Here is a step-by-step action plan to structure your case presentation and handle the viva like a confident, competent junior doctor:

Phase 1: The 5-Minute Pre-Presentation Prep

Before the examiner enters, organize your thoughts on paper using this template:

Action Tip: If the examiner arrives while you're still writing, immediately stand up, greet them, and say: "May I have 30 seconds to finish organizing my findings, sir/ma'am?" (They almost always agree, and it shows professionalism.)

Phase 2: The Presentation Structure (Use This Script)

1. The Opening (30 seconds)

Stand straight, make eye contact, speak clearly.

"Good morning, sir/ma'am. I present the case of Mr./Ms. [Name], [Age] years old, [Occupation], who presented with the following complaints for the past [duration]..."

Why this works: Shows you treat the patient as a person, not a "case."

2. Chief Complaints (45 seconds)

• List 1-3 complaints in chronological order of appearance
• Use patient's words, NOT medical terminology here
• Include duration for each

"First, progressive breathlessness on exertion for 3 months (currently NYHA Class III). Second, bilateral leg swelling for 1 month. Third, two episodes of paroxysmal nocturnal dyspnea in the past week."

Key Action: Pause briefly after each complaint. This signals confidence and gives the examiner a chance to interrupt if needed.

3. History of Presenting Illness (90 seconds)

Use the "OLD CARTS" mnemonic for each symptom:

• Onset, Location, Duration
• Character, Aggravating/Alleviating factors
• Radiation, Temporal sequence, Severity

Actionable Strategy: Frame it as a story with clinical reasoning:

"The breathlessness started insidiously 3 months ago initially on climbing two flights of stairs, but has progressed to occur on walking 100 meters on flat ground over the past month. It is relieved by rest within 5 minutes. There is associated orthopnea requiring two pillows, and one episode of paroxysmal nocturnal dyspnea last week—suggesting left ventricular failure..."

4. The "Safety Check" (30 seconds)

Explicitly mention red flags you ruled out. This impresses examiners immediately:

"There is no history of chest pain, palpitations, syncope, or hemoptysis. No fever, chronic cough, or significant weight loss to suggest infective or malignant etiology."

5. General Physical Examination (60 seconds)

Present vitals first, then head-to-toe:

"The patient is conscious, cooperative, and well-oriented. Pulse is 96/min, regular, normal volume. BP is 110/70 mmHg in right arm supine position. Respiratory rate is 24/min. On inspection, there is pallor of conjunctiva and bilateral pedal edema up to the knees. No icterus, cyanosis, or lymphadenopathy. Jugular venous pressure is raised 4 cm above the sternal angle at 45 degrees..."

Pro Tip: If you missed a finding, don't lie. Say: "I would like to re-examine the pulse character more carefully, sir," and do it quickly.

6. Systemic Examination (90 seconds)

Use the "Inspection-Palpation-Percussion-Auscultation" format. Only mention relevant findings:

"On cardiovascular examination: Apex beat is shifted to the 6th intercostal space, anterior axillary line. S1S2 heard, with an audible S3 gallop in the mitral area. A soft pansystolic murmur of grade 2/6 heard at the apex radiating to the axilla, consistent with mitral regurgitation secondary to dilated cardiomyopathy..."

Crucial: Mention negative findings relevant to your differentials (e.g., "No clubbing or cyanosis to suggest bronchiectasis").

7. Summary & Diagnosis (30 seconds)

Synthesize everything:

"In summary, this is a 55-year-old hypertensive, diabetic male with progressive dyspnea, orthopnea, bilateral pedal edema, raised JVP, and an S3 gallop—provisional diagnosis being Congestive Heart Failure (NYHA Class III) likely secondary to dilated cardiomyopathy."

Then offer 2-3 ranked differentials briefly explaining your reasoning for each.

Phase 3: Handling the Viva Voce

When asked a question you know:

• Answer in 3-4 sentences max, then stop. Don't over-elaborate.
• Structure: Definition → Key Features → Clinical relevance.

When asked a question you DON'T know: NEVER guess or bluff. Use this exact phrase:

"Sir, I am not certain about the specific criterion, but I know it involves [related concept you know]. I would look this up immediately after the case to ensure patient safety."

When asked to demonstrate a procedure:

• Wash hands (even if you just did it—examiners notice)
• Explain to the patient what you're doing (shows communication skills)
• Position the patient correctly before starting
• Commentate your actions: "I am now percussing the cardiac borders, starting from the left mid-clavicular line..."

Phase 4: Common Pitfalls to Avoid

Final 60-Second Checklist Before the Examiner Arrives

• Vitals written down accurately?
• Patient's name and occupation memorized?
• One "interesting" finding identified to highlight?
• Pen capped and paper folded away?
• Stethoscope draped correctly (earpieces forward)?
• Hands clean and warm?

