PLAB Part 2 is not a difficult exam!!!

PLAB Part 2

11/28/14, 10:25 PM

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PLAB Part 2 is not a difficult

exam!!!
Author: akanksha (http://www.rxpgonline.com/modules.php?
name=User_Info&file=redirect&member=akanksha), Posted on
Monday, November 28 @ 05:59:39 IST by RxPG
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(http://www.rxpgonline.com/modules.php?
name=Your_Account&op=userinfo&username=akanksha) Yeah! PLAB

2 is not a difficult exam if you know where exactly they are

testing you; and take it from me that this exam tests only how
professional you are.
At this stage of our profession, I think all of us have enough
knowledge to elicit a relevant history and reach a probable
diagnosis. All of us have acquired all relevant skills to perform
basic examination of any system. We had been doing all these
things all these years, and PLAB 2 is just a chance to show off
how good you are at it.
Introduction: The test starts as soon as you enter the cubicle.
The way you have dressed up for the exam, the confidence with
which you walk in, your genuine smile, they way you introduce
yourself to the examiner and shake hands. You get your first
grade here.
The coaching centres usually have their own way of teaching you
this but when it comes to introducing urself, I think all of us have
our own way to do that and I sticked to my own style. Of course,
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PLAB Part 2 is not a difficult exam!!! PLAB Part 2

11/28/14, 10:25 PM

try an avoid using 'Sir' when u greet them. A casual 'Good

Morning Doctor' is a good way to start. I always preferred to wait
for few seconds for the examiner to respond to this,and luckily for
me, all the 15 examiners did respond back and we went further
with checking of my GMC number.
Remember, your station actually starts after this initial intro with
the examiner. Try and avoid the mistake of turning to the patient
directly and starting with your station straight to save time!!! The
examiner needs to confirm first that he is marking the correct
candidate.
After settling with the examiner, you need to turn to the patient
and confirm first that you are talking to the right person. Make
sure u remember the patient's name (esp. the surname). In case
of any doubt, ask the examiner if could have a look at the
question once again, just before you turn to the patient and start
with your station.
Introduction with the patient is slightly different from how you u
introduced yourself to the examiner. Usually the question wud
specify, that you are an SHO in a particular department and u
introduce yourself accordingly.
Introduction with patient is important as these simulators might
sometimes refuse talk to you at all. The logic is, why should
anyone discuss their personal problems with a stranger. The
patient doesnt know who you are till you introduce yourself to
her!!!
Be clear and sufficiently loud throughout the station as the aim is
to get the true and best grade you deserve. The conversation
between you and the patient is intended for the examiner to hear.
1st Station:
My first station was a young 28 year old lady with lower
abdominal pain. The station clearly asked NOT TO EXAMINE, take
RELEVANT history and discuss differential diagnosis with the
examiner.
After checking her identity and introducing myself I started with
how was she feeling today. She went direct on the topic that she
having this pain and pointed at her right iliac fossa. So I went on
asking about the 'pain' history first, then the associated
symptoms. The diagnosis of 'appendicitis' which had flashed in
my mind after her pointing to right iliac fossa, soon disappeared
as no other associated symptoms matched. Rather, on further
probing she gave a positive history of purulent vaginal discharge
and the presence of IUCD as well. She also gave a positive
history of unprotected sex coinciding with the onset of her
abdominal pain. She also had a previous history of 2 abortions in
last one year and a previous history of chlamydia vaginal
infection as well.
I quickly finished up with the entire history taking format,
thanked her and turned to the examiner for the second part of
the question. The DDs I put forth as PID, STD, Mittleschmerz (her
LMP was jus 2 weeks back), Ectopic pregnancy and lastly acute
appendicitis. I also gave reasons of why I thought these as to be
the probable diagnoses. Added that I wud like to do further
investigations, bell rang and me out of the cubicle after thanking
Article Rating
the examiner.

