Cases for PACES

Stephen Hoole is a Consultant Cardiologist, Royal Papworth Hospital, Cambridge, UK. Andrew Fry is a Consultant in Acute Medicine and Nephrology, Addenbrooke’s Hospital, Cambridge, UK. Rachel Davies is a Consultant Respiratory Physician, Hammersmith Hospital, London, UK.

• Foreword ixPreface xAcknowledgements xiiAbbreviations xiiiAdvice xxRespiratory 1Clinical mark sheet 1Respiratory exam – general advice 2Pulmonary fibrosis 4Bronchiectasis 5Old tuberculosis 6Surgical respiratory cases 7Chronic obstructive airways disease 8Pleural effusion 10Lung cancer 12Cystic fibrosis 14Pneumonia 15Pulmonary hypertension 17Cardiology 19Clinical mark sheet 19Cardiology exam – general advice 20Aortic stenosis 22Aortic incompetence 25Mitral stenosis 27Mitral incompetence 29Tricuspid incompetence 31Pulmonary stenosis 32Prosthetic valves: aortic and mitral 33Implantable devices 35Constrictive pericarditis 36Common Congenital Defects 38Atrial septal defect 38Ventricular septal defect 39Associations with Congenital VSD 401. Fallot’s tetralogy 402. Coarctation 403. Patent ductus arteriosus (PDA) 40Hypertrophic (obstructive) cardiomyopathy 42Heart failure 44Neurology 46Clinical mark sheet 46Neurology exam – general advice 47Dystrophia myotonica 51Cerebellar syndrome 53Multiple sclerosis 54Stroke 56Spastic legs (i.e. spinal cord lesion) 59Syringomyelia 61Motor neurone disease 63Parkinson’s disease 64Hereditary motor sensory neuropathy aka Charcot–Marie–Tooth 66Friedreich’s ataxia 67Facial weakness 68Myasthenia gravis 70Tuberous sclerosis 71Neurofibromatosis 72Abnormal pupils 73Horner’s pupil 73Holmes–Adie (myotonic) pupil 73Argyll Robertson pupil 74Oculomotor (III) nerve palsy 74Optic atrophy 75Retinal Pathology 77Age-related macular degeneration 77Retinitis pigmentosa 78Retinal artery occlusion 79Retinal vein occlusion 79Abdominal 80Clinical mark sheet 80Abdominal exam – general advice 81Chronic liver disease and hepatomegaly 83Haemochromatosis 86Splenomegaly 88Renal enlargement 90The liver transplant patient 92The renal patient 93Communication 95Clinical mark sheet 95Communication station – general advice 96Ethics and Law in Medicine 97Contents viiPrinciples of medical ethics 97Competency and consent 98Legal aspects 98Confidentiality 101End-of-life decisions 102Types of Communication 104Information delivery 104Breaking bad news 105Dealing with a difficult patient 106Worked Examples 108Duty of candour/medical mistake 108Advanced care planning 108Needlestick injury 110Epilepsy 111Huntington’s chorea 111Paracetamol overdose 112Brain-stem death and organ donation 113Non-compliant diabetic 115Vaccination compliance 116Shared decision making 117Sample questions for self-directed learning 119Consultations 120Clinical mark sheet 120Consultation – general advice 121Chest pain 122Pericarditis with effusion 124Atrial fibrillation 125Hypertension 127Eisenmenger’s syndrome 130Ataxia 131Headache 132Altered conscious state 135Syncope 137Worsening mobility 139Fall and a fragility fracture 141Dyspnoea – asthma 142Dyspnoea – acute pulmonary embolus 144Haemoptysis 146Persistent fever 148Anaemia 151Sickle cell disease 153Glandular fever 155Nephrotic syndrome 157Jaundice 159Inflammatory bowel disease 161Infectious (traveller’s) diarrhoea 164Swollen calf 166Leg ulcers 168Red rashes 170Skin malignancy 174Skin and hyperextensible joints 176Rheumatoid arthritis 178Systemic lupus erythematosus 181Systemic sclerosis 183Ankylosing spondylitis 185Marfan’s syndrome 186Paget’s disease 188Other joint problems 189Hypercalcaemia 191Diabetes and complications 192General diabetes questions 192Diabetes and the skin 192Diabetic retinopathy 194Hyperthyroidism and Graves’ disease 197Hypothyroidism 199Amenorrhoea 201Acromegaly 203Cushing’s syndrome 205Addison’s disease 208Index 210