About the Book
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 Diffi culty 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 fi rst 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 immunodefi ciency 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 diffi cile), 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 confi dentiality, 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 (since 2009), 367 Full PACES experiences in the first person (before 2009), 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 fi rst 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 fi rst 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
