PESCI-X

They were 3 nice doctors, I think all GPs and they asked about my CV a bit and went into the scenarios very soon because of the
time limits.

1- A man with weeping rash on his leg (old question).

They asked about the approach:

I explained the hx and the differential diagnosis, they liked me to say as many
as possible.
He had hx of diabetes but stopped the Metformin a while ago because thought is
fine.
When I asked the examination, he had a mild fever and BSL was high. He had fruity smell breath but there was only Glu+ in urine
no ketones.

they asked about my management and I explained that he needs to go to hospital

because of DKA/HONK. One doctor asked whether he needs to go tonight, he is feeling fine otherwise.
I said even if it is not DKA/HONK still needs to go because of uncontrolled diabetes.

They seemed to be happy with it.

2- A ?40y man with rib pain on the left lower side.

I first started with management of a MI and gave him GTN for his pain but then he got headache with it and I realised they want to
change my direction. So, I continued with the Hx and found out that the pain is pleuritic and he had a hx of recent travel overseas.

So, then I gave him O2, and called for ambulance. They asked about Mx in hospital and I mentioned about the blood tests and
CTPA but I think I forgot about thrombophilia screening. I also mentioned about clexane inj and warfarin afterwards, One of the
examiners asked about the new medication for blood thinning and I said it is not yet approved for PE.

3- A ?30 yo with eye pain. PMHx of RA on MTX.

Initially they wanted me to tell as many as DDx as I could.

Then they showed me a photo of the eye which only showed conjunctival injection
and some ? swelling of the cornea, then I talked about the examination and possibility of Herpetic Keratitis. They wanted me to
draw a diagram of herpetic changes after fleurceine staining of the cornea.

I explained that the patient needs to go to hospital. One said can he go by himself. I
said if there is someone to drive him to hospital yes otherwise ambulance should take him.

4- This was a new question: a 47 yo female is asking for further script for her Nexium and OCP. She has been on them for a long
time and is going to go on a holiday. Normal BP.

They asked about my approach and the contraindications of the OCPs. The patient
is a smoker 15/day. I said that it is contraindicated for her but the patient was reluctant and said that other doctors have always
prescribed for her and now she
needs it for this holiday because is going to have a lot of sex. I suggested other
ways of contraception like condom or even progesterone tabs or injections but she
was reluctant. At the end she asked for Nexium with repeats and I asked her whether she had any endoscopies done recently and
she said last one was 10 years ago. I agreed to provide some for her but told her that she needs to see her
GP to organise another endoscopy to rule out other causes for her sx. They also
asked about the strength of Nexium and how long should she be on 40 mg before
going to 20 mg tabs and I said 2 months or she can go on another medication that
does not need dose change.

I have not got my results yet so cannot comment about the answers.
Good Luck.