PassPACES.MRCP Station 4 - Your Gateway to MRCP

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Tutorial for MRCP PACES Station 4( Last Modified : 11 January 2007 )

OK, we talked about the general principles about station in previous page. In MRCP PACES station 4 , there are a few common scenarios always asked in exam, these questions are,

a) Breaking Bad News

It is always a popular question. There are two main types of illness commonly appear in station 4. The first type is chronic illnesses that is incurable but not fatal immediately, these diseases are Multiple Sclerosis,Motor Neuron Disease, Parkinson's disease, Alzheimer's disease, Systemic lupus erythematosus(SLE), Dystrophia Myotonica, Cystic Fibrosis etc. The second type of disease is advanced cancer and brain death.As I mentioned in my previous article before, I found that the second scenario is much easier than the first. For the first type of diseases, you need to have some knowledge about certain illnesses, for example if they ask you to break the bad news to patient that he is having motor neuron disease, you will not score well if you know nothing about motor neuron disease. As compared to the second type of illness, you require minimal knowledge to get your task done.Therefore, always learn some important facts about certain chronic illnesses and try to explain them in layman's terms!

b) Conflicting Interest With Patients

You may be given a case that your patient is not satisfied of your plan of management. Usually, your patient in exam will request something (some investigations etc)that are not necessary. Your task is to convince your patient to do otherwise Always remember that in this type of case, you must ask you patient the reasons he/she is acting that way. For an example, if a patient insists to get a CT brain done although your consultants think that he/she might be only having migraine. You must always ask your patient the reason why he/she is excessively worried about this. He/she may tell you that someone in the family died recently because of brain cancer. Always show empathy towards patient's feeling and concern. Another example is that patient may insist to do something which are advised otherwise such as driving in an epileptic patient.

If you fail to convince you patient, ask your patient is there anyway he/she can change his/her mind. Leave this issue to your consultant if you still fail to convince your patient at the end of your consultation.

c) End of Life Issues

There are a few issues that commonly asked in MRCP especially when patient is terminally ill. These issues include DO NOT RESUSCITATE, WITHDRAWAL OF TREATMENT and ORGAN DONATION. Always ask about advance directive from family members if patient is comatose or incompetent. Learn about these three scenarios well!

d) Investigation/ Event Procedures

In this type of case, you must know the agreed procedure to do something. Examples are performing HIV test, Post exposure prophylaxis treatment, adverse reaction/ incident ( complaints about doctor) reporting. Learn all these from any MRCP books!

Hope you find this information useful!Click here to see the first page!