MY PACES

𝗦𝗽𝗮𝗰𝗲𝗱 𝗹𝗲𝗮𝗿𝗻𝗶𝗻𝗴| 𝑳𝒆𝒂𝒓𝒏𝒊𝒏𝒈 𝒕𝒉𝒂𝒕 𝒊𝒔 𝒔𝒑𝒓𝒆𝒂𝒅 𝒐𝒖𝒕 𝒂𝒏𝒅 𝒓𝒆𝒑𝒆𝒂𝒕𝒆𝒅 𝒐𝒗𝒆𝒓 𝒕𝒊𝒎𝒆 𝒊𝒔 𝒓𝒆𝒈𝒂𝒓𝒅𝒆𝒅 𝒂𝒔 𝒎𝒐𝒓𝒆 𝒆𝒇𝒇𝒆𝒄𝒕𝒊𝒗𝒆 𝒕𝒉𝒂𝒏 𝒊𝒏𝒕𝒆𝒏𝒔𝒆 𝒍𝒆𝒂𝒓𝒏𝒊𝒏𝒈 𝒐𝒗𝒆𝒓 𝒂 𝒔𝒉𝒐𝒓𝒕 𝒑𝒆𝒓𝒊𝒐𝒅 𝒐𝒇 𝒕𝒊𝒎𝒆.

𝗧𝗵𝗶𝘀 “𝘀𝗽𝗮𝗰𝗲𝗱 𝗹𝗲𝗮𝗿𝗻𝗶𝗻𝗴” 𝗶𝘀 𝗮𝗹𝘀𝗼 𝗯𝗲𝗹𝗶𝗲𝘃𝗲𝗱 𝘁𝗼 𝗯𝘂𝗶𝗹𝗱 𝗺𝗼𝗿𝗲 𝗲𝗻𝗱𝘂𝗿𝗶𝗻𝗴 𝗸𝗻𝗼𝘄𝗹𝗲𝗱𝗴𝗲 𝘁𝗵𝗮𝗻 𝗼𝗻𝗲-𝘁𝗶𝗺𝗲 𝗺𝗲𝗺𝗼𝗿𝗶𝘇𝗮𝘁𝗶𝗼𝗻.

𝐼𝑡 𝑖𝑠 𝑏𝑒𝑙𝑖𝑒𝑣𝑒𝑑 𝑡ℎ𝑎𝑡 𝑟𝑒𝑝𝑒𝑡𝑖𝑡𝑖𝑜𝑛 𝑟𝑒𝑖𝑛𝑓𝑜𝑟𝑐𝑒𝑠 𝑤ℎ𝑎𝑡 𝑎𝑙𝑟𝑒𝑎𝑑𝑦 𝑖𝑠 𝑘𝑛𝑜𝑤𝑛 𝑎𝑛𝑑 𝑐𝑜𝑛𝑠𝑜𝑙𝑖𝑑𝑎𝑡𝑒𝑠 𝑛𝑒𝑤 𝑘𝑛𝑜𝑤𝑙𝑒𝑑𝑔𝑒 𝑤𝑖𝑡ℎ 𝑒𝑥𝑖𝑠𝑡𝑖𝑛𝑔 𝑘𝑛𝑜𝑤𝑙𝑒𝑑𝑔𝑒!

Never underestimate the importance of 'Clinical Reasoning' in PACES.

Unlike medical licensing exams, in PACES, which essentially is a higher level exam, you are not expected to just present the findings and a default list of diagnosis/Ix. Moreover, your clinical judgement/decision making (Mx plan) also comes into play.

Tip: Practice simulated case scenarios to improve your clinical thinking.

A RENAL ABDOMEN IN PACES:

Commonly missed things:

1. Scars d/ previous central lines.

2. Scar of parathyroidectomy d/t secondary or tertiary hyperparathyroidism.

3. A scar in LIF with a mass underneath- d/t failure of a previous transplant (on the right side).

Complete your case presentation by mentioning that you would like to do a urine dipstick and check the blood pressure.

In general, your performance declines a few days before your actual exam, owing to anxiety.

Your pre-exam mock PACES exams (no matter how well organized they are) do not truly reflect on your actual potential and the predictability of success,nevertheless, they are very much useful and are highly recommended.

