This new edition of An Aid to the MRCP Paces Volume 2: Stations 2 and 4 has been fully revised and updated, and reflects feedback from PACES candidates as to which cases frequently appear in each station.
The cases and scenarios have been written in accordance with the latest examining and marking schemes used for the exam providing an invaluable training and revision aid for all MRCP PACES candidates.
Table of Contents:
Preface ix
Introduction xiii
Section D: History-Taking Skills 1
Station 2, History-Taking Skills 7
1 Abdominal swelling 8
2 Ankle swelling 10
3 Asymptomatic hypertension 13
4 Back pain 16
5 Breathlessness 19
6 Burning of the feet 23
7 Chest pain 26
8 Cold and painful fingers 28
9 Collapse? cause 30
10 Confusion 32
11 Cough 35
12 Diabetic feet 37
13 Difficulty in walking 40
14 Dizziness and feeling faint 43
15 Double vision 45
16 Dysphagia 48
17 Epigastric pain and nausea 50
18 Facial swelling 52
19 Funny turns 55
20 Haemoptysis 58
21 Headache 60
22 Hoarse voice 63
23 Hypercalcaemia 65
24 Hyperlipidaemia 67
25 Jaundice 70
26 Joint pains 73
27 Loin pain 76
28 Loss of weight 78
29 Lower gastrointestinal haemorrhage 80
30 Macrocytic anaemia 82
31 Neck lump 85
32 Painful shins 87
33 Painful shoulders 89
34 Palpitations 91
35 Personality change 93
36 Pins and needles 96
37 Polyuria 98
38 Pruritus 100
39 Purpuric rash 102
40 Pyrexia 104
41 Renal colic and haematuria 107
42 Tiredness 109
43 Tremor 112
44 Visual disturbances 114
45 Vomiting 117
46 Vomiting and forgetfulness 120
47 Weakness of the right arm 123
48 Weight gain 126
49 Weight loss and chronic diarrhoea 129
50 Wheeze 131
Section E: Communication Skills and Ethics 135
Station 4, Communication Skills and Ethics 145
Category 1: Informed Consent
1 Consent for a lumbar puncture 147
2 Consent for oesophagogastroduodenoscopy (OGD) 150
3 Emergency surgery under principles of ‘best interests’ 154
4 A competent patient’s refusal of treatment 157
Category 2: Diagnoses and Management Advice
5 Obesity management 160
6 Side-effects of cardiac medication 163
7 Presentation of a first seizure 166
8 Rheumatoid arthritis 169
9 Valvular heart disease in a young woman 172
10 Air travel with chronic obstructive pulmonary disease 175
11 Polypharmacy 178
12 Blood transfusion 181
13 Hormone replacement therapy 183
14 Lifestyle adjustments after a myocardial infarction 186
15 Smoking cessation 189
16 Starting insulin therapy 192
17 Refusal of analgesia 194
Category 3: General Clinical Issues
18 Human immunodeficiency virus testing 196
19 Communication of a human immunodeficiency virus-positive result 200
20 New diagnosis of tuberculosis 204
21 Non-compliance with anti-tuberculous treatment 208
22 Multidrug-resistant tuberculosis 211
23 ‘Hospital superbug’ 1 (Clostridium difficile) 215
24 ‘Hospital superbug’ 2 (methicillin-resistant Staphylococcus aureus) 219
25 Assessing suicide risk 223
26 Genetic counselling 226
27 Fitness for anaesthesia/surgery 230
28 Screening for prostate cancer 232
Category 4: Breaking Bad News
29 Malignancy in a young patient 235
30 A chronic illness 238
Category 5: Ethical and Legal Issues
31 A patient with a functional illness 240
32 Brainstem death testing and organ transplantation 243
33 Hospital postmortem 248
34 Coroner’s postmortem 253
35 Do not attempt resuscitation decisions 257
36 Withholding information from patients 262
37 Maintaining patient confidentiality 266
38 Advance care decisions 270
39 Healthcare decisions for a patient who lacks mental capacity 274
40 Care of the vulnerable adult 278
41 Blood transfusion for a Jehovah’s Witness 282
42 Eligibility for major surgery 285
43 Postponement of an investigation 287
44 Clinical error in drug administration 289
45 Fitness to drive 292
46 Limits of treatment in end-stage disease 295
47 Withdrawing treatment 298
48 Enrolling a patient in a clinical trial 301
49 Industrial Injuries Disablement Benefit 304
50 Internet therapy 306
51 Unrelated live donor transplant 309
Category 6: Dealing with Difficult Patients/Relatives
52 A patient desperate for a diagnosis 311
53 A missed tumour 315
54 An unhappy inpatient 319
55 Delay in investigation 322
56 A patient wanting to self-discharge 324
Category 7: Professional Issues and Communication with Colleagues
57 Major incident exercise 327
58 A struggling team of doctors 330
59 A colleague with hepatitis B infection 334
60 A colleague with a needlestick injury 337
61 The improper doctor 340
62 The incompetent doctor 343
63 The sick doctor 345
64 Consent for medical examination 347
65 Submitting an audit project 350
66 Treating a prisoner 353
67 A violent and abusive patient 355
68 Withdrawing treatment in intensive care 357
Section F: Experiences, Anecdotes, Tips, Quotations 359
Full PACES experiences in the first person (since2009) 367
Full PACES experiences in the first person (before2009) 389
Additional Station 2 experiences 427
Additional Station 4 experiences 431
Invigilators’ diaries – Stations 2 and 4 435
Some anecdotes from our most recent surveys 435
Experiences 437
The power and range of the candidate’s observations 439
The candidate’s examination technique 441
The clinical competence of the candidate 443
Common errors 444
Look first 444
Double pathology 445
Tell them of the expert that told you 445
Apologies accepted 445
‘Even though I didn’t mean to say it – I did’ 446
Invigilator’s diaries 446
Fly on the wall – complete accounts 448
Ungentlemanly clinical methods 452
Miscellaneous ‘pass’ experiences 452
You never know you’ve failed until the list is published 464
Survivors of the storm 466
Some ‘fail’ experiences 470
Downward spirals 475
Anecdotes 477
Some anecdotes in the first person 480
Miscellaneous 483
Useful tips 483
Quotations 484
Adopt good bedside manners 485
Practise clinical examination and presentation 485
Get it right 486
Listen, obey and do not stray 486
One wrong does not make one fail 487
If you say less they want more 487
Humility is more persuasive than self-righteousness 487
Keep cool: agitation generates aggression 488
Simple explanations raise simple questions 488
Think straight, look smart and speak convincingly 488
You have seen it all before 489
Use your eyes first and most 489
Doing and forgetting 489
Examiners are different 489
Additional comments and quotes from candidates 490
Appendices 491
1 Website links 493
2 Abbreviations 495
Index 497
About the Author :
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
