This is a detailed an excellent experiece in plab 2 exam written by a plab exam candidate
- Bimanual Examination
I explained the procedure to the patient and had taken the consent. I had some sensation of cystic swelling at the cervical opening. Palpation of the fornices was also difficult. In my opinion, the uterus was retroverted. I completely forgot about the lubricant or the KY jelly. My examiner was pressing me for the differential diagnosis but the finding at the cervix was occupied in my thoughts. So I was repeatedly telling him about the swelling at the cervix. He was not happy with my answer.
- My experience in next station was meeting with a post partum lady with some kind of depression
She was 4-6 weeks postpartum and visually looking depressed. Anybody could have diagnosed a case of postpartum depression. When I asked further, she was in a mood to commit suicide and harming the baby as well. My recommendation was hospitalization for both of them.
- Art of taking a history of constipation from a nurse
Initially I thought it would be an easy station. Actually during my preparation, I always neglected it and did not practice it so well. Therefore, the net result was always it had to be. My performance was worst there. After the foreword questions, I was having difficulties and was thinking the way out. I maintained silence for about 20 seconds. When I started again, I was trying to exclude malignancies and any emergency condition. I was sure that the effects were due to drugs as the patient was admitted with fracture femur for a long time. He must be prescribed codeine and calcium supplements. But I was having a hard time to ask appropriate questions from a third person to exclude the differential diagnoses. If you can do so, you can expect more marks than merely sticking to a single diagnosis. It is my advice here to practice everything well in advance and not to think to make up in the stage.
- How to talk to a mother of 18 months child with history of epilepsy
The station was a mixed history and counseling type. He gave the history of febrile fit for the first time. As I used up much time to take the history, therefore I had little time to counsel her. I had just the time to explain that it was a simple febrile convulsion and it normally occurs in children. When I said that it was a normal condition and she looked very much surprised. I consumed the stipulated time as I explained her about our next course of action.
- My next station was talking to the daughter of an 83 years old lady who was suffering from CA ovary. We were discussing about pain management in this disease. The lady was sitting comfortably in that room with a pen and paper. She was asking about medications we prescribe during pain management of CA ovary.
- Suture materials
Primarily, I explained the procedure to the examiner, taken the consent but not anesthetized the wound. I was provided with prolene suture and was struggling to make a knot. Add to my bad luck were the instruments. They were not of good quality; needle holder was not locking properly and I was provided with tooth forceps. Finally I gave up and made the knot with my hands. I had the time to make only one suture. As I was leaving the room, I did not forget to drop the needle in the bin placed to discard the sharp objects.
- Speaking to a lady about medications who had a MI 6 weeks back with heart failure
I was not sure about the patient. I managed to realize from the primary questionnaire that she was taking medicines irregularly as she was not reviewed her prescription from the GP after 2 weeks. I preferred to start with general advice. Gradually I explained her about each and every medication. She was keen to know about side effect of all the medicines. I informed her about lifestyle modifications and also told her to control her weight and edema of the legs. At the last stage of the station, I thought that I should inform her about frusemide. So, just before the final bell, I told her to take water pills.
- My next station: Speaking about MMR
I was talking to the father of a child about MMR. He was young and cordial. He had some idea about the vaccine and was speaking continuously. All I had to do was to add some points filling his conversation.
- Convince a lady to stay at the hospital having suspected ectopic pregnancy
It was one of my toughest jobs. She was continuously pleading to get a discharge and my duty was to convince her to stay. I understood her point as she had a job interview, but she was not a case to be discharge. I told her there might be bleeding per vagina and out of that she may die. Could a job be more important than a life? I gave her telephone number and some letters from the hospital. I also inquired about her other children and her family. She was repeatedly pleading to get a discharge. Later, I thought that I should have revealed some facts about infertility and future ectopic pregnancies.
- Clinical examination of a shoulder
Next patient was a Painful Arc Syndrome; at least I had this diagnosis. To my contrary, the examiner was not happy with the diagnosis and pressing me for the differentials. I was informed that the patient had injury to supraspinatous. So I thought it could be tendonitis. It never seemed like simple muscular injury as he was having pain and difficulty in abduction after 90 degrees.
- Examination of respiratory system (PEFR was part of the job)
I failed here and could not able to complete it. I also forgot about percussion of the back side. I missed face during General Physical Examination. But at the last moment when the 30 seconds bell was there, I managed sometime to take 2 PEFR readings.
- Examination of a patient having diabetic foot
I was checking the vibration sense when I heard the 30 sec bell. I thought that I would check the reflexes ideally and asked the patient to stand up and walk. Noting down the gait was so important in this kind of examination. The patient was not having any vibration sense below his ankles. All other sensations and the gait were normal.
- Next station: a lady with abdominal pain.
My next patient was a young lady lying in right lateral position. She placed her hand over the left lumber region and gave the history of radiating pain from loin to groin. She was also having vague complaints regarding her urinary system and some flu like symptoms. I had to take history and discuss the differentials with the examiner.
- Demonstration adult CPR
To my surprise, I did not forget to check my watch before starting the procedure as I always failed to remember it during practice back home. To me, I did not miss anything. As I finished the station, my examiner told me that the next station is rest time. So I kept sitting till the second bell.
- Rest station
- Next station: patient with Temporal Arteritis
I had to examine the patient and inform him about short and long term management. This time I had an Asian examiner. He was nice. My patient was middle aged and understanding. I asked him whether he had any idea about his present disease and informed about it as he was asking about it. Then I told him about high doses of steroids just to save his vision. I also mentioned about long term steroid for 2 years. The examiner was asking about the long dose schedule but I did not remember it. I informed that I would check the BNF.
All my intention to write this article was to share my experiences in PLAB 2. I know, I am not a writer and this article is not well written. But I think it will benefit the new candidates to have a general idea about how the PLAB 2 is conducted.
My best wishes to all aspirants.