A 54-year-old man, Mr Glower has come to the Medicine out

patient clinic with symptoms of cough with expectoration.

He is a chronic smoker and smokes about 40 cigarettes a day
for the past 25 years. He is a known hypertensive, currently
on Ramipril 2.5 mg a day and his blood pressure is well
controlled. Do the complete Respiratory System examination
and the PEFR and report your findings to the examiner.

Mavis Francis is a 22-year old footballer playing for the

Newcastle united football team. He had sustained a fall on
his outstretched hand during the game and now complains
of pain at the base of his right thumb. Examine his right
hand and discuss the plan of management with the
examiner. The X ray reports are back. Discuss the findings
with the examiner. Also discuss the plan of management
with the examiner.

Mr. Bond, a 45-year-old man has been brought to the

Medical out patient clinic by his wife. He has been
experiencing some discomfort in his chest and is also short
of breath for the past few hours. He is a non-smoker but
occasionally takes alcohol when he parties with his old
schoolmates. His past medical history is insignificant. He had
undergone Appendicectomy when he was 21 years old. Do
the complete Cardiovascular System examination of this
patient and report the findings to the examiner.

Mrs. Greenwich, a 67-year-old lady has come to the

Neurology Department with headache and some problems
related to her vision. She is very anxious about her
complaints. She is a known hypertensive and diabetic for the
past 20 years on regular medications which include:-
Enalapril 5 mg once daily, Gliclazide 60 mg once daily. She is
a non smoker and never drinks alcohol. She lives with her
daughter at her house. Please examine the cranial nerves 1-
7 and discuss the findings with the examiner. You are
provided with all the necessary equipments.

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 Mrs. Greenwich, a 67-year-old lady has come to the
Neurology Department with headache and dizziness. She is
very anxious about her complaints. She is a known
hypertensive and diabetic for the past 20 years on regular
medications which include:- Enalapril 5 mg once daily,
Gliclazide 60 mg once daily She is a non smoker and never
drinks alcohol. She lives with her daughter at her house.
Please examine the cranial nerves 8 – 12 and discuss the
findings with the examiner.

Mr. Frances, a 57-year-old man has come to the Department

of Neurology with his complaints of seeing things “double”.
Apart from double vision, he has no other medical problems.
He is a very healthy man who goes for a walk in the
evenings and is very particular about what he eats. He
smokes about 10 cigarettes daily and occasionally drinks
alcohol. Do the relevant examination of this patient and
report your findings to the examiner.

A 32-year-old man has come to the Medical out patient

clinic. He says he goes “dizzy” several times in a day and is
unable to cope with this problem. He is a bank officer by
profession and says that he undergoes a lot of stress while
he is at work. He smokes about 30 cigarettes a day but
never drinks alcohol. He is unmarried and is currently
staying with his girlfriend. He has no other medical
problems. You are the medical SHO attending the out patient
clinic today. Do the relevant examination of this patient and
report your findings to the examiner.

Ms Penelope was referred by the GP, with complaints of

headache, fever and photophobia of one-day duration.
Examine the patient and discuss the findings and
management with the examiner.

Mr. Matt was found unconscious by the Castleford rear view

Park. He has been brought to the accident and emergency
department. Primary and secondary survey has been done
and he is in come. Assess GCS and do a neurological
examination

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 Mr. Simon, a 36-year-old gentleman has come to the
Medicine out patient clinic because of his increasing
tiredness for the last 2 months. He also had some mild fever
a couple of weeks back. He is really worried about his
health. He is a non-smoker and has never drunk alcohol. Do
the Lymphoreticular system examination of this patient and
report your findings to the examiner.

Mr. Smith, a 45-year-old man has come to you with

complaints of tummy pain of 16 hours duration. He states
that he is feeling sick and the pain is getting progressively
worse. Do the Abdominal examination of this patient and
report the findings to the examiner.

Mr Huckling had a sudden fall from the balcony of his house

and has been brought to the A & E Department. The
Paramedics have brought him to the hospital within 15
minutes of the accident. You are the SHO in the A & E
Department. Do the primary survey of this patient.

