PLAB 2 Mock test feedback:: Symptomatic Differential Medicine-Suspected Dementia:: 1st Attempt

Mock Date: 09/07/2025
Case 1:
Topic: Symptomatic Differential: Medicine
Case Name: Suspected Dementia
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:
You are an FY2 doctor in a GP clinic. Your patient, Mrs. Margaret Thompson, is a 65-year-old female who is concerned about potential dementia due to recent forgetfulness and her daughter's observations. She has a history of Type 2 diabetes managed with Metformin and a family history of Alzheimer's disease. Your task is to address her concerns, gather relevant information, and provide appropriate management and reassurance.
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	Patient identifiers: Confirm full name and age	0:05	yes	You confirmed her full name and age at the start efficiently. Good initial rapport established.
Data Gathering	Confirm the reason for the visit and current symptoms: 'My daughter thinks I have dementia.'	0:23	yes	You clarified the presenting complaint clearly by asking why her daughter booked the appointment. Good job.
Data Gathering	Explore presenting complaint comprehensively: Ask “Can you tell me more about what your daughter has noticed recently?”	0:40	no	You asked about her daughter's reason but did not directly ask what the daughter noticed recently. Next time, use this wording to elicit specific external observations of decline.
Data Gathering	Explore symptoms: Ask about memory issues, specific incidents, and frequency	1:10	partial	You asked about memory issues and she gave examples, but you did not specifically ask about frequency explicitly. Next time ask, “How often does this happen in a week?” to quantify.
Data Gathering	Ask about onset and progression: “When did these memory issues start, and have they been getting worse?”	3:40	yes	You explored duration (6 months) and worsening (last 2-3 months). Good focused timeline.
Data Gathering	Assess cognitive function: Inquire about difficulty remembering new things, forgetting names, and significant dates	-	no	You asked about general memory issues but did not ask about forgetting names or significant dates specifically. Next time incorporate these to assess semantic and episodic memory domains.
Data Gathering	Evaluate daily functioning: Ask about getting lost, driving, and managing daily activities	-	no	You asked about daily activities broadly but did not ask about driving or getting lost. Next time ask directly about navigation safety and driving competence.
Data Gathering	Rule out reversible causes: Ask about recent infections such as UTIs or chest infections.	5:45	yes	You asked about general health, fever, and headaches. This partially covers infection ruling out. Next time specifically ask about UTIs or chest infections to be thorough.
Data Gathering	Rule out vascular dementia causes: Ask about past strokes, mini-strokes, or cardiovascular conditions.	-	no	You did not ask about strokes or cardiovascular history. This is essential in any cognitive decline case to rule out vascular causes.
Data Gathering	Mental health screening: Check for hallucinations and feelings of depression	1:02	partial	You asked about mood but not hallucinations. Next time ask, “Have you ever seen or heard things that others cannot?” to screen for hallucinations clearly.
Data Gathering	Medical and family history: Confirm past medical conditions, medications, and family history of dementia	2:41	partial	You asked about diabetes and hypertension and her medication, but did not ask about family history of dementia. Always include family history to assess risk.
Data Gathering	Social history: Inquire about living situation daily routines and diet and exercise	3:13	partial	You asked about her living situation but did not ask about diet, exercise, or daily routine details. Next time ask, “What do you eat daily? Do you exercise or walk regularly?”
Data Gathering	Perform MMSE orientation task: “Can you tell me today’s date, day of the week, and where we are right now?”	2:10	yes	You assessed orientation appropriately. Good structured approach.
Data Gathering	Perform MMSE registration task: Ask them to repeat three words: “Apple, Table, Penny.”	-	no	You did not perform registration. This is a required MMSE component for cognitive assessment.
Data Gathering	Perform MMSE attention task: Ask them to spell “WORLD” backwards (D-L-R-O-W).	-	no	You did not perform this. Next time incorporate after registration task.
