PACES-TOPICS TO BE DISCUSSED

STATION-01: ABDOMEN

*CLD (Alcoholic Liver Disease, PBC,Hemochromatosis) *Ascites *Hepatomegaly *Hepatosplenomegaly

*Splenomegaly *IBD *Renal Transplant *PKD*Liver Transplant *Abdominal Mass

STATION-01: RESPIRATORY:

*Pulmonary Fibrosis (SLE, Systemic Sclerosis, RA-Rheumatoid Lung, DM/PM, CFA)

*Bronchiectasis (CF, Primary Ciliary Dyskinesia)
*Old TB (Apical Fibrosis, Phrenic Nerve Crush,Thoracoplasty)
*Lobectomy/Pnumonectomy *COPD
*Dullness at the lung base (Lung Consolidation Lung Collapse, Pleural Effusion)
*Carcinoma Lung (SVCO)
*Stridor *Pneumothorax *Lung Transplantation

STATION-02: HISTORY TAKING

1.

Neurology: (Falls & Rehabilitation, Collapse, Dizziness, feeling faint, Funny turns, Seizures,
Confusion (Acute Confusion, Memory loss/Mild Cognitive impairment & Dementia)

*Headache (Acute Headache, Chronic Intermittent Headache, New Headache of Recent onset)
*TIA *Multiple Sclerosis *Visual disturbances *Double vision *Personality change *Tremor *Weakness of an
arm *Difficulty in Walking/Limb weakness *Pins and *Needles/Paraesthesia *Gait disturbance *Muscle
weakness

1.

Cardiology: (*Syncope *Chest Pain *Palpitations *AF *Shortness of Breath *Heart failure *HTN
*Hyperlipidaemia)

2.

Respiratory: (*Ankle swelling *Breathlessness *Chronic Cough *Wheeze *Haemoptysis *Hoarse

voice)

C.GIT: (*Diarrhoea, Altered Bowel Habit *Lower GIT bleeding, PR bleeding *Weight loss *Family H/OCancer *Dysphagia *Dyspepsia/ Abdominal pain *Alcohol dependence & Abdominal Pain *Macrocytic
Anaemia *Vomiting/vomiting & forgetfulness)

1.
2.

Hepatobiliary: (*Jaundice, deranged LFT *Abdominal Swelling)

Nephrology: (*Loin pain *Renal colic &Haematuria *Haematuria *Acute Renal Failure *CKD & RRT
*Glomerulonephritis *Systemic Vasculitis *Hypercalcaemia *Hyponatraemia *Poisoning and metabolic
disturbance *Incontinence)

3.

Endocrine & Metabolic: *Burning Feet *DM-(DM-1, DM-2, Diabetic Feet)*Facial swelling
*Hypercalcaemia *Polyuria *Weight gain *Tiredness *Neck Lump

*Musculoskeletal: (*Back Pain *Cold & painful fingers *Joint pains *Painful shins *Painful shoulders-PMR
*Raised Inflammatory markers)
1.

Dermatology: (*Pruritus ,*Pigmentation)

H.Infectious Disease: (*Pyrexia *Fever and neck stiffness *HIV *DSH-Deliberate Self Harm)
1.

Hematology: (*Anaemia *SCD &Thalassaemia *Haemophilia *Purpuric Rash *DVT *Thrombophilic

Tendency *Myeloma)

STATION-03: CARDIOLOGY

*Prosthetic AV *Prosthetic MV *AS/AR (Mixed) *MS/MR (Mixed) *MVP MR *AF *VSD *ASD *PDA
*TOF-LT Thoracotomy Scar-BT shunt *Dextrocardia *PS-Noonans Syndrome/PR *CoA-Turners Syndrome
*HOCM *Heart Transplant/Heart-Lung Transplant

