Introduction - Address findings specific to the condition (e.g.

,
- Greet the examiner: "Hello, Examiner." wheezing, crepitations):
- State your GMC number: "My GMC number is 123456." - "I'll examine your chest. Does it hurt when I press?
- Seek permission to proceed: "May I proceed?" Now, I'll listen for any unusual sounds."
- Express gratitude: "Thank you." - Administer appropriate medications or treatments
based on findings: "I hear wheezing, so I'll give you a
Initial Assessment nebulized medication."
- Explain that you've taken universal precautions: "I've
ensured universal precautions are in place." Circulation
- Mention that you've called for help, and your team is en - Monitor blood pressure and peripheral perfusion: "Your
route: "I've called for help, and my team is on their way." blood pressure is low, and your hands are cold. We need to
improve your circulation."
Primary Survey - Manage hypotension or shock with IV fluids: "We'll start
- Evaluate consciousness: an IV and provide fluids to raise your blood pressure."
- Assess level of consciousness and response: "Hello, can - Initiate the massive hemorrhage protocol if necessary:
you hear me? Squeeze my hand if you understand." "I suspect significant bleeding, so we're activating a
- ABCDE approach: protocol to address it."
- Airway: - Address bleeding sources and control bleeding: "We'll
- Confirm airway patency: "Can you speak?" locate and stop the bleeding."
- Administer oxygen as needed: "I'm going to provide
you with oxygen. Please take deep breaths." Neurological Assessment
- Breathing: - Assess the patient's level of consciousness using the
- Check for breathing, and initiate CPR if absent: "I Glasgow Coma Scale: "Name, can you tell me your name and
don't see any breathing. We need to start CPR the date?"
immediately." - Check blood glucose levels: "I'll check your blood sugar
- Assess breath sounds, chest movement, and oxygen to rule out low blood sugar."
saturation: "I'll listen to your chest and check your - Consider the use of antidotes if applicable (e.g., naloxone
oxygen levels." for opioid toxicity): "We'll consider opioid antidotes if
- Circulation: needed."
- Check for signs of shock or hypotension: "I'll check
your blood pressure and peripheral perfusion." Full Exposure
- Establish IV access and administer fluids if - Perform a comprehensive head-to-toe examination:
necessary: "We'll place an IV line and give you fluids." - Check for temperature abnormalities, signs of bleeding,
- Manage bleeding sites, if identified: "If there's rashes, and injuries: "I'm examining your entire body for
bleeding, we'll stop it." (Then glucose, and exposure) any signs of problems."
- Inspect for medical devices or catheters: "Do you have
Secondary Survey any medical devices or tubes attached?"
- Gather patient history: - Provide appropriate interventions (e.g., antipyretics,
- Presenting complaint and onset: "Name, what brought antihistamines): "I'll give you paracetamol for fever."
you here, and when did the symptoms start?"
- Past medical history, current medications, allergies: "Do Summary
you have any medical conditions, take any medications, or - Summarize: "We've assessed your airway, breathing, and
have allergies?" circulation, and provided appropriate treatment. Your
- Relevant personal and social history: "Tell me about oxygen levels are improving."
your lifestyle and any recent social changes." - Provide a preliminary diagnosis and initial management to
the patient: "You likely have a severe respiratory issue,
Focused Physical Examination and we're treating it. We'll continue to monitor and adjust
- Airway: your treatment."
- Ensure ongoing airway patency and administer oxygen: - Discuss the need for further evaluation or specific
"Your airway seems clear. We'll continue your oxygen." treatments: "We may need more tests and possibly
- Breathing: hospitalization."
- Expose the chest and perform a systematic respiratory - Mention the potential level of care required (ward, HDU,
examination: ICU): "Depending on your condition, you may need to be in
- Inspection, palpation, percussion, and auscultation. the ICU."
 SCENARIOS CHECKLIST

- Chest Pain: Assess for myocardial infarction, administer aspirin.

- Shortness of Breath: Evaluate for causes of dyspnea, administer oxygen.

- Fainting (Syncope): Assess for underlying causes, monitor vitals.

- Abdominal Pain: Diagnose source of pain, rule out appendicitis.

- Head Injury: Evaluate for signs of concussion, neurological assessment.

- Sepsis: Identify infection source, start antibiotics, fluid resuscitation.

- Allergic Reaction: Administer epinephrine for anaphylaxis.

- Pediatric Fever: Assess the child's condition, consider sepsis.

- Gastrointestinal Bleeding: Identify bleeding source, stabilize patient.

- Acute Psychiatric Disturbance: Assess patient's mental state, provide reassurance.

- Unconscious Patient: Check ABCs, consider causes (e.g., hypoglycemia).

