Clinical examinations in the OSCE style of marked stations are daunting for students, whether undergraduates or MRCP candidates. The introduction of the 5-station PACES (Progressive Assessment of Clinical Examination Skills) exam inspired a great deal of apprehension. This book provides coverage of common medical cases of PACES and similar exams.
Salient Features * A one-volume text giving candidates complete preparation for the PACES exam within one portable volume * 250 cases organised into the 5 stations of the PACES exam – respiratory and abdominal system, history taking, cardiovascular and nervous system, communication and ethics and skin, locomotion, eyes and endocrine systems * Engaging question-and-answer approach at the end of each case – excellent preparation for the exam * Boxed tips highlight vital information – helps identify what is most important to remember
Table of Contents INTRODUCTION STATION 1 RESPIRATORY AND ABDOMINAL SYSTEM RESPIRATORY SYSTEM Examination of the respiratory system Cases 1.1 Chronic obstructive pulmonary disease 1.2 Consolidation 1.3 Dullness at the lung base 1.4 Pneumonia 1.5 Lung cancer 1.6 Pancoast’s syndrome 1.7 Superior vena cava obstruction 1.8 Collapse/pneumonectomy/lobectomy 1.9 Bronchiectasis 1.10 Cystic fibrosis 1.11 Kartagener’s syndrome 1.12 Tuberculosis 1.13 Idiopathic pulmonary fibrosis and diffuse parenchymal lung disease 1.14 Rheumatoid lung 1.15 Extrinsic allergic alveolitis 1.16 Asbestos-related lung disease and pneumoconiosis 1.17 Pulmonary sarcoidosis 1.18 Pulmonary hypertension 1.19 Cor pulmonale 1.20 Pulmonary embolism 1.21 Pleural effusion 1.22 Pleural rub 1.23 Pneumothorax 1.24 Obstructive sleep apnoea-hypopnoea syndrome 1.25 Lung transplant ABDOMINAL SYSTEM Examination of the abdominal system Cases 1.26 Chronic liver disease 1.27 Jaundice 1.28 Ascites 1.29 Alcoholic liver disease 1.30 Viral hepatitis 1.31 Autoimmune hepatitis 1.32 Primary biliary cirrhosis 1.33 Hereditary haemochromatosis 1.34 Wilson’s disease 1.35 Hepatomegaly 1.36 Splenomegaly 1.37 Hepatosplenomegaly 1.38 Felty’s syndrome 1.39 Abdominal mass 1.40 Crohn’s disease 1.41 Ulcerative colitis 1.42 Carcinoid syndrome 1.43 Enteric and urinary stomas 1.44 Chronic myeloid leukaemia 1.45 Polycythaemia vera, myeloproliferative disorders and myelodysplasia 1.46 Chronic lymphocytic leukaemia 1.47 Lymphadenopathy and lymphoma 1.48 Polycystic kidney disease 1.49 Nephrotic syndrome 1.50 Renal transplant STATION 2: HISTORY-TAKING SKILLS Introduction to history-taking skills Clinical reasoning The traditional medical history model Incorporating the patient's perspective ideas, concerns and expectations History-taking skills the communication skills that make history-taking effective The traditional model and communication skills putting these two together Cases Respiratory problems 2.1 Breathlessness 2.2 Asthma Abdominal problems 2.3 Dyspepsia 2.4 Dysphagia 2.5 Abdominal pain 2.6 Altered bowel habit Cardiovascular problems 2.7 Prevention of cardiovascular disease and weight gain 2.8 Chest pain and angina 2.9 Acute coronary syndrome 2.10 Heart failure 2.11 Palpitations 2.12 Atrial fibrillation 2.13 Dyslipidaemia 2.14Hypertension Neurological problems 2.15 Headache 2.16 Transient ischaemic attack 2.17 Weakness and wasting 2.18 TMultiple sclerosis 2.19 Tremor Locomotor problems 2.20 Back pain 2.21 Joint pain Eye problems 2.22 Visual loss Endocrine problems 2.23 Type 1 diabetes mellitus 2.24 Type 2 diabetes mellitus Renal and metabolic