Thoughts on my Finals (for future reference)

[eltombarno52]

Hey everyone, seein as melon put his up, i thought i'd put mine up as well.

Mine was in the royal (everyone said that would be bad... but it really wasn't, all cases were straight forward)

DAY 1 (MED & SURG)

Headache history
Lady had 1 month hx of unilateral headaches lasting a long time with nausea, vomiting & photophobia. Turned out she had a subarachnoid haemorrhage but she really didn't give me that sort of history... anyway, was asked about how to investigate & manage a SAH.

Surgical abdo
This examination was on a man who had an A-V fistula on his left arm, hockey stick scar and ballotable mass in left iliac fossa. Also had a peritoneal dialysis scar on his abdomen. He also had a midline sternotomy and graft harvest scar on his left leg. So this patient basically had had renal transplant surgery. Was questionned on what would cause him to need this operation and what drugs he would be on (immunosupression).

Neck swelling
Was a multinodular goitre - smooth swelling in midline, moved on swallowing not on tongue sticking out. Examined thyroid status & was normal except mild brady of 60/min. Got asked DDx of thyroid swelling, how to investigate & how to Tx this patient. Also got asked the cause of her brady (probably beta blockade) and what sign in the arms you would get on massive thyroid swelling (Pemberton's sign).

Cardiac exam
Large female patient who had normal CV examination but had scar over left upper aspect of chest with palpable pacemaker beneath it. Got asked causes of brady & tachy arrhythmias, symptoms of both, how to investigate and also the battery life of pacemakers (which the examiner was just interested in... didn't even know himself!!!)

Arthritis history
Patient had pain in many joints, symmetrical and mainly involving DIP & PIP of hands. Stiffness & pain lasted >1hr in morning. Also had OA of left knee. Was asked the anatomy of the hip joint (this went awfully haha!), investigations and management for OA.

Neuro exam
Asked to do exam of lower limbs but not sensory. Motor was weird - had 4/5 movement pretty much everywhere, except 2/5 on right dorsiflexion of foot. Gait was all over the place with shuffling but wide based. Then got told his sensation was gone from knee down. Got asked Dx (peripheral neuropathy), then got asked causes and questionned a bit on parkinsons for some reason.


DAY 2 (SPECIALTIES)

Paeds Hx
Was a history of boy having myoclonic jerks and absences. Also had klinefelters. Hx was from mum alone. Got questionned on what type of epilepsy it was (generalised/partial) then also questionned on treatment. Then got asked what klinefelters was (think this was bonus points question.. he didn't seem interested)

Paed exam
Respiratory on pretty well 7 year old boy. Had mildly raised RR and slight inspiratory wheeze. Got asked diagnosis (asthma), then asked how to measure respiratory distress, how would I communicate findings to mother (examiner pretended to be mum, very weird, I held back from calling him mrs!!) The questionned on Tx

Obs Hx
Very basic obs hx - normal 28 weeks. Got asked what screening is involved - what happens at booking, stages of labour, ultrasound scans etc.

Incontinence hx
Woman had history of urge & stress incontinence & hx of spinal injury - turned out to be irrelevant. Patient also had glaucoma (therefore can't use anti muscarinics). Got asked what cystometic studies are - whats involved. Then asked further investigation & management.

Dementia hx from carer
Pretty stratight forward - alzheimers - had to ask about risk. Patient was pretty much unable to live alone - needed 24hr care. Got asked types of dementia - what my level of risk was, drugs for dementia.

Community hx
Was hypertension caused by acromegaly. Didn't need to bother about acromegaly - got asked about investigation & treatment for hypertension.

Hope this helps, if you have any questions or want to know how the writtens went then PM and i'll get back to you.

[AndreaD81]

My that sounds difficult! I wonder if I would be able to do it if I get a place in few years time!

[iem]

Typed up mine for Dr Clarke too, thought I’d add it to the collection here ;p Mine was at Arrowe Park

Day 1 – Medicine and Surgery

Abdo exam – Young man with a colostomy, very straightforward. Questions were on difference between colostomy and ileostomy, whether I thought patient’s was colostomy or ileostomy (right side but i couldn’t see a spout. I probably shouldn’t have, but I asked the patient if there was one while I was examining him and he said there wasnt), potential complications of the stoma.

Neck lump exam – did horribly in this, I saw that the man had an obvious lump on the left side of his neck, and jumped straight to palpating the lump after a quick general inspection. Examiner kept asking me if I wanted to do anything else but i stood there doing nothing despite the prompts! He gave up after a bit, and started questioning me for the remaining time. Got asked loads of questions about differentials and how I would investigate for each, signs and symptoms in malignancy, why a sebaceous cyst (what the guy had) recurs. Other people I spoke to got asked only differentials and ix.

