Station 1 - Respiratory System

• step-by-step approach to respiratory system is easily available in any clinical medicine book ie. Clinical Examination by Talley O'Connor
• for those who has just begun to prepare for PACES, it is good to go through such books - to remind us back the physiology/pathophysiology of clinical signs
• go through the steps until you master it and able to perform it naturally. Need not to be on real patients.. teddy bear, friends, or even in your mind...
• time issue? make an effort to perform full clinical examination during ward rounds or clinic encounter. It should only take 6 minutes of your time for 1 system.
• preparing a good and impressive presentation need a lot of hard work and practice. Unless you have exceptionally good command of english.
• Maybe at the initial period as you are just starting to get yourself used to PACES, conservative way (from periphery to the the organ of concern) is a good idea. In a way it helps you not to forget examination steps. Once you are more matured in terms of exam preparation, you can choose to present "hit-hard" or maintain the conservative way
• Most importantly, choose a method that you are comfortable with so that you look smart on the exam day
• In general.. examiners like "hit-hard". I say this because, unless you are the first candidate, by the end of the 6th minute, their question: "Tell me your positive findings"
• Important in the presentation to make sure the presentation is short and sweet. Ryder and Freeman has good examples of presentations
• end the examination by requesting to see sputum pot, temperature chart, oxygen saturation, PEFR (if necessary)
• at the end of presentation, tell the examiner the diagnosis, likely cause and current functional status.
• example a case of pleural effusion:

Mr X is in respiratory distress as he is tachypnoeic, tachycardic and using his accessory muscles of respiration to breathe. He requires oxygen therapy via 2L/min nasal prong. He has bilateral finger clubbing and nicotine staining. He is not cyanosed and does not have signs of carbon dioxide retention. His trachea is deviated and apex beat displaced/not felt (if necessary, comment on pulmonary component of the second heart sound). On examination of the chest the findings are localized to: _____ whereby there is reduced chest expansion, reduced vocal resonance and fremitus, stony dull to percussion and diminished breath sound.

In conclusion, Mr X has massive pleural effusion, most likely secondary to ___, currently in respiratory distress.