- Drug Overdose: Assess type of overdose, administer antidote if available.

- Stroke with Hemiparesis: Rule out contraindications for thrombolysis.

- Status Epilepticus: Administer benzodiazepines, prepare for intubation.

- Neonatal Respiratory Distress: Evaluate for causes, initiate neonatal resuscitation.

- Ectopic Pregnancy: Assess for abdominal pain and bleeding.

- Meningitis in Child: Perform lumbar puncture if indicated.

- Asthma Exacerbation: Administer bronchodilators, steroids.

- Severe Head Injury: Consider neurosurgical intervention.

- Toxic Ingestion (Salicylates): Administer activated charcoal.

- Pediatric Dehydration: Assess for signs of shock, start rehydration.

- Tension Pneumothorax: Needle decompression, chest tube.

- Cardiac Arrest: Follow ACLS protocol, start CPR and defibrillation.

- Hypoglycemia (Diabetic): Administer glucose IV or IM.

- Post-Operative Complications: Assess for signs of bleeding or infection.

- Triage (Mass Casualty): Assess and prioritize patients.

- Obstetric Emergency (Placental Abruption): Prepare for emergent delivery.

- Postpartum Hemorrhage: Administer uterotonic medications.

- Severe Dehydration (Child): Rehydrate cautiously, assess for shock.

- Alcohol Withdrawal: Monitor vitals, consider benzodiazepines.

- Pulmonary Embolism: Assess for signs, consider anticoagulation.

- Pneumonia: Diagnose and initiate appropriate antibiotics.

- Seizure in Child: Consider febrile seizure, assess for causes.

- Myocardial Infarction: Administer aspirin, nitroglycerin.

- Anaphylaxis (Insect Sting): Administer epinephrine, antihistamines.

- Pediatric Respiratory Distress: Assess for bronchiolitis, asthma, or pneumonia.

- Atrial Fibrillation: Rate and rhythm control.

- Appendicitis: Diagnose and prepare for surgery.

- Gastrointestinal Obstruction: Assess for complications.

- NSTEMI: Evaluate for further cardiac workup and medications.

- Hypothermia: Rewarm patient, manage arrhythmias.

- Upper GI Bleed: Administer PPI, assess for endoscopy.

- Child with Febrile Neutropenia: Start antibiotics and isolation.

- Pediatric Severe Allergic Reaction: Administer epinephrine.

- Severe Hypertension: Assess for end-organ damage, initiate treatment.

- Congestive Heart Failure: Administer diuretics and vasodilators.

- Severe Trauma (Polytrauma): Follow ATLS protocol.

- Acute Pancreatitis: Supportive care, pain management.

- Intracerebral Hemorrhage: Manage hypertension, assess for surgery.

- New-Onset Diabetes: Evaluate blood glucose, consider insulin.

 STRATEGIES
1. SAMPLE History: Use the SAMPLE acronym to structure your patient history-taking:
- Signs & Symptoms
- Allergies
- Medications
- Past medical history
- Last oral intake
- Events leading to the present condition

2. SOAP Note: Use the SOAP acronym to structure your clinical notes:
- Subjective: What the patient tells you.
- Objective: What you observe and measure.
- Assessment: Your diagnosis and assessment of the patient's condition.
- Plan: Your plan for treatment and management.

3. ABCDE Assessment: When dealing with critically ill patients, remember to assess in the following order:
- Airway
- Breathing
- Circulation
- Disability (neurological status)
- Exposure (examine for other injuries)

4. HAM-D Assessment: A mnemonic for the Hamilton Rating Scale for Depression, which assesses the severity of
depression:
- H: Hopelessness
- A: Anxiety (psychic)
- M: Mood (depressed)
- D: Diurnal variation of mood

5. CAGE Questionnaire: Used for alcohol abuse screening:

- C: Have you ever felt the need to Cut down on your drinking?
- A: Have you ever felt Annoyed by criticism of your drinking?
- G: Have you ever felt Guilty about your drinking?
- E: Have you ever needed an Eye-opener (drink in the morning) to steady your nerves?

6. GALS Examination: A simple musculoskeletal screening mnemonic:

- G: Gait
- A: Arms
- L: Legs
- S: Spine

7. OPQRST Assessment: A mnemonic for assessing pain:

- Onset
- Provocation/Palliation
- Quality
- Radiation
- Severity
- Time

8. SAMPLE Mnemonic for Trauma Assessment:

- Signs and Symptoms
- Allergies
- Medications
- Past medical history
- Last oral intake
 - Events leading to the injury

9. Glasgow Coma Scale (GCS): Used to assess a patient's level of consciousness:

- Eye Opening (E)
- Verbal Response (V)
- Motor Response (M)

10. PRIME-MD: A mnemonic for psychiatric evaluation:

- P: Psychiatric disorders
- R: Reassurance and education
- I: Informing patients about treatment options
- M: Medication options
- E: Establishing and planning care
TEACHING

Introduction:
"Good [morning/afternoon], I'm [Your Name], and I'll be your senior doctor today. I understand that we have a
teaching session scheduled, and I'd like to take this opportunity to discuss [the topic of the teaching station].
Before we begin, please let me know if you have any previous knowledge or experience related to this topic, so I
can tailor my teaching accordingly.

