This week Sam has Gastro SpR Dr Simone Lin on the podcast to tackle Dysphagia as it might be presented in a Clinical Consultation station! We go through the broad range of differential diagnoses and Sim gives her approach to appropriately investigating these patients!

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Dr Retesh Bajaj and Dr Bunny Saberwal, both interventional cardiologists, join Sam in discussing patients presenting with chest pain. This episode is jam-packed with learning points, not just for PACES but your clinical practice too!

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Dr Stewart Brown, Cardiology SpR and devices fellow joins Sam to discuss cardiac devices, how they appear on chest x-rays and how to structure your approach to managing these patients when they present on the medical take!

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Dr Dan Furmedge joins Sam again to discuss the most common PACES pitfalls he has observed in his years examining PACES! We talk through each marking domain and how to avoid the most common pitfalls that candidates fall into.

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Sam welcomes back returning guest Dr Suzy Morton, Consultant Haematologist to discuss this ever-popular PACES topic!

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Sam is joined by Dr Matt Wells, Rheumatology registrar, on the show this week to discuss Giant Cell Arteritis. This is a brilliant topic which we know comes up in PACES and Matt takes us through all the critical points to include in your station!

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Sam catches up with Megan, Varvara and Maria who all attended PACES Ahead in January 2024 and get their first hand opinion of how they found the course!

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Sam was joined for this episode by Dr Dan Furmedge, consultant in Geriatric medicine, regional IMT TPD and active PACES examiner. Dan runs Sam through the PACES approach to a patient presenting with cognitive impairment and what we can realistically expect from this sort of station in a PACES context.

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This episode is a REPOST from the fantastic Home of Medicine podcast, hosted by Dr Amie Burbridge. Amie has featured TWICE before on the podcast and so it only felt right that Sam returned the favour by featuring on Home of Medicine. Listen to Sam describe tackling an interesting case during a night shift on-call as the Medical SpR. Would you have done anything differently? Get in touch via the website or our twitter!

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Welcome to the second part of Sam's highlight of 2023! More of the best bits from the year gone by. We will be back to usual programming in the next couple of weeks! Enjoy the episode!

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Filling the stocking of your podcast feed this Christmas Eve is the Pre PACES Podcast Christmas Special! Have a listen to this year's bloopers in this bite-sized episode whilst driving home for Christmas!

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As 2023 winds it way to its merry end, we take the opportunity to look back at some of Sam's highlights from 2023! All of these are Sam's person highlights that provide YOU the listeners with the best bang for your buck. Hear all the best bits from the year gone by in this episode!

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Sam welcomes back Neurology SpR Dr Kim Monks as a follow up to her INO episode to discuss other eye movement palsies as they might be presented in PACES! We go into detail of cranial nerve 3, 4 and 6 palsies! Towards the end of the show, Kim tackles a Harry Potter related Reg Against The Machine!

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As we wind down towards Christmas, the tables are turned this episode as Dr Jennie Gough interviews Sam and the process behind producing the Pre PACES Podcast is brought to you the listeners! Who is your podcast host and what goes into producing the podcast - find out in this episode!

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Sam was DELIGHTED to be joined by Dr Amie Burbridge and Dr Ben Lovell, both consultants in Acute Medicine to discuss Same Day Emergency Care. How can medical trainees gain meaningful experience in SDEC and learn important skills to develop themselves in their quest to consultancy!

Home of Medicine podcast

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Dermatology registrar, Dr Naomi Jones, joins Sam to discuss everything dermatological related to PACES. Naomi is also our next guinea-pig on Reg Against the Machine!

DermnetNZ and BAD patient leaflets

Music:

Chase & Superepic by Alexander Nakarada | https://www.serpentsoundstudios.com Music promoted by https://www.free-stock-music.com Attribution 4.0 International (CC BY 4.0) https://creativecommons.org/licenses/by/4.0/

Cinematic Epic Motivational Music | FILM by Alex-Productions | https://www.youtube.com/channel/UCx0_M61F81Nfb-BRXE-SeVA

Music promoted by https://www.free-stock-music.com

Creative Commons Attribution 3.0 Unported License

https://creativecommons.org/licenses/by/3.0/deed.en_US

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Sam's going solo this week discussing his process for consenting patients for invasive procedures with three examples of lumbar puncture, chest drain and ascitic drain.

