PLAB 2 Mock Test Feedback :: Acute Glaucoma Amitriptyline :: Eye ENT Symptomatic Differentials

Mock Date: 21/12/2024

Action Items:

• Practice and Review the case in the OSCE workbench: Click Here

• Read the Mock Feedback Blog:  Click Here

• Additional Resources: Click Here

• Deep Dive into your performance below:

Scenario Summary:

You are an FY2 doctor in a GP surgery, and your patient is Carol Foster, a 50-year-old lady presenting with severe eye pain. She is wearing dark sunglasses and is reluctant to be admitted to the hospital due to childcare responsibilities. Your task is to take a focused history, assess her condition, and discuss initial management.

My Performance:

🔍Let’s Deep Dive into your performance:

The Domain-wise evaluation shows areas where you did well and others where you have room to grow. 

• A "Yes" means you covered that point effectively

• A "Partial" indicates that you did some of it well but missed some key details. 

• A "No" means there was an important opportunity that wasn’t addressed.

Don’t worry if you see several areas marked "No" or "Partial"—this is common and simply highlights where you can focus your learning. 

By reflecting on these areas and practicing, you’ll be able to improve and feel more confident in your consultations. Remember, every bit of feedback is an opportunity to grow, and you’re on the right path by taking these steps.

Timestamps are provided to show exactly when during the consultation you covered or missed key points. Reviewing these can help you see how well you're managing your time and where you might need to be more efficient in addressing important areas.

Domain	Point	Timestamp	Response	Remarks
Data Gathering	Patient identifiers: Confirm full name and age	0:10	Partial	You confirmed the patient’s name but missed verifying their age. Always ensure you ask for both name and age to confirm identity comprehensively.
Data Gathering	Presenting Complaint: Use SOCRATES for eye pain and ODPARA for red eye	00:20, 00:30	Partial	Asked about pain onset but did not fully explore characteristics, duration, or aggravating/relieving factors systematically as per SOCRATES/ODPARA.
Data Gathering	Differential Diagnosis: Ask about halos around lights to rule out glaucoma	N/A	No	Did not ask about halos around lights. This is critical for ruling out glaucoma. Integrate this question next time to strengthen diagnostic accuracy.
Data Gathering	Differential Diagnosis: Inquire about discharge and contact lens use for conjunctivitis	N/A	No	Missed asking about eye discharge and contact lens use. These are essential for considering conjunctivitis as a possibility.
Data Gathering	Differential Diagnosis: Ask about headache, nausea, and vomiting for cluster headache	0:40	Yes	Covered appropriately by asking about associated headache, nausea, and vomiting. Well done here.
Data Gathering	Differential Diagnosis: Check for recent eye injury for trauma/foreign body	N/A	No	Missed asking about recent trauma or foreign body exposure. Ensure this is routinely included when assessing eye complaints.
Data Gathering	Red Flags: Ask about any vision changes or loss	1:20	Partial	Mentioned vision concerns briefly but did not delve into specific changes or loss. Address this in detail to uncover red flags.
Data Gathering	Past Medical History: Use PMAFTOSA for previous conditions, medications, allergies, family history	00:50, 01:00	Partial	Took medication and family history but did not ask about allergies or previous eye conditions. Apply PMAFTOSA thoroughly next time.
Data Gathering	ICE: Explore patient's ideas, concerns, and expectations	1:40	Partial	Addressed concerns partially but did not fully explore ideas and expectations. Explore all ICE aspects for a more patient-centered consultation.
Management	Immediate Actions: Measure BP, pulse, oxygen saturation, respiratory rate, temperature	N/A	No	Did not address immediate vital sign measurement. Make this a priority in acute presentations to ensure no systemic issues are missed.
Management	Immediate Actions: Conduct thorough eye examination including intraocular pressure	1:00	Yes	Appropriately conducted an eye examination and assessed intraocular pressure. This was well executed.
Management	Provisional Diagnosis: Suspect acute glaucoma and link with Amitriptyline use	2:00	Yes	Correctly linked symptoms to acute glaucoma and amitriptyline. This demonstrated good clinical reasoning.
Management	Explanation to Patient: Define glaucoma and discuss risk factors	2:10	Partial	Provided a partial explanation but missed discussing detailed risk factors and progression. Enhance clarity and ensure the patient understands.
Management	Plan: Hospital admission for specialist evaluation and medications to reduce intraocular pressure	2:30	Yes	Advised hospital admission and medication. Clearly communicated the urgency, which was appropriate.
Management	Plan: Provide pain relief (ibuprofen) and antiemetic (metoclopramide)	2:40	Yes	Addressed symptom management effectively by recommending pain relief and antiemetics.
Management	Long-Term Management: Stop amitriptyline, consider alternatives	3:00	Partial	Mentioned stopping amitriptyline but did not discuss alternatives or long-term follow-up comprehensively. Address these aspects in future cases.
Management	Patient Education: Provide leaflet on acute glaucoma and discuss importance of prompt treatment	N/A	No	Did not provide educational materials or emphasize the importance of prompt treatment. Include this to empower the patient.
Management	Safety Netting: Advise on avoiding dark glasses and driving, notify DVLA	3:20	Partial	Advised against driving but missed discussing dark glasses or the need to notify DVLA. Ensure full safety-netting advice is given.
Interpersonal Skills	Show empathy and understanding of patient's concerns and reluctance	2:00	Yes	Demonstrated good empathy and acknowledged the patient’s concerns effectively.
Interpersonal Skills	Provide clear, simple explanations and reassurance	2:10	Partial	Explanations were partially clear but occasionally used jargon or lacked sufficient detail. Simplify and check patient understanding throughout.
Interpersonal Skills	Address patient's questions thoroughly, including hospital procedures and prognosis	2:50	Partial	Addressed concerns but did not fully explain hospital procedures or prognosis. Take more time to clarify these aspects.
Interpersonal Skills	Explore and attempt to mitigate barriers to hospital admission	3:10	Yes	Explored barriers and suggested solutions effectively. This was well done.
Interpersonal Skills	Ensure the patient feels heard and supported throughout the consultation	3:30	Yes	Maintained a supportive and attentive demeanor. Excellent work here.

Feedback Statement Checklist

	Feedback Statements:	Needs Improvement
Consultation	Ensure a more structured approach and address all points systematically.	✔️
Diagnosis
Examination
Findings	Does not identify abnormal findings or results or fails to recognise their implications​.	✔️
Issues
Management	Does not develop a management plan reflecting current best practice, including follow up and safety netting​.	✔️
Rapport
Listening	Does not make adequate use of verbal & non-verbal cues. Poor active listening skills​.	✔️
Language	Does not use language or explanations that are relevant and understandable to the patient​.	✔️
Time

Additional Remarks

• Data Gathering: Focus on asking systematic, comprehensive questions, especially for differential diagnosis and red flags. Practice integrating frameworks like SOCRATES and ODPARA into consultations for efficiency.

• Management: Ensure immediate actions, safety netting, and patient education are fully addressed. Create a habit of offering written or verbal patient education materials.

• Interpersonal Skills: Work on simplifying language and ensuring the patient understands medical terms. Spend extra time addressing patient concerns and verifying their understanding.