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

Mock Date: 21/07/2025
Case 2:
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	Response	Remarks
Data Gathering	Confirm Amber's full name and age.	Yes	You confirmed both the name and age clearly at the start of the consultation. Good job on establishing identity early.
Data Gathering	Open with presenting complaint: "Can you tell me what brought you to A&E today?"	Yes	You asked this clearly and early on – well done. It helped open the consultation smoothly.
Data Gathering	Explore vomiting in detail: Ask about onset, frequency, content (e.g., blood or bile), amount, and timing.	Partial	You asked about frequency and content (blood/food), but you missed asking about amount and timing (e.g., relation to food intake or time of day). Adding these would give a clearer clinical picture.
Data Gathering	Ask about associated symptoms: headache, dizziness, ear pain, abdominal pain, diarrhoea, urinary changes.	Partial	You asked about dizziness, abdominal pain, diarrhoea, and urinary pain but missed headache and urinary frequency or urgency. These are key in vomiting cases. Try using a systems review format next time.
Data Gathering	Explore past medical history: Ask about any prior similar episodes, any chronic illnesses.	Yes	You asked both about chronic illness and previous episodes. Well covered.
Data Gathering	Medication and allergy history: Ask about current medications, over-the-counter drug use, and any known allergies.	Yes	You asked about regular meds and allergies – well done.
Data Gathering	Ask about recent travel history: To rule out travel-related GI infections or foodborne illness.	Yes	Asked appropriately and explored. Clear and concise.
Data Gathering	Politely ask parents to step outside to ensure confidentiality for adolescent-specific history.	Yes	You asked the parents to step out appropriately. Great job handling this sensitively.
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.	Yes	Excellent handling of confidentiality concerns – very reassuring.
Data Gathering	Menstrual history: Ask about last menstrual period, regularity, duration, and any recent changes.	Partial	You asked about the last period but did not ask about regularity or any changes. These are important when assessing pregnancy.
Data Gathering	Assess sexual activity and contraception use.	Partial	You asked about sexual activity but missed asking about contraception use. This is key for determining pregnancy risk and counselling.
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.	Partial	You covered partner age and consent well, but contraception and number of partners were not asked. Full safeguarding should include these.
Data Gathering	Ask about psychosocial history, including school life, dietary habits, exercise routine, smoking, and alcohol use.	Yes	Covered well with relevant lifestyle and social questions.
Data Gathering	Perform a general physical examination, including assessment of hydration status and vitals such as temperature, pulse, blood pressure, and respiratory rate.	No	You mentioned examining vitals but did not demonstrate or document the findings. Please ensure you actually perform or state the findings next time.
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.	Partial	You did the pregnancy test, but no mention of abdominal exam or urinalysis. These are vital in this context. Always aim to cover all key assessments.
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.”	Yes	You communicated this clearly and sensitively – well handled.
Management	Acknowledge emotional response: “I understand this might be a shock; how are you feeling about it?”	Partial	You gave reassurance, but did not explicitly explore her emotional state or ask how she feels. Consider using open questions to let the patient express her emotions.
Management	Offer reassurance and support: Emphasize that she is not alone and support is available regardless of her decision.	Yes	You reassured her well and validated her feelings.
Management	Explain cause of vomiting: Describe pregnancy-related nausea (linked to rising hCG) in understandable terms.	No	You said it could be morning sickness but did not explain why (e.g., rising hCG). This helps build understanding and trust.
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.	Partial	You prescribed cyclizine, but did not give any dietary or hydration advice. Both are expected.
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.	Yes	You handled this sensitively and appropriately. Great job.
Management	Refer Emily to a GP or NUPAS for further advice on managing the pregnancy.	Yes	You offered GP and counselling referral – well done.
Management	Ensure proper documentation: Record findings, diagnosis, decisions made, and any safeguarding concerns.	No	This was not mentioned. Always state you’ll document everything, especially safeguarding issues.
Management	Provide safety netting: Advise to return or seek help if symptoms worsen, new symptoms appear, or she feels emotionally overwhelmed.	No	You didn’t offer safety netting advice. Always include a line like “come back if symptoms worsen or you feel worse emotionally.”
Management	Schedule follow-up appointments for continued support and monitor her condition.	No	No mention of follow-up – try offering GP follow-up for support.
Management	Offer leaflets and contact info: Provide printed information about pregnancy options, support services, and emergency contacts.	Yes	You offered leaflets and this was well done.
Interpersonal Skills	Maintain a calm, empathetic, and non-judgemental language throughout the consultation.	Yes	Your tone was gentle and reassuring. Good empathy shown.
Interpersonal Skills	Ensure clear, direct communication and avoid medical jargons.	Yes	Clear communication used, appropriate for patient age.
Interpersonal Skills	Ensure confidentiality: Reassure her that what she shares stays private unless there’s a serious risk.	Yes	Very well done. Clear explanation provided.
Interpersonal Skills	Use gentle, non-judgmental tone when discussing sexual history and pregnancy diagnosis.	Yes	You kept it respectful and caring. Very well done.
Interpersonal Skills	Always assure patient confidentiality and validate her concerns.	Yes	You gave assurance and validated her stress. Strong skill.
Interpersonal Skills	Be prepared to provide information about confidential services like NUPAS.	Yes	You mentioned advisory services – great.
Interpersonal Skills	Encourage support-seeking behavior: Offer information about counseling and support groups for young people facing unplanned pregnancy.	Partial	You offered referral but did not explicitly mention counseling or support groups. Always give full options.

	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
3	2	3