Lumber puncture sources:

https://www.hey.nhs.uk/patient-leaflet/lumbar-puncture/

https://www.wsh.nhs.uk/CMS-Documents/Patient-leaflets/Neurology/5561-1Lumberpunctureandconsent.pdf

https://www.nhs.uk/conditions/lumbar-puncture/

https://www.esht.nhs.uk/wp-content/uploads/2022/02/0957.pdf

Chest drain sources:

https://www.health.qld.gov.au/__data/assets/pdf_file/0016/150028/thoracics_04.pdf

https://policyonline.nhslothian.scot/wp-content/uploads/2023/03/Chest%20Drain%20Insertion%20Consent%20Form.pdf

https://www.jpaget.nhs.uk/media/279437/CT-5-Insertion-of-a-Chest-Drain-llt-v1-print.pdf

https://www.guysandstthomas.nhs.uk/health-information/chest-drain

Ascitic drain sources:

https://patientinfo.nhshighland.scot.nhs.uk/Liver/Abdominal%20Paracentesis%20%28drainage%20of%20ascites%29.pdf

https://hgs.uhb.nhs.uk/wp-content/uploads/Tapping-Ascites-guidelines-03.05.19.pdf

https://www.cddft.nhs.uk/media/659993/ascitic%20tap-drain.pdf

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Dr Sarah Verhemel, structural heart disease fellow at Erasmus Medical Centre in Rotterdam, joins Sam to discuss aortic regurgitation in PACES.

Music:

Chase & Superepic by Alexander Nakarada | https://www.serpentsoundstudios.com Music promoted by https://www.free-stock-music.com Attribution 4.0 International (CC BY 4.0) https://creativecommons.org/licenses/by/4.0/

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This episode's PACES classic topic is Systemic sclerosis, brought to you with a smile by Dr Sam Williams (as usual) and Dr John Pauling, consultant rheumatologist at North Bristol NHS Trust. This episode covers all the key elements of Systemic sclerosis as it might be presented in a PACES style scenario and is surely essential listening for your PACES preparation.

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Sam welcomes Dr Alex Carpenter, cardiology registrar with a specialist interest in electrophysiology to tackle the topic of palpitations. This is such a common topic with tons of clinical crossover and we discuss the common causes of palpitations, how they typically present and how you can tease this out in your history. We also talk through how to strategise the investigation of your patients and the various types of ambulatory ECG monitoring.

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In this second episode of Sam's chat with Dr Phil Berry, consultant hepatologist at Guy's & St Thomas's hospital in London, we cover the investigations, management, common examiner questions of chronic liver disease. Phil also tackles his all important Quiz the Consultant topic of STAR WARS - one NOT to be missed!

Music:

Chase & Superepic by Alexander Nakarada | https://www.serpentsoundstudios.com Music promoted by https://www.free-stock-music.com Attribution 4.0 International (CC BY 4.0) https://creativecommons.org/licenses/by/4.0/

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Dr Phil Berry, consultant hepatologist at Guy's & St Thomas's is Sam's next expert guest on the podcast to discuss another HUGE PACES station that comes up time and time again - chronic liver disease. This is absolutely essential for your PACES preparation. In this episode, Sam and Phil cover the examination of your patient, the presentation to the examiner and the differential diagnosis!

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The second part of Sam's chat with Dr Paul Sellors covers thrombectomy, hyperacute stroke theory and then ANOTHER up to date chat on the updated National Clinical Guideline for Stroke. We cover the important updates in the guidelines published in 2023 on thrombectomy, posterior strokes and wake-up strokes. Essential listening for anyone expected to cover the thrombolysis calls whether in-hours or out-of-hours!