Data Gathering	Perform MMSE recall task: Ask them to recall the three words you gave earlier (Apple, Table, Penny).	-	no	Not done as registration was skipped. Remember sequencing is crucial.
Data Gathering	Perform MMSE language naming task: Show them a pen or watch and ask, “What is this?" Ask them to repeat the phrase, “No ifs, ands, or buts.”	-	no	You missed this language component. Next time integrate naming and repetition systematically.
Management	Discuss findings: Summarize concerns and findings with the patient	5:09	partial	You explained dementia generally but did not summarise specific findings from your history and MMSE clearly to the patient. Next time summarise, “Based on what you’ve told me about forgetting appointments and dates…”
Management	Reassure and educate: Explain memory issues and the significance of MMSE results. Explain possible differential diagnoses including dementia, depression, thyroid disorders, vitamin deficiencies, and medication side effects.	6:02	partial	You explained dementia and mentioned blood tests but did not explain differentials like thyroid issues or vitamin deficiencies clearly. Next time list differentials to reassure it may not be dementia alone.
Management	Reassure that memory issues can have many causes, not always dementia.	5:56	yes	You reassured her about age-related memory decline. Good empathetic framing.
Management	Arrange immediate blood tests: FBC, U&E, calcium, LFTs, thyroid function tests, Vitamin B12 and folate levels, and HbA1c.	6:06	partial	You mentioned blood tests including FBC, liver and kidney function, and sugar levels but missed thyroid, calcium, B12, and folate specifically. Always list them to show thoroughness.
Management	Plan routine referral to Memory Clinic for detailed cognitive assessment and possible neuroimaging.	-	no	You did not mention referral to Memory Clinic. Always ensure next step specialist involvement is clear to the patient.
Management	Immediate advice: Avoid driving and provide memory aids	6:12	partial	You suggested a diary and medication box but did not advise avoiding driving. Always advise avoiding driving if cognition is impaired.
Management	Advise lifestyle measures: maintain routine, use memory aids, adopt Mediterranean diet, regular walks, and social engagement.	6:17	partial	You advised diary and routine but missed Mediterranean diet, walks, and social engagement. Next time cover these systematically to empower the patient.
Management	Follow-up: Arrange follow-up appointment and provide contact for urgent concerns	-	no	You did not mention follow-up appointment or urgent contact. Always safety-net with a clear plan.
Management	Provide safety net advice: Seek urgent help if sudden worsening of confusion, hallucinations, significant behavioural changes, or getting lost occurs.	-	no	You did not safety-net clearly. Next time use exact wording to cover all red flags for dementia deterioration.
Management	Leaflets and pamphlets: Provide written information on dementia and memory clinics	-	no	You did not provide written information. Always mention providing leaflets to reinforce verbal advice.
Interpersonal Skills	Empathy and active listening: Show understanding and acknowledge feelings	01:04, 04:03	yes	You acknowledged her feelings gently: “It must be very difficult for you.” Good natural empathy.
Interpersonal Skills	Clear communication: Use simple language and ensure understanding	01:00-07:00	yes	You explained dementia in simple terms without jargon. Well done.
Interpersonal Skills	Building rapport: Maintain eye contact and encourage questions	6:44	partial	You maintained rapport but did not explicitly encourage her to ask questions about management. Next time say, “Do you have any questions about what we discussed today?”
Interpersonal Skills	Respect and sensitivity: Involve patient in decision-making and be sensitive to emotions	4:11	yes	You involved her in decision-making and respected her concerns throughout. Good patient-centred approach.
Interpersonal Skills	Signposting: Guide the patient through the consultation process	1:50	partial	You signposted at some points but not throughout. Next time, for each section say, “Now I will ask about your daily activities…” to guide logically.
Interpersonal Skills	Reassure: Offer hope for improvement with proper adjustments	5:56	yes	You reassured her memory issues can be improved with support and adjustments. Good hopeful closure.

	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
2	1	2