PLAB 2 Mock test feedback:: Symptomatic Differential OBGYN-Teenage Pregnancy presenting with Vomiting :: 1st Attempt

Mock Date: 21/07/2025
Case 1:
Topic: SymDD_OBGYN:: Case UID: Antenatal12
Case Name: Teenage Pregnancy
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:
This case involves a 15-year-old girl, Amber Shelly, who has been brought to the A&E department by her parents due to acute vomiting. The consultation will require a detailed history to uncover the potential causes of vomiting, including assessing for pregnancy. Amber is pregnant, a fact unknown to her or her parents.
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 Amber's full name and age.	1:00	Yes	You confirmed both the patient's full name and age early in the consultation. Well done on doing this promptly and clearly.
Data Gathering	Open with presenting complaint: "Can you tell me what brought you to A&E today?"	1:00	Partial	You asked "How may I help you?" which opened the discussion, but did not explicitly ask the patient what brought her to A&E. A direct question using the patient's own words from the scenario title would have been more targeted.
Data Gathering	Explore vomiting in detail: Ask about onset, frequency, content (e.g., blood or bile), amount, and timing.	1:01	Partial	You covered onset and frequency, but did not ask about content (e.g., bile or blood), amount, or specific timing of vomiting. These details are crucial for a complete GI history.
Data Gathering	Ask about associated symptoms: headache, dizziness, ear pain, abdominal pain, diarrhoea, urinary changes.	1:03	Partial	You asked about dizziness and diarrhoea, but did not ask about headache, ear pain, abdominal pain, or urinary changes. Try to systematically go through common associations next time.
Data Gathering	Explore past medical history: Ask about any prior similar episodes, any chronic illnesses.	1:03	Partial	You asked about any medical conditions, but did not ask about previous similar episodes. Including that could have helped assess if this was a recurrent problem.
Data Gathering	Medication and allergy history: Ask about current medications, over-the-counter drug use, and any known allergies.	1:03	Yes	You asked clearly about medications and allergies, including over-the-counter use. This was done well.
Data Gathering	Ask about recent travel history: To rule out travel-related GI infections or foodborne illness.	—	No	Travel history was not explored. You could have asked this when discussing food habits or external meals.
Data Gathering	Politely ask parents to step outside to ensure confidentiality for adolescent-specific history.	1:06	Yes	You handled this well and offered to talk alone after the patient expressed discomfort. This was appropriate and respectful.
Data Gathering	Reassure the patient about confidentiality by explaining that what she shares will remain private unless there's a serious risk of harm, and that she will be informed before anything is shared.	1:06	Partial	You reassured her somewhat by saying “this is a safe space,” but did not explain fully about the limits of confidentiality or that she would be informed before anything is shared. This is especially important in adolescent consultations.
Data Gathering	Menstrual history: Ask about last menstrual period, regularity, duration, and any recent changes.	1:06	Partial	You asked only about the LMP, but did not explore regularity, duration, or changes. These are important to interpret pregnancy likelihood and other menstrual-related conditions.
Data Gathering	Assess sexual activity and contraception use.	1:06	Partial	You asked about sexual activity but not about contraception. Both should be explored, especially in a case of suspected pregnancy.
Data Gathering	Sexual and safeguarding history: Ask sensitively about sexual activity, number of partners, contraception use, partner’s age, relationship status, and any coercion/consent concerns.	—	No	No safeguarding details were explored. You missed asking about coercion, partner's age, and relationship status, which are important when dealing with teenage pregnancy.
Data Gathering	Ask about psychosocial history, including school life, dietary habits, exercise routine, smoking, and alcohol use.	1:04	Partial	You asked about diet, exercise, stress, and alcohol, but missed school life and smoking. Try using a structured HEADSS approach in adolescents to be more comprehensive.
Data Gathering	Perform a general physical examination, including assessment of hydration status and vitals such as temperature, pulse, blood pressure, and respiratory rate.	1:05	Partial	You mentioned checking vitals but did not clearly state checking hydration status or completing a general exam. Always verbalise what systems you’re assessing.