Mr. Thompson met with a road traffic accident and is

brought to the A & E Department. He has injured his right leg
severely in the accident. Primary survey has been done and
the cervical spine has already been immobilised. You are the
SHO in A & E department. Do the secondary survey of this
patient.

A middle-aged man was found lying unconscious at the Orrel

Park station. He was brought to the A & E department by the
paramedical staffs. They state that there were no witnesses
to this incident. You are the Senior House Officer in the
Department of A & E. Do the examination of this unconscious
patient.

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 Mr. Swan, a 58-year-old man, has come to the hospital since
he has got some sensation of pins and needles in both his
feet. He is a known diabetic for the past 35 years and has
been on insulin twice daily. He regularly checks his blood
glucose levels. He does not have hypertension. He is a non-
smoker and never drinks alcohol. Do the relevant
examination of both his legs and report your findings to the
examiner.

Mr. Scott is a 42 year old Postman working with the Royal

Mail. His general practitioner with the suspicion of a hyper
functioning thyroid gland has referred him to the out patient
clinic. You have taken a history that favours
hyperthyroidism. Perform the relevant clinic examination
and discuss you findings with the examiner.

Mr. Ronald has come to the department of Orthopaedics with

some pain in his knee. He is the captain of the University
football team, and is worried that he will not be able to
make for his forthcoming match. Examine the Knee joint
examination of this patient and report your findings to the
examiner.

Mr. James, a 45-year-old man, had a fall recently and hurt

his buttocks. He was seen then by his GP who gave him
painkillers and the pain had disappeared. However, Mr
James now reports of pain during walking. Examine the Hip
joint and report your findings to the examiner.

Mr Simmons, a 60-year-old man is complaining of low back

pain for the last 2 months, which increases after activity and
gets worse towards the evening. He was prescribed by tge
General practitioner and he has referred Mr. Simmons to you
for further evaluation. Examine the spine and discuss your
findings with the examiner.

Mrs Jones, 56 year old female is currently on Methotrexate

20 mg per week for rheumatoid arthritis . She has come to
the clinic complaining of pain and swelling of the hands.
Examine her hands.

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 Mr Hog, a 26 year old male is complaining of pain in the right
shoulder for the last 2 days. The pain was noticed after
sustaining a fall near the fish market four days back.
Examine the patient and discuss your findings and
management with the examiner.

Mr Edwards is complaining of pain in his right elbow since 2

months. The pain is keeping him off his sporting activity.
Examine the elbow joint and discuss the management with
the patient.

Miss Ransome Dorothy is a 22-year-old secretary in an

engineering firm. She is concerned that she has been gaining
weight. Talk to the patient and discuss the differential
diagnosis with the examiner.

Joan booth is a 28-year-old teacher in the Mersey side

primary school. She had submitted an application for the
post of a head teacher and has been short listed for the
interview scheduled for this afternoon. However, she
presented to the gynaecology clinic this morning with an 8-
week history of amenorrhoea and abdominal pain and was
diagnosed with ectopic pregnancy. The consultant has
advised that she should undergo admission. However, she is
very keen to attend the interview, as she thinks it is a
stepping-stone in her career. She is requesting you to
discharge her. Talk to Mrs. Booth

Paula woods works as a sales manager in the Liverpool

ASDA superstore. She is considering undergoing permanent
sterilization. Talk to her about this and address her
concerns.

Robert Daubing had been on a holiday to Thailand. He is very

worried that he has contacted HIV infection. He had sex with
a prostitute and his condom slipped accidentally. Take a
history form Mr. Daubing and assess his risk factors with
regard to HIV/AIDS. Also counsel him regarding the HIV
test, as he is interested to undergo the test.

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 Mr. Daubing had been admitted to the hospital for
emergency appendectomy. Whilst in hospital, he was noted
to have an infection of his surgical wound. Subsequent
investigations revealed that he had an infection with MRSA.
He is very worried about it. Talk to him and address his
concerns.

Miss Mary Neilson is a 24-year-old secretary in a legal firm.