Today, we're going to discuss [briefly mention the main topic or objective of the teaching station, e.g., 'the
management of acute asthma exacerbations']."

Objectives:

"Our objectives for this session are as follows:

1. To understand the key clinical features of [the condition or topic].

2. To discuss the diagnostic criteria and assessment of patients with [the condition or topic].
3. To go over the initial management steps, including [mention key interventions or treatments].
4. To address any questions or concerns you may have about [the condition or topic]."

Presentation:

"I'll begin by providing a brief presentation on [the condition or topic], including its background, epidemiology,
and relevant clinical aspects."

Discussion:

"Once we've covered the basics, I'd like to engage in a discussion with you. Please feel free to ask any questions
or share any thoughts or experiences you have related to [the condition or topic]."

Demonstration:

"If applicable, I can also provide a practical demonstration of certain aspects. For instance, I can demonstrate
how to perform a [relevant clinical skill or procedure] if you'd find that helpful."

Practical Exercises (if relevant):

"Next, we can proceed with practical exercises. Depending on the topic, we may engage in hands-on activities,
role-play, or case discussions to reinforce your understanding."

Feedback and Evaluation:

"I value your input, so throughout this session, please don't hesitate to ask questions, seek clarification, or
share your thoughts. At the end of our session, I'll provide feedback on your performance, if applicable. I'm
here to support your learning."

Conclusion:

"Before we conclude, do you have any final questions or concerns? I encourage you to review the main points
we've discussed today and, if necessary, seek further resources or guidance in your ongoing learning."
Closure:

"Thank you for your active participation today. I hope you found this teaching session informative and valuable.
If you ever have more questions or need further guidance on [the condition or topic], please feel free to reach
out. Have a great day."
PHRASES

Introduction and Greeting:

1. "Good morning/afternoon."
2. "My name is [Your Name]."
3. "I'm here to help you with your concerns."
4. "How can I assist you today?"
5. "Thank you for coming in today."

Empathy and Understanding:

6. "I understand this might be difficult for you."
7. "I'm here to listen and support you."
8. "Your well-being is our priority."
9. "It's completely natural to feel this way."
10. "Your feelings are important, and we'll address them together."

Explanation and Education:

11. "Let me explain what we're going to do."
12. "This is a common procedure that..."
13. "Here's why we're recommending this treatment."
14. "It's important to know the risks and benefits."
15. "Understanding this information will help you make an informed decision."

Seeking Consent:
16. "We need your consent before proceeding."
17. "Is it okay with you if we move forward?"
18. "Do you have any questions before we begin?"
19. "Your consent is essential for your care."
20. "We'll respect your decision."

History-Taking:
21. "Can you describe your symptoms in detail?"
22. "Tell me when this problem started."
23. "Have you noticed any other associated symptoms?"
24. "Let's go over your medical history."
25. "Is there a family history of this condition?"

Physical Examination:
26. "I'll explain each step of the examination."
27. "Please let me know if you experience any discomfort."
28. "Take deep breaths; we'll go through this systematically."
29. "We're almost done with the examination."
30. "Your cooperation is greatly appreciated."

Patient Counseling:
31. "Here are some lifestyle changes that may help."
32. "You should follow up with your primary care doctor."
33. "Remember to take your medications as prescribed."
34. "This brochure provides more information on your condition."
35. "If you have any concerns, don't hesitate to contact us."
Explaining Test Results:
36. "I have the results of your tests."
37. "The results show that..."
38. "This is what the numbers mean."
39. "You're making progress, which is a good sign."
40. "We'll continue to monitor and adjust treatment as needed."

Support and Encouragement:

41. "You're doing a great job managing your health."
42. "It's normal to have ups and downs."
43. "I'm here for you every step of the way."
44. "You have a strong support system."
45. "You're not alone in this."

Setting Expectations:
46. "Recovery may take some time, and we'll monitor your progress."
47. "We'll aim for gradual improvement."
48. "This treatment may have side effects, but we'll manage them."
49. "We'll see you for a follow-up appointment in [timeframe]."
50. "If you have any questions or concerns, please reach out to us."