New Station 5 - Brief Clinical Consultation (BCC)

As everyone knows… from time to time RCP will make changes to the examination format or even marking format. So called to keep up the standard. Oct 2009 was the first time ever those radical changes were introduced. Station 5 had 180 degree transformation. Marking format also changed. I will talk about change in the marking scheme in a different post.

Whatever it is, I think the new Station 5 is more practical and more realistic. It’s not about showing “museum” cases involving locomotor, skin, eyes and endocrine systems. Here, it is about knowing what is important in history and physical examination when dealing with a particular complaint. And of course, not to forget, dealing with patient’s concerns and not neglecting the patient’s welfare.

Before you start the station, you have 5 minutes to read and prepare both questions – about 2.5 minutes each question. The case scenario is usually short and may not be able to help you much until you actually see the patient. However, important history ie. underlying Psoriasis might be disclosed to you. Once the bell rings, it is time for you to start seeing your first patient, please make sure you have the correct patient for the correct case. Then start the show… you have 8 MINUTES to clerk and examine… do it in any order or even simultaneously. I prefer to take a quick look at the patient and start talking with the patient.. just to get hints on how to proceed further. If necessary.. do take past medical history, drug history.. better if can be done in the right order. This can be done while examining the patient. One of the PACES examiner I met during a course said.. even though it can be done in any order, she would prefer it to be done systematically.. ie.. try not to examine the tummy then only look at the face or mouth.

If you notice in the MRCP website, they mentioned that the cases can be of the 4 systems from the old station 5, or CVS, Respiratory, Neurology or Abdomen. They even advise you to study 20 common medical presentation from the JRCPTB website. Well, at this moment, since this new Station 5 stil new.. I personally think more attention will be given towards one of the 4 systems from the old station 5. Here are the possible case scenarios:

• Sudden onset of blurring of vision with irregular pulse

- It could also be transient body weakness/numbness etc associated with irregular pulse

• Blurring of vision in a patient with newly diagnosed HPT (acromegaly with pituitary tumour)
• increasing ring size with diabetes (acromegaly)
• underlying asthma with symptoms of diabetes (Cushing’s secondary to iatrogenic steroid), or any underlying medical problem that usually requires steroid ie. SLE, autoimmune bullous disorder,
• patient admitted with uncontrolled DM and complains of whitish patches at his hands (Autoimmune Polyendocrine Syndrome)
• admitted with recurrent seizure and has multiple skin nodules (tuberous sclerosis)
• admitted with UGIB, and has hyperpigmentation at the lips and buccal mucosa
• underlying psoriasis with multiple joint pains
• underlying psoriasis with neck stiffness (spondylitic type PsA)
• underlying RA with painful red eye/SOB
• complains of SOB (but when you see the patient, she has features of scleroderma)
• complains of blurring of vision (when see the patient, has exophtalmus and ophthalmoplegia – Grave’s ophthalmopathy)
• bilateral LL weakness – prior to that had multiple blisters over a dermatomal distribution (transverse myelitis post Zoster infection)
• abdominal pain (renal colic) in patient who has tophaceous gout.
• Carpal tunnel syndrome in patient who has gout

Basically… it can be anything! Until there is new publication on this nStation 5, I suggest you continue reading Ryder/Baliga. While reading/studying it.. imagine how it’ll come out in Station 5.. possible complaints and how to approach it. I will share some example.. from what my friends and I did and cases I had during PACES courses.