Examination Medicine: A Guide to Physician Training (2 page)

Examination Medicine
is now, in 2014, in its seventh edition. It has clearly fulfilled a need widely recognised by physician trainees for over 25 years. Not only does it give wise advice about how candidates should prepare themselves, conduct themselves in the exam, use their time to best effect and avoid pitfalls, it also imparts a lot of medical knowledge. One might cavil at the number of long lists encountered, but they can be readily put into context by a trainee physician, if not by a medical student. Overall, trainees will gain a helpful perspective from this volume which will stand them in good stead.

This seventh edition follows the general format of previous editions. It contains many high-quality colour illustrations not seen before. There are also newly filmed videos available for both long and short cases to include history-taking and physical examination under the eye of the authors.

This edition of
Examination Medicine
is both instructive and informative. I have no doubt that it will be welcomed by today’s generation of physician trainees as the preceding editions were by those who went before.

Richard Smallwood

AO MBBS, MD(Melb), Hon DMedSc(Melb), FRACP, FRCP, FACP(Hon), FAMM(Hon), FAMS(Hon)

Emeritus Professor of Medicine, Professorial Fellow at the University of Melbourne

Preface to the 7th edition

This book is written to help candidates sitting for the Royal Australasian College of Physicians (Part One) examination … It is the masterly application of clinical skills, as well as the breadth of theoretical knowledge that makes a doctor a consultant physician whose advice is sought after by his or her colleagues. We hope this book will help candidates understand what it means to be a physician.

When we wrote this preface to the first edition of
Examination Medicine
in 1985 neither of us imagined there would be a need to write a preface for a 7th edition nearly 30 years later. Both the FRACP clinical examination and the book have been remarkably enduring. The exam now lasts a whole day instead of half a one, and this book has evolved too (or at least become longer). However, the primary function of the exam, to select people to progress to advanced training and become specialist physicians, has not changed. We still believe strongly that to be successful in the examination, candidates need to understand what it
means
to be a specialist physician.

FRACP training has an international reputation as one of the most difficult and rigorous in the world. There is no doubt in our view that the exam has become fairer, but it remains very difficult. Up to now attempts to replace the clinical exam with only a written exam or in-training summative assessments have been resisted by the College.

It is the College examiners, a remarkable group of talented and dedicated physicians who have supported the clinical exam with their time and thoughtful approach, who have ensured the exam has academic rigour. There is a genuine feeling among examiners that the exam must be fair, but that standards should remain very high. One question examiners often ask themselves is: ‘Would I want this candidate working as my registrar?’ This means they want candidates to be sensible and safe. Of course, many candidates after being examined must ask themselves, ‘Would I ever want to work as this person’s registrar?’

Preparation is the key to success and to quote Winston Churchill, ‘Never give in. Never. Never. Never. Never.’ When we wrote this book most information for candidates came from stories told to the upcoming cohort by senior registrars who were often given to exaggeration. There is now plenty of information available to candidates. A number of examiners have been concerned by a tendency for candidates to be ‘over-prepared’. By this they mean they hear or see very similar approaches to long and short cases from numerous candidates based on a formula, rather than taking into account the individual case. Practising medicine of the highest standard is both art and science; physicians are meant to think and think deeply. A mature clinical approach requires you to understand each patient’s unique personal and social environment, and complex medical problem-solving must be considered in this context. Use this book as a help for your preparation, not something to be learned by heart.

To quote from the end of the 1985 preface ‘we sincerely hope our contribution will minimise the pain of preparing for the FRACP (Part One) examination’.
¹

Nicholas J. Talley and Simon O’Connor,
Newcastle and Canberra, 2014

¹
There has not been a part two exam for a very long time.

Authors’ statement

Professor Nick Talley is President-Elect of the Royal Australasian College of Physicians (RACP) and will be inaugurated as President in May 2014. Dr Simon O’Connor is a member of the Senior Examination Panel (SEP). This book, first published in 1985, is not a College publication, nor is it endorsed by the College. Trainees should directly consult the College website to obtain up-to-date information about policy and procedures as these are subject to regular change.

Acknowledgements

The publishers and authors would also like to thank the following people for their valuable feedback on the book:

Professor Adrian Gillin, Senior Staff Specialist Physician in the Department of Renal Medicine at Royal Prince Alfred Hospital in Camperdown, Sydney NSW Australia, as well as Clinical Associate Professor in the Department of Medicine at the Sydney Medical School (University of Sydney).

Prof. James D’Rozario, Consultant Haematologist, The Canberra Hospital ACT Health.

In addition, particular thanks are extended to Associate Professor Ashley Watson, Consultant Physician in Infectious diseases and HIV medicine at The Canberra Hospital, who provided many new photographs for this edition. Thanks are also due to Prof. Frank Bowden at Canberra Hospital for the filming of the short case and long case videos on site.

