MRCP- It teaches more than it tests
This is the quote that I find most inspiring and it really holds true as you venture along the path of being a 'mrcpian'.
Singing the 'songs' after the end of each examination would better be termed singing the 'choruses', as each of these would invariably be repeated for tonnes of times before one would sit for the exam:)I would like to complete my examination by...
1) CVS: AR
BP for wide pulse pressure
Peripheral signs for AR
Signs of IE if suspected
2) CVS: AS
BP for low systolic/narrow pulse pressure
Signs of IE if suspected
3) CVS: TR (functional or structural)
(Of course, you'd have found a PSM at lower LSE best heard at inspiration along with a promivent v wave to say this:)
Examine the abd, in particular, to look for a pulsatile liver
4) CVS: Severe MS +/- pulm HT
BP
Signs of IE if suspected
Examine the lungs to look for bronchial breathing at left middle zone (collapsed consolidation of left middle lobe d/t enlarged left atrium compressing on the left brochus)
Talk to patient to look for Ortner's syndrome (hoarseness of voice secondary to left recurrent laryngeal nerve palsy from left atrium enlargement)
5) CVS: prosthetic valve(s)
Midline sternotomy scar is present...there is a metallic click which coincides with the 1st HS best heard over the mitral area...and there is no evidence to suggest leakage of valve...and clinically there is no evidence to suggest overwarfarinisation.
6) Abd: CLD
Scrotum for testicular atrophy
PR to look for malaenic stool (if pallor present)
...there are signs to suggest CLD as evidenced by the presence of... Therefore, I think this pt has CLD, but there is no sign to suggest that he is in hepatic encephalopathy. The possible etiologies I'd like to consider are...
7) Abd: APKD
Examine the BP to look for hypertension.
Dipstick the urine to look for proteinuria & haematuria
Examine the CVS in particular to look for MVP.
...previous peritoneal dialysis scar noted at the infraumbilical region... I think this patient has adult polycystic kidney disease in ESRF requiring haemodialysis. No signs of fluid overload. No signs to suggest that this patient is in uraemic encephalopathy.
8) Abd: Hepatosplenomegaly d/t myeloproliferative disease
Examine all the lymph nodes to look for generalised lymphodenopathy
9) Respiratory: Pleural effusion
Examine the sputum macroscopically, in particular, looking for haemoptysis
Dipstick the urine for evidence of gross proteinuria
....the etiologies I would like to consider are mitotic lesion of the lungs as evidenced by finger clubbing, cachexia and heavy nicotine stains; mycobacterium infection of the lungs and the remote possibility of a parapneumonic effusion of the lungs.
10) Respiratory: AECOAD
Examine the sputum mug to look at the sputum macroscopically, and to do a bedside PEFR for the pt.
11) Respiratory: Bronchiectasis
Examine the sputum mug to look for foul smelly copious sputum and haemoptysis
CVS- dextrocardia (if suspected Kartegener synd); loud P2 with left parasternal heave to suggest pulm HT
12) Respiratory: Dullness/consolidation apex
Examine for wasting of the 1st dorsal interossei of the ipsilateral hand, and to look hard for ipsilateral Horner's synd.
13) Neuro: Parkinson disease
Examine the standing and lying BP, examine for coordination to look for cerebellar signs and to check patient's upward gaze. I also would like to look for any evidence of long tract signs by carrying out a full upper limbs and lower limbs neurological examination.
14) Neuro: Unilateral facial nerve palsy
Examine for cerebellar signs, checking patient's ant 2/3 of the tongue for taste & sensation. Further examine the 8th CN by doing Rinne & Weber's test and to do a full otoscopic examination.
15) Fundus: DR with maculopathy
Examine pt's visual acuity (& to plan for an urgent ophthalmology referral; esp when there is significant VA impairment)
MRCP; Membership of Royal College of Physician- They only give that to the crowned heads of the world:)
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