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Sam sits down for a solo episode this week where he discusses absent ankle jerks and upgoing plantar reflexes before going into more detail on one of the differential diagnosis for this presentation: Friedreich's ataxia.

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We welcome another fantastic returning guest in the form of Dr Paul Sellors, consultant in stroke medicine at North Bristol Hospital NHS Trust. Sam and Paul discuss tricky cases in Stroke medicine including stroke mimics, the modified Rankin score, the NIHSS, thrombolysis and thrombectomy! Plenty to unpack in this episode so sit back and enjoy!

03:00 Basic stroke nomenclature and physiology

11:00 Thrombolysis and stroke assessment

22:20 Seizure activity and stroke

28:00 Contraindications to thrombolysis

38:00 Calling the Stroke Consultant

42:00 Digression: BP control in stroke

47:30 Digression: Glucose control in stroke

50:00 Wake-up strokes

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Dr Tom Minton, neurology registrar in the Severn deanery joins Sam again in this episode of the podcast to discuss Bell's palsy including the important differentials and the critical management steps to take.

09:00 Presentation

14:30 Examination

19:20 Differential diagnosis

27:45 Management

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Dr Alex Thompson, honorary consultant neurologist at Oxford University Hospitals NHS Trust, joins Sam for today's episode looking at motor neurone disease in PACES. We talk through the history, examination signs, differential diagnoses, investigations and management of this condition and Alex gives us an insight into his current research looking at treating this condition.

04:00 Basics of MND:

13:00 Presenting symptoms

21:30 Examination

27:15 DDx

36:35 Investigations

40:50 - Management

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Sam goes solo this week to perform a full review of the recent RCP Webinar with an update on the PACES 2023 format with some more information and Sam's opinion on some of this new information.

Link found here:

https://www.mrcpuk.org/PACES23Webinar

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Dr Sajini Wijetilleka, acute medical consultant with dual accreditation in endocrine and diabetes, joins Sam this episode to discuss Cushing's syndrome in a PACES setting. As always, we discuss the important symptoms, signs, investigations, management and common examiner questions.

See Sajini's fantastic Sri Lankan food Instagram page here!

Music:

Chase & Superepic by Alexander Nakarada | https://www.serpentsoundstudios.com Music promoted by https://www.free-stock-music.com Attribution 4.0 International (CC BY 4.0) https://creativecommons.org/licenses/by/4.0/

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This week Sam is joined by consultant neurologist at Southmead Hospital in Bristol, Dr Beth Mallam, who has a sub-specialist interest in functional neurology.

Sam & Beth talk through the difficulties in positively diagnosing this cohort of patients and importantly, some signs which will help you determine whether a seizure is a tonic-clonic seizure or a non-epileptic attack. The website Beth talks about is : https://neurosymptoms.org/en/

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We complete our discussion with Dr Arrianne Laws, looking at the investigations, management and common examiner questions of rheumatoid arthritis.

Listen to more of Arrianne on the Medical Take Podcast!

Music:

Chase & Superepic by Alexander Nakarada | https://www.serpentsoundstudios.com Music promoted by https://www.free-stock-music.com Attribution 4.0 International (CC BY 4.0) https://creativecommons.org/licenses/by/4.0/

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Consultant Rheumatologist and co-host of the Medical Take podcast, Dr Arrianne Laws, joins Sam on the podcast this week to discuss another PACES classic of rheumatoid arthritis.

Listen to more of Arrianne on the Medical Take Podcast! Click here!

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Dr Time Nye joins Sam on the show this week to discuss a PACES success story with a twist....how does an ACCS anaesthetics trainee, working in a small hospital, as the only person sitting PACES manage to achieve success in the exam? Find out by listening in to Tim's best advice in how he overcame multiple obstacles and achieved success in the MRCP PACES.

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Consultant in Intensive Care and Anaesthetics, Dr Andy Foo joins Sam on the podcast to discuss an essential topic for any budding Medical SpR on-call and that is escalating the sickest patients in the hospital to the highest levels of care. Andy gives a brilliant insight into his thought process as an ICU consultant and also his best advice to take on board when we escalate referrals as the Medical SpR on-call.