Reviewers

Elsevier Australia and the authors extend their appreciation to the following reviewers for their comments and insights on the entire manuscript:

Stephen Clarke OAM MBBS PhD MD FRACP FAChPM

Senior Staff Specialist in Medical Oncology, Professor of Medicine University of Sydney, Director of Northern Translational Cancer Research Unit, NSW

Arvin Damodaran BScMBBS MMedEd FRACP

Director, Clinical Teaching Unit, POWCS, UNSW

Rheumatology Consultant, Prince of Wales Hospital, Randwick, NSW

Lilijana Gorringe MBBS (Hons) BMedSc (Hons) MPH DCH DipO&G

General Practitioner and Clinical Associate Lecturer, Faculty of Medicine, The University of Sydney, NSW

Patrick Manning BHB MBChB MMedSc FRACP

Consultant Endocrinologist, Dunedin Hospital, Dunedin, New Zealand

Zoë Raos MBChB FRACP

Gastroenterologist and General Physician, North Shore Hospital – Waitemata District Health Board, Auckland, New Zealand

Phil Robinson BMedSc MBBS MD PhD FRACP

Director CF Services, Consultant Respiratory Physician, Respiratory Medicine

Associate Professor, Royal Children’s Hospital, Melbourne, VIC

Valerie Taylor MBBS Dip Fam Med FACRRM

General Practice, and International Medical Graduate Assessor, QLD

Prof. Mark Walker NHMRC PRF

Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences

The University of Queensland, QLD

Jack R Wall MD PhD FRACP FRCPC

Professor of Medicine, Nepean Clinical School, University of Sydney and Consultant Endocrinologist, Sydney West Area Health Service, NSW

Abbreviations

ABP
ambulatory blood pressure

ABVD
adriamycin, bleomycin, vinblastine and dacarbazine

ACE
angiotensin-converting enzyme

ACTH
adrenocorticotrophic hormone

ADP
adenosine diphosphate

AF
atrial fibrillation

AFB
acid fast bacilli

AHI
apnoea hypopnoea index

AICDs
automatic implantable cardioverter-defibrillators

AIDS
acquired immunodeficiency syndrome

ALL
acute lymphocytic leukaemia

ALT
alanine aminotransferase

AMA
antimitochondrial antibody

AMC
Australian Medical Council

ANA
antinuclear antibody

ANCA
antineutrophil cytoplasmic antibody

anti-LKM1
anti-liver and kidney microsomes type 1

AP
anteroposterior

APC
activated protein C

APD
automated peritoneal dialysis

AR blocker/ARB
angiotensin II receptor blocker

AR
aortic regurgitation

AS
aortic stenosis

ASAP
Australian Self-Assessment Programme

ASCA
anti-Saccharomyces cerevisiae antibodies

ASD
atrial septal defect

ASH
asymmetrical hypertrophy

ASMA
anti-smooth muscle antibody

AST
aspartate aminotransferase

ATP
antitachycardia pacing

AV
atrioventricular

B2-GP-1
beta2-glycoprotein-1

BCG
Bacille Calmette-Guerin

b.d.
twice a day

BiPAP
bilevel positive airways pressure

BMD
bone mineral density

BMI
body mass index

BMS
bare metal stent

BNP
B-type natriuretic peptide

BPPV
benign paroxysmal positional (positioning) vertigo

CABG
coronary artery bypass graft

CAD
coronary artery disease

CAPD
continuous ambulatory peritoneal dialysis

CCP
citrullinated cyclic peptide

CEA
carcinoembryonic antigen

CFE
Committee for Examinations

CIDP
chronic inflammatory demyelinating polyradiculoneuropathy

CKD
chronic kidney disease

CML
chronic myeloid leukaemia

CMV
cytomegalovirus

CNS
central nervous system

COP
cryptogenic organising pneumonia

COPD
chronic obstructive pulmonary disease

COX-2
cyclo-oxygenase 2

CPAP
continuous positive airways pressure

CPT
Committee for Physician Training

CREST
calcinosis cutis; Raynaud’s phenomenon; (o)esophageal involvement; sclerodactyly; telangiectasia

CRH
corticotropin-releasing hormone

CRP
C-reactive protein

CRT
cardiac resynchronisation therapy

CT
computed tomography

CVP
cyclophosphamide, vincristine and prednisone

DAF
decay-accelerating factors

DC
direct current

DES
drug-eluting stent

DEXA
dual-energy X-ray absorptiometry

DIC
disseminated intravascular coagulation

DIP
distal interphalangeal

DLCO
diffusion capacity for carbon monoxide

DLE
discoid lupus erythematosus

DMARDs
disease-modifying, antirheumatic drugs

DOT
direct observed treatment

DPE
Director of Physician Education

DPT
Director of Physician Training

dsDNA
double-stranded DNA

DVT
deep venous thrombosis

EBV
Epstein-Barr virus

ECG
electrocardiogram

ECOG
Eastern Cooperative Oncology Group

EF
ejection fraction

EIA
enzyme immunoassay

EMG
electromyogram

ENA
extractable nuclear antigen

EPG
electrophoretogram

EPS
electrophysiological studies

ES
educational supervisor

ESR
erythrocyte sedimentation rate

FAP
familial adenomatous polyposis

FBC
full blood count

FET
forced expiratory time

FEV1
forced expiratory volume in one second

FFP
fresh frozen plasma

FHH
familial hypocalciuric hypercalcaemia

FS
fractional shortening

FSH
facio-scapulo-humeral

FSH
follicle-stimulating hormone

FVC
forced vital capacity

G6PD
glucose-6-phosphate dehydrogenase

GGT
gamma-glutamyl transferase

GH
growth hormone

GI
glycaemic index

GM-CSF
granulocyte-macrophage colony stimulating factor

GORD
gastro-oesophageal reflux disease

GPI
glycosylphosphatidylinositol

GTHs
general teaching hospitals