Cardio exam – had to examine patient from the left. Felt a collapsing pulse for the first time ever, and he had a diastolic murmur. I couldn’t feel his apex beat or jvp, and told the examiner but he didn’t seem to mind. Questions were what I thought the patient had, and three bedside tests I would do.

Respiratory exam – was told to only examine the lady’s back. she had rheumatoid hands (that I missed, examiner pointed it out later on and asked if ive ever seen any), and fine inspiratory crackles. Questions were what it could be, and to link RA with the fibrosis, what I would do if I was a gp and seeing the lady for the first time, and treatment, and a bit on lung function tests.

Osteoarthritis history – standard history, got asked anatomy of knee, treatment for OA, types of knee surgery

Resp history – a complicated history of a guy with wegener’s and cancer with metastasis. He also said he was recently told about the mets, so I sort of went into comms skills mode after that instead of taking a proper history =/. Questions were on differentials, investigations, and treatment

Specialties

Hyperlipidaemia/hypertension hx – took a history and was asked on what id do to find out complications of drugs (look in a bnf!) and what bp the guy should have

Antenatal hx – took an uncomplicated antenatal hx from a lady and questions were on booking dates, blood tests at first booking, stages of labour

Paeds hx – took one from the mother of a child with cf, who was happy to have his mother answer the questions. I got asked about differentials, investigations, and management.

Paeds exam – respiratory history of a very sweet little girl with several scars and kyphoscoliosis. Didn’t do very well in this, examiner told the mother to explain what the girl had, but I had no clue what she was talking about, and could only stare back blankly when asked later on what I thought the girl had. (I think it was oesophageal atresia and something else) Was asked about types of congenital heart conditions, and to name the scars

Dysmenorrhoea hx – typical hx. Questions were on differentials, investigations and treatment.

Psych hx – history taken from the carer of a patient with alzheimers. Was told to do a mental state examination too. Patient was in a nursing home and bed bound, and appeared to be always happy. I had no idea who it was that I was meant to perform the MSE on, so I made a feeble attempt at doing one on the patient. Was asked risks of the patient, and treatment of alzheimers

[Chang]

Since everyone else has done it…

Locas at Warrington
Day 1 – med/surg

1. surg hx 1 - osteoarthritis
Lovely chap with OA and knee and hip replacements. First thing he said was “I’ve got osteoarthritis and I’ve had my hip and knee replaced”, so there wasn’t really much to investigate. Ran out of time as he nattered on a bit trying to help me, but the examiner didn’t really care, he just wanted to see I was asking half decent questions in a logical fashion. Questioned on anatomy of the hip – stopped me after briefly describing the gross anatomy and then gave up attempting to drag the surface anatomy out of me. Asked how to treat first presentation of osteoarthritis as a gp, and about the analgesic ladder (because I mentioned it). Examiner told me I had passed as I left.

2. surg exam 1 – abdo with stoma and Laparotomy scar
my worst station, did a slick abdo exam, then had just got on to the stoma when the bell went, so had only looked at the skin and felt the contents of the bag. Stupidly I had noticed the fairly obvious parastomal hernia during the exam then didn’t mention it in my summary, so he asked me complications of stomas and eventually I said hernia. I then said it was an colostomy simply going on the fairly solid bag contents, (I hadn’t looked for a spout, totally ignored the fact it was on the right, and very embarrassingly forgot that the pt had said his laparotomy scar was from a total colectomy… oops). Cue some rather furious backpeddling to the obvious amusement of the examiner. Also got flustered and couldn’t make up my mind if it was a parastomal hernia or an incisional hernia (given there was obviously an incision there where the stoma was if you see my logic). Eventually I came to my senses and said parastomal. also pressed me on whether the pt should have his hernia repaired (baring in mind I hadn’t actually examined it). Others got questions on causes of splenomegally and risks of splenectomy (the pt had also had his spleen removed)

3. surg exam 2 – varicose veins
woman with obvious varicosities all the way down the long and short saphenous on both legs. I was all set to do tourniquet tests and doppler etc, but all they wanted was tap test over S-F junction and describe what we’d do with a tourniquet. Finished very early so examined peripheral pulses for the sake of using up a minute, which he seemed vaguely amused about. Was questioned on treatments and basic venous anatomy of legs.

