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Year Guide: Fourth Year: COMP 2


Assessments

Written Paper:

Care of the elderly, General Practice and Dermatology

This was quite tough. It focused on clinical cases and you had to say how you would diagnose/treat them.
Revision: read the booklets (even though that seems like a really way of revising, but it works and that is all you need to know)

Useful resources:

  • Gawkrodger Dermatology (lots of detail)
  • Oxford Handbooks on General Practice and Geriatrics (Really really good and in exactly the right style/content which we need to know just in a more accessible format than the booklets)
  • www.dermnetnz.org (brilliant website)

OSCE:

*The majority of the marks*

This is a really fair exam. They test you on what is common presents commonly. All of the history taking stations will want to focus on the presenting complaint so PMH etc will all be minimal.

Overall tips:

  • Keep calm
  • Pretend you are a doctor
  • Start with 2-3 open questions
  • Check allergies wherever possible
  • Practice, practice, practice. One evening before the week of exams do some OSCE practice as I found that helped direct your revision slightly especially as the OSCE is such a large proportion of the marks. And the best revision for this is to with a friend reenact the consultations as there is nothing like actually saying it.
  • Make sure you ask questions like what has the patient come in for, what are they expecting, come back in 1 week, give them leaflets and ensure they know they plan of what is going to happen. Ask family history and find out worries.
  • Provide literature and safety net

Stations Summer 2009

1. Dermatology Written
Task: 3 pictures and had to write

  • Case scenario: Atopic Eczema (Quite straightforward about a boy who came out in a rash. Ensure you write ATOPIC eczema otherwise you don’t get the marks)
    • Also had to write 3 risk factors/things that had caused it
    • Treatment regiment including doseage and strength and guidance (ie quite detailed)
  • Case scenario: Alopecia areata (Barn door obvious pictures showing someones scalp. diagnosis once again ensure you write alopecia AREATA)

2. Dermatology Viva

  • Picture 1: Psoriasis – had to describe the lesions then discuss three different treatments and their advantages and disadvantages.
  • Picture 2: Palmoplantar psoriasis and then describe the treatment
  • Picture 3: Scenario and picture
  • Patient with a history of psoriasis. Flare up. Picture of psoriatic erythroderma.

    • Tips: actually not that easy coming up with 3 treatments for psoriasis and accounting their advantages and disadvantages in detail. Need to know greater detail than for the written. But only on the core topics

3. Consultation: A & E: Fall
Scenario: Patient had come into A and E due to a fall. Ask standard fall questions. They want you to ask what happened:

  • Before fall
  • During fall
  • After fall

Also ensure you ask: collateral history, colour of patient during fall, loss of consciousness. Management and plan: make sure you know which investigations you would do eg 24hour ECG was what they wanted

4. Consultation: GP Reflux and alcohol
Patient presented with barn door history of reflux.
Take the history and what I did was at the end of history of presenting complaint ask about the risk factors which could increase reflux. Alcohol came up. Ask how much drink (I didn’t know how many units in a pint… 3 apparently!) Look at the behaviour change guidance in the GP booklet and then talk about management under two broad headings of conservative and medical.

5. Consultation: GP Migraine Management
Patient with long standing history of migraine. Very stressed at the moment and migraines getting worse. She wanted treatment. Her friend had been prescribed a triptan with a weird name.
Know about side effects of triptans and when you are supposed to take them

6. Consultation: GP Depression in Carer
Patient came in due to advice from health visitor. Her father has got severe dementia and she is struggling. Explore current situation, what’s going on etc.

7. Consultation: GP Angina
Patient presented with chest pain when walking up Park Street. Barn door angina.

  • Remember to explore differentials to rule out others just in case (quickly)
  • I got good feedback for having some banter with the patient at people generally struggling to walk up Park Street.
  • Management and plan: REFER!!!! Needs exercise ECG. I also said I would prescribe some GTN and see if that would relieve symptoms, and she could use it in advance. He said that was good in the feedback but I’m still not convinced that was the model answer!!
  • Also gave brief lifestyle advice (and a leaflet!!!)

8. Written: Pseudodementia/Depression
Situation describing patient who was confused. Looked like dementia but on the Folstein the concentration was decreased so that indicated depression rather than dementia.
Had to write investigations, assessments, treatment.

9. Examination: Cranial Nerves
Scenario: Lady came into A and E because earlier that day she had difficulty swallowing and talking. Now totally recovered. Do a cranial nerve exam (no need to do fundoscopy, gag and corneal reflex)
Straight forward CN exam. Keep calm and go slow.
Ensure you do rinne and webers
Also look in the throat and ask to say Ah to look for lifting of the palate and deviation of the uvula.

10. Disability: Peak Flow
Visually impaired lady in the corridor. You have to go and get her.
Make sure you ask:

  • I understand you have problems with your eyesight. Would you like to be guided? How?
  • Once she’s in the room; Is the light in here alright for you? There is myself here and I am sitting opposite you etc and there is also an examiner in the room too.
  • What do you think you are here for today? Peak flow. Great that’s what I expected too.
  • Have you ever done this before? Even if they said yes, I just described what I was doing ie just fitting the mouth piece on. Then if you make good seal with your lips, blow as hard as you can etc… I will look at the dial. Need to do it 3 times and we will take the highest value

Stations Easter 2009

  • Drug history
  • Deaf person with UTI
  • GP lady with cough, had to refer for xray
  • Upper limb neuro exam
  • Blood pressure, calculation of CV risk
  • Falls history
  • GP morning after pill consultation
  • Dermatology acne
  • Dermatology written of skin cancers
  • Care of elderly written Pressure sores

Stations February 2008

  • Man comes in with reflux. CAGE and depression score needed
  • Dermatology: you are told a 19 yr old presents with acne
  • 47yr old lady comes in for annual medication check up having been on ACE-I & statin for a year.
  • Communicating with deaf person – lady had UTI
  • Do a CVS exam and discuss an ECG
  • Starting warfarin
  • Lady with persistent cough
  • Pressure sore/leg ulcer – know causes, treatments.
  • Atopic eczema – know causes treatments

Stations February 2007

  • History Station. Lady with lung cancer,
  • Women comes in for the morning after pill.
  • Women in hospital, has broken wrist from a fall. We were told take some history of how it happened and assess her for discharge.
  • Written Station – Dermatology Pictures and Questions section.
    a. Brief hx of someone with actopic eczema. Write causes and treatments
    b. Second question was a photo of pemphigus.
  • Care of the Elderly written. This was a double-sided sheet of questions with a list of drugs (6-10) and questions like which drug might cause postural hypotension.
  • Back pain.
  • Dermatology Viva. All about skin cancer.
  • Blind person. – Peak flow
  • Man who lives with Dad who has Alzheimer’s.
  • CVS Exam. Man has dizziness, ?postural hypotension. Do a lying and standing BP.

Knowledge

A couple of aspects which are really core knowledge a I would advise knowing about:

Care of the Elderly

  • Causes and differentials of dementia and delirium
  • How to do a fall history
  • Different treatment options after a TIA/Stroke

General Practice

  • Attendance and Disability allowance
  • The pages full of text about how General Practice works at the front of the booklet
  • RED FLAGS and when to refer
  • Investigations to do after presentation of specific condition
  • And when investigations would be done on referral
  • Type 2 DM

Dermatology

  • Skin cancers: BCC, SCC, MM
  • Common dermatological conditions: psoriasis, eczema, acne and how to treat
  • Venous/arterial ulcers