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Cases for PACES
Stephen Hoole, Andrew Fry, Rachel Davies
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eBook - ePub
Cases for PACES
Stephen Hoole, Andrew Fry, Rachel Davies
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About This Book
Cases for PACES is concise, ideal for quick reference, and the perfect study aid to Part II of the MRCP examination. Including all the essential information for the exam in colour-coded sections for each station, it lets you quickly understand the most common cases. Now in full colour, it features new case material, updated content on ethics and law, and revised brief clinical consultations that better reflect the current exam. Cases for PACES also includes hints and tips for preparing for the exam, and what to expect on the day. The authors have condensed their own experiences in learning and teaching PACES to provide you with exactly what you need to pass. With its informal style it is ideal for self-directed learning in groups, and will help you hone your clinical skills and boost your confidence throughout your revision.
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Information
Station 1
Abdominal and Respiratory
Clinical mark sheet
| Clinical skill | Satisfactory | Unsatisfactory |
| Physical examination | Correct, thorough, fluent, systematic, professional | Incorrect technique, omits, unsystematic, hesitant |
| Identifying physical signs | Identifies correct signs Does not find signs that are not present | Misses important signs Finds signs that are not present |
| Differential diagnosis | Constructs sensible differential diagnosis | Poor differential, fails to consider the correct diagnosis |
| Clinical judgement | Sensible and appropriate management plan | Inappropriate management Unfamiliar with management |
| Maintaining patient welfare | Respectful, sensitive Ensures comfort, safety and dignity | Causes physical or emotional discomfort Jeopardises patient safety |
Chronic liver disease and hepatomegaly
This man complains of weight loss and abdominal discomfort. His GP has referred him to you for a further opinion. Please examine his abdomen.
Clinical signs
Signs of chronic liver disease
- General: cachexia, icterus (also in acute), excoriation and bruising
- Hands: leuconychia, clubbing, Dupuytren’s contractures and palmar erythema
- Face: xanthelasma, parotid swelling and fetor hepaticus
- Chest and abdomen: spider naevi and caput medusa, reduced body hair, gynaecomastia and testicular atrophy (in males)
Signs of hepatomegaly
- Palpation and percussion:
- Mass in the right upper quadrant that moves with respiration, that you are not able to get above and is dull to percussion
- Estimate size (finger breadths below the diaphragm)
- Smooth or craggy/nodular (malignancy/cirrhosis)
- Pulsatile (TR in CCF)
- Auscultation
- Bruit over liver (hepatocellular carcinoma)