4. med hx 1 – UC
lovely lady, she had evidently been told not to give away the condition, which she took to heart making it quite amusing to watch her trying to answer questions without giving too much away. Kind of wanted to say to her she could drop it as I knew it was IBD from the first line “I’ve had bloody diarrhoea for about 10 years…” loads of questions differentials, investigations and treatment – what drugs she was on, possible cause of her b12 deficiency if it was crohns not UC

5. med exam 2 - cryptogenic fibrosing alveolitis
barn door fibrosis – couldn’t miss it if you tried. Also had AF. Had to examine the pt sitting and standing as he couldn’t lie down (ankylosing spondylitis I think). Questions on differentials, causes of pulmonary fibrosis, investigations, likely results of respiratory function tests, drug treatments

6. med exam 2 – mitral regurg
the pt was a cardiothoracic surgeon (slightly off putting!) very nice murmur – classic mitrac regurg, but loads of people thought it was aortic stenosis, I guess as its more common. Examiner seemed impressed that I knew it was MR, I think they would have been happy just with sysolic murmur and differentials. Differentials and investigations, likely ecg changes, and then she ran out of questions. Very nice examiner again.

Day 2 – specialties

1. gynae hx - DUB
not bad hx, but examiner a little less friendly. Seemed to be sticking exactly to the mark sheet and not moving on until you had got EVERY differential or investigation possible. Not that many questions but a few awkward silences where other examiners would have asked another question but she just sat there and looked at me, despite having given all the answers I could.

2. community hx – familial dyslipidaemia
not bad, wanted you to ask about first presentation and assess CV risk. Just a few questions on investigations, her risk, drug treatment and other advice to give pt.

3. psyc hx – carer of pt with dementia
lady was a bit teary so it turned more into a comm skills session, just let her talk through what had happened. Pt had just gone into a nursing home, so asked about problems they had been having at home. Sheet said to do a MSE on the patient, without him there I didn’t really know what to do but the examiner seemed happy with questions about his behavior and memory loss etc. no real questions at the end, more of a teaching session.

4. paeds hx – kartageners syndrome
this is their favourite that gets brought out every year; the patient and his mum are very well practiced, they don’t give anything away! It threw us all a bit because the examiner said take a hx AND then examine him. So the hx was rather rushed, and then I just listened to his chest after asking the examiner if he wanted me to do a full resp exam in 1.5 minutes. Not many questions, more of an explanation of kartageners with a few questions in between to get me to link it all together.

5. paeds exam – VSD
nice kid with a cracking thrill and murmur. Lots of questions on diagnosis, did I know how it was fixed and did it need to be, and then she ran out of things to ask.

6. obs palpation - 38/40 gestation
no tape measure so couldn’t do FH, had no idea where the baby was, debated lying but figured I might as well say what I thought - oblique lie, breech presentation right – sacro – anterior … yeah… I don’t think so either, but heyho. They didn’t seem to care what you said it was. “tell me about antenatal care and screening” nice waffly question, probably took up three minutes on that then a couple of questions on hypertension in pregnancy (that was what the pt was in with), after which he gave up.

all in all very fair cases and good examiners. also impressed with warringtons organisation of it, they were all nice and calm which helped a lot on the first day.

[jade51]

Hey, sorry I've been trying to write a new thread but my laptop won't let me!

Just finished third year (woo!) and was wondering if there are any books or equipment I need to get for 4th year?

Any help would be greatly appreciated, thanks!

[Chang]

not really. 4th year is all about the revision books. "at a glance", "lecture notes in..." "master medicine" etc are all popular, but i pretty much stuck with the OHCM and OHCS and they did me ok. there's no hurry so wait till your back at uni and see what you like. no equipment required (possibly a supply of b-blockers and diazepam - you'll be needing it by christmas )

[mars84k]

hello everyone,

I have a question for current 5th years / intercalators: was there a lot of s&f in your paper 1?? i'm asking this because we had our formatives (4th yr) and in the paper 1 i was expecting mostly clinical questions but this time there was quite a major s&f section (e.g. there was a diagram of a testes that we had to label various parts of and function of various cells in testes etc).... that was totally unexpected, and other quite a few s&f Questions, to be honest in 3rd yr paper 1 was almost 99% clinical that is why i was quite surprised.

i didnt want to start a new thread to ask this question, so asking here instead.

thanks for any replies in advance,
A scared 4th yr medic !!

[purplegoblin]

hi i heard there are some practice exercises for death certification/ ABG questions on the clin skills website on vital? can anyone tell me how to find them? thanks

[Lyns]

Considering i have now made it to 5th year - yay! I thought i would also post up my thoughts on finals for future years I also have the added bonus of having done LOCAS twice, so have 2 sets of info on that one (Haha! - Yes it's true, you can fail LOCAS!!!)

Writtens:

- Paper 1 - pretty standard random questions. We had lots of questions on rheumatology and dementia for some reason. Best advice for this paper - get on pastest or onexamination.com and do as many questions as possible - thats what got me through.

- Paper 2 - Learn your definitions for this one and the ethics was again the 4 principles

- Paper 3 - had a really horrible question on renal masses and some other not so nice ones of SLE and JIA. Basically learn as much as possible as anything can come up. Questions were mainly on investigations and management, not so much on symptoms and signs anymore.