Data Gathering	Perform focused physical and bedside assessments, including abdominal examination, urine pregnancy test (with consent), and urinalysis to evaluate for pregnancy-related causes, UTI, or dehydration.	—	No	No abdominal exam or urine test was discussed or performed. These are vital in this case and expected to be verbalised.
Management	Explain diagnosis clearly. Discuss the results of the pregnancy test in a sensitive manner. “The test we did shows you're pregnant, which can explain the vomiting.”	1:07	Yes	You explained the diagnosis sensitively and clearly. Good phrasing and timing once the privacy was established.
Management	Acknowledge emotional response: “I understand this might be a shock; how are you feeling about it?”	1:07	No	You did not ask how she felt about the news. This would have shown empathy and helped build trust during a difficult moment.
Management	Offer reassurance and support: Emphasize that she is not alone and support is available regardless of her decision.	1:08	Partial	You said “we are here” and “it’s your choice” but could have been more explicit about available support and that she is not alone.
Management	Explain cause of vomiting: Describe pregnancy-related nausea (linked to rising hCG) in understandable terms.	1:07	Partial	You said “this is called morning sickness,” but did not explain the mechanism or that it’s linked to hormonal changes (like rising hCG).
Management	Symptomatic treatment: Offer safe antiemetics in pregnancy like cyclizine or prochlorperazine, if clinically appropriate. Dietary advice: Recommend small, frequent meals, hydration with ORS, and avoiding spicy/fatty foods.	—	No	You did not offer any dietary advice or antiemetics. This is important in managing nausea in early pregnancy.
Management	Offer involvement of parents or a trusted adult, reassuring Emily that this will only happen with her consent and that support is available regardless of her choice. Reassure Emily about confidentiality and support services available.	—	No	You did not explore involving a trusted adult or explain support services. This is important for safe and supportive decision-making.
Management	Refer Emily to a GP or NUPAS for further advice on managing the pregnancy.	—	No	You missed referring her to a GP or pregnancy service like NUPAS. This is a major component in follow-up and decision-making support.
Management	Ensure proper documentation: Record findings, diagnosis, decisions made, and any safeguarding concerns.	—	No	There was no mention of documentation. Always say you would document the findings and management plan.
Management	Provide safety netting: Advise to return or seek help if symptoms worsen, new symptoms appear, or she feels emotionally overwhelmed.	—	No	You did not provide any safety netting. This is a key aspect of safe management.
Management	Schedule follow-up appointments for continued support and monitor her condition.	—	No	No mention of arranging follow-up. A handover to GP or young people services is expected.
Management	Offer leaflets and contact info: Provide printed information about pregnancy options, support services, and emergency contacts.	—	No	You did not offer any leaflets or contact information. Doing so empowers the patient and ensures continuity of support.
Interpersonal Skills	Maintain a calm, empathetic, and non-judgemental language throughout the consultation.	01:00–01:08	Yes	You maintained a calm and non-judgemental tone. That was appreciated especially during the sensitive moment of delivering the pregnancy result.
Interpersonal Skills	Ensure clear, direct communication and avoid medical jargons.	01:00–01:08	Yes	You spoke clearly and avoided medical jargon. Your explanations were simple and easy to follow.
Interpersonal Skills	Ensure confidentiality: Reassure her that what she shares stays private unless there’s a serious risk.	1:06	Partial	You partially covered this by saying it's a safe space, but you didn’t explicitly outline the exceptions to confidentiality.
Interpersonal Skills	Use gentle, non-judgmental tone when discussing sexual history and pregnancy diagnosis.	1:06	Yes	You handled the sexual history and diagnosis delicately and without judgement. This was appropriate for the scenario.
Interpersonal Skills	Always assure patient confidentiality and validate her concerns.	—	Partial	You assured confidentiality but did not validate her concerns or how she was feeling about the pregnancy.
Interpersonal Skills	Be prepared to provide information about confidential services like NUPAS.	—	No	You missed an opportunity to mention NUPAS or similar services, which is expected in managing adolescent pregnancies.
Interpersonal Skills	Encourage support-seeking behavior: Offer information about counseling and support groups for young people facing unplanned pregnancy.	—	No	No counselling or support groups were mentioned. These are important to empower the patient and guide her through decision-making.

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