From now onwards, every patient that you see in hospital; a ward patient, an ED admission or a clinic patient, should be seen as a short case opportunity.
This is the time for you to focus on developing good clinical habits.
Get hold of some good books on clinical examination techniques, stick to that style and do it over and over again.
The most important thing, is to do it properly each time and sticking to that routine. No more 10 seconds neurological exam and documenting in the notes, NAD (No Abnormality Detected) or some cynics would say ‘Not Actually Done’ 😉
Just like the most decorated Olympic athlete in history, Michael Phelps, you need to develop a routine when practicing your short case but to also be prepared for every possible scenario that they may throw at you during the exam.
Again, having a good strategy is key to being successful in the exam. In one of the articles taken from the RACP News 2009, the college released a list of short case diagnoses that came out in the actual FRACP Adult Medicine Clinical Examination for that year.
The article can be viewed HERE.
Note the frequency or number of cases for each diagnoses as this should provide you with some strategy as to which type of cases you should be practicing for and how best to prepare for it. For example, there were a total of 27 cases for mitral incompetence but only 4 cases of pulmonary incompetence.
This does not mean that you should ignore the murmurs of pulmonary incompetence as such, but to rather focus your efforts and your precious practice time to become very familiar and well versed when faced with a case of mitral incompetence in your exam.
I can’t stress it enough but nothing beats practice when it comes to good presentation and discussion in the clinical exam both the short and long cases. You should be practicing on as many cases as you can get your hands on and have a plan of ‘attack’ for each possible question that the examiners may ask you in the exam.
There is no fixed way of presenting. Every person have their own style of presentation and you will over time develop your own style of presentation as you practice on more and more patients each day.
So on that note, as part of my preparation for the clinical exam, I recorded a selection of short cases which I would listen to during my commute to work and whenever the opportunity arises (even before bedtime). It helped me ‘visualize’ the case and prepare my thoughts for the real exam.
Here is an example of one of the audio recordings I made on the case of a patient with optic neuritis.
So if you are interested, I have made a compilation of all these recordings which can be accessed via our Short Case Audio Series course.
Please note that this is a digital product accessible via our website rather than a physical product.
Cardiology:
- Aortic regurgitation
- Aortic stenosis
- Hypertrophic Cardiomyopathy
- Mitral incompetence
- Tetralogy of fallot
- Tricuspid incompetence
- Ventricular septal defect.
Endocrinology:
- Acromegaly
- Ankylosing spondylitis
- Goitre
Respiratory:
- Interstitial lung disease
- Lobectomy
- Bronchiectasis
- Dullness at the bases
- Pneumonectomy
Neurology:
- Bulbar palsy
- Charcot Marie Tooth Disease
- Fascioscapulohumeral dystrophy
- Friedreich’s ataxia
- Multiple sclerosis
- Myasthenia Gravis
- Myotonic Dystrophy
- Optic neuritis
- Parkinson’s disease
- Motor neuron disease
- Peripheral neuropathy
Rheumatology:
- Psoriatic arthropathy
- Rheumatoid arthritis
- Marfan’s syndrome
- Dermatomyositis
Gastroenterology:
- Liver cirrhosis
Hematology:
- Splenomegaly.
Renal:
- PCKD with renal transplant
