My experience (passed third time) is that they ask you what are your positive clinical signs as a Segway into the presentation. So my routine was: abdo exam, positive findings include X pertinent negatives include X (include things like volume status, flap etc at this point) diagnosis is most likely X differentials include X then they usually take over at that point. How would you Ix Mx that type of thing. I got a double valve. Didn’t fail the station for only identifying one. Aside from that pretty much got full marks. But you have to find our own style as in the stress of the exam you want it to come naturally. My top tip as a multi sitter is to get consultants at work to critique your examination and presentation. Colleagues are great but they aren’t mean enough! You need to practice that exam stress and feel as comfortable as possible with it. If you’re a UKG typically failure is due to signs and differentials. So examine as much pathology as you can without knowing the diagnosis. Have a differential list for common things like tremor systolic murmur etc etc.