STATION-03: Neurology

*Parkinsons Disease *CMT *Peripheral Neuropathy *Common Paroneal Nerve Palsy & L5 Nerve Root Lesion
*Ulnar / Radial/Median (CTS) Nerve Palsy *Old Polio *Neurosyphilis-TabesDorsalis, Taboparesis *MND
*Cerebellar Syndrome *Myotonic Dystrophy *Myaesthenia Gravis *Hemiparesis *Multiple Sclerosis *Spastic
Paraparesis-Spinal Cord Compression *WSMH-Wasting of the Small Muscles of Hands *Syringomyelia
*Friedreichs Ataxia *SACD of Spinal Cord *Cervical Myelopathy *FSHD-Fascio-Scapulo-HumoralDystrophy *DMD & BMD *Cranial Nerve Palsy: 3,6, 4,7 *Ophthalmoplegia *Cavernous Sinus Syndrome
*Cerbello-Pontine Angle Lesion *Proximal Myopathy-PMR, PM *Nystagmus *Visual Field defect
*Pupillary abnormalities-(*Argyll Robertson Pupil *Homes-Adie Pupil *Horners Syndrome)
*Speech: (*Dysarthria, Dysphasia, Dysphonia *Bulbar & Pseudo-bulbar palsy *Gait Abnormality)

STATION-04: COMMUNICATION SKILLS &

ETHICS:

Breaking Bad News (BBNs):

*Lung cancer *Mesothelioma *Malignant effusion in a young female *Oesophageal cancer palliative care
only *Colorectal cancer dukes A *Pancreatic cancer and poor prognosis-No definitive diagnosis but suspected
pancreatic cancer *Hodgkins Lymphoma/NHL *Astrocytoma of frontal lobe *Informing the partner of a patient
that her husband had a primary brain tumour *Thyroid carcinoma and cerebral metastasis *Malignant melanoma
in a young patient *Downs syndrome pregnancy *Sick daughter *HIV-Results to HIV positive patient
//promiscuous man and IVDU presents with PCP consent for HIV//Needle-stick injury from an HIV patient//
Third party confidentiality *MS *ESRF-End Stage Renal Failure *SAH-Bad news of SAH to wife of 42 year

old and approach discussion of organ donation *DCM+AF-Patient with Dilated Cardiomyopathy and permanent
AF *DM-1 *HOCM *IBS *Acromegaly *HCR-Hysteric Conversion Reaction *Asbestosis and Industrial
benefits *Parkinsons disease

Counseling
*HIV testing *Epilepsy-Seizure & fitness to drive-chronic COPD patient put on aminophylline infusion, and has
a first seizure. HGV driver *Post-MI discharge with medication-Life style adjustments after an anterior MI
*CAG-CSA with ETT positive with risk factors proceeding to CAG *Jehovahs witness *HH-Diagnosis of
haemachromatosis and alcohol use *HBV/HCV *Advanced Directives *DNAR *Brain stem death & organ
donation *Genetic Counseling-(*Breast cancer *Colorectal cancer *Hungtingtons disease) *Insulin therapy
*HRT *Ulcerative colitis and IV steroids in Acute Colitis *RA and Monoclonal Ab therapy discussion *Man
with TB *Coeliac disease *Asthma *Obesity advice *Man wanting self discharge *Warfarin and Pregnant
woman *Worried about infection after BT-Blood Transfusion *Patient requesting Cannabis *Recruiting patient
into a clinical trial *The aggressive patient *The near miss: discussion with the patient *Herbal therapy for
angina

Explain
*Explain prognosis and implications of meningococcal meningitis to patients wife *Explain diagnosis of renal
failure requiring renal replacement therapy *Ethics of patient with TB wanting to travel *Daughter who doesnt
want to take her mother home while the mother is competent and wishes to go home *Explain an iatrogenic
empyema post chest drain for pneumothorax and the need for a further chest drain *Warfarin therapy for patient
with dilated cardiomyopathy and permanent atrial fibrillation *DVT in pregnancy/ Pregnancy & pharmacy
*Dealing with the poor compliance *DSH *Eligibility for CABG surgery

MISTAKES
*Mistake and angry family *Family member thinks GP has missed diagnosis of myeloma *Lost FNA specimen
*Concerns over Infection Control-MRSA-Angry woman upset as her father had a stroke and hadnt been
admitted to the stroke ward as there were no beds, had developed pressure sores with MRSA and poor hygiene
on the ward *Managing a complaint after an adverse incident *Refusal to have effective analgesia
*Withdrawing treatment *Dealing with poor compliance *To ventilate or not to ventilate-Speak to son who
doesnt want his fathers care escalated to ITU *Improper doctor/Incompetent doctor/The sick doctor
*Apologizing for a delay with investigative management

