Sarcoid: frequently tested

Sarcoid : RCP’s favorite in Station 1-2-4-5

Try practice Sarcoidosis in term of Seven core clinical skills assessed in the PACES examination.

Here is a sample from 2010/2 diet:

station 2: jt pain , dry cough and bilateral gld + in CXR,

two candidates sat apart 2 weeks in a UK centre got the same scenario.

(PS. in station 4,don’t bother skill D, ie.Differential Dx;but it is assessed in all other stations!)

Clinical Skill/Skill Descriptor

A

Physical Examination

Demonstrate correct, thorough, systematic (or focused in Station 5 encounters), appropriate, fluent and professional technique of physical examination.

B

Identifying Physical Signs

Identify physical signs correctly, and not find physical signs that are not present.

C

Clinical Communication

Elicit a clinical history relevant to the patient’s complaints, in a systematic, thorough (or focused in Station 5 encounters), fluent and professional manner.

Explain relevant clinical information in an accurate, clear, structured, comprehensive, fluent and professional manner.

D

Differential Diagnosis

Create a sensible differential diagnosis for a patient that the candidate has personally clinically assessed.

E

Clinical Judgement

Select or negotiate a sensible and appropriate management plan for a patient, relative or clinical situation.

Select appropriate investigations or treatments for a patient that the candidate has personally clinically assessed.

Apply clinical knowledge, including knowledge of law and ethics, to the case.

F

Managing Patients’ Concerns

Seek, detect, acknowledge and address patients’ or relatives’ concerns.

Listen to a patient or relative, confirm their understanding of the matter under discussion and demonstrate empathy.

G

Maintaining Patient Welfare

Treat a patient or relative respectfully and sensitively and in a manner that ensures their comfort, safety and dignity.

PACES 2010/3

from a candidate

Respiratory: ?bronchiectasis with R mastectomy and bilateral thoracotomy scars,

CVS: young lady with small L thoracotomy scar in the back, and asked “why SOB in pregnancy?”

Hx: longstanding SOB+ suddenly worse, FH of CVA, MI and PE,

Abdomen: PKD

Neurology: peripheral sensory neuropathy in diabetic

Ethics: explain to a patient  recently diagnosed coeliac disease!

Station 5:

1. diabetic w necrobiosis lipoidica,reached to the diagnosis but examiner not happy because I didn’t address her concerns.

2. 60 year old lady w painless LN in cervical area, said all possible malignancies, then pushed and said sarcoidosis and amyloid, think she had sarcoidosis.

Arm Drift

• FINDINGS:

  Downward Drift,Spreading of Fingers,Pronation of Wrist and Flexion of Elbow on RIGHT side.

  INTERPRETATION:

  ? Pyramidal Weakness
  ? Cerebellar Disease
  ? Pseudoathetosis