"Respiratory"

MRCP-PACES 30th November 2005

Station 1:
Respiratory:
A middle-aged lady presented with shortness of breath. Examine her respiratory system. First, I started from the periphery and went up to the head. No abnormality. Then, I went on to feel for the trachea. It was central. As I had discussed with my friend before, I proceeded to examine the back after telling the examiner. There, I noted a needle puncture mark at the left posterior wall. My instinct told me, this should be a case of pleural effusion. It was further confirmed pleural effusion after I elicited stony dullness percussion note with a reduced breath sound and reduce VR. Examiner went on to ask me about how I investigate and manage the patient.

Comment:

This case was relatively straight forward and questions asked was quite direct. I made a terrible mistake here. My friend who sat in UMMC found a centrally placed trachea and he proceeded to examine from the back. After that, he mentioned to the examiner that he would like to complete examination by examining from the front and the examiner said, that was ok and stopped. So, presumed I got the similar scenario, I told the examiner the same thing and he asked me to proceed! I was panicky, there was only three minutes left! Instead, my mind went crazy, I examined the patient's breasts!!! (Thinking there might be a clue there).

Outcome: 4/3 (Thanked God!).