Always remember that (despite having the same knowledge) you will be a totally different person on your exam day! The attitude on exam day is what matters the most!

It is usually the skills that decide a pass or fail (not the knowledge). You have to take this exam as your usual day in clinic in order to enhance your chances of success!
Just be logical and keep in mind the examiners' expectations!

You cannot simply be concerned about 100 things while performing a task; you have to be natural in order to set the flow of consultation.

Management plan to be given for a patient who presented with Syncope/collapse:

1. General:

Patient education : explain the condition and advise not to drive (until medically allowed to do so).

2. Specific for the condition:

(i) Cardiac arrhythmia:

a) May require a permanent pacemaker if it is a symptomatic heart block.

b) May require an implantable cardiac defibrillator if it is a malignant arrhythmia.

c) May require electrophysiological studies / accessory pathway ablation.

(ii) Seizure:

a) No need to start on anti-epileptics if this is the first episode and no underlying cause is found.

b) May recur in the future.

c) Pregnancy counselling in women of child-bearing age.

(iii) Vasovagal:

a) Stay well hydrated.

b) Avoid rapid changes in position/posture.

(iv) Endocrine:

a) Adjust medication to avoid hypoglycaemia.

b) Patient education on symptoms of hypoglycaemia and how to avoid it.

There are a no. of physical signs to be looked for in a case of Renal Transplant in PACES.

The commonly missed 2 signs are:

1. Pallor

2. Parathyroidectomy scar (tertiary hyperparathyroidism)

'The Mental Capacity Act' defines the capacity to make decisions as:

- The ability to understand information related to a decision.
- The ability to retain that information.
- The ability to use that information as part of the decision-making process.
- The ability to communicate the decision (by any interpretable means).

PACES TIP:

If a patient has a tracheal deviation, accompanied by a dull percussion note over the same side of chest (anteriorly) along with reduced breath sounds and vocal resonance over the same area, in the absence of a lateral thoracotomy scar, the most likely diagnosis should be a LOBAR COLLAPSE!

Possible D/Ds in such a case (dullness to percussion with a reduced air entry and tracheal deviation) include:

- Pleural plaques
- A loculated pleural effusion.

PACES TIP:

While presenting your findings and the most likely diagnosis, always keep in mind the clues given in the written case scenario outside the room!

For example, if a patient has Peripheral Neuropathy on physical examination and the information in the case scenario outside is that the patient either has:

DM/ is taking statin/ has a Hx/O R.A. (MTX) etc, your most likely diagnosis should be accordingly and this will give a good impression.

You will always get full marks in any case if your DDs include the most likely diagnosis.

In Station 5 (Brief Clinical Consultation/ Integrated Clinical Skills), the examiners will ask you to present the positive findings only and ask about only those things in viva which you haven't explained to the patient already because they have only 2 minutes for viva here unlike all other stations.

Keeping in view the above, when you are given a warning that only 2 minutes are remaining, please aim to mainly:
1. Explain the diagnosis (clinical communication skill) and give a very quick overview of the management plan to the patient.

2. Ask about and address the concerns (managing the patient's concerns skill)

Explain your better management plan to the examiner during viva (clinical judgement skill) rather than rushing it through during the very precious last 2 minutes with patient!

You will find it relatively easier to give a detailed management plan to the examiner rather than the patient because you need not to check the examiner's understanding/opinion in between, whereas, on the other hand, if you miss the opportunity to address the concerns of the patient, you will not be able to address them in viva!

PLAN YOU CONSULTATION WISELY!
PACES IS ALL ABOUT PRACTICE!

Dear PACES aspirants as the results of diet 1 are releasing we want to thank to all our amazing course participants who made us proud all over the globe 🌏 .
We have candidates passed from Ireland 🇮🇪, UK 🇬🇧, Pakistan 🇵🇰, India 🇮🇳 and Oman 🇴🇲 . Apologies if we have missed to notify any country .
We will share the lists soon .
To book our upcoming course this weekend email now at [email protected]
Or visit our website mypaces.co.uk

Heartiest congratulations to Dr. Hissan Saqib (Post Graduate Resident in Neurology) on passing PACES with a very high score of 170/172 from Pakistan centre (Diet 2/2023)!
He took special guidance for Station 5 from team 'MY PACES'.

We are really glad to see your wonderful success and we wish you great luck ahead as well.