She has presented to outpatients clinic with complains of
pain in abdomen. She has taken half-day leave from her
work due to the pain. Take a history from Miss Neilson and
discuss the differential diagnosis with the examiner

Robert Edwards had been diagnosed with a right-sided

indirect inguinal hernia fourteen months back. He had to
wait for fourteen months to get his name in the operating
list and was listed for the operation scheduled for tomorrow.
However, the anaesthetist mentioned that he was
overweight and decided not to go ahead with the operation,
unless he brings his weight under control. Mr. Edwards has
come to the surgical clinic to see you about this issue. Talk
to him and address his concerns.

You are the SHO in the department of medicine. Marie

Gibson has come to the clinic with the complaints of
headache. Take a history from Marie Gibson and talk to her
about the condition.

Mrs. Hartshorne has come to see you in the medical out

patient department. She has a history of migraine dating to
some one year back. She is currently on amitriptyline, and is
worried that her headache is persistent. She has come to
request for a CT scan of the brain. Talk to Mrs. Hartshorne.

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 Mrs Jones is 54 yr old. She was feeling depressed for last 3
months and her GP prescribed her Amitriptyline. She has not
improving and is not happy with her treatment. Address her
concerns.

Police has brought 32 yr old Mr Ratcliff to A& E. He was

running in the road and has threatened the police officers.
He feels that he is under surveillance. You are the
psychiatric SHO on call. Take a History.

Mr. Charles Clarke is a 22-year-old security guard. He was

diagnosed with temporal lobe epilepsy eight months back
and is currently on carbamazepine 400 mg twice daily.
However, Mr. Clarke states that he is still having fits and has
not noticed any difference in the frequency of fits. Take a
history from Mr. Clarke and discuss the condition with him.

Dennis Hall works as a driver for the arriva bus service that
runs between Liverpool and Manchester. He could not get
behind the wheel this morning as he noticed that things
were appearing the double of original. Unable to execute his
duties he has taken leave from his work and has come to the
out patient clinic. Take a history from Mr. Hall and discuss
the differential diagnosis with the examiner.

Miss Marion is a 14-year-old student. She has been referred

by the general practitioner with the main symptoms of
shortness of breath and wheeze. Take a history and outline
your plan of management to the patient

Mr Graham is 71 yr old gentleman. His brother brought him

to A & E. He was found wondering in the street. He is
medically fit. Do a cognitive assessment.

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 Shirley Richardson, a 32-year-old gentleman, has come to
the out patient clinic with a two-day history of pain in his
right foot. Take a history form Mr. Richardson and outline
your plan of management.

Allen Moreland is a 70-year-old retired head teacher. He was

referred by his general practitioner for evaluation of his
tremor and gait problems. A detailed neurological evaluation
was undertaken and necessary investigations were
performed. The neurologist has decided that all his
symptoms can be attributed to Parkinson’s disease. Explain
to Mr. Moreland that he has Parkinson’s disease and counsel
him about the long-term management.

Ralph Atkins is a 76-year-old retired plumber. He has been

brought to the outpatient clinic by his carer stating that he
has bruising around his body. Take a history from the carer
and discuss your plan of management.

Mrs Beck is a 42-year-old teacher. She had undergone a

routine cervical screening and the results have revealed that
the cells show dysplastic changes. The changes are
suggestive of CIN III. Explain the condition to Mrs. Beck and
discuss the management.

You are the SHO in the paediatrics out patient clinic. Mrs.
Betty whale has come to clinic with her 13-month-old son,
Tommy who is due for the MMR vaccine. She is bit worried
about the vaccine. Talk to Mrs. Whale and address her
concerns

Little Nodder is an 8-year-old boy and he had sustained a

road traffic accident whilst he was playing with his roller
skates this morning. He has been examined in the
emergency and was resuscitated. The results of the
investigations are back and ultrasonography has
demonstrated rupture of his spleen. An emergency
splenectomy needs to be performed. Mr. Robert Nodder is
very worried about the condition of his son. Discuss the
management of his condition to Mr. Nodder.

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 David Donson, a four-year-old boy was discharged from the
hospital 2 days back. Investigations performed during
hospital stay were all normal and your consultant had
declared a normal examination. However, the mother is back
to the emergency department with the baby because of
excessive crying. You have again examined the baby and
have noted no abnormal findings. Talk to the mother and
reassure her.

