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

Mock Date: 28/07/2025
Case 2:
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 confirmed both the patient’s name and age early in the consultation. Well done starting with identity checks.
Data Gathering	Open the history with a broad question: “Can you tell me what brought you in today?” to allow the patient to elaborate naturally.	Yes	You asked “What brings you in today?” which allowed the patient to start elaborating. Good open-ended start.
Data Gathering	Acknowledge the presenting concern: Recognise the facial swelling and associated anxiety — “I understand this swelling must be worrying.”	No	You never verbally acknowledged the patient’s concern or showed empathy for the facial swelling. A simple statement like “I can see this must be distressing for you” at 1:28:07 or 1:31:33 would have helped show empathy.
Data Gathering	Elicit a detailed history of swelling: Ask about onset, progression, location, associated pain, triggers, and whether it has occurred before.	Partial	You asked about onset, progression, and whether it happened before. However, you didn’t ask about pain or precise location. Try to include all these aspects systematically.
Data Gathering	Assess for red flag symptoms: Ask specifically about difficulty breathing, swallowing, hoarseness, dizziness, rash, or chest pain to rule out airway compromise or anaphylaxis.	Partial	You asked about breathing, swallowing, dizziness, and rash. You missed hoarseness and chest pain. It’s essential to screen fully for airway risk.
Data Gathering	Inquire about known allergies: Ask if the patient has any drug or food allergies that might be contributing.	Yes	You asked this clearly and the patient denied any known allergies.
Data Gathering	Ask about current and recent medications: Specifically confirm use of ACE inhibitors like Ramipril, as they are common causes of angioedema.	Yes	You asked about medications and explicitly clarified Ramipril, including duration and dose changes. 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 confirmed hypertension and previous swelling. But you missed asking about asthma, autoimmune disease, or past hospital admissions. Try to remember the full PMAFTOSA screen.
Data Gathering	Assess lifestyle factors: Ask about smoking, alcohol intake, diet, and exercise — particularly relevant for hypertension management.	Partial	You asked about smoking, alcohol, and diet. However, you didn’t ask about exercise.
Data Gathering	Explore related symptoms and their impact on daily life.	No	You didn’t explore how the swelling is affecting daily activities or self-image, which would be especially relevant since the face is involved.
Data Gathering	Explore the patient’s Ideas, Concerns, and Expectations (ICE) individually to understand their perspective and tailor the consultation accordingly.	Yes	You did a good job covering ICE explicitly and responding to them. Well done.
Data Gathering	Check vitals, do general physical examination and examine the swelling	Yes	You described the physical examination clearly and explained the findings. Good job.
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.”	Yes	You clearly mentioned the diagnosis and linked it to Ramipril. Good clinical reasoning.
Management	Explain the condition in lay terms: “Angioedema means deep swelling under the skin, and one of the known causes is medications like Ramipril used for blood pressure.”	Yes	You explained bradykinin mechanism and clarified it’s not an allergy. Nicely done.
Management	Advise immediate discontinuation of Ramipril: “You must stop taking Ramipril now — it’s likely the cause of this swelling.”	Yes	You told the patient to stop Ramipril clearly and immediately.
Management	Explain need for emergency assessment: “Although your airway is not currently affected, this can change quickly. We’ll admit you to A&E for monitoring.”	Yes	You explained the risk and need for monitoring appropriately.
Management	List what happens in A&E: Include close airway observation, regular vital checks, IV access, and possible use of antihistamines or steroids.	Partial	You mentioned vitals and medications but didn’t explain IV access or close airway monitoring in depth.
Management	ACE-inhibitor–induced angioedema is bradykinin-mediated (not allergic), so standard anaphylaxis treatment may not be effective but is given empirically (adrenaline, antihistamines, steroids) to cover all causes until diagnosis is confirmed; consider icatibant if available.	No	You mentioned steroids and antihistamines, but didn’t clarify that adrenaline is often used empirically or mention icatibant.
Management	Discuss potential airway management: Mention that ENT or anaesthetics may intervene if breathing becomes compromised.	No	You didn’t mention ENT or anaesthetics role in airway compromise. This is key in management of progressive facial swelling.
Management	Offer safe alternative treatment: “We’ll switch you to another antihypertensive — such as a calcium channel blocker — that doesn’t carry this risk.” NEVER restart ACE inhibitors	Yes	You switched to amlodipine and stated Ramipril shouldn’t be restarted. Well done.
Management	Arrange follow-up: Schedule a GP review in 1–2 weeks to evaluate response to new antihypertensive and check for recurrence of swelling.	Yes	You scheduled a 2-week review, appropriate and timely.
Management	Provide clear advice on when to seek further medical help during the transfer and while in the hospital: problems like swelling of the tongue or throat, which can make it hard to breathe	No	You didn’t specifically advise what red flags to look out for and when to seek urgent help. You should’ve said “if swelling worsens or you notice tongue or throat involvement, seek help immediately.”
Interpersonal Skills	Demonstrate understanding and respect for the patient’s feelings.	Partial	You showed basic kindness, but didn’t really validate the patient’s emotional state. A little more verbal empathy early on would’ve helped.
Interpersonal Skills	Acknowledge positive efforts in managing their condition.	Yes	You acknowledged his healthy habits, which is great for rapport building.
Interpersonal Skills	Avoid jargon and use layman's terms to explain medical information.	Yes	You avoided jargon and broke things down well when discussing the condition.
Interpersonal Skills	Pause frequently to check for understanding and encourage questions.	No	You did not ask at any point if the patient had understood or had any questions. This is a missed opportunity, especially after diagnosis explanation.
Interpersonal Skills	Maintain a professional demeanor while being approachable and kind.	Yes	You were calm and polite throughout. Good patient-centred tone.

	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
4	2	2