OSCE:

- 32 stations, lots of double stations. Not too bad as far as OSCEs go - comms skills was what people found tricky, one station was on counselling a parent about their 10yr old son who was self harming. We also had a 10min station to take an Obs hx, do BP and urinalysis and tell the patient what was going on - tight for time in that one. Basically learn the study guides inside out esp for things like aseptic technique and learn a set of Ix and DD for common things.

LOCAS

- Take one!

My summative LOCAS took place in Lancaster.

Med & Surg day:

- joint hx = RA was pretty straightforward, was asked questions on DD, Ix and Tx.

- PVD hx = had a really chatty patient who wasn't too clear on his PMH with regards to timings etc which made me run out of time to ask about associated conditions. Was asked questions on DD, Ix and anatomy of arteries in lower limb (was shocking at that one!)

- CVS exam = woman in her 30s with a systolic murmur. Was told outside she had health problems at 6mths old. So assumed congenital heart murmur and was right (wasn't expecting that in an adult case!). Asked questions on DD, Ix and why i thought it was congenital (because hx said outside!)

- Abdo exam = man with midline scar and stoma. Was asked DD, why thought it was UC/Crohn's and what had been removed.

- Upper limb neuro = man with an obvious tremor and rigidity in upper limbs- barn door Parkinson's. Was asked diagnosis and tx.

- Neck lump exam = the lump wasn't obvious at all, i thought i could see and feel something so casually asked the patient "when were you diagnosed with the lump?" to which she replied "4 years ago" so i knew there was definitely supposed to be one. Was asked DD and Ix.


Specialities:

- Paeds resp exam = patient had clubbing and chest wall deformity and outside had a huge long list of meds inc. Creon so knew he was CF. Was asked DD and how you diagnose CF.

- Paeds CVS hx = 2mth old baby. Mum was told baby had heart murmur at birth. Everything else was normal. Was asked DD (baby was acyanotic so reeled off list of acyanotic heart murmurs) and Ix.

- Comm hx - diabetic review. Was asked about types of diabetes and pathology and Tx of diabetes.

- Psych hx - carer of a patient with dementia. This was quite tricky and my risk assessment was terrible. Had to take a hx, do MSE and risk assessment which was hard work considering the patient wasn't there!

- Obs hx - normal pregnancy, had high BMI and aunty with T2DM so had had a GGT done. Was asked indications for a GGT in pregnancy and stages of labour.

- Gynae hx - menorrhagia. Was asked Ix and causes.


Take 2:

Resit was done at Arrowe Park - they were really lovely (think it was because we were all so nervous!)

Med & Surg:

- Neck lump exam - patient had a pleomorphic adenoma. Was asked to describe lump, Ix and DD.

- Abdo exam - female patient who was very overweight so was difficult to feel much. She had some laparoscopy scars and i thought she had palmar erythema, spider naevi and hepatomegaly. Was asked to come up with diagnosis (CLD) and causes, also was asked what operation she had had done.

- Joint hx - OA of the hip. Was asked xray differences between OA and RA and Ix.

- Resp hx - Patient had COPD. Was asked DD and Ix.

- Resp exam - lady had rheumatoid hands so figured it was lung disease associated with RA. Didn't hear anything in her chest so was asked to listen again - she had end inspiratory crackles. Was asked for diagnosis (Pulmonary fibrosis secondary to RA) and Tx.

- CVS exam - patient had a systolic heart murmur and AF (which we all missed first time around and was asked to feel his pulse again!) - he also had some peripheral oedema. Was asked for diagnosis and what we thought murmur was and Ix.


Specialities:

- Paeds resp exam - patient had median sternotomy, lateral thoracotomy and tracheostomy scar and scoliosis. No other findings. Was told mum had polyhydramnios and was asked for diagnosis (Tracheo-oesophageal fistula) and which scar had meant that op and how would Ix scoliosis.

- Paeds resp hx = mum and son came in. He had recurrent chest infections and meconium ileus at birth. Mum said he had CF and was on pancreatic enzymes. Was asked DD for chest & bowel problems and tests for diagnosing CF and what an abnormal score was.

- Obs hx = normal pregnancy, no problems. Had GGT as mum T2DM. Was asked why GGT, stages of labour and blood tests and antenatal screening.

- Gynae hx = menorrhagia - asked causes, Ix and Tx.

- Comm hx - familial hypercholesterolaemia. Was asked tx and S/E of statins and how to calculate CVS risk.

- Psych hx - bipolar patient was asked to take hx, assess level of functioning and do MSE. Asked how treat acute depression and mania and how to treat severe depression.


Hopefully this will help lower years with their finals - just make sure you see loads of patients and practice examining them LOCAS style and get doctors to watch and criticise you.