Which specialty cases are you most worried about—Medicine, Surgery, Pediatrics, or Obstetrics? I can give you specialty-specific templates (e.g., how to present an obstetric case with obstetric scores, or how to structure a pediatric history with birth history and immunization). Also, do you have a specific case coming up soon where you'd like to rehearse the presentation?

How to Impress Examiners in MBBS Practical Exam Case Presentation

MBBS practical exams (especially in Medicine, Surgery, Pediatrics, etc.) test your clinical skills, knowledge, and communication. Examiners look for structure, clarity, confidence, clinical reasoning, and professionalism. Follow this step-by-step guide to prepare and execute effectively. Aim to present in 5-8 minutes unless specified otherwise.

1. Preparation (1-2 Weeks Before)

Build a strong foundation to appear polished and knowledgeable.

• Master the Standard Format: Use this universal structure for long/short cases:
  1. Patient demographics (e.g., "45-year-old gentleman, Mr. X").
  2. Chief complaints (CC) in patient's words, with duration.
  3. History of present illness (HOPI): Chronological, ONSET (Onset, Nature, Severity, Exacerbating/relieving factors, Timing, Associated symptoms).
  4. Past medical/surgical history (PMH/PSH), drug history, family/social history, allergies.
  5. Review of systems (ROS): Relevant positives/negatives.
  6. Summary of history.
  7. Physical examination: General (vitals, built), systemic (e.g., CVS, RS with inspection/palpation/percussion/auscultation).
  8. Provisional diagnosis/differential diagnosis.
  9. Investigations planned/relevant findings.
  10. Management plan.
• Practice Daily:
  • Examine 2-3 mock patients (friends/classmates) using checklists from textbooks like Hutchison's Clinical Methods or Macleod's.
  • Record yourself presenting (5-7 mins) and review for filler words (um/ah), pacing, and eye contact.
  • Time yourself: History (2 mins), Exam (3-4 mins), Presentation (5 mins).
• Study High-Yield Cases: Focus on common ones (e.g., anemia, diabetes, MI, appendicitis). Know DDx, investigations (CBC, ECG, USG), and management per NMC guidelines.
• Dress & Etiquette: Clean white coat, stethoscope, neat hair. Practice greeting: "Good morning, sir/mam. May I start?"

2. During Patient Examination (Hands-On Phase)

Examiners observe your bedside manner and thoroughness.

• Introduce Yourself: "Hello sir/mam, I'm [Name], final-year MBBS. Permission to examine?"
• Gain Consent & Comfort: Explain steps, ensure privacy, wash hands.
• Be Systematic:
  • Vitals first (BP, pulse, RR, temp, BMI).
  • General exam (pallor, icterus, clubbing, edema).
  • Systemic: Follow IPPA (Inspection, Palpation, Percussion, Auscultation). Voice findings aloud (e.g., "Apex beat in 5th ICS MCL").
• Pro Tip: Note relevant negatives (e.g., "No peripheral pulses deficit"). Show empathy: "Does this hurt?"
• Document Briefly: Jot key positives/negatives on a notepad for presentation.

3. During Case Presentation (Key Impression Moment)

Stand straight, face examiners, speak clearly (moderate pace, loud enough).

• Start Strong: One-liner summary (e.g., "45-year-old male with 3-day fever, cough, and SOB").
• Flow Logically: Use transitions ("Moving to examination..."). Avoid reading notes—glance only.
• Impress with Reasoning:
  • End history with: "Suggestive of pneumonia."
  • DDx: 2-3 logical ones with justification (e.g., "TB vs. viral—smoker, no weight loss").
  • Investigations: Prioritize (e.g., "CXR for infiltrates, sputum AFB").
• Visuals if Allowed: Point to patient/exam findings (e.g., "See crepitations here").
• Body Language: Smile, maintain eye contact (rotate between examiners), nod to show listening.

4. Handling Viva Voce/Q&A (Seal the Deal)

Examiners probe deeper—stay calm.

• Listen Fully: Don't interrupt. Repeat question if needed: "So, management of DKA?"
• Answer Structured: Short + Long (e.g., "ABC, fluids, insulin infusion per guidelines").
• Admit Gaps Gracefully: "I'm not sure, but I'd consult Harrison's for that."
• Show Depth: Use mnemonics (e.g., SOCRATES for pain), guidelines (RNTCP for TB), recent updates (e.g., 2025 diabetes management).

5. Common Mistakes to Avoid

• Rushing or mumbling—practice enunciation.
• Forgetting patient respect (no "the case," say "this gentleman").
• Overloading details—prioritize relevant info.
• Poor hygiene/posture—examiners notice.
• Ignoring negatives—mention them to show completeness.

Quick Checklist for Exam Day

Follow this, and you'll stand out. Practice 10+ full cycles—you'll score high (aim for 80%+).

Which subject (e.g., Medicine, Surgery, Ortho) or specific system/case are you preparing for? Do you have access to mock patients or need tips for a particular exam board (e.g., MUHS, RGUHS)?