An Aid to the MRCP PACES V 2 – Stations 2 and 4

<p>Preface ix<br /><br />Introduction xiii<br /><br />Section D: History–Taking Skills 1<br /><br />Station 2 History–Taking Skills 7<br /><br />1 Abdominal swelling 8<br /><br />2 Ankle swelling 10<br /><br />3 Asymptomatic hypertension 13<br /><br />4 Back pain 16<br /><br />5 Breathlessness 19<br /><br />6 Burning of the feet 23<br /><br />7 Chest pain 26<br /><br />8 Cold and painful fingers 28<br /><br />9 Collapse? cause 30<br /><br />10 Confusion 32<br /><br />11 Cough 35<br /><br />12 Diabetic feet 37<br /><br />13 Difficulty in walking 40<br /><br />14 Dizziness and feeling faint 43<br /><br />15 Double vision 45<br /><br />16 Dysphagia 48<br /><br />17 Epigastric pain and nausea 50<br /><br />18 Facial swelling 52<br /><br />19 Funny turns 55<br /><br />20 Haemoptysis 58<br /><br />21 Headache 60<br /><br />22 Hoarse voice 63<br /><br />23 Hypercalcaemia 65<br /><br />24 Hyperlipidaemia 67<br /><br />25 Jaundice 70<br /><br />26 Joint pains 73<br /><br />27 Loin pain 76<br /><br />28 Loss of weight 78<br /><br />29 Lower gastrointestinal haemorrhage 80<br /><br />30 Macrocytic anaemia 82<br /><br />31 Neck lump 85<br /><br />32 Painful shins 87<br /><br />33 Painful shoulders 89<br /><br />34 Palpitations 91<br /><br />35 Personality change 93<br /><br />36 Pins and needles 96<br /><br />37 Polyuria 98<br /><br />38 Pruritus 100<br /><br />39 Purpuric rash 102<br /><br />40 Pyrexia 104<br /><br />41 Renal colic and haematuria 107<br /><br />42 Tiredness 109<br /><br />43 Tremor 112<br /><br />44 Visual disturbances 114<br /><br />45 Vomiting 117<br /><br />46 Vomiting and forgetfulness 120<br /><br />47 Weakness of the right arm 123<br /><br />48 Weight gain 126<br /><br />49 Weight loss and chronic diarrhoea 129<br /><br />50 Wheeze 131<br /><br />Section E: Communication Skills and Ethics 135<br /><br />Station 4 Communication Skills and Ethics 145<br /><br />Category 1: Informed Consent<br /><br />1 Consent for a lumbar puncture 147<br /><br />2 Consent for oesophagogastroduodenoscopy (OGD) 150<br /><br />3 Emergency surgery under principles of best interests 154<br /><br />4 A competent patient s refusal of treatment 157<br /><br />Category 2: Diagnoses and Management Advice<br /><br />5 Obesity management 160<br /><br />6 Side–effects of cardiac medication 163<br /><br />7 Presentation of a fi rst seizure 166<br /><br />8 Rheumatoid arthritis 169<br /><br />9 Valvular heart disease in a young woman 172<br /><br />10 Air travel with chronic obstructive pulmonary disease 175<br /><br />11 Polypharmacy 178<br /><br />12 Blood transfusion 181<br /><br />13 Hormone replacement therapy 183<br /><br />14 Lifestyle adjustments after a myocardial infarction 186<br /><br />15 Smoking cessation 189<br /><br />16 Starting insulin therapy 192<br /><br />17 Refusal of analgesia 194<br /><br />Category 3: General Clinical Issues<br /><br />18 Human immunodefi ciency virus testing 196<br /><br />19 Communication of a human immunodeficiency virus–positive result 200<br /><br />20 New diagnosis of tuberculosis 204<br /><br />21 Non–compliance with anti–tuberculous treatment 208<br /><br />22 Multidrug–resistant tuberculosis 211<br /><br />23 Hospital superbug 1 (Clostridium difficile) 215<br /><br />24 Hospital superbug 2 (methicillin–resistant Staphylococcus aureus) 219<br /><br />25 Assessing suicide risk 223<br /><br />26 Genetic counselling 226<br /><br />27 Fitness for anaesthesia/surgery 230<br /><br />28 Screening for prostate cancer 232<br /><br />Category 4: Breaking Bad News<br /><br />29 Malignancy in a young patient 235<br /><br />30 A chronic illness 238<br /><br />Category 5: Ethical and Legal Issues<br /><br />31 A patient with a functional illness 240<br /><br />32 Brainstem death testing and organ transplantation 243<br /><br />33 Hospital postmortem 248<br /><br />34 Coroner s postmortem 253<br /><br />35 Do not attempt resuscitation decisions 