PLAB 2 Mock test feedback:: : Acute On Chronic Pancreatitis

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Mock Date: 11/08/2025
Case 1:
Topic: Medicine Symptomatic Differentials
Case Name: Acute On Chronic Pancreatitis; CaseUID: BowelIssues12
Action Items:
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Deep Dive into your (Private) performance below:
Scenario Summary:
You are an FY2 doctor in the A&E department. Your patient is a 55-year-old male with a history of diabetes mellitus, presenting with intermittent abdominal pain for 6 months, which has worsened recently. The patient also reports bulky, foul-smelling stools.
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 practising, 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	Confirm the patient's full name and age.	0:08, 0:20	Yes	You asked the patient to confirm their name and age at the beginning, which was clear and well done.
Data Gathering	Acknowledge and validate the patient's emotions regarding their symptoms.	5:24	Partial	You acknowledged the patient’s concern about cancer being a possibility, but more empathetic reflection such as “That must be quite worrying for you” could have helped validate their distress.
Data Gathering	Begin with open-ended questions to allow the patient to describe their symptoms in their own words.	0:23	Yes	You opened the consultation with an open-ended “Can I know what brought you in today?”, which was appropriate and allowed the patient to share freely.
Data Gathering	Explore the pain using SOCRATES to cover site, onset, character, radiation, associated symptoms, timing, exacerbating/relieving factors, and severity.	0:40–2:22	Partial	You covered site, character, radiation, associated symptoms, and exacerbating/relieving factors. However, onset and severity were not clearly explored. Asking “When did this pain first start?” and “How would you rate the pain on a scale of 1 to 10?” would have completed the SOCRATES approach.
Data Gathering	Clarify stool changes in detail — colour, consistency, volume, frequency, floating, and presence of undigested food.	1:42	Partial	You asked about stools, and the patient mentioned bulky, foul-smelling, difficult-to-flush stools. However, you didn’t ask about colour, floating, or presence of undigested food. Consider asking: “Have you noticed any change in the colour of your stools?” or “Do they float or contain bits of food?”
Data Gathering	Ask about associated symptoms such as nausea, vomiting, fever, jaundice, bloating, fever, lumps or weight loss.	1:27–2:51	Partial	You covered nausea, vomiting, fever, appetite, and weight loss, but missed asking about jaundice, bloating, and lumps. A question like “Have you noticed yellowing of your eyes or skin?” could have helped.
Data Gathering	Screen for red flag symptoms — severe sudden abdominal pain, confusion, hypotension, persistent vomiting.	—	No	You missed screening for red flag symptoms. Asking “Did the pain ever come on suddenly?” or “Have you felt dizzy or confused recently?” would have helped.
Data Gathering	Enquire about past medical history — especially previous pancreatitis, gallstones, hyperlipidaemia, diabetes, and any abdominal surgeries.	2:51–3:08	Partial	You asked about diabetes and long-term conditions, but didn’t specifically ask about previous pancreatitis, gallstones, hyperlipidaemia, or surgeries. Consider asking more targeted PMH questions next time.
Data Gathering	Ask about current medications, adherence, and any allergies with the nature of reaction.	3:13–3:42	Yes	You effectively asked about medications and allergies. You also confirmed there were no other medications and that the patient was adherent.
Data Gathering	Inquire about any recent dietary changes or alcohol consumption.	3:45–4:13	Yes	This was explored well. You asked both about general alcohol intake and any recent increase, which was appropriate.
Data Gathering	Perform focused physical examination — vitals, abdominal exam, check for jaundice, dehydration, and abdominal tenderness.	5:40–6:14	Partial	You mentioned examining vitals and the abdomen and stated there was upper abdominal tenderness, but you didn’t comment on checking for jaundice or dehydration. Consider verbalising these findings or intentions.
Data Gathering	Arrange initial investigations — FBC, U&Es, LFTs, CRP, amylase/lipase, blood glucose, abdominal ultrasound.	7:19–7:28	Partial	You mentioned blood tests including lipase and a CT scan, but didn’t mention other tests such as FBC, U&Es, LFTs, CRP, or ultrasound. You can say: “We’ll also check your liver function, kidneys, and do an ultrasound scan.”
Management	Explain the diagnosis of acute on chronic pancreatitis in layman terms.	6:14–7:01	Yes	You did a good job linking symptoms to pancreas function and simplified the explanation.
Management	Discuss the initial management plan including admission and IV fluids.	7:04	Partial	You explained admission and pain control well, but didn’t mention IV fluids directly or the rationale behind admission. Consider saying, “We’ll admit you to give you fluids and manage your pain to prevent complications.”
Management	Start initial management: IV fluids, analgesia, antiemetics, nil by mouth initially.	7:04	Partial	You covered analgesia and antiemetics, but didn’t mention nil by mouth or IV fluids explicitly. Try to verbalise all these components for clarity.
Management	Refer to gastroenterology for cause identification and management of chronic changes.	7:40	Yes	Clear referral plan to gastroenterology was mentioned. Well done.
Management	Order imaging — abdominal ultrasound initially; CT or MRCP if needed.	7:28	Partial	You mentioned CT and X-ray, but didn’t mention ultrasound. Always start with ultrasound unless contraindicated or if CT is immediately indicated.
Management	Refer to diabetes team for glycaemic control review and possible medication adjustments.	—	No	This was missed. You should mention involving the diabetes team since the patient is on metformin and might need adjustment.
Management	Monitor closely: Regular observations including vitals, urine output, and oxygen saturation. Insert NG tube if vomiting is persistent.	—	No	No mention of regular monitoring or NG tube if vomiting persists. You could add: “We’ll also monitor your vitals and fluids closely.”
Management	Assess for exocrine pancreatic insufficiency and consider prescribing PER, pancreatic enzyme replacement therapy (e.g., Creon)	—	No	Not mentioned. In future, say something like: “We’ll also assess how well your pancreas is functioning and may start enzyme supplements.”
Management	Provide lifestyle advice — strict alcohol abstinence, healthy diet, and adherence to diabetes management.	—	No	Missed. You should address lifestyle directly especially alcohol abstinence. This is a key learning opportunity.
Management	Refer to a dietitian for nutritional support.	—	No	Not addressed. Say: “We’ll involve a dietitian to help support your nutrition as your pancreas recovers.”
Management	Safety netting — advise to return immediately if fever, worsening abdominal pain, jaundice, or vomiting develop.	—	No	Missed. You could say: “If you feel worse or develop fever or yellowing of eyes, come back right away.”
Management	Arrange follow-up for diabetic nurse input for education and monitoring.	—	No	This was not included. Important to mention this for long-term diabetes support.
Management	Provide patient education on pancreatitis, managing diabetes and abstaining from alcohol.	—	No	You explained pancreatitis well, but did not provide any structured advice on managing diabetes or abstaining from alcohol.
Interpersonal Skills	Use sensitive and empathetic language throughout the consultation.	5:24	Partial	You acknowledged the patient’s concern about cancer and provided reassurance, but tone and expression of empathy could have been stronger throughout. Try to show warmth, even with short phrases like “That sounds really worrying.”
Interpersonal Skills	Signpost during the consultation to keep the patient informed about the next steps.	5:40, 6:00	Yes	You did well to signpost examination and explain what you were going to do next. Clear and professional.
Interpersonal Skills	Ensure the patient understands the information provided and check for any questions or concerns.	7:36	Yes	You checked understanding after explaining the diagnosis and also asked if the plan was clear. Well done.
Interpersonal Skills	Provide reassurance and support to alleviate the patient's anxiety.	5:24	Partial	You offered support when the patient mentioned cancer concerns, but could be more reassuring overall. Reassure about what you’ll do to help and the availability of further care.
Interpersonal Skills	Avoid medical jargon, keeping explanations in everyday language.	6:30–7:01	Yes	You avoided jargon and used understandable explanations like “organ called pancreas that helps digest food”. Great work.
Interpersonal Skills	Maintain a patient-centred approach, adapting the discussion to the patient’s beliefs, preferences, and priorities.	5:03–5:34	Yes	You asked for patient expectations and responded to concerns thoughtfully. You respected preferences in communication and decision-making.

