Preparation for MRCP PACES 1/2007

On Tuesday we examined a patient with a cardiovascular problem. As mentioned in the last post we concentrated on method. I asked the candidate to examine the patient and then commented on his technique and then demonstrated the correct method and then one of the other candidates went through the method and we watched and corrected at every step.
This may seem painstaking but this is very important, as wrong method is a sure way of failing the exam.
The case was very difficult, congenital heart disease with a single ventricle and multiple operations so I do not think discussion of the findings will be useful. Such cases, fortunately, are rare.
The main learning point was the importance of going through every step of the examination technique and noting the findings at each step instead of trying to do a lot at once.
When asked to examine the hands the candidate made no comment on any abnormality. But when asked to look at the size and shape of the hands everyone present, including two medical students, was able to pick up that the patient had arachnodactyly. Similarly, when asked to comment on the mouth, no abnormalities were seen. But, when asked to look at the hard palate in particular it was easily picked up that the patient had a high arched palate. Lastly, when the instruction was to run the fingers down the spine and note whether there was an abnormality, it was easy to pick up the fact that the patient had a kyphoscoliosis. In short, the patient had marfanoid features, which were easily missed unless one examined using the correct method.