This document lists recurrent themes, scenarios, and management issues that may be encountered in clinical practice. It includes over 200 examples across various specialties such as cardiology, psychiatry, obstetrics/gynecology, pediatrics, and more. Common presentations involve hypertension, diabetes, depression, asthma, UTI, and cancer screening. Ethical dilemmas encompass disclosure of information, demanding treatment, and medical errors. Counseling needs relate to smoking, contraception, and sexual health. Procedures frequently taught include ECGs, injections, examinations, and scopes.

1. RECURRENT THEMES / SCENARIOS
TEACHING ECG x5
EpiPen x4
DipStick x3
Inguinal Swelling x2
Speculum x2
TELEPHONE &
HXp
Autism x7
Overweight / Obesity x4
Headache (PMS / SAH & High BP / Sinusitis / GCA /
Migraine and with Aura / transmale pt )
x10
Heroin Addiction x5
Pneumonia x1
HTN x1
Dementia & Memory problems x14
Psychosis x5
Polymyalgia rheumatica x1
Euthanasia x1
Transgender x1
Cystic fibrosis x1
Post herpetic neuralgia x3
Septicemia x1
Chronic fatigue x3
Meningitis prophylactics x5
BBN (simulator
or telephone)
ICH (dad / husband/brain Tu) x9
Breast Cancer x1
TIA x6
Aortofemoral bypass x1
Haemorrhagic Gastroenteritis x1

2. HIV x2
Post-op bleeding x1
Aneurysm x2
Pregnancy x2
ETHICS &
ANGRY PTS
Medical colleague (coming late / cocaine ) x2
Disclose and not disclose information (Ca mother /
daughter depression)
x2
Angry son/daughter (HF ttmt / levothyroxine dose / late Ca
CXR dx )
x10
Concerned relative (Confused dad / mother with son /
dementia mum / premature son / baby not cared / child in
NICU / epilepsy)
x10
Demanding treatment (OCP 6m prescription / Atbcs /
migraine wants CT / varicose vein
x6
Missing investigation (bx / Full blood / Foreign body x4
Medical error (Pneumonia / Leg swelling / missed child
fracture)
x3
Information governance (change note / FB post) x5
Angry with colleague (post-MI with physiotherapist /
change counsellor / GP could not complain)
x3
Abortion and Miscarriage x3
EXAMINATION
&
PROCEDURES
Testicular examination (epididymitis / test. Mass / teaching
/ undescended testis / scrotal mass )
x16
Ear pain / Otoscopy (ear wax / FB / cholesteatoma / loss of
hearing )
x10
Catheterisation x2
Abdominal examination (alcoholic liver disease ) x6
Antenatal examination x1
Prostate examination (PSA result / demanding ) x10
Pap Smear (Mild dyskaryosis / lesbian ) x3
MMSE x2
ABG x1
Venepuncture (PCTM OD / blood culture ) x4

3. Breast examination (lump ) x2
COUNSELLING Herbal medication (mother to child) x3
2 people policy x7
CF Pre-natal Counselling x1
Smoking cessation (COPD ) x4
Drug dependance x1
Contraception x3
Alcohol cessation x1
Concerned about dx or treatment (Breast Ca chemo ) x2
MRSA x1
16yo pregnant vomiting x1
Unwell taking oxybutynyn (confused/nausea/vomiting) x3
Post op knee operation x2
Sexual orientation and gender identity counselling x3
Bullying (lesbian / workplace ) x4
SIMMAN Acute Ashtma Attack x3
Sepsis (Uro ) x9
Anaphylaxis x5
Confusion (infection / low Na / UTI / urinary retention /
citalopram)
x6
AFib (& Pulmonary Oedema / & HF x10
Acute limb ischaemia x2
Hypoglycaemia x5
Pulmonary Embolism (Hysterec ) x4
Post- TURP x1
PEDS Baby w/ rash (amoxi allergy / urticaria ) x4
Enuresis x4
Infection (UTI / Chlamydia x5
Immunization (8w ) x4

