PLAB 2 Mock test feedback:: Medicine: Acute Pancreatitis

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Mock Date: 09/08/2025
Case 1:
Topic: Medicine Symptomatic Differentials; Case UID: BowelIssues11
Case Name: Acute Pancreatitis
Action Items:
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Additional Resources:	Click Here
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 man named Joe Moony, presenting with severe upper abdominal pain that started after consuming alcohol. Your task is to take a detailed history, perform a focused examination, and explain the likely diagnosis and management plan to the patient.
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.	00:38	Yes	You confirmed the patient's name and date of birth, but you didn’t explicitly confirm the numerical age — you inferred it from “I’m 55 years.” In the exam, it’s better to verbally confirm both name and age to avoid assumptions.
Data Gathering	Clarify setting and purpose using an open question: Introduce yourself as a doctor in A&E and ask, “Can you tell me more about what brought you in today?” to encourage the patient to describe the issue in their own words.	00:16, 00:48	Yes	You introduced yourself and encouraged the patient to tell you more about what happened, which allowed them to explain the pain’s onset.
Data Gathering	Use SOCRATES method to thoroughly explore the abdominal pain (site, onset, character, radiation, associated symptoms, timing, exacerbating/relieving factors, severity).	00:54–03:08	Partial	You covered site, onset, radiation, relieving factor, severity, and some associated symptoms. You missed character (e.g., sharp/dull), timing pattern in detail, and full exacerbating factors. Next time, make sure to ask these explicitly to complete the SOCRATES framework.
Data Gathering	Screen for peptic ulcer disease: Ask about burning epigastric pain, acid reflux, or indigestion. Screen for cholecystitis: Ask about history of similar pain, especially right upper quadrant pain and relation to fatty meals.		No	You didn’t explore for reflux, indigestion, or relation to fatty meals, and you didn’t check for RUQ pain specifically. This could have helped rule in/out differential diagnoses.
Data Gathering	Rule out any intestinal obstruction: by asking about bowel habits	03:36–03:44	Yes	You asked about bowel habits and confirmed patient passed gas, which is good practice.
Data Gathering	Take full PMAFTOSA history: Past medical conditions, medications, allergies, family history, recent travel, smoking, alcohol use (particularly binge pattern), and previous surgeries.	04:02–05:15	Partial	You covered PMH, meds, allergies, family history, alcohol use, but missed travel history, smoking, and previous surgeries. Including these would ensure a full PMAFTOSA.
Data Gathering	Explore alcohol intake in detail: Ask how much he drank last night, drinking patterns in general, and any previous complications from alcohol.	02:00, 05:02	Yes	You explored both the specific episode and general patterns, plus clarified no known complications.
Data Gathering	Perform focused physical examination: Comment on general appearance (distress), abdominal tenderness, absence of guarding/rebound, negative Murphy’s sign, and check for features of peritonitis.		No	You mentioned examining the abdomen but didn’t verbalise the findings such as tenderness, guarding, Murphy’s sign, or peritonitis. Even if time is short, say these aloud so the examiner hears your thought process.
Management	Explain likely diagnosis in layman terms as acute pancreatitis, relating it to alcohol use and inflammation of the pancreas.	06:04–06:26	Yes	You clearly explained acute pancreatitis, its meaning, and its link to alcohol.
Management	Order blood tests: FBC, U&Es, LFTs, CRP, amylase or lipase.	06:52–06:58	Partial	You said you’d take bloods but didn’t specify the exact tests. In PLAB 2, naming them shows a structured plan.
Management	Start nil by mouth (NPO) to allow the pancreas to rest and reduce irritation.	06:36–06:41	Yes	You instructed no food or drink, meeting this point.
Management	Inform about immediate admission: Explain that he will need to stay in hospital for monitoring and treatment.	07:11–07:13	Yes	You clearly stated the need for hospital admission.
Management	Consider chest X-ray to rule out other causes and request abdominal ultrasound to check for gallstones or biliary obstruction as potential triggers.		No	You did not mention these investigations. Adding them would show awareness of full workup.
Management	Initiate IV fluid resuscitation with isotonic fluids to maintain hydration and perfusion.	06:44	Yes	You mentioned starting IV fluids.
Management	Administer IV analgesia: Start with paracetamol, escalate to opioids like morphine if necessary.		No	You planned pain relief but didn’t specify the drug choice or route.
Management	Give antiemetics to relieve nausea and vomiting (e.g., IV ondansetron or cyclizine).		No	You did not mention antiemetics despite patient vomiting three times — this is a missed opportunity for symptom control.
Management	Monitor closely: Regular observations including vitals, urine output, and oxygen saturation. Insert NG tube if vomiting is persistent.	05:33–05:43	Partial	You planned observations but didn’t mention urine output monitoring or NG tube if vomiting persisted.
Management	Refer to surgical/gastro team for further input and ongoing inpatient management.	07:13–07:19	Yes	You said you’d inform senior team, which fits this point.
Management	Discuss alcohol cessation: Emphasise that stopping alcohol is essential to prevent recurrence and permanent damage.	07:37–07:59	Yes	You discussed alcohol limits and prevention advice.
Management	Explain recovery and follow-up: Most people improve in a few days, but complications are possible and follow-up will include assessment for gallstones, triglycerides, and alcohol cessation.		No	You didn’t explain recovery timeline or follow-up plans beyond hospital stay.
Management	Safety net clearly: Warn about worsening pain, fever, confusion, or vomiting, and when to alert staff urgently.		No	No explicit safety netting advice given — this is a key PLAB 2 expectation.
Management	Provide educational leaflet about pancreatitis, and risks associated with alcohol and the pancreas.	07:59–08:01	Partial	You mentioned a leaflet but were cut off — make sure to deliver or summarise key points before time ends.
Interpersonal Skills	Use sensitive and empathetic language.	00:54, 03:06	Yes	You acknowledged pain, apologised, and showed empathy appropriately.
Interpersonal Skills	Signpost throughout the consultation.	01:49, 05:18	Yes	You signposted when changing topic and before examination.
Interpersonal Skills	Ensure clear and structured communication.		Partial	Your structure was mostly good but some questions jumped around slightly (e.g., PMHx before completing SOCRATES), which can affect flow.
Interpersonal Skills	Provide reassurance and support to the patient.	03:08, 07:29	Yes	You reassured about pain management and hospital care.
Interpersonal Skills	Ask if the patient has any questions or if they would like anything explained again.		No	You didn’t check for patient questions before ending — this could improve patient-centredness.

	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	3