Cases for PACES

Foreword ix Preface x Acknowledgements xii Abbreviations xiii Advice xx Respiratory 1 Clinical mark sheet 1 Respiratory exam – general advice 2 Pulmonary fibrosis 4 Bronchiectasis 5 Old tuberculosis 6 Surgical respiratory cases 7 Chronic obstructive airways disease 8 Pleural effusion 10 Lung cancer 12 Cystic fibrosis 14 Pneumonia 15 Pulmonary hypertension 17 Cardiology 19 Clinical mark sheet 19 Cardiology exam – general advice 20 Aortic stenosis 22 Aortic incompetence 25 Mitral stenosis 27 Mitral incompetence 29 Tricuspid incompetence 31 Pulmonary stenosis 32 Prosthetic valves: aortic and mitral 33 Implantable devices 35 Constrictive pericarditis 36 Common Congenital Defects 38 Atrial septal defect 38 Ventricular septal defect 39 Associations with Congenital VSD 40 1. Fallot’s tetralogy 40 2. Coarctation 40 3. Patent ductus arteriosus (PDA) 40 Hypertrophic (obstructive) cardiomyopathy 42 Heart failure 44 Neurology 46 Clinical mark sheet 46 Neurology exam – general advice 47 Dystrophia myotonica 51 Cerebellar syndrome 53 Multiple sclerosis 54 Stroke 56 Spastic legs (i.e. spinal cord lesion) 59 Syringomyelia 61 Motor neurone disease 63 Parkinson’s disease 64 Hereditary motor sensory neuropathy aka Charcot–Marie–Tooth 66 Friedreich’s ataxia 67 Facial weakness 68 Myasthenia gravis 70 Tuberous sclerosis 71 Neurofibromatosis 72 Abnormal pupils 73 Horner’s pupil 73 Holmes–Adie (myotonic) pupil 73 Argyll Robertson pupil 74 Oculomotor (III) nerve palsy 74 Optic atrophy 75 Retinal Pathology 77 Age-related macular degeneration 77 Retinitis pigmentosa 78 Retinal artery occlusion 79 Retinal vein occlusion 79 Abdominal 80 Clinical mark sheet 80 Abdominal exam – general advice 81 Chronic liver disease and hepatomegaly 83 Haemochromatosis 86 Splenomegaly 88 Renal enlargement 90 The liver transplant patient 92 The renal patient 93 Communication 95 Clinical mark sheet 95 Communication station – general advice 96 Ethics and Law in Medicine 97 Contents vii Principles of medical ethics 97 Competency and consent 98 Legal aspects 98 Confidentiality 101 End-of-life decisions 102 Types of Communication 104 Information delivery 104 Breaking bad news 105 Dealing with a difficult patient 106 Worked Examples 108 Duty of candour/medical mistake 108 Advanced care planning 108 Needlestick injury 110 Epilepsy 111 Huntington’s chorea 111 Paracetamol overdose 112 Brain-stem death and organ donation 113 Non-compliant diabetic 115 Vaccination compliance 116 Shared decision making 117 Sample questions for self-directed learning 119 Consultations 120 Clinical mark sheet 120 Consultation – general advice 121 Chest pain 122 Pericarditis with effusion 124 Atrial fibrillation 125 Hypertension 127 Eisenmenger’s syndrome 130 Ataxia 131 Headache 132 Altered conscious state 135 Syncope 137 Worsening mobility 139 Fall and a fragility fracture 141 Dyspnoea – asthma 142 Dyspnoea – acute pulmonary embolus 144 Haemoptysis 146 Persistent fever 148 Anaemia 151 Sickle cell disease 153 Glandular fever 155 Nephrotic syndrome 157 Jaundice 159 Inflammatory bowel disease 161 Infectious (traveller’s) diarrhoea 164 Swollen calf 166 Leg ulcers 168 Red rashes 170 Skin malignancy 174 Skin and hyperextensible joints 176 Rheumatoid arthritis 178 Systemic lupus erythematosus 181 Systemic sclerosis 183 Ankylosing spondylitis 185 Marfan’s syndrome 186 Paget’s disease 188 Other joint problems 189 Hypercalcaemia 191 Diabetes and complications 192 General diabetes questions 192 Diabetes and the skin 192 Diabetic retinopathy 194 Hyperthyroidism and Graves’ disease 197 Hypothyroidism 199 Amenorrhoea 201 Acromegaly 203 Cushing’s syndrome 205 Addison’s disease 208 Index 210