Owen Longmont had been diagnosed with a right-sided

indirect inguinal hernia fourteen months back. He had to
wait for fourteen months to get his name in the operating
list and is listed for the operation tomorrow. Talk to Mr.
Longmont about the operation and address his concerns.

Mr. Hart Daubes is a 42-year-old plumber. He states that he

has noticed a reddish discoloration of his urine. Take a
history and discuss differential diagnosis with the examiner.

Brian Caswell is a 42-year-old gentleman. He states that he

has been feeling dizzy since the last 10 – 12 hours. Take a
history from him and discuss the differential diagnosis with
the examiner.

Mr. Ian Marshall is a 46 year old gentleman and works as a

barman in the local Chinese restaurant. The general
practitioner referred him for evaluation of his dyspeptic
symptoms after he did not respond to ranitidine. General
examination was unremarkable. You have decided to
investigate him further with upper gastrointestinal
endoscope. Talk to him about the procedure.

Audrey is a seven-month-old boy. His mother has brought

him to the emergency department. She states that he is
crying all the time. Take a history from the mother and
discuss the differential diagnosis with the examiner

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 Ruth brown is a 36-year-old gentleman working as a sales
representative. He has presented to the clinic with the
complaints of red eye. Take a history form Mr. Brown and
discuss the differential diagnosis with the examiner.

Mrs. Elizabeth Corley has presented to the clinic with the

complaints of hot flushes and mood changes since the last
several months. You have carried out necessary
investigations including FSH, LH and oestradiol. The results
have confirmed menopause. She is quite keen to go on the
hormone replacement therapy. Talk to her about her
condition and about hormone replacement therapy.

Dorothy walker is student in the Liverpool University. She

has come to the clinic requesting for termination of
pregnancy. She has discussed this issue with her partner
and she has made up her mind to live with the decision. Talk
to her and address her concerns.

Mrs. Thompson had been diagnosed with a fibroid uterus

that was complicated by menorrhagia. She is now admitted
for hysterectomy. Talk to her about the operation and take
her consent.

Mrs. Healy has come to the clinic to obtain the reports of

diagnostic laparoscopy that was performed earlier for
evaluation of her symptoms. Explain to her that the
investigation has demonstrated endometriosis and give her
the treatment options.

Dennis Hall works as a driver the arriva bus service that runs
between Liverpool and Fazakerly. He could not get behind
the wheel this morning as he was seeing double. Take a
history from Mr. Hall and discuss the differential diagnosis
with the examiner.

Mrs. Dorothy Haywood is a 35-year-old lady in her 10th

week of first pregnancy. She has heard that the risk of
having a baby with Down’s syndrome increases with age and
is quite worried about it. She wishes to undergo screening
and wants to know the possible options. Discuss the options
with her.

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 Mrs. Maureen Jansen is a 64year old lady. She had an attack
of sudden weakness of her right leg this morning and has
been referred to the medical assessment unit for further
evaluation. Take a history from Mrs. Jansen and assess the
risk factors for stroke.

You are the SHO in the emergency department. Mrs. Barbara

grimes rings up the department and states that her daughter
is having diarrhoea. Talk to the mother over the phone and
discuss your plan of management with the mother.

You are the SHO in the emergency department. Mrs. Sandra

wells rings up the department to inform that her son is
having a persistent fever. She had gone to the general
practitioner yesterday evening and he had prescribed
paracetamol. Talk to Mrs. Wells over the phone and discuss
your plan of management

You are the SHO in the medicine out patient clinic. Mr.
Audrey Heckling has presented to you with complaints of
hoarseness of voice. Take a history and discuss the
differential diagnosis with the examiner.

Mr. Hartshorne has come to the clinic with his four year old
son. He had earlier visited the clinic when he noticed that his
son had not been gaining weight and had frequent loose
motions. You had examined little Hartshorne and the results
of investigations are back. You have finally made a diagnosis
of Celiac disease. Talk to Mr. Hartshorne about the condition
and management.

Mrs. Pauline Burchill is a 38-year-old lady who works in a

restaurant. She has been admitted to the hospital following
complaints of dizziness and lethargy. She had been
diagnosed with Leukaemia six months back and is on
chemotherapy. Her blood pressure is 100/70 mm of Hg.
Investigations have revealed haemoglobin of 6mg/dl. Your
registrar has decided that she needs a blood transfusion.
Talk to Mrs. Burchill about the plan of management

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 .

