Topics To Be Discussed | PACES





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

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





*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





  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/O-Cancer *Dysphagia *Dyspepsia/ Abdominal pain *Alcohol dependence & Abdominal Pain *Macrocytic Anaemia *Vomiting/vomiting & forgetfulness)


  1. Hepatobiliary: (*Jaundice, deranged LFT *Abdominal Swelling)
  2. 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)



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


STATION-03: Neurology


*Parkinson’s 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 *Friedreich’s Ataxia *SACD of Spinal Cord *Cervical Myelopathy *FSHD-Fascio-Scapulo-Humoral-Dystrophy *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 *Horner’s Syndrome)

*Speech: (*Dysarthria, Dysphasia, Dysphonia *Bulbar & Pseudo-bulbar palsy *Gait Abnormality)






Breaking Bad News (BBNs):

*Lung cancer *Mesothelioma *Malignant effusion in a young female *Oesophageal cancer – palliative care only *Colorectal cancer duke’s A *Pancreatic cancer and poor prognosis-No definitive diagnosis but suspected pancreatic cancer *Hodgkin’s 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 *Down’s 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 *Parkinson’s disease




*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 *Jehovah’s witness *HH-Diagnosis of haemachromatosis and alcohol use *HBV/HCV *Advanced Directives *DNAR *Brain stem death & organ donation *Genetic Counseling-(*Breast cancer *Colorectal cancer *Hungtington’s 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 prognosis and implications of meningococcal meningitis to patient’s wife *Explain diagnosis of renal failure requiring renal replacement therapy *Ethics of patient with TB wanting to travel *Daughter who doesn’t 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



*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 hadn’t 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 doesn’t want his father’s care escalated to ITU *Improper doctor/Incompetent doctor/The sick doctor *Apologizing for a delay with investigative management


*Consent from a patient who doesn’t 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





*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/Marfan’s 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)


*Rheumatoid hands *Psoriatic Arthritis *SLE &Sjogren’s Syndrome *Painful Hands: Systemic Sclerosis *Polyarticular Gout/ Chronic Tophaceous Gout *Ankylosing Spondylitis *Acute hot joint *Osteoarthritis *Marfan’s syndrome *Osteomalacia and Rickets *GCA & PMR *Down’s Syndrome *OsteogenesisImperfecta *Paget’s Disease *Polydactyly//Laurance Moon BardtBiedel syndrome


*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: Horner’s Syndrome *Cataract//Ocular prosthesis *Vitreous opacities//Myelinated nerve fibers


*DM & Diabetic Foot *Hyperthyroidism (Grave’s disease) *Hyperthyroidism (Toxic Multinodulargoitre) *Hypothyroidism *Acromegaly// Hypopituitarism *Addison’s disease *Cushing’s syndrome *Gynaecomastia//Klinefelter’s Syndrome *Infertility in female patients//Turner’s Syndrome *Pseudohypoparathyroidism


*Scleroderma//Morphoea *Raynaud’s 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 *PXE-Pseudoxanthomaelasticum *EDS-Ehlers-Danlos-Syndrome *Acanthosisnigricans *Lupus pernio//Lupus vulgaris







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