Cases for PACESAction Plan: Follow standard history taking format sensibly. You are …… tell me more about the symptoms how frequent?any blood? still much the same or getting worse? any medication?help Cigarette Caffeine Alcohol Any change in period Any SoB etc. Diet SOCRATES is useful mnemonics for associated PAIN. Site Onset: ? following infective episodes or travel Character? how [...]
Try practice Sarcoidosis in term of Seven core clinical skills assessed in the PACES examination. Here is a sample from 2010/2 diet: station 2- jt pain , dry cough and bilateral gld + in CXR, two candidates sat apart 2 weeks in a UK centre got the same scenario. (PS. in station 4,don’t bother skill D, ie.Differential Dx;but [...]
Scan as a whole: enlarged head with hearing aid,bow legs. tall,thin man with pectus excavatum,arachnodactily and flat feet. extended neck,kyphoscoliosis with loss of lumbar lordosis. feel the pulse: high volume look at the eyes: reduced acuity,afferent pupillary defect,optic atrophy and angioid streak. thick spectacle,tremor of iris and dislocated len, small pupil,sluggish pupillary response,circumcorneal injection Listen [...]
be interactive! Get hold of a friendly Registrar, and have a go at these two short sample questions on Comm Skills + Ethics. You’ll find some other useful teaching materials here as well. As usual, you can download the full set of learning of materials – each question contains the instructions to the examiner, to [...]
Scan the Face: Jaundice, Parotid Swelling,Plethora,Pigmented Cachexia Pale with Periorbital edema Myxoedematous Neck for: Raised JVP Cervical nodes
Elderly man Smoker Hypertensive evidence of PVD ( other causes: Mycotic, Marfan,Ehlers-Danlos ) 6 monthly scan if size 4 – 5.4 cm Elective Surgery or Endovascular Repair if rapidly increased in diameter AP diameter > 5.5 cm Most AAA are infrarenal
Obesity ( truncal or abdominal), an enlarged neck circumference, and high blood pressure. A crowded airway may be noted on inspection of the throat. Look for Cyanosis Elevated JVP Signs of Pulmonary Hypertension. Ankle Edema Be ready to ask: Daytime sleepiness Awakening with a sensation of choking Restless fitful sleep Moodiness Morning headaches Decreased libido [...]
The most important factor in reducing long-term progression of COPD is to STOP SMOKING. Patients must stop smoking and they should have support with this and the offer of buproprion or NRT. (NICE, evidence level B). PULMONARY REHAB if functionally disabled by COPD (usually MRC grade 3 and above) A programme includes physical training, disease education, [...]