Mr. Trevor Hurling is a retired head teacher. He had an

episode of deep vein thrombosis one-year back that was
complicated by pulmonary embolism. This Easter he had
another episode of deep vein thrombosis, which required
further admission to the hospital. Your consultant has
decided that he should be on warfarin to prevent further
episodes. He is ready for discharge and you are asked to
discuss the medication with Mr. Hurling. Do not take a
history.

Karen Wagstaff is an 18-year-old student. She has finished

her GCSE examinations and has recently entered into a
relationship with her classmate. She is very keen to go on
the oral contraceptive pills. Talk to her and assess whether
she is suitable to go on the pill.

Mr. Ralph Nicholson is a 55-year-old gentleman who works

as a driver in the GNER train service. He had presented to
the clinic with the history of headache and pain in his jaw.
Routine investigations revealed that the ESR is elevated at
70 and the right temporal artery is thickened and tender.
Your consultant has diagnosed him as a case of temporal
arteritis. Counsel the patient regarding this condition and
the plan of management.

You are the SHO in the gynecology out patient clinic. Mrs.
Eileen savage has been referred to the clinic by her general
practitioner because she has been having per vaginal
bleeding. Take a history from Mrs. Savage and discuss the
differential diagnosis with the examiner.

You are the SHO in the pediatric out patient clinic. Mr.
Hampton has come to the clinic with his little son. He is
worried that his son has not yet started walking. He states
that his son in up to date with the immunizations. Take a
history form Mr. Hampton and discuss the condition with
him.

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 Linda greenwood works as a social care worker in the
Merseyside city council. Her general practitioner has
referred her to the clinic because she has not experienced
periods for the last three months. Take a history form the
patient and discuss the differential diagnosis with the
examiner

George Lightfoot is a 22-year-old gentleman. He has

presented to the clinic with complains of breathlessness, and
cough. Take a history and discuss differential diagnosis with
the examiner.

Mary White works as a hairdresser in the Leeds central

hairdressing centre. Her general practitioner has referred
her to your clinic because he is concerned of her weight loss.
Take a history from Miss White and discuss the differential
diagnosis with the examiner.

Mary Hart is a 65-year-old lady. She complains of pins and

needles in her right hand since the last six weeks. She does
not have any history of fever. Take a history form the patient
and discuss the differential diagnosis with the examiner.

Mrs. Dawn is a 26-year-old sales person at the Tesco

supermarket. She has presented to the genito urinary clinic
with the complaints of per vaginal discharge. Examination
has been done and investigations reveal that she has
Gonorrhea. Talk to Mrs. Dawn about the condition and
treatment. Also talk about partner management. She is
currently on Oral Contraceptive pills.

Mrs. Mavis Hartland was earlier diagnosed with a localized

breast cancer. She had undergone mastectomy for it, two
months back. She has come to the postoperative follow up
clinic and is worried. Talk to Mrs. Hartland about her
worries.

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 Mr. Arthur Morris is a 65-year-old retired SAS soldier. He had
presented to the clinic earlier with complains of blood in his
motions. An examination was performed and investigations
revealed that he had an early bowel cancer localised to left
descending colon. Your consultant decided that he needs to
undergo left hemi-colectomy with a temporary colostomy.
He is anxious about the operation. Talk to Mr Morris about
the operation and take his consent.

Mr. James Dorothy is a 58 year old carpenter. His general

practitioner has referred him to the out patient clinic for
further evaluation. Mr. Dorothy gives a history of
constipation. Take a history from Mr. Dorothy and discuss
the differential diagnosis with the examiner.

You are the SHO in the department of medicine. Thomas

Shelly comes to the clinic with the complaints of
palpitations. Take a history and discuss the differential
diagnosis with the examiner.

You are the SHO in the outpatient’s clinic in the department

of medicine. Mr. Ralph Atkins is referred by the general
practitioner with the main symptoms of coughing up of
blood. Take a history from Mr. Atkins and discuss the
differential diagnosis with the examiner.

