Table Of ContentThe MRCP PACES Handbook
Second Edition
The MRCP PACES Handbook
Second Edition
Saira Ghafur
CCT in Respiratory and General Internal Medicine and Harkness
Fellow in Health Care Policy and Practice
New York City, New York, USA
Parminder K Judge
ST6 in Nephrology
Oxford, England, UK
Richard Kitchen
Consultant in Palliative Medicine
Glasgow, Scotland, UK
and
Samuel Blows
Consultant Geriatrician and Acute Physician
Ipswich, England, UK
Foreword by
Dr Fiona Moss
Dean of the Royal Society of Medicine
London, England, UK
CRC Press
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Contents
Foreword ix
Preface xi
Authors xiii
Acknowledgements xv
List of Abbreviations xvii
The PACES Examination xxiii
Top Tips for PACES Success: An Examiner Speaks xxv
1 Station 1: Respiratory 1
Hints for the Respiratory Station 2
Bronchiectasis 2
Chronic Obstructive Pulmonary Disease 4
Consolidation 7
Cystic Fibrosis 9
Fibrotic Lung Disease 12
Lung Cancer 14
Old Tuberculosis 16
Pleural Effusion 18
Patient with Previous Lung Surgery 20
Respiratory Station Summary 22
2 Station 1: Abdominal 23
Hints for the Abdominal Station 24
Abdominal Case with a Normal Abdomen 24
Chronic Liver Disease 26
Generalised Lymphadenopathy 29
Hepatosplenomegaly 31
Multiple Abdominal Scars 33
Palpable Kidneys 36
Renal Replacement Therapy 39
Splenomegaly 42
Abdominal Station Summary 45
v
Contents
3 Station 2: History Taking 47
Hints for the History-Taking Station 48
Patient with an Abnormal Blood Result 48
Patient with Back Pain 51
Patient Who Has Collapsed 53
Patient with a Cough 56
Patient with Diarrhoea 58
Patient with Jaundice 60
Patient with Joint Pains 63
Patient with Left Arm Weakness 65
Patient with Visual Disturbance 67
Patient with Weight Loss 70
History-Taking Station Summary 73
4 Station 3: Neurology 75
Hints for the Neurology Station 76
Cerebellar Syndrome 77
Hemiparesis 78
Myotonic Dystrophy 81
Ocular Palsies 83
Parkinson’ s Disease 85
Peripheral Neuropathy 88
Mononeuropathies 90
Motor Neurone Disease 92
Multiple Sclerosis 95
Spastic Paraparesis 97
Visual Field Defects 99
Neurology Station Summary 100
5 Station 3: Cardiology 101
Hints for the Cardiology Station 102
Aortic Stenosis 102
Aortic Regurgitation 105
Eisenmenger’ s Syndrome 107
Hypertrophic Cardiomyopathy 110
Mitral Stenosis 112
Mitral Regurgitation 114
Mitral Valve Prolapse 117
Mixed Aortic Valve Disease 119
Mixed Mitral Valve Disease 120
Prosthetic Heart Valves 122
vi
Contents
Tricuspid Regurgitation 124
Ventricular Septal Defect 127
Cardiology Station Summary 130
6 Station 4: Ethics and Communication Skills 131
Hints for the Ethics and Communication Skills Station 132
Breaking Bad News 133
Care in the Deteriorating Patient 135
Driving Regulations 137
Initiating a New Therapy 140
Long-Term Condition 142
Medical Error 145
Mental Capacity 147
New Diagnosis 149
Organ Transplantation 152
Ethics and Communication Skills Station Summary 155
7 Station 5: Brief Clinical Encounters 157
Hints for the Brief Clinical Encounters Station 158
Ankylosing Spondylitis 158
Anticoagulation 161
Diabetic Retinopathy 163
Facial Nerve Palsy 165
Falls 167
Headache (Idiopathic Intracranial Hypertension) 170
Hyperthyroidism 172
Neck Lump 174
Osteoporosis 175
Proximal Myopathy 177
Psoriasis 179
Rheumatoid Arthritis with Carpal Tunnel Syndrome 182
Systemic Sclerosis 184
Third Nerve Palsy or Patient Presenting with Diplopia 186
Brief Clinical Encounters Station Summary 188
Afterword: Hawks and Doves 189
Index 191
vii
Foreword
Postgraduate medical exams are significant both as career-defining milestones for the
candidate and as one of the ways of ensuring that doctors who progress have all that it takes
to provide excellent patient care. Exams focus the minds of candidates for whom exam con-
tent and exam approach define what examiners consider important and so perhaps mould
approaches to practise. The Practical Assessment of Clinical Examination Skills (PACES), the
final part of the Membership of the Royal Colleges of Physicians (MRCP) examination, is a
pivotal step for all aspiring physicians, and this book will be an enormous support for them.
But, the MRCP PACES Handbook is so much more than a book for passing exams. A compre-
hensive book, it succinctly covers much of the necessary content, and for that it will be useful
to candidates. Responses and analyses to the questions posed are logical and practical and
cleverly proceed from the likely and frequent to the rarefied. It is also very well organised,
demonstrating not just how to pass an exam, but also the importance of an ordered approach
to clinical reasoning. Lists of key points at the ends of chapters keep the reader on track, and
the well-chosen lists of references really do encourage further reading. The real strength of
this handbook is that it gets to the heart of the purpose of the PACES examination.
The PACES exam reflects the work done through MRCP UK to develop assessments of all
the skills necessary for excellent clinical practice. Of course, this includes physical exami-
nation, recognition of clinical signs and differential diagnosis, the stuff of medical exami-
nations for many years. Now, assessments have become more patient centred and more
holistic and are designed to demonstrate explicitly the expectation of modern physicians
and good medical practice. Clinical judgement, communication, managing patient con-
cerns and maintaining patient welfare are four of the seven skills assessed through the
PACES exam, and these skills are very well covered in this handbook.
Not only are technical points covered, but by including, for example, outlines of themes
explored, suggestions for candidates and expectations for both candidates and patients,
this handbook provides a succinct but in-depth outline of some of the difficult but crucial
aspects of medical practice.
The simplicity of approach and the clear language throughout make it clear that this is not
a book for the ‘ superficial learner’ wanting a ‘ quick fix’ for an impending exam, but one
that encourages understanding and a mature approach to developing all the skills neces-
sary for becoming a good physician.
PACES, the final part of the MRCP exam, is what is says: practical. And reflecting the
essence of the PACES exam, this handbook is a supremely practical ‘ vade mecum’ . It is
a handbook that not only will be essential for those approaching their PACES exam or
those considering becoming a physician, but also will be a useful and continuing guide to
‘ practise after PACES’ for those entering higher training after PACES, and it will be useful
for anyone who teaches postgraduate or undergraduate medicine.
This is a book that will be bought and used to help aspiring physicians through their
PACES, will encourage development of a patient-centred approach to care and then, for
many years after, will stay in easy reach.
Dr Fiona Moss, CBE, MD, FRC
Dean of the Royal Society of Medicine
ix