Average Score: 4.76

Votes: 34

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PLAB Part 2 is not a difficult exam!!! PLAB Part 2

11/28/14, 10:25 PM

Long station, I should say! Try and wrap up things fast so that
you finish both parts of the question well within the time
provided. Always, finish the complete format for history taking. It
will always lead to the diagnosis. Dont stick to the first clue the
patient provides (for this station, was the Right Iliac Fossa).
Always expand further thinking of other possibilities depending on
the age of the patient and the nature of pain.
2nd Station:
Here was a patient just after a small attack of myocardial
infarction, ready for discharge. The question clearly stated that
the patient is OBESE and I was supposed to give him advice for
life style modifications.

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Now, post MI life style modification is quite a common station and Related Links
usually we are supposed to counsel the patient on his food habits, GMC Website (http://www.gmc-uk.org)
smoking, alcohol, work, sex, driving as well as medications.
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However, as the question hinted directly at him being OBESE, I
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preferred to focus my counselling accordingly.
After introducing myself with the examiner and the patient and
investing some time over general questions to create a good
rapport, I went on to advise him regarding loosing weight. He
seemed reluctant to carry on with advices I gave him regarding
food modifications and daily exercise regimen. But all I was
supposed to do was to inform him of the benefits of following the
advices and then leave it upto him if he actually wanted to follow
or not. After a quick discussion over obesity, I switched over to
his smoking habits and drinking habits.

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Overall the discussion was good, although very long especially

when the simulator seemed reluctant at every advice I
suggested; but it was nothing different from what we usually
have to face in day-to-day practice.
Also, the most important points in this station were:

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1. Do not forget to give advice on loosing weight. The question

name=NukeWrap&page=http://www.med-ed.virginia.edu/courses/pom1/videos/neuro.cfm)
mentioned that straight! Most candidates who lost this station
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2. Never pester a patient that You SHOULD loose weight (or any
other advice). You can only suggest him of the best possible
options. Leave it on him to choose what he thinks best for him.
Why the simulator was showing reluctance on each n every
advice the candidates were giving him, was only because they
were testing if we know the art of suggesting the patient about
everything we want to, yet not forcing anything on them.

name=NukeWrap&page=http://www.med-ed.virginia.edu/courses/pom1/videos/focused-sexualhist.cfm)

3rd Station:
This was young lady recently diagnosed with Idiopathic epilepsy
and started on carbamezepine. She has come for follow up and
has poorly controlled fits. Talk to her and give relevant advice.
After initial formalities with the examiner and the patient, I
confirmed if she is actually being diagnosed with the condition
and prescribed a medicine. Asked her if she knows how to take it
and if she is actually complying with the directions of her
consultant and taking the medications regularly. Then she came
out with the real problem, that because she is working, she keeps
forgetting to take the medications. I offered her a couple of

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PLAB Part 2 is not a difficult exam!!! PLAB Part 2

11/28/14, 10:25 PM

simple methods to help her with this 'forgetting issue' and told
her the importance of taking the medications regularly.
She also asked if we could change the medications, as the fits are
anyway not controlled. I advised her on this as well and also
ruled out other causes for uncontrolled fits (viz skipping meals,

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less sleep, bright light, watching TV for long, loud music and the
rest).
I finished this one just at 4 30 bell and all three of us sat together

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looking at each other for the next 30 seconds.

4th station:
Here was a young guy and the question said that he had been

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abusing opioid, but now he wants to quit. Talk to him.

I went ahead with the initial formalities and first went in
accordance with the questionnaire to confirm if he is actually
dependent. The usual questions about what he was abusing,
which route, for how long, from where he gets the drug and

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money to get it. He said that he started with sniffing n now he

was injecting direct into his veins. The very next question was, if
he is aware of the needle exchange programme. Thankfully, he
said yes and we went ahead with further questions determining

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tolerance, compulsion and any prob with the law.

Once his dependence was confirmed I talked about the de
addiction centres and how exactly it will help him out with his

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habit. He was happy and I asked if he had any more concerns to

be answered.
Cool station! wrapped up by thanking him and the examiner.

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5th station:
This was a teenager with recently diagnosed with asthma. The
question clearly said that the patient is not aware that he has
asthma. Tell him about the diagnosis and address his concerns.

