Cases for PACES

Stephen Hoole,Andrew Fry,Rachel Davies

• Verlag: Wiley
• Jahr: 2015
• ISBN:
  9781118983607
• Auflage: 3
• Thema: Medizin
• Thema: Medizinische Weiterbildung

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.

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

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This man complains of weight loss and abdominal discomfort. His GP has referred him to you for a further opinion. Please examine his abdomen.

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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)

Evidence of an underlying cause of hepatomegaly ...