PLAB 2 Mock test feedback:: Counseling-Counseling Medication: Angioedema ACEI :: 1st Attempt

Mock Date: 28/07/2025
Case 1:
Topic: Counseling; Case UID: CounselingMedication19
Case Name: Angioedema ACEI
Action Items:
Practice and Review the case in the OSCE workbench:	Click Here
Watch the (Private) Mock Test Video Recording:	Click Here
Read the Case Blog:	Click Here
Additional Resources:	Click Here
Deep Dive into your (Private) performance below:
Scenario Summary:
Mr. Morty Longfellow presents with facial swelling, likely due to angioedema from Ramipril. The doctor gathers details, confirms the diagnosis, and recommends stopping the medication and monitoring in A&E. The doctor provides clear, empathetic advice on next steps and when to seek further help.
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	Response	Remarks
Data Gathering	Confirm the patient's full name and age	Yes	You asked how the patient prefers to be addressed and confirmed their age. Good start to establishing rapport.
Data Gathering	Open the history with a broad question: “Can you tell me what brought you in today?”	Partial	You said, “I can see from your nose that you have made an appointment…” which is a leading question. A better option would have been “Can you tell me what brought you in today?” to allow the patient to elaborate naturally.
Data Gathering	Acknowledge the presenting concern: Recognise the facial swelling and associated anxiety — “I understand this swelling must be worrying.”	No	You did not explicitly acknowledge the patient's anxiety or empathise with how the swelling may be affecting them. A phrase like “I understand this must be worrying for you” would have helped.
Data Gathering	Elicit a detailed history of swelling: Ask about onset, progression, location, associated pain, triggers, and whether it has occurred before.	Yes	You asked about onset, pain, previous episodes, location, and triggers. All aspects were covered.
Data Gathering	Assess for red flag symptoms: Ask specifically about difficulty breathing, swallowing, hoarseness, dizziness, rash, or chest pain.	Partial	You asked about breathing, swallowing, rash, and dizziness but missed hoarseness and chest pain. Next time, try to go through a quick checklist to rule out all red flags.
Data Gathering	Inquire about known allergies: Ask if the patient has any drug or food allergies that might be contributing.	Yes	You asked this directly and also clarified it later. Good reinforcement.
Data Gathering	Ask about current and recent medications: Specifically confirm use of ACE inhibitors like Ramipril.	Yes	You clearly identified Ramipril, asked about duration and any recent dose change. Well done.
Data Gathering	Screen for relevant past medical history (PMAFTOSA): Include hypertension, asthma, autoimmune disorders, previous episodes of swelling, or hospital admissions.	Partial	You only asked about hypertension. You missed asking about asthma, autoimmune disorders, previous hospital admissions. Try asking a broader PMH question like “Any other long-term conditions or hospital visits?”
Data Gathering	Assess lifestyle factors: Ask about smoking, alcohol intake, diet, and exercise — particularly relevant for hypertension management.	Partial	You asked about smoking and alcohol but missed diet and exercise. You could have asked: “What’s your usual diet and activity level like?” to complete this.
Data Gathering	Explore related symptoms and their impact on daily life.	No	You didn’t explore how the swelling was affecting daily functioning, speaking, eating, etc. Asking “Has this made it difficult to eat, drink, or talk?” would have helped.
Data Gathering	Explore the patient’s Ideas, Concerns, and Expectations (ICE) individually.	Yes	You addressed all three: ideas (allergy), concerns (long-term health), and expectations (find out cause & prevent recurrence). Good ICE elicitation.
Data Gathering	Check vitals, do general physical examination and examine the swelling	Yes	You clearly stated vitals, general physical exam, and urine dip were done. Well structured.
Management	Explain the likely diagnosis of ACE inhibitor-induced angioedema. Name the diagnosis clearly: “Based on what you’ve described, it seems like you may have angioedema, likely triggered by your medication Ramipril.”	Partial	You said “I think you're having a condition called angiitis.” The term is incorrect — the correct term is “angioedema.” You should explicitly link it to Ramipril and name it properly to score fully.
Management	Explain the condition in lay terms: “Angioedema means deep swelling under the skin…”	Partial	You explained it's a side effect of Ramipril, but you didn’t describe what angioedema is in lay terms. This helps patients understand the condition better.
Management	Advise immediate discontinuation of Ramipril	Yes	You clearly stated the need to stop Ramipril immediately. Well done.
Management	Explain need for emergency assessment: “Although your airway is not currently affected…”	No	You missed this entirely. You reassured the patient and allowed them to go home without advising an A&E visit or any airway observation. This is a serious safety issue.
Management	List what happens in A&E: airway observation, vitals, IV access, possible use of antihistamines or steroids.	No	Not mentioned at all. You could have said: “In A&E they will monitor your breathing, give some medications, and keep an eye on you for a few hours.”
Management	ACE-inhibitor–induced angioedema is bradykinin-mediated… consider icatibant if available.	No	This wasn’t mentioned at all. It’s okay to skip specific drug names, but you should’ve acknowledged that standard allergy treatments might not work.
Management	Discuss potential airway management: ENT or anaesthetics may intervene if breathing worsens	No	Not addressed. Even a basic warning like “If breathing worsens, specialists may need to intervene” would suffice.
Management	Offer safe alternative treatment: “We’ll switch you to another antihypertensive…”	Partial	You said a change in medication will be done, but you didn’t specify to never restart ACE inhibitors or mention the alternative (like calcium channel blocker).
Management	Arrange follow-up: Schedule a GP review in 1–2 weeks	Yes	You said “come back in two weeks” — appropriate and clear.
Management	Provide clear advice on when to seek further medical help	No	You didn’t safety net. You should have warned the patient to return if symptoms worsen — e.g., tongue swelling or breathing difficulty.
Interpersonal Skills	Demonstrate understanding and respect for the patient’s feelings	Partial	You acknowledged worry briefly, but didn’t explore emotions deeply or offer reassurance in a comforting way. Try something like “I can see this is making you anxious — we’ll get to the bottom of it together.”
Interpersonal Skills	Acknowledge positive efforts in managing their condition	Yes	You praised his healthy lifestyle and limited alcohol — nicely done.
Interpersonal Skills	Avoid jargon and use layman's terms to explain medical information	Partial	You used some lay terms, but also said “angiitis” which is incorrect and confusing. Avoid incorrect terminology.
Interpersonal Skills	Pause frequently to check for understanding and encourage questions	Partial	You offered to explain, but didn’t actively check understanding or pause during your explanation. Ask “Is that clear?” or “Does that make sense so far?”
Interpersonal Skills	Maintain a professional demeanor while being approachable and kind	Yes	Calm and professional throughout. Good tone, gentle transitions.

	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	1	3