ARTICLE TOOLS

This was a cool young guy called Sam. I started the main part of
station telling him the cause of his breathlessness and that we
think its asthma and asked him if he knew anything about the

condition. He said yes, but wanted to know more. I explained the PLAB Part 2 section (article-topic-5.html)
Articles by akanksha (modules.php?name=Your_Account&userinfo&username=akanksha)
basic mechanism of the disease and went ahead talking on
allergens and ways he could identify and avoid them. I went
further talking about the type of medications we would put him

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on. Also told him how important is to keep people informed about
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his condition. His main concern was if he would be able to play
hockey as he was joining the hockey team that summer. I told
him that we will have to see how u respond to the medications
and also, if exertion is a precipitating factor for him.
He was happy n convinced towards the end and I myself left the
cubicle satisfied.
6th Station:

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This was the usual telephonic conversation regarding a patient

who had collapsed in the post op ward. He was operated for hemi mode=books&keyword=PLAB&tag=rxpgonline-21)
colectomy in the morning. TPR chart was given and I was
supposed to discuss this with the consultant on phone.

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Traditional station, and I did nothing more than what was taught
at the coaching centre. After confirming whum I was talking to
and introducing myself, I told the consultant about the patient's

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PLAB Part 2 is not a difficult exam!!! PLAB Part 2

11/28/14, 10:25 PM

condition straight from the question, interpreted the TPR chart

and told him about his previous as well as present readings. The
examiner at this point asked me, 'What exactly u think is going
on with this patient?' I talked about my provisional diagnosis with
valid reasons based on the chart provided. Then went ahead with
immediate resuscitation, investigations and informing the theatre
as well the anaesthetist. Wrapped up by requesting him to come
down and have a look at the patient and decide on further
management.
Went smooth! finished just in time!
7th station:
This was a young lady diagnosed who had a cervical smear done
and dyskaryosis (Grade III/IV) was observed. Counsel her
regarding colposcopy and further treatment options.
Went ahead with telling her first about the smear results and told
her why we need to do colposcopy at this point. Went further
describing the colposcopy process and told her about spotting,
and also how we gonna proceed further once her colposcopy
results are available. Talked about LLETZ and further follow up
smears required.
Again I should say, a very familiar station. Tackled the same way
I learnt during my mock tests.
8th station:
Now this was examination of the thyroid. The question also said
to discuss the findings with the examiner as you go ahead with
the examination.
I went ahead first with examination of the gland proper and then
with the general examination. That way I could finish the main
part of question (ie examination of thyroid) with cool head and
also had enough time left towards the end to carry out a fast
general examination.
It was a colloid goitre and lobes were bilaterally enlarged.
For a station like this:
1. Do not forget to tell the patient that u will be going behind him
to carry out the examination.
2. Do not forget to do the special tests to check for
opthalmoplegia, lid lag and exopthalmos.
3. Ask for a stethoscope to ausculate for an bruit. I was provided
with one and I carried out with ausculation and commented that
no bruit heard over the gland.
4.Do not forget to check for tremor, moist hands and pulse rate
while doing general examination. Talk about sleeping pulse rate.
9th station:
This was a young lady with pain in her left elbow. Do relevant
examination, tell the patient about the diagnosis and talk to her
about further management of the condition.
Ufff! I actually hate examination stations. Wish I could escape
from such stations. First thyroid and then this.
Anyway, the lady was quite co operative and gave me hint
straight away about Lateral epicondylitis. I quickly finished up
with the elbow joint examination ending with the special tests.

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PLAB Part 2 is not a difficult exam!!! PLAB Part 2