problems 2.25 Acute renal failure 2.26 Chronic kidney disease and renal replacement therapy 2.27 Glomerulonephritis 2.28 Systemic vasculitis 2.29 Hypercalcaemia 2.30 Hyponatraemia 2.31 Poisoning and metabolic disturbance Haematological problems 2.32 Anaemia 2.33 Sickle cell disease and thalassaemia 2.34 Purpura 2.35 Haemophilia 2.36 Deep vein thrombosis 2.37 Thrombophilic tendency 2.38 Myeloma Infectious disease 2.39 Human immunodeficiency virus infection Other general internal medicine and elderly care problems 2.40 Falls and rehabilitation 2.41 Syncope 2.42 Seizures 2.43 Acute confusion 2.44 Mild cognitive impairment and dementia 2.45 Incontinence 2.46 Raised inflammatory markers 2.47 Polymyalgia and giant cell arteritis 2.48 Pyrexia and sepsis 2.49 Weight loss 2.50 Tiredness STATION 3: CARDIOVASCULAR SYSTEM AND NERVOUS SYSTEM CARDIOVASCULAR SYSTEM Examination of the cardiovascular system Cases 3.1 Mitral stenosis 3.2 Mitral regurgitation 3.3 Aortic stenosis 3.4 Aortic regurgitation 3.5 Tricuspid regurgitation and Ebstein’s anomaly 3.6 Other right-sided heart murmurs 3.7 Mixed valve disease 3.8 Mitral valve prolapse 3.9 Prosthetic valves 3.10 Permanent pacemaker 3.11 Infective endocarditis 3.12 Congenital heart disease 3.13 Cyanotic heart disease 3.14 Hypertrophic (obstructive) cardiomyopathy 3.15 Pericardial rub and pericardial disease NERVOUS SYSTEM Examination of the nervous system Overview of the organisation of the nervous system and how to examine it Cranial nerves Higher cortical function and specific lobes Speech and language Power and sensation Upper limbs Lower limbs Gait Cases 3.16 Visual field defects 3.17 Ocular nerve lesions 3.18 Internuclear ophthalmoplegia 3.19 Nystagmus 3.20 Ptosis 3.21 Large pupil 3.22 Small pupil 3.23 Horner’s syndrome 3.24 Cerebellopontine angle syndrome 3.25 Facial nerve palsy 3.26 Bulbar palsy 3.27 Anterior circulation stroke syndromes 3.28 Dysphasia and dysarthria 3.29 Pseudobulbar palsy 3.30 Agnosias and apraxias 3.31 Posterior circulation stroke syndromes 3.32 Parkinson’s disease 3.33 Cerebellar disease 3.34 Spastic paraparesis and Brown Sequard syndrome 3.35 Syringomyelia 3.36 Absent ankle jerks and extensor plantars 3.37 Motor neurone disease 3.38 Cervical myeloradiculopathy 3.39 Cauda equina syndrome 3.40 Carpal tunnel syndrome (median nerve lesion) 3.41 Ulnar nerve lesion 3.42 Radial nerve lesion 3.43 Wasting of the small (intrinsic) muscles of the hand 3.44 Common peroneal nerve lesion 3.45 Peripheral neuropathy 3.46 Charcot-Marie-Tooth disease and hereditary neuropathies 3.47 Guillain-Barre syndrome 3.48 Myasthenia gravis 3.49 Myotonic dystrophy STATION 4: COMMUNICATION SKILLS AND ETHICS COMMUNICATION SKILLS AND ETHICS Introduction to communication skills and ethics Cases Discussing clinical management 4.1 Explaining a diagnosis 4.2 Explaining an investigation 4.3 Discussing a treatment 4.4 Discussing management, prognosis and possible complications in a patient with multiple problems 4.5 Discussing diagnostic uncertainty 4.6 Discussing risk and treatment effect 4.7 Negotiating a management plan for a chronic disease/long-term condition 4.8 Encouraging concordance with treatment and prevention Communication in special circumstances 4.9 Cross-cultural communication 4.10 Communicating with angry patients or relatives 4.11 Communicating with upset and distressed relatives 4.12 Discharge against medical advice 4.13 Delayed discharge Breaking bad news 4.14 Cancer – potentially curable 4.15 Cancer – likely incurable 4.16 Cancer – patient not fit for active treatment 4.17 Chronic disease 4.18 Discussing an acutely terminal situation with relatives Confidentiality, consent and capacity 4.19 Legal points in confidentiality 4.20 Breaching confidentiality when a third party may be at risk 4.21 Breaching confidentiality in the public interest 4.22 Confidentiality when talking with relatives and other third parties 4.23 Consent for investigation or treatment 4.24 Consent and capacity 4.25 Refusal to consent 4.26 Deliberate self-harm End of life issues 4.27 Resuscitation-status decision-making discussion with patient 4.28 Resuscitation status decision-making discussion with relative 4.29 Appropriateness of intensive therapy unit transfer 4.30 Withholding and withdrawing life-prolonging treatments Artificial hydration and nutrition 4.31 Withholding and withdrawing life-prolonging treatments antibiotics and drugs 4.32 Percutaneous endoscopic gastrostromy feeding 4.33 Palliative care 4.34 Advance directives/decisions 4.35 Persistent vegetative state 4.36 Brainstem death 4.37 Discussing live organ donation 4.38 Requesting an autopsy (post-mortem) Clinical Governance 4.39 Critical incident 4.40 Managing a complaint and the question of negligence 4.41 Fitness to practice poor peformance in a colleague 4.42 Fitness to practice misconduct in a colleague 4.43 Fitness to practice health problems in a colleague 4.44 Recruitment to a randomised controlled trial Other communication, ethical and legal scenarios 4.45 Genetic testing 4.46 HIV testing 4.47 Needlestick injury 4.48 Medical opinion on fitness for anaesthesia 4.49 Fitness to drive 4.50 Industrial injury benefits STATION 5: SKIN, LOCOMOTOR SYSTEM, EYES, ENDOCRINE SYSTEM SKIN Examination of the skin Cases 5.1 Psoriasis 5.2 Dermatitis 5.3 Lichen planus 5.4 Blistering skin condititions 5.5 Facial rash 5.6 Scleroderma, vitiligo and autoimmune skin disease 5.7 Oral lesions 5.8 Nail lesions 5.9 Shin lesions 5.10 Neurofibromatosis 5.11 Tuberose sclerosis 5.12 Neoplastic skin lesions 5.13 Skin vasculitis 5.14 Xanthomata and xanthelasmata 5.15 Skin and soft tissue infection LOCOMOTOR SYSTEM Examination of the joints Examination of the hands and arms Examination of the legs Examination of the spine Cases 5.16 Rheumatoid hands and rheumatoid arthritis 5.17 Ankylosing spondylitis and spondyloarthropathies 5.18 Systemic lupus erythematosus 5.19 Scleroderma 5.20 Crystal arthropathy 5.21 Osteoarthritis 5.22 Paget’s disease 5.23 Marfan’s syndrome 5.24 Ehlers-Danlos syndrome 5.25 Osteogenesis imperfecta EYES Examination of the eyes Cases 5.26 Diabetic retinopathy 5.27 Hypertensive retinopathy 5.28 Swollen optic disc and papilloedema 5.29 Optic atrophy 5.30 Chorioretinitis 5.31 Retinitis pigmentosa 5.32 Central retinal vein occlusion 5.33 Central retinal artery occlusion 5.34 Retinal detachment and vitreous haemorrhage 5.35 Drusen and age-related macula degeneration (asteroids) 5.36 Angioid streaks 5.37 Myelinated nerve fibres 5.38 Glaucoma 5.39 Cataracts 5.40 Uveitis and red eye ENDOCRINE SYSTEM Examination of the thyroid Cases 5.41 Hyperthyroidism and Grave’s disease 5.42 Hypothyroidism 5.43 Goitre and neck lumps 5.44 Acromegaly 5.45 Hypopituitarism 5.46 Cushing’s syndrome 5.47 Hypoadrenalism and Addison’s disease 5.48 Hirsutism and polycystic ovarian syndrome 5.49 Hypogonadism and gynaecomastia 5.50 Pseudohypoparathyroidism APPENDIX 100 tips for passing PACES INDEX
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