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Scenario N
MRCP(UK) PACES
Station 5: BRIEF CLINICAL CONSULTATION
Patient details:
Your role:
Mrs XX aged 33
You are the medical doctor on call
You will be asked to see two patients at this station. The clinical information about one of these
patients is given in the box below. You should have a second sheet giving you information about
the other patient.
You have 10 minutes with each patient. The Examiners will alert you when 6 minutes have
elapsed and will stop you after 8 minutes.
In the remaining 2 minutes, one Examiner will ask you to report on any abnormal physical signs
elicited, your diagnosis or differential diagnoses, and your plan for management (if not already
clear from you discussion with the patient).
Referral text:
Clinical problem: This lady was admitted to the orthopaedic ward for a carpal tunnel release
operation.
She mentioned to the orthopaedic doctors that she has swelling in her neck and they have
asked for the opinion of a physician. You were asked by your consultant to see the patient and
to assess the suspected swelling in her neck.
Advise the patient of your probable diagnosis (or differential diagnoses), and your plan for
investigation and treatment where appropriate.
Respond directly to any specific questions which the patient may have.
Any notes you make must be handed to the examiners at the end of the station
Scenario N
MRCP(UK) PACES
Station 5: BRIEF CLINICAL CONSULTATION
You are:
Mrs XX aged 33
Background information
Past medical and surgical history
You have been suffering from pain in your right forearm and a numb or tingly feeling in your right
hand affecting your 3rd, 4th and 5th fingers. The aching in your arm is worse at night and you
have found it more and more difficult to get comfortable. The problem has been present for
several years and was worse when you were pregnant with your daughter 3 years ago but
improved for a time after that.
A trapped nerve in your wrist has been diagnosed and you are having a short admission to have
the nerve released.
Family history
Your sister, who is 38, has an underactive thyroid.
Medication record
Current medications (if relevant)
You are on no medications.
Personal history
Relevant personal, social, occupational or travel history
You work as a typist and find that the pain and numbness of your hands is beginning to hamper
your work.
Occupational history
You are a typist.
Scenario N
Physical examination
Relevant clinical findings
There is a smoothly enlarged goitre. There is no bruit to hear. The gland does not extend below
the level of the manubrium. The patient is clinically euthyroid. There are also signs of bilateral
median nerve damage with reduced light touch sensation over the distribution of the median
nerves.
You have some specific questions for the doctor at this consultation:
-
Scenario N
DATE
CYCLE
MRCP(UK) PACES
Station 5: BRIEF CLINICAL CONSULTATION
Examiners should advise candidates after 6 minutes have elapsed that You have two minutes
remaining with your patient. If the candidate appears to have finished early remind them how
long is left at the station and enquire if there is anything else they would like to ask or examine.
If they have finished, please remain silent and allow the candidate that time for reflection.
The Examiner should ask the candidate to describe any abnormal physical findings that have
been identified. The Examiner should also ask the candidate to give the preferred diagnosis and
any differential diagnoses that are being considered. Any remaining areas of uncertainty eg
regarding the plan for investigation or management of the problem may be addressed in any
time that remains.
Examiners should refer to the marking guidelines in the five skill domains on the mark sheet.
Examiners are reminded that, during the calibration process, the patient should be rehearsed
and specific aspects of the scenario that require clarification or emphasis should be discussed.
The boxes on the next page indicate areas of potential interest in this case which both
examiners should consider, along with any other areas they feel appropriate. Examiners must
agree the issues that a candidate should address to achieve a Satisfactory award for each skill
and record these on the calibration sheet provided. Examiners should also agree the criteria for
an Unsatisfactory award at each skill.
Problem:
Candidates role:
Patients name:
Scenario N
Goitre
Medical doctor on call.
Mrs XX aged 33
Examiners are reminded that the boxes below indicate areas of potential interest, but are not intended as
absolute determiners of Satisfactory performance. It is for the Examiners to agree and record the specific
criteria they will assess the candidate on during the calibration process.
Clinical skill
Key issues
Clinical
Communication
Skills (C)
Note the history of neck swelling and the family history of thyroid disease.
Enquire about symptoms of disturbed thyroid function.
Physical
Examination (A)
Clinical
Judgement
(E)
Identify that the swelling in the neck is a smoothly enlarged thyroid gland.
Conclude that the patient is clinically euthyroid.
Managing
Patients
Concerns (F)
Confirm to the patient that her thyroid gland does seem enlarged but
reassure that the gland seems to be working normally.
Identifying
Physical Signs (B)
Differential
Diagnosis (D)
Probable Diagnosis:
Early Hashimotos thyroiditis.
Plausible alternative diagnoses:
Early multinodular goitre.
Maintaining
Patient Welfare
(G)
See marksheet