257<br /><br />36 Withholding information from patients 262<br /><br />37 Maintaining patient confi dentiality 266<br /><br />38 Advance care decisions 270<br /><br />39 Healthcare decisions for a patient who lacks mental capacity 274<br /><br />40 Care of the vulnerable adult 278<br /><br />41 Blood transfusion for a Jehovah s Witness 282<br /><br />42 Eligibility for major surgery 285<br /><br />43 Postponement of an investigation 287<br /><br />44 Clinical error in drug administration 289<br /><br />45 Fitness to drive 292<br /><br />46 Limits of treatment in end–stage disease 295<br /><br />47 Withdrawing treatment 298<br /><br />48 Enrolling a patient in a clinical trial 301<br /><br />49 Industrial Injuries Disablement Benefit 304<br /><br />50 Internet therapy 306<br /><br />51 Unrelated live donor transplant 309<br /><br />Category 6: Dealing with Difficult Patients/Relatives<br /><br />52 A patient desperate for a diagnosis 311<br /><br />53 A missed tumour 315<br /><br />54 An unhappy inpatient 319<br /><br />55 Delay in investigation 322<br /><br />56 A patient wanting to self–discharge 324<br /><br />Category 7: Professional Issues and Communication with Colleagues<br /><br />57 Major incident exercise 327<br /><br />58 A struggling team of doctors 330<br /><br />59 A colleague with hepatitis B infection 334<br /><br />60 A colleague with a needlestick injury 337<br /><br />61 The improper doctor 340<br /><br />62 The incompetent doctor 343<br /><br />63 The sick doctor 345<br /><br />64 Consent for medical examination 347<br /><br />65 Submitting an audit project 350<br /><br />66 Treating a prisoner 353<br /><br />67 A violent and abusive patient 355<br /><br />68 Withdrawing treatment in intensive care 357<br /><br />Section F: Experiences Anecdotes Tips Quotations 359<br /><br />Full PACES experiences in the first person (since 2009) 367<br /><br />Full PACES experiences in the first person (before 2009) 389<br /><br />Additional Station 2 experiences 427<br /><br />Additional Station 4 experiences 431<br /><br />Invigilators diaries Stations 2 and 4 435<br /><br />Some anecdotes from our most recent surveys 435<br /><br />Experiences 437<br /><br />The power and range of the candidate s observations 439<br /><br />The candidate s examination technique 441<br /><br />The clinical competence of the candidate 443<br /><br />Common errors 444<br /><br />Look first 444<br /><br />Double pathology 445<br /><br />Tell them of the expert that told you 445<br /><br />Apologies accepted 445<br /><br /> Even though I didn t mean to say it I did 446<br /><br />Invigilator s diaries 446<br /><br />Fly on the wall complete accounts 448<br /><br />Ungentlemanly clinical methods 452<br /><br />Miscellaneous pass experiences 452<br /><br />You never know you ve failed until the list is published 464<br /><br />Survivors of the storm 466<br /><br />Some fail experiences 470<br /><br />Downward spirals 475<br /><br />Anecdotes 477<br /><br />Some anecdotes in the fi rst person 480<br /><br />Miscellaneous 483<br /><br />Useful tips 483<br /><br />Quotations 484<br /><br />Adopt good bedside manners 485<br /><br />Practise clinical examination and presentation 485<br /><br />Get it right 486<br /><br />Listen obey and do not stray 486<br /><br />One wrong does not make one fail 487<br /><br />If you say less they want more 487<br /><br />Humility is more persuasive than self–righteousness 487<br /><br />Keep cool: agitation generates aggression 488<br /><br />Simple explanations raise simple questions 488<br /><br />Think straight look smart and speak convincingly 488<br /><br />You have seen it all before 489<br /><br />Use your eyes fi rst and most 489<br /><br />Doing and forgetting 489<br /><br />Examiners are different 489<br /><br />Additional comments and quotes from candidates 490<br /><br />Appendices 491<br /><br />1 Website links 493<br /><br />2 Abbreviations 495<br /><br />Index 497&nbsp;</p>