalra book (essential revision notes for mrcp) and OXFORD HANDBOOK OF CLINICAL MEDICINE these 2 books in my opinion combined with easterbrook book for basic science is more than enough to study for mrcp uk part 1  and the most important thing you have to notice is that you have to buy the latest editions of these books as you are required to have the latest knowledge  about diagnosis and management not more 18 months before the actual exam date and as for bigger textbooks like kumar and davidson you can resort to it from time to time to clarify some points only.

3- subscribe to one or two online mrcp revision courses and the best ones in my opinion is onexamination.com and pastest courses which have a huge question bank containing thousands of multiple choice questions that covers all aspects of mrcp curriculum  and every question is followed by good explanation and the good thing is many questions is taken from previous exams of MRCP UK part1   and both courses are much better and more comprehensive than all best of five questions books you can find in the market today which is mostly not related directly to questions you will actually have in the real exam

4- in the exam day don’t arrive at exam center so early  i mean like 2 hours or something and don’t discuss exam wi

th any other candidate either before the exam or in-between paper one and paper 2 as this will only increase your nervousness.

here is some useful websites

mrcp uk exam official website

pastest course

onexamination course

good luck for all  MRCP UK part 1 candidates.

how to pass mrcp part 2 written exam

 

 

 

 

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