An Aid to the MRCP PACES, Volume 2 Stations 2 and 4

Dev Banerjee Department of Medicine, Birmingham Heartlands Hospital, Heart of England NHS Foundation Trust and City Hospital, Birmingham

N. Sukumar Department of Medicine, Birmingham Heartlands Hospital, Heart of England NHS Foundation Trust and City Hospital, Birmingham

Robert E.J. Ryder is Consultant Physician and Clinical IT Lead at City Hospital NHS Trust, Birmingham, and Honorary Senior Lecturer in Medicine at the University of Birmingham.

Dr M. Afzal Mir is Senior Lecturer and Consultant Physician at University Hospital of Wales, Cardiff

Dr Anne Freeman is Consultant Physician at Royal Gwent Hospital, Newport, and Clinical Adviser and Chairwoman of the Welsh Stroke Alliance

Preface

Introduction

Section D

Station 2, History Taking Skills

1 Abdominal swelling

2 Ankle swelling

3 Asymptomatic hypertensive

4 Backpain

5 Breathlessness

6 Burning of the feet

7 Chest pain

8 Cold and painful fingers

9 Cause of collapse?

10 Confusion

11 Cough

12 Diabetic feet

13 Difficulty in walking

14 Dizziness and feeling faint

15 Double vision

16 Dysphagia

17 Epigastric pain and nausea

18 Facial swelling

19 Funny turns

20 Haemoptysis

21 Headache

22 Hoarse voice

23 Hypercalcaemia

24 Hyperlipidaemia

25 Jaundice

26 Joint pains

27 Loin pain

28 Loss of weight

29 Lower gastrointestinal haemorrhage

30 Macrocytic anaemia

31 Neck lump

32 Painful shins

33 Painful shoulders

34 Palpitations

35 Personality change

36 Pins and needles

37 Polyuria

38 Pruritus

39 Purpuric rash

40 Pyrexia

41 Renal colic and haematuria

42 Tiredness

43 Tremor

44 Visual disturbances

45 Vomiting

46 Vomiting and forgetfulness

47 Weakness of the right arm

48 Weight gain

49 Weight loss and chronic diarrhoea

50 Wheeze

Section E

Station 4, Communication Skills and Ethics,

Category 1: Informed Consent

1 Consent for a Lumbar puncture

2 Consent for OGD

3 Emergency surgery under principles of ‘best interests’

4 A competent patient’s refusal of treatment

Category 2: Diagnoses and management advice

5 Obesity Management

6 Side-effects of cardiac medication

7 Presentation of a first seizure

8 Rheumatoid arthritis

9 Valvular heart disease in a young woman

10 Air-travel with COPD

11 Polypharmacy

12 Blood transfusion

13 Hormone replacement therapy

14 Lifestyle adjustments after a myocardial infarction

15  Smoking cessation

16 Starting insulin therapy

17 Refusal of analgesia

Category 3: General clinical issues

18 HIV testing

19 Communication of an HIV positive result

20 New diagnosis of tuberculosis

21 Non-compliance with anti-tuberculous treatment

22 Multi-drug resistant tuberculosis

23 “Hospital Superbug” 1 (Clostridium Difficile)

24 “Hospital Superbug” 2 (MRSA)

25 Assessing suicide risk

26 Genetic counselling

27 Fitness for anaesthesia/surgery

28 Screening for prostate cancer

Category 4: Breaking Bad News

29 Malignancy in a young patient

30 A chronic illness

Category 5: Ethical and legal issues

31 A patient with a functional illness

32 Brainstem death testing and organ transplantation

33 Hospital post-mortem

34 Coroner’s post-mortem

35 Do not attempt resuscitation decisions

36 Withholding information from patients

37 Maintaining patient confidentiality

38 Advanced care decisions

39 Healthcare decisions in a patient who lacks mental capacity

40 Care of the vulnerable adult

41 Blood transfusion for a Jehovah’s witness

42 Eligibility for major surgery

43 Postponement of an investigation

44 Clinical error in drug administration

45 Fitness to drive

46  Limits of treatment in end-stage disease

47 Withdrawing treatment

48 Enrolling a patient in a clinical trial

49 Industrial benefits

50 Internet therapy

51 Unrelated live donor transplant

Category 6: Dealing with Difficult Patients/Relatives

52 A patient desperate for a diagnosis

53 A missed tumour

54 An unhappy inpatient

55 Delay in investigation

56 A patient wanting to self-discharge

Category 7: Professional Issues and Communication with Colleagues

57 Major incident exercise

58 A struggling team of doctors

59 A colleague with Hepatitis B infection

60 A colleague with a needlestick injury

61 The improper doctor

62 The incompetent doctor

63 The sick doctor

64 Consent for medical examination

65 Submitting an audit project

66 Treating a prisoner

67 A violent and abusive patient

68 Withdrawing treatment in intensive care

Section F: Experiences, Anecdotes, Tips, Quotations

Full PACES experiences in the first person

The following full PACES experiences predate the changes in Station 5 that occurred in Autumn 2009

Additional Station 2 experiences

Additional Station 4 experiences

Invigilators diaries—Station 2 and 4

Some anecdotes from our most recent surveys

Experiences,

The power and range of the candidate’s observations,

The candidate’s examination technique

The clinical competence of the candidate

Common errors

Look first

Double pathology

Tell them of the expert that told you

Apologies accepted

‘Even though I didn’t mean to say it—I did’

Invigilator’s diaries

Fly on the wall—complete accounts

Ungentlemanly clinical methods

Miscellaneous ‘pass’ experiences

You never know you’ve failed until the list is published,

Survivors of the stor

Some ‘fail’ experiences

Downward spirals,

Anecdotes

Some anecdotes in the first person

Miscellaneous

Useful tips

Quotations

Adopt good bedside manners

Practise clinical examination and presentation

Get it right

Listen, obey and do not stray

One wrong does not make one fail

If you say less they want more

Humility is more persuasive than self-righteousness

Keep cool: agitation generates aggression

Simple explanations raise simple questions

Think straight, look smart and speak convincingly

You have seen it all before

Use your eyes first and most

Doing and forgetting

Examiners are different

Additional comments and quotes from candidates

Appendices

1 Website links

2 Detailed contents of Section F

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