PLAB 2 Mock Test Feedback :: ENT :: Epistaxis :: Attempt2

Mock Date: 25/06/2025
Case 1 : Attempt2
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	33:54:00	yes	You confirmed her name and age at the start smoothly. Good natural introduction here.
Data Gathering	Acknowledge and validate the patient's concerns about recurrent nosebleeds	34:26, 35:16	yes	You validated her worries multiple times, e.g. “I’m sorry to hear about that” and “It’s understandable how worried you are.” Well done for this natural empathy.
Data Gathering	Clarify the nature of the presenting complaint – Ask the patient to describe the episodes in their own words.	34:09:00	partial	You asked “Would you like to tell me more about that?”, but when she hesitated, you did not rephrase or encourage her to describe in her own words specifically. Next time, if a patient hesitates, gently prompt: “Could you tell me what actually happens when you bleed?” to get the exact sequence in their words.
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.	34:28, 34:51	yes	Both frequency, duration and site were well asked. Clear structured data gathering here.
Data Gathering	Inquire about specific triggers such as cold weather, dry air, or temperature changes.	35:07:00	yes	The patient volunteered winter as a trigger and you reflected on cold air impact later. You could have asked directly about dry air, but overall covered under cold weather mention.
Data Gathering	Quantify blood loss and ask about whether there is blood dripping down the throat.	34:51, 35:19	yes	You quantified streaks of blood and asked about blood dripping down the throat. Good clear questioning here.
Data Gathering	Screen for red flag symptoms – headache, dizziness, palpitations, shortness of breath, fever.	36:07:00	partial	You asked about dizziness, headaches, fever, and weakness, but missed palpitations and shortness of breath. Next time, remember to screen systematically for all cardiorespiratory symptoms to exclude anaemia or significant blood loss.
Data Gathering	Ask about bleeding tendencies – bruising, gum bleeding, heavy periods, or prolonged bleeding after cuts (to rule out coagulopathies).	35:28:00	partial	You asked about bleeding elsewhere but did not specifically ask about bruising, gum bleeding, heavy periods, or bleeding after cuts. Always screen with the full bleeding tendency history to rule out coagulopathies confidently.
Data Gathering	Review past medical and surgical history – especially history of nasal trauma, surgery, allergies, or known blood disorders.	35:54, 36:46	partial	You asked about trauma, long-term illnesses, and blood disorders, but missed allergies and any surgical history. Next time, incorporate “Any past surgeries or allergies I should know of?” as part of your routine PMH screen.
Data Gathering	Explore family history of bleeding disorders such as hemophilia or Von Willebrand disease.	37:14:00	yes	You asked about family history of bleeding disorders. Well covered here.
Data Gathering	General physical examination, vitals and examination of the nose	38:23:00	yes	You stated intention to check vitals and examine the nose. Good integrated examination plan.
Management	Explain the likely diagnosis – epistaxis due to fragile nasal blood vessels aggravated by dry air or trauma.	38:35:00	yes	You explained epistaxis due to fragile vessels aggravated by cold weather clearly. Good structured explanation.
Management	Reassure patient that it’s common and usually not serious unless accompanied by other warning signs.	38:50:00	yes	You reassured it is common and not serious. Clear reassurance provided.
Management	Demonstrate first aid steps: pinch soft part of nose, lean forward, hold for 10-15 minutes, and use a cold compress.	39:32:00	partial	You explained pinching and leaning forward with an ice pack, but missed stating hold for 10-15 minutes specifically. You said "five to ten minutes" which is less than guideline. Next time, emphasise the full recommended duration clearly.
Management	Advise against nose picking and blowing the nose forcefully.	40:02:00	yes	You advised against picking and blowing forcefully. Covered.
Management	Recommend nasal saline spray to keep nasal lining moist.	40:20:00	yes	You recommended saline spray. Good advice.
Management	Suggest petroleum jelly application inside nostrils twice daily during dry seasons.	-	no	You did not suggest petroleum jelly application. Next time, include this as part of conservative nasal care for dryness-induced epistaxis.
Management	Advise use of a humidifier at home during winter or in dry environments.	40:20:00	yes	You advised humidifier use. Good.
Management	Mention nasal cautery (e.g., with silver nitrate) as a next step if conservative measures fail.	40:57:00	yes	You mentioned nasal cautery. Clear escalation plan provided.
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.	41:17:00	partial	You covered duration, dizziness, swallowing blood but did not mention signs of anaemia or bleeding elsewhere. Next time, explicitly include all red flags for thorough safety netting.
Management	Offer leaflets or written material about nasal care and managing nosebleeds at home.	41:38:00	yes	You mentioned giving a leaflet. Good health promotion.
Management	Arrange follow-up in 1-2 weeks for review	41:38:00	partial	You advised follow up in a month but guidelines recommend 1-2 weeks for review, especially if symptoms are frequent. Next time, suggest earlier follow-up for assessment of response to measures.
Interpersonal Skills	Use sensitive and empathetic language throughout the consultation	34:26, 35:16	yes	Your language was warm and validating throughout. Well done.
Interpersonal Skills	Signpost the patient before moving on to different parts of the consultation	36:47:00	partial	You signposted before medical history and examination, but signposting was minimal in other transitions. Next time, use clear signposts like “I’d like to move on to ask about your general health now” to structure flow logically.
Interpersonal Skills	Ensure the patient understands the management plan	39:48:00	yes	You checked understanding well after explaining management. Good practice.
Interpersonal Skills	Provide reassurance and validate the patient's concerns	34:26, 35:16	yes	You reassured and validated concerns repeatedly. Well done.

Feedback Statements:	Needs Improvement
Consultation	Disorganised / unstructured consultation	✔️
Diagnosis
Examination
Findings
Issues	Does not recognise the issues or priorities in the consultation (partial bleeding tendency and red flag screen)	✔️
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 (when patient hesitated describing symptoms)	✔️
Language
Time	Shows poor time management (some elements not covered)	✔️

Data_gathering	Management	IPS
3	3	4