Shirley Richardson, a 32-year-old gentleman, has come to

the surgical clinic with four-week history of lump in his right
testis. There is no history of trauma and no history of fever.
Examination revealed that the swelling is confined to the
right testis, is non transilluminable and is one and half times
the size of the left testis. Talk to the patient regarding
further investigations and plan of management. Do not take
history.

Margaret Nippers is a 67-year-old lady. She had been

diagnosed with diabetes six years back and is currently on
Metformin and Glicazide. She has noticed some blurring of
vision and has heard that diabetes can render people blind.
An indirect ophthalmoscopy has been done and she is noted
to be Grade I Diabetic retinopathy. Talk her about the
condition.

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 Mrs. Christine has brought her three-year-old Johnny to the
accident and emergency department. When she returned
from the kitchen she found that Johnny was playing with her
bag and she thinks that he may have swallowed something.
She is worried about Johnny. Take a history from Mrs.
Christine and explain your plan of management to her.

You are the SHO in the pediatrics out patient clinic. Mrs.
Betty whale has come to clinic with her 13-month-old son,
Tommy who is due for the MMR vaccine. She is bit worried
about the vaccine, because of the current rumors
surrounding the MMR vaccine. Talk to Mrs. Whale and
address her concerns.

Mr. Michael Kinsey works as a solicitor in a legal firm based

at Manchester. He has been having problems with
swallowing and had gone to his general practitioner. The
general practitioner has referred Mr. Kinsey to your clinic.
Take a history form Mr. Kinsey and discuss the differential
diagnosis with the examiner.

Miss Beryl Wyatt is starting her university this summer and

she is eagerly looking forward for it. However, she had a
second attack of seizure a couple of days back and was
diagnosed with Epilepsy. She was evaluated by the
neurologist and has been started on Carbamazepine. Miss
Wyatt is worried about the implications this diagnosis could
have on her lifestyle. Talk to Miss Wyatt about the necessary
measures and precautions one needs to take once diagnosed
with Epilepsy

You are the SHO in the Genitourinary clinic . Starkey heralds

has presented to the clinic with the complains of “discharge
from my water pipe”. Mr. Heralds is anxious and wants to
undergo evaluation. Take a history from Mr. Heralds and
discuss your plan of management with him.

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 Harold Turner works as a sales manager in the Liverpool
ASDA superstore. His job demands a lot of hard work and
dedication. He is considering undergoing permanent
sterilization. He has come to the clinic to explore about this
method of family planning. Talk to him about the procedure.

Mr. John Glover is a 59 year old gentleman from London. He

was admitted to the coronary care unit following an acute
inferior wall myocardial infarction. His hospital stay was
uneventful and he has recovered from it. He is about to be
discharged and is already on anti-anginals. Advice him about
lifestyle changes that is important following an episode of
myocardial infarction .

Karen Hammond is a 68-year-old housewife from Newcastle.

She has been diagnosed with with Non Hodgkin’s Lymphoma
with associated B symptoms and has received a course of
chemotherapy comprising of cyclophosphamide, vincristine
and prednisolone. Your consultant has asked you to talk to
Mrs. Hammond and outline the possible approaches to
management of pain. Talk to Mrs. Hammond about pain
management.

Allen Moreland, 28 years old male is a rugby player in the

Sheffield team. A couple of months back he had sustained
injury to his right ankle during the final rugby match, and
has been off the game since then. He had fractured his right
ankle and an open reduction and internal fixation was
carried out. He has now come for the removal of the screws.
You are the anesthetic SHO in the clinic. Talk to Mr.
Moreland and assess his suitability for day case surgery.

Mrs. Christine Franks is a 35-year-old lady who works as a

fashion designer in a garment industry. She had presented
earlier to the clinic with a history of sudden transient loss of
vision and weakness of right leg. The results of the
investigations are back and a neurological opinion was
taken. The neurologist has decided that all her symptoms
can be attributed to multiple sclerosis. Explain to Mrs.
Franks that she has Multiple sclerosis and counsel her about
the long-term management.

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 Mr. Scott is a 56-year-old postman who works with Royal
mail. He states that he is having pain in his calves since the
last couple of weeks. Take a history from Mr. Scott and
outline the management to him.