Capacity

*Consent from a patient who doesnt have the capacity to give consent-Insertion of a PEG tube *Informed
consent for an emergency operation *Informed refusal to therapy *Internet therapy *Consent for a bedside
teaching *Second opinion *Post-mortem examination

STATION-05: BRIEF CLINICAL CONSULTATION

ACUTE MEDICINE
*Shortness of breath *TIA/Transient Visual disturbance *Headache *Chest pain *Chest pain and swallowing
difficulty *HTN *Upper GIT bleeding *Irregular Pulse *Pyelonephritis *PVD *DVT//Swollen knee *Leg
ulcers-Venous, Arterial, Neuropathic *Neck lump *Leg swelling/Swollen Calf *Altered Conscious state-DKA
*Agitation & Tremor-Thyrotoxic crisis 8Anaemia-Microcytic anaemia-IDA *Haemoptysis-Bronchial
Carcinoma *Immobility in the elderly-UTI *Persistent fever-IE *Palpitations *Tall stature/Marfans syndrome
*Cold hands *Tremor *Diarrhoea *Deterioration in renal function *Skin rash *Loss of vision *Drooping eyelid
*Headaches and visual disturbance *Back pain and breathlessness *Facial rash *Painful joints *Recurrent nose
bleeds *Mitochondrial Myopathy: MELAS (MERRF, LHON, SNHL)

RHEUMATOLOGY
*Rheumatoid hands *Psoriatic Arthritis *SLE &Sjogrens Syndrome *Painful Hands: Systemic Sclerosis
*Polyarticular Gout/ Chronic Tophaceous Gout *Ankylosing Spondylitis *Acute hot joint *Osteoarthritis
*Marfans syndrome *Osteomalacia and Rickets *GCA & PMR *Downs Syndrome *OsteogenesisImperfecta
*Pagets Disease *Polydactyly//Laurance Moon BardtBiedel syndrome

OPHTHALMOLOGY
*Diabetic Retinopathy *Hypertensive Retinopathy//Papilloedema *Retinal vein occlusion//Retinal artery
occlusion//Sudden loss of vision: Vitreous haemorrhage *Gradual loss of vision: Retinitis Pigmentosa//Old
Choroiditis //ARMD-Drusen *Subacute visual loss: Optic Atrophy// Glaucoma *Thyroid eye disease *Visual
field defect *Double vision: 3rd nerve palsy//Anisocoria: Horners Syndrome *Cataract//Ocular prosthesis
*Vitreous opacities//Myelinated nerve fibers

ENDOCRINOLOGY
*DM & Diabetic Foot *Hyperthyroidism (Graves disease) *Hyperthyroidism (Toxic Multinodulargoitre)
*Hypothyroidism *Acromegaly// Hypopituitarism *Addisons disease *Cushings syndrome

*Gynaecomastia//Klinefelters Syndrome *Infertility in female patients//Turners Syndrome

*Pseudohypoparathyroidism

DERMATOLOGY
*Scleroderma//Morphoea *Raynauds phenomenone *Cutaneous Lupus Erythemaosus, Livedoreticularis
*Psoriasis//Eczema *Neurofibromatosis *Vitiligo// Lichen planus *Pyodermagangrenosum
*NecrobiosislipoidicaDiabeticorum *Erythema nodosum// Erythema multiforme *Pretibial myxoedema *HHT//
Peutz-Jeghers syndrome *Purpura *Alopecia *Tuberous Sclerosis *Bullous skin eruptions //PCT *Skin
Malignancies-SCC-Squamous Cell Carcinoma/BCC-Basal Cell Carcinoma/MM-Malignant Melanoma *PXEPseudoxanthomaelasticum *EDS-Ehlers-Danlos-Syndrome *Acanthosisnigricans *Lupus pernio//Lupus
vulgaris