4. Gilbert syndrome x1
Fall from height (NAI / OI / Orthop) x1
Viral encephalitis x1
Seizure x1
Febrile convulsion x1
Sore throat (sinusitis) / tonsilitis (and tonsillectomy) x4
Jaundice (physiological / neonatal x3
Chicken pox (also in OBGYN) x2
Neonatal conjunctivitis (Gonorrhea caused) x1
Meconium premature baby x1
Scabies x1
Developmental Milestones (Speech / walking ) x4
Impetigo x1
HX BASED Barrett Oesophagus x5
Chest pain x2
Vestibular Neuritis x1
Allergic rhinitis x1
Distended abdomen x2
Pericarditis x2
Fit (epilepsy ) x3
Skin lesion (seborrheic kheratosis / melanoma / Rash &
Cellulitis / wedding coming / scabies )
x6
Ductal Carcinoma in situ x5
Dizziness (BPPV / Menieres / Spells ) x5
Gout x1
Urinary incontinence x1
Infection (UTI / Syphilis x3
Dysphagia x1
Hemangioma x2

5. Leukemia x1
Tummy pain x1
Diarrhea (Coeliac disease / IBS) x8
Thalassemia x1
Diabetic retinopathy x5
Obstructive Sleep Apnoea Syndrome x2
Back pain (Renal colic / sprain / MM ) x8
Otitis Media (Acute Supurative) x3
Facial palsy x1
Eye Pain (Glaucoma / MS / Optic neuritis ) x3
Oesophageal Cancer x1
Prostate cancer x1
Age-related macular degeneration x3
Cataract x1
Diabetic Ketoacidosis (DKA also in PED) x4
Haematuria (painless ) x1
Bell’s Palsy x1
Pulmonary Embolism (Trans ) x1
Fall (Postural hypotension ) x4
Palpitation x1
COPD (& Tiredness x2
Haematuria x1
Erectile dysfunction (gay pt x7
Raynaud’s Syndrome x1
Lump in neck x2
Anaemia (vegan diet / iron def ) x6
Insomnia (domestic violence / post partum depression ) x5
MANAGEMENT Post MI (HF / Lifestyle mods / not walk / SOB / drug side
effects )
x6

6. Reluctant to be admitted / going to hospital (MI / DKA) x8
Blood reports (Alcoholic hepatitis/ High WBC / PCO ) x3
Stroke assessment x1
Post-mortem x3
ABG - refer to cardio x1
Testosterone overdose x1
Cannula (blocked / IV / post apendec ) x3
Scopy (sigmoidosc colorectal polyp / Coeliac endosc ) x2
Analgesia (nephropathy ) x1
Meds side effects (tiredness & ED) x1
Needlestick injury x2
Lesbian cervical smear x1
Pre-op assessment (screw removal) x1
Post-op complication (cyst infection ) x3
Review meds (hypothyroidism ) x1
SC Heparin x1
Denying treatment (breast Ca / PMR and steroids / HF) x5
Swab test: Gardnerella vaginalis +ve x1
OBGYN Antenatal clinic (Rubella -ve, smoker, alcoholic, breech) x8
Polycystic Ovarian Syndrome x2
Post-menopausal bleeding x2
UTI in pregnant woman x1
Pre-eclampsia (Ramipril pregnant lady ) x2
Pelvic Inflammatory syndrome x1
Vaginal discharge x1
Pre-eclampsia x1
Premature Ovarian Failure x1
PSYCH Mood swing, stopped Depo-provera x2
Depressive lesbian after partner’s miscarriage x1

7. Low Mood (4, weight loss after husband left / 5 / because
of daughter )
x4
Depression ( not improving with CBT / suicidal ideation ) x5
Behaviour problems in child (tantrum / conduct disorder ) x3
Delusional disorder x1
Psychotic episode x1
RECURRENCE CHART
1 2 3 4 5 6 7 8 9 10 >11