Mr. James Dorothy is a 58 year old carpenter. His general

practitioner has referred him to the out patient clinic for
evaluation of his per rectal bleeding. Take a history from Mr.
Dorothy and discuss the differential diagnosis with the
examiner.

Scott is a seven months old baby. His mother has brought

her to the accident and emergency department. She
complains that he has been passing some blood with his
stools. Take a history and talk to the mother

Mr. Alex Ferguson is a 72-year-old gentleman. He had been

diagnosed with osteoarthritis of the left hip 2 years back and
has been on regular analgesics and physiotherapy. His
symptoms are getting progressively worse and are not
responding to conservative management. Your consultant
has decided that he needs to undergo a hip replacement.
Talk to Mr. Ferguson about the operation.

Mrs. Mary Hart is a 65-year-old lady from Warrington. Her

general practitioner has referred her to your clinic for
further evaluation. She complains of sensation of “pins and
needles” in her right hand of six weeks duration. Take a
history form the Mrs. Hart and discuss the differential
diagnosis with the examiner.

John Wright had been referred by the general practitioner

for urgent evaluation. Following assessment and
investigations a diagnosis of Menigococcal septicaemia is
made and treatment has been instituted. Talk to the father
who is very worried about the condition of his son

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 Mrs. Marion has come to the pediatric outpatient clinic with
her daughter. She is four and half years old. She is
concerned that her daughter is losing weight since the last
couple of months. Take a history from the mother and talk to
her about the condition of her daughter.

You are the SHO in the department of surgery. You have

been asked by the nurse in the high dependency unit to see
a patient who had a right hemicolectomy six hours back for a
localized early tumor. The following are the current
observations:
Temperature: 38 degree Centigrade
Blood Pressure: 80/60 mm. Hg
Pulse: 130/min
Abdomen: distended.
Your registrar is busy in the theater. Ring your consultant
and talk to him about this patient.

June Carter is a 32-year-old teacher. She has presented to

the emergency department with a history of pain in her
abdomen of ten hours duration. Take a history from Mrs.
Carter and talk to her.

Mrs. Walton has been diagnosed with gallstones and is

scheduled to undergo a laproscopic cholecystectomy
tomorrow. You are the SHO in the department of surgery.
Talk to her about the operation.

Thomas is a three and half years old boy. He was brought to

the accident and emergency department following an attack
of convulsions. He was documented to be febrile during the
episode. Neurological examination was unremarkable and
investigations are normal. Your consultant has declared that
it is an attack of febrile convulsion. Talk to the mother about
this condition.

Mr. Harold has come to the accident and emergency

department with his little son. He states that he has been
walking with a limp. Take a history from Mr. Harold and
explain the condition to Mr. Harold. Also, discuss you plan of
further management.

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 Mrs. Thompson has come to the pediatric outpatient clinic.
She had a recent delivery and on neonatal assessment it was
noted that her baby is having Down’s syndrome. This is her
first child and she is very distraught after this diagnosis.
Counsel Mrs. Thompson who is very worried about this
condition.

Mrs. Hartshorne has come to the clinic with her son who has
been recently diagnosed with asthma. Explain to Mrs.
Hartshorne the method of use of spacer and the necessary
precautions required.

Mr. David Gibson is a 36-year-old lecturer in the Manchester

Metropolitan University. He has come to the medical out
patient clinic complaining of fever. Take a history form Mr.
Gibson and discuss the differential diagnosis with the
examiner.

Mr. David Jansen is a 24year old old university student.

He was brought to the accident and emergency department
after he was found unconscious by the green lane leading to
the canteen. General examination was unremarkable and
routine investigations were all normal. He is now fully
consciousness and well oriented. Take a history from Mr.
Jansen and talk to him.

You are the SHO in the department of pediatrics. Mrs. Alison

has come to the clinic with her 3 year-old daughter. The
general practitioners had referred her to the clinic after
establishing a diagnosis of urinary tract infection. Explain
the condition to Mrs. Alison who is very worried and outline
further management.

You are the SHO in the medicine out patient. Mr Healy has
been referred by his general practitioner for further
evaluation of his symptoms. He had presented to the GP with
a nine month history of tiredness. The G.P had requested for
a series of investigations and the results were
unremarkable. Take a history from Mr. Healy and discuss the
condition with him.