	Feedback Statements:	Needs Improvement
Consultation	Disorganised / unstructured consultation. Includes illogical and disordered approach to questioning. You did not demonstrate sufficiently the ability to follow a logical structure in your consultation. For example, your history taking may have appeared disjointed, with your line of questioning erratic and not following reasoned thinking. You may have undertaken practical tasks or examination in an illogical order that suggested you did not have a full grasp of the reason for completing them or a plan for the consultation.
Diagnosis	Does not make the correct working diagnosis or identify an appropriate range of differential possibilities.
Examination	Does not undertake physical examination competently, or use instruments proficiently.
Findings	Does not identify abnormal findings or results or fails to recognise their implications. You did not identify or recognise significant findings in the history, examination or data interpretation.
Issues	Does not recognise the issues or priorities in the consultation (for example, the patient’s key problem or the immediate management of an acutely ill patient). You did not recognise the key element of importance in the station. For example, giving health and lifestyle advice to an acutely ill patient.	✔️
Management	Does not develop a management plan reflecting current best practice, including follow up and safety netting.	✔️
Rapport	Does not appear to develop rapport or show sensitivity for the patient’s feelings and concerns, including use of stock phrases. You did not demonstrate sufficiently the ability to conduct a patient centred consultation. Perhaps you did not show appropriate empathy or sympathy, or understanding of the patient’s concerns. You may have used stock phrases that show that you were not sensitive to the patient as an individual, or failed to seek agreement to your management plan.
Listening	Does not make adequate use of verbal & non-verbal cues. Poor active listening skills. You did not demonstrate sufficiently that you were paying full attention to the patient’s agenda, beliefs and preferences. For example, you may have asked a series of questions but not listened to the answers and acted on them.
Language	Does not use language or explanations that are relevant and understandable to the patient, including not checking understanding. The examiner may have felt, for example, that you used medical jargon, or spoke too quickly for the patient to take in what you were saying.
Time	Shows poor time management. You showed poor time management, probably taking too long over some elements of the encounter at the expense of other, perhaps more important areas.	✔️

Data_gathering	Management	IPS
3	2	3