PLAB 2 Mock Test Feedback :: ENT :: Epistaxis :: Attempt1

Mock Date: 25/06/2025
Case 1 :: Attempt 1
Topic: ENT
Case Name: Epistaxis
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:
Miss Lynn Taylor, a 25-year-old teacher, presents with recurrent nosebleeds. She experiences these episodes a few times a month, especially in winter or when transitioning from warm to cold environments. Each episode lasts about 5-10 minutes, with bleeding primarily from the right nostril. She is generally healthy with no significant past medical history or medication use. She is concerned about the possibility of an underlying serious condition and seeks advice on how to stop the nosebleeds permanently.
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	0:00	yes	Well done confirming name and age early. You asked politely and ensured correct identity before history taking, which builds safety and rapport.
Data Gathering	Acknowledge and validate the patient's concerns about recurrent nosebleeds	0:42	partial	You said “I’m sorry about that” but did not clearly validate her worry about frequency and cause. Next time explicitly say, “I can understand this is worrying you especially as it is happening often” to reassure her you take her concern seriously.
Data Gathering	Clarify the nature of the presenting complaint – Ask the patient to describe the episodes in their own words.	0:16	partial	You mentioned “you’ve come in with a history of recurrent nosebleeds, is that correct?” but did not explicitly ask her to describe what happens in her own words. Next time, ask “Can you tell me exactly what happens when you have a nosebleed?” to gain clarity.
Data Gathering	Ask about frequency and duration of each episode to assess severity, Clarify the site of bleeding – whether it's from one nostril or both.	0:25, 0:46	yes	Excellent – you asked about frequency, duration and later clarified which nostril bleeds. Keep up this structured approach.
Data Gathering	Inquire about specific triggers such as cold weather, dry air, or temperature changes.	2:05	yes	Good – you elicited cold exposure as a trigger when she mentioned temperature changes. Well done picking this up and probing further.
Data Gathering	Quantify blood loss and ask about whether there is blood dripping down the throat.	1:00	partial	You asked about how much blood but did not check about blood dripping down the throat. Next time ask, “Do you ever feel the blood going down your throat?” to assess posterior bleeds.
Data Gathering	Screen for red flag symptoms – headache, dizziness, palpitations, shortness of breath, fever.	2:18, 3:15	partial	You asked about fever and breathing difficulties but missed headache, dizziness, and palpitations. Always run through a quick systemic red flag checklist to avoid missing them.
Data Gathering	Ask about bleeding tendencies – bruising, gum bleeding, heavy periods, or prolonged bleeding after cuts (to rule out coagulopathies).	-	no	You did not ask about other bleeding tendencies such as bruising, gum bleeding, heavy periods or prolonged cuts bleeding. This is crucial to rule out coagulopathies. Please integrate it into your systemic bleeding enquiry next time.
Data Gathering	Review past medical and surgical history – especially history of nasal trauma, surgery, allergies, or known blood disorders.	3:46, 4:00	yes	You asked about injury, long-term illnesses, allergies, and blood disorders. Good comprehensive approach.
Data Gathering	Explore family history of bleeding disorders such as hemophilia or Von Willebrand disease.	4:50	yes	You asked about family history of similar issues – well done including this to rule out inherited conditions.
Data Gathering	General physical examination, vitals and examination of the nose	6:20	yes	You planned a general and nasal examination. Ensure you actually perform or describe examination fully in real PLAB stations if required.
Management	Explain the likely diagnosis – epistaxis due to fragile nasal blood vessels aggravated by dry air or trauma.	6:39	partial	You mentioned blood vessels close to skin but explanation was vague and did not include dry air or trauma as aggravating factors clearly. Next time summarise clearly: “This is likely due to fragile vessels aggravated by dry winter air.”
Management	Reassure patient that it’s common and usually not serious unless accompanied by other warning signs.	-	no	You did not reassure her that it is common and usually harmless, which would have eased her anxiety. Always add this to reduce worry unless red flags are present.
Management	Demonstrate first aid steps: pinch soft part of nose, lean forward, hold for 10-15 minutes, and use a cold compress.	-	no	Missed demonstrating first aid. Next time teach step by step first aid as it empowers the patient to manage recurrences effectively.
Management	Advise against nose picking and blowing the nose forcefully.	-	no	You asked about nose picking but did not advise against it or blowing nose forcefully. Always provide this preventative advice.
Management	Recommend nasal saline spray to keep nasal lining moist.	-	no	Missed this. Always recommend saline sprays for nasal hydration to reduce recurrence risk in dry seasons.
Management	Suggest petroleum jelly application inside nostrils twice daily during dry seasons.	-	no	You did not suggest petroleum jelly. Include this practical tip to maintain mucosal moisture.
Management	Advise use of a humidifier at home during winter or in dry environments.	-	no	Missed advising on humidifier use. This environmental modification helps patients prevent future bleeds.
Management	Mention nasal cautery (e.g., with silver nitrate) as a next step if conservative measures fail.	-	no	You did not discuss nasal cautery as the next step if conservative measures fail. Include it to complete your management hierarchy.
Management	Provide clear safety netting – Seek urgent care if bleeding lasts >20 minutes, heavy bleeding, blood in throat, dizziness, or signs of anemia or bleeding elsewhere.	-	no	Missed safety netting completely. Always clearly state when they should seek urgent help to ensure safe care.
Management	Offer leaflets or written material about nasal care and managing nosebleeds at home.	-	no	You did not mention leaflets. It’s helpful to provide written reinforcement of your advice.
Management	Arrange follow-up in 1-2 weeks for review	-	no	Missed arranging follow up. Always ensure continuity of care is addressed.
Interpersonal Skills	Use sensitive and empathetic language throughout the consultation	0:42	partial	Your tone was polite but missed deeper empathy validation phrases when she expressed worry. For example, “I can imagine this must be worrying for you, I’ll try to get to the bottom of it today.”
Interpersonal Skills	Signpost the patient before moving on to different parts of the consultation	3:58	partial	You signposted before system review but could improve by consistently signposting before each major section change. This helps orient the patient better.
Interpersonal Skills	Ensure the patient understands the management plan	7:04	no	You did not confirm understanding of your explanation or plan. Next time ask “Does that make sense to you?” or “Do you have any questions about what we’ve discussed today?”
Interpersonal Skills	Provide reassurance and validate the patient's concerns	0:42	partial	You apologised for the issue but did not clearly reassure her regarding severity or provide a comforting summary. Always integrate reassurance early and at closing to reduce anxiety.

	Feedback Statements:	Needs Improvement
Consultation	Disorganised / unstructured consultation	✔️
Diagnosis	Explanation was vague	✔️
Examination
Findings
Issues	Did not address management priorities adequately	✔️
Management	Did not develop a full management plan with safety netting and follow-up	✔️
Rapport	Missed deeper empathy and reassurance	✔️
Listening	Missed cues about patient worry needing reassurance	✔️
Language	Needs to simplify and clarify diagnosis explanation	✔️
Time	Spent too long on some data gathering without covering management	✔️

Data_gathering	Management	IPS
3	0	2