MRCPUK INFORMATION FOR THE CANDIDATE
SCENARIO 2
Membership of the royal of college of physician of the United Kingdom
MRCP(UK) PACES
Station 5: BRIEF CLINICAL CONSULTATION
Patient details: Mrs FLORA aged 23.
Your role: You are the doctor in the MOPD clinic
You have 10 minutes with each patient. The Examiners will alert you when 6 minutes have elapsed and will
stop you after 8 minutes. In the remaining 2 minutes, one Examiner will ask you to report on any abnormal
physical signs elicited, your diagnosis or differential diagnoses, and your plan for management (if not already
clear from your discussion with the patient).
Referral text:
CLINICAL PROBLEM: This lady has been referred by her family doctor presented with right upper
and lower limb weakness for 1 day. She was treated as TIA and referred to your clinic for further
evaluation.
Physiological observations for the patient Reading on arrival
above
Respiratory rate (respirations per minute) 16/min
Pulse rate (beats per minute) 88/min
Systolic blood pressure (mm Hg) 160
Diastolic blood pressure (mm Hg) 90
Oxygen saturations (%) 98% under RA
Temperature 37 celcius
Other relevant observation data (units if -
applicable)
Please interview her brother, Mr.Robert for further history.
Your task is to:
• Assess the problem by means of a brief focused clinical history and a relevant physical
examination. You do not need to complete the history before carrying out an appropriate
examination.
• Advise the patient of your probable diagnosis (or differential diagnoses), and your plan for
investigation and treatment, where appropriate.
• Respond
Any notes youdirectly
make mayto any specific
be taken intoquestions / concerns
the examination room which the
for your patient may
reference, have.
but must be handed to the
examiners at the end of the station.
INFORMATION FOR THE SURROGATE
MRCPUK SCENARIO 2
Membership of the royal of college of physician of the United Kingdom
NOT TO BE SEEN BY CANDIDATES
MRCP(UK) PACES
Station 5: BRIEF CLINICAL CONSULTATION
Candidates will have a very limited time (8 minutes) with you to gather all the information they require,
perform an examination and explain what further tests or treatments they would like to arrange, as well as
answer your questions. The scenario below may be based upon your case, however some aspects of your
medical history may have been simplified or left out from the scenario for the purpose of the exam e.g. other
health problems, previous tests and treatments. It is very important that you stick to the history given below
and do not deviate from it. This is essential to ensure that the exam is fair for all candidates. Those organising
the exam will contact you before the exam to run through the scenario with you. Please read through the
history carefully beforehand and you will have the opportunity at that point to answer any questions or
concerns you may have.
Patient details: Mrs FLORA aged 23.
Your role: You are the doctor in the MOPD clinic
History of current problem
Information to be volunteered at the start of the consultation
2 days ago, while your sister were working in the office, suddenly she felt her right arms and right leg
heaviness and unable to life up and hold objects in the office. She was panicked and been asking
colleagues to help her massage the arms and legs, after about 1 hour the weakness slowly and
progressively improving. she went to her GP clinic, and her GP doctor suspected she had stroke, hence
was referred to medical clinic for further evaluation.
Information to be given if asked
This is the first time.
She has on and off headache for the past 1 year, throbbing in nature and usually worsen when working.
she thinks is due to migraine, after taking paracetamol she feels slightly relief.
She has on and off mild right-hand numbness and pain for the past 1 year. Symptoms worsen when she is
working, but relieved during resting and does not required taking pain relief.
Background Information
Past medical and surgical history
Not known medical illness.
Relevant family history
- Father had stroke before this during 60 years old of age. Currently able to ambulate with walking
aids.
- Has 3 siblings. She is the youngest. No similar complaints among other family members.
Medication record
Current medications
- Started aspirin 150mg od by GP doctor.
- Paracetamol on and off for headache.
Personal History
Relevant personal, social or travel history
- Worked as clerk in bank.
- Non-smoker, non-drinker.
- Active in sport.
Physical examination
You have a few specific questions for the doctor at this consultation.
- Is my sister having stroke?
- Can she still able to drive and travel?
INFORMATION FOR THE EXAMINER
MRCPUK SCENARIO 2
Membership of the royal of college of physician of the United Kingdom
NOT TO BE SEEN BY CANDIDATES
MRCP(UK) PACES
Station 5: BRIEF CLINICAL CONSULTATION
Examiners should advise candidates after 6 minutes have elapsed that “You have two minutes remaining with
your patient”. If the candidate appears to have finished early remind them how long is left at the station and
enquire if there is anything else they would like to ask or examine. If they have finished, please remain silent
and allow the candidate that time for reflection.
The Examiner should ask the candidate to describe any abnormal physical findings that have been identified.
The Examiner should also ask the candidate to give the preferred diagnosis and any differential diagnoses that
are being considered. Any remaining areas of uncertainty e.g. regarding the plan for investigation or
management of the problem may be addressed in any time that remains.
Examiners should refer to the marking guidelines in the seven skill domains on the mark sheet.
Examiners must fully rehearse the scenario with the patient / surrogate during calibration. The boxes on the
next page indicate areas of potential interest in this case which both Examiners should consider, along with
any other areas they feel appropriate. Examiners must agree the issues that a candidate should address to
achieve a Satisfactory award for each skill and record these on the calibration sheet provided. Examiners
should also agree the criteria for an Unsatisfactory award at each skill.
MRCPUK INFORMATION FOR THE EXAMINER
SCENARIO 2
Membership of the royal of college of physician of the United Kingdom
PROBLEM: Takayasu arteritis with young TIA and headache
CANDIDATE’S ROLE: doctor in MOPD clinic
PATIENT’S NAME: Miss Flora
PATIENT OR SURROGATE: surrogate, Mr Robert
CLINICAL SETTINGS: MOPD
Examiners are reminded that the boxes below indicate areas of potential interest, but are not intended as
absolute determiners of satisfactory performance. It is for the Examiners to agree and record the specific
criteria they will assess the candidate on during the calibration process.
CLINICAL SKILLS ISSUES
CLINICAL - Able to obtain focus history of limb weakness and headache
COMMUNCATION SKILLS - Able TRO other cause of TIA.
(C)
PHSYICAL EXAMINATION - Offer to measure BP
(A) - Auscultate abdomen and carotid bruit
- Palpate pulse
CLINICAL JUDGEMENT (E) - Investigate: ESR, CRP, Autoimune workup, carotid usg, CT brain, CTA.
- Treat: steroid/immunosuppressive therapy.
- Advice: not to drive until diagnosis sort out and symptoms resolved.
MANAGING PATIENTS - Addresses the patient’s questions and concerns in an appropriate
CONCERN (F) manner.
IDENTIFYING PHYSICAL - Able to appreciate carotid bruit
SIGNS(B) - Able to appreciate weak/absent pulse
DIFFERENTIAL - Diagnosis: takayasu arteritis
DIAGNOSIS(D) - Ddx: Carotid artery stenosis, brain tumor…
MAINTAINING PATIENT - Treats the patient respectfully, sensitively and ensures comfort, safety
WELFARE(G) and dignity.
- Does not cause physical or emotional discomfort or jeopardise safety.