11/28/14, 10:25 PM

Then we sat and told her about the diagnosis and what exactly it
is. Asked her about her profession and stressed on the
importance of rest. Told her about the pain killers. Asked her that
further treatment would depend on how she responds to this and
we need to see her again in few weeks time to determine whats
best for her.
Short station! Finished quite ahead of time!
10th Station:
This was a middle aged man was posted for herniorapphy.
However, his routine investigations revealed Hb >8 mg/dl. Talk to
the patient and counsel why his surgery needs to be postponed.
This man was not quite happy with the postpontment of his
operation date. I explained about his low Hb, when he asked what
could have caused this. I then took a short history to rule out
causes for anemia in a middle aged man. He didnt give anything
positive in the history which could have explained the cause, so I
went further saying dat we wud need to do some investigations to
find out the cause of his anemia. and then he wanted to know what investigations. I quickly brushed on the investigations and
again stressed on the fact that his anemia needs to be corrected
before we can go on with his scheduled surgery. He was sorta
satisfied towards the end and I wrapped up by asking if he had
any more concerns.
11th Station:
Here was an anxious mother whose baby had a fall and got
unconscious. Take a short relevant history and discuss
management with the mother.
On reading the question, I wasnt really sure whether it was a
head injury station or a station on Non Accidental Injury. I went
ahead as usual and elicited the history ruling out the possibility of
both non accidental injury as well as head injury. Mother told me
dat her baby went 'floppy' after the fall. Next I went ahead with
the management part of the questions and discussed it with
mother.
In this sort of stations it is important that:
1. You carefully rule out non accidental injury.
2. If its head injury, do not forget to ADMIT the baby.
3. Ensure you are as gentle as possible as these simulators are
always tearful.
4. Read carefully, if the question requires you to discuss
management with the patient or with the examiner. One of my
friend lost this station as she went on to discuss management
with the examiner.
12th Station:
Here was a middle aged lady with complaints of diplopia. The
question clearly asked carry out relevant examination and DO
NOT TAKE ANY HISTORY.
Short station! I carried out the examination of III, IV and VI
nerve and complemented it with the examination of the V and VII
nerve as well. The patient clearly showed lateral rectus affection
(Right). I dunno if the question asked to discuss findings with the
examiner but he asked me the diagnosis and probable causes for
such a presentation at this age group. Could list only a couple of
causes when the bell rang and I went out with a relief.

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PLAB Part 2 is not a difficult exam!!! PLAB Part 2

11/28/14, 10:25 PM

13th Station:
This was a manniquin station and we were supposed to do
venepuncture.
I went ahead like any other manniquin station. Everything went
fine till I introduced the needle and kept the vacutainer in position
- NO BLOOD!!! God damn! I could see clearly the channels in the
manniquin were connected with a bag full of some red fluid. I
tried advancing the needle tip a bit, but all in vain!! My vacutainer
was still empty. Gosh!!! am messing up with this station!!!
Decided to withdraw the needle and give a second try. Withdrew
the needle and discared it in the sharps bin, talked about
hemostasis and also the second try. Took a new set of needle n
swipes and went ahead again at a different site. Introduced the
needle, placed vacutainer in position --- but no blood means NO
BLOOD AGAIN!!!! 4 30 bell rang! I disposed off the needle,
removed tourniquet, talked abt hemostasis and told the examiner
that I would tell the patient that I could not complete the
procedure and would come later to try again. I also added, that if,
I would have completed the procedure, I would have labelled the
vacutainer appropriately and sent for investigations.
Thats it!!! Almost ran out of the cubicle at 5 'o' clock bell. :-|
14th Station:
This was Paediatric CPR. The universal precautions were taken
and cervical injury already ruled out. We just needed to go ahead
with the procedure. Went well and smooth!
15th Station:
This was REST!!!!!!!!!!! 6 minutes in a stretch!!!!! Good time to
sit back and relax!
16th Station:
This was again manniquin - Testicular Examination. The question
asked only to discuss findings with the examiner and nothing was
mentioned if we were also supposed to discuss the diagnosis.
There were two examiners in this station (the 2nd one was
observer, I suppose). I carried out with the examination and
described 2 swellings. Went ahead with the fluctuation test and
asked that I would like a torch and transilluminoscope to carry
out transillumination test. No translilluminoscope!! Only pen torch
was provided. So I asked If I could dim the lights and carry on
with the test. Instead of him saying, 'Assume doctor, its done',
the observer went ahead and switched off the light. I carried out
with the test and then discussed the findings. 4 30 bell rang and
then ........OVER!!!!
PLAB 2 over.... what a relief!!!
I was definitely anxious about my results especially after the way
I had messed up with the venepuncture station, but then thank
God that I passed! Still wonder what grade I got for that
station!!!
So good luck to all you folks taking plab 2 in near future. Its not a
difficult exam. Keep your cool and be confident, you will definitely
succeed!
Good Luck!

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PLAB Part 2 is not a difficult exam!!! PLAB Part 2

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