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 Leslie Dobson, a 33-year-old teacher is in the 32nd week of
her first pregnancy. Her blood pressure has been
consistently in the upper range and her latest blood pressure
is 150/90. Examination revealed that the fetal height
corresponds to the period of gestation and she is having
pedal edema. Urinalysis has revealed proteinuria. Your
Registrar has told you to talk to the patient that she is
having pre-eclampsia and needs to undergo admission. Talk
to Mrs. Dobson.

You are the SHO in the orthopedics clinic. Mr. John Glover,
23-year-old male has come to the clinic with a limp in his
right leg. He had sustained an injury to his right ankle while
playing a friendly football match with the Liverpool team.
The X- rays of his right ankle are normal. Talk to the patient
and advice him regarding further management.

Mr. Shirley Thompson is a 68 year old gentleman. He has

been admitted to the hospital for a TURP that is scheduled
for tomorrow. Counsel the patient about the operation and
take consent.

Mr. Alex Ferguson is a 72-year-old gentleman. He had been

diagnosed with osteoarthritis of the right knee 2 years back
and has been on regular analgesics and physiotherapy. His
symptoms are getting progressively worse and are not
responding to conservative management. Your consultant
has decided that he needs to undergo a knee replacement.
Talk to Mr. Ferguson about the operation.

Mrs. Dawn Franks had sustained a head injury when she was
involved in a Road traffic accident. She had a GCS of 14/15
during initial evaluation. A scan of the head was
unremarkable. She is now ready for discharge. Give advice
to Mrs. Franks regarding the precautions that need to be
observed following head injury.

Mr. Michael Kinsey is an 80 year old gentleman. He has

presented to the out patient clinic with the history of
difficulty in passing urine. Take a history and discuss the
condition with Mr. Kinsey.

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 June carter is an 80-year-old lady. She had undergone
admission to the Geriatric ward after an episode of severe
hypothermia. She has now recovered and is ready for
discharge. Her son has come to take her home. Discuss the
condition with the son and the measures that are necessary
to prevent a further episode.

Jack Healy is a three-year-old boy. He had been evaluated

for his weight loss, and the results confirm that he is
suffering from Diabetes Mellitus. The mother has come the
clinic. Talk to her regarding management and prognosis. Do
not take a history.

You are the SHO in department of accident and emergency.

Talk to Mrs. Betty whale who has come to the department
with her seven year old son, who had sustained a needle
stick injury whilst he was playing in the central park. She is
worried about her son.

6 Yr old child is found by the side of the pool in fitness first

gym. Do a basic Life Support

GP has referred 35 yr old Mrs Smith to the A & E. She has

been suffering from rheumatoid arthritis for last 5 years and
has been taking regular pain killers. She had recently gone
to see her GP complaining of worsening of pain in the small
joints of her hand over last 3 months. She has lost her job
due to the sickness. She is extremely concerned about the
pain and her future. Take a detailed history and discuss the
DD with the examiner.

26 Yr old Mrs Kelly has taken an overdose of 60 paracetamol

tablets. She is now medically stable to go home. Medical SHO
from A& E has asked you to see Mrs Kelly regarding further
management. You are a Psychiatric SHO. Do a risk
assessment
Mr Jones is 27 yr old. He feel that he is going mad. He states
that he needs to repeatedly check the door to make sure that
it is locked. He has been having problems with his sleep.
Take a history and discuss the diagnosis with Mr Kelly

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 Mrs Jones is an executive officer in a private firm. He has
been having problems with anxiety for last 6 months. He has
noted that his symptoms are getting worse. He gets cramps
and paresthesia. He wishes to know what might me the
cause for this new symptoms. Take a brief history and
explain the illness.

Mr Thompson suffers from depression for last 2 years. He

has been taking Fluoxetine for last 2 years. He went to see
his GP 4 weeks back because he noticed worsening of his
mood. His GP prescribed him Amitriptyline 75mg in addition
to Fluoxetine.
He now complains of feeling anxious, getting flushes,
palpitations, fever, dizziness and tremor. Take a brief history
and explain the management plan

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