Music:

Chase & Superepic by Alexander Nakarada | https://www.serpentsoundstudios.com Music promoted by https://www.free-stock-music.com Attribution 4.0 International (CC BY 4.0) https://creativecommons.org/licenses/by/4.0/

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Welcome to the second part of Sam's conversation with Dr Luke Austen and Dr Josh Davies on supporting juniors. Herein Sam, Luke and Josh discuss giving and receiving feedback, hot debriefs and underperforming trainees.

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BEWARE OF THE BIG DOG. Sam was delighted to be joined this week by BIG DOG in the Royal College of Physicians and the first MBE to feature on the show: Dr Aranthakrishnan Raghuram, known affectionately as Raghu, Respiratory medicine consultant at Gloucester & Cheltenham hospitals. This is an absolutely critical station to get right and one of the most common to come up in PACES.

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In our second episode covering hemiparesis, Sam & Dr Paul Sellors, Consultant in Stroke Medicine at Southmead Hospital in Bristol, finish off the discussion on examining our patient as well as covering the pertinent investigations, management steps, presenting your patients and the all important examiner questions.

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Dr Paul Sellors, Consultant in Stroke medicine at North Bristol NHS Trust joins Sam to discuss the first steps in assessing a patient in PACES with hemiparesis!

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Sam was joined once again by fan favourite Dr Jennie Gough to outline the new information available on NEW PACES FORMAT coming in the third diet of 2023.

Sam is also joined by a very special mystery guest so listen out for that later in the show!

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Welcome to our best bits from 2022, with more brilliant learning points from some of the fantastic guests we had on the show during the second half of the year. We wish you all the very best for 2023 and hope you will stick around to listen for at least another year!

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It's the present that nobody needed, wanted, hoped or asked for - it's the Pre PACES Podcast Christmas Special! Featuring bloopers from some of the fantastic guests who have joined us on the show over the past 12 months! We are so grateful to all our wonderful listeners for continuing to help make the show what it is. From all of us here at the Pre PACES Podcast, a very Merry Christmas and a Happy New Year!

Music used from https://www.FesliyanStudios.com

Music by Grand_Project from Pixabay

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We look back through Sam's best bits from the first half of 2022. We are so grateful to all of you for your continued support for the podcast and don't forget to keep your eyes and ears peeled for a special Christmas treat coming down your chimney's on Christmas Day! We love you all for listening & hope you manage to take some time to rest and relax with friends, family and loved ones at this festive time of year.

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Sam welcomes along Dr Alice Hoole, A-cute Medical SpR in the Wales Deanery to discuss the highs and lows of handing over. This is something you'll have done as a junior doctor, but how is it different as a medical SpR? All is revealed in this episode!

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Sam was delighted to welcome back consultant gastroenterologist Dr Ajay Verma to the show! This episodes looks at the management of acutely unwell gastro patients which may require out-of-hours discussion with the Gastro consultant on call.We take a particularly close look at upper GI bleeds, what the on-call endoscopist needs to know and what your initial management should consist of!

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This week we cover probably one of the first episodes most likely to be seen in a History-taking station: Polycythaemia. Sam was joined by Consultant Haematologist Dr Suzy Morton, co-host of the fantastic Blooducation podcast series (link below).

BLOODUCATION with Dr Suzy Morton et al

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Sam sits down with anaesthetics CT3 and author Luke Austen, and IMT3 Joshua Davies to discuss how we can support our postgraduate or resident doctor colleagues when working as the medical registrar on call!

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Internal Medical Training applications are looming on the horizon. With this in mind Sam is joined by Dr Manuela Amaya (Manny) to run through the timeline of events around IMT applications and talk through the application self-assessment which is submitted with your application. Sam and Manny give their best advice on how to maximise your score for your IMT portfolio and how you can score as many points as possible to secure that all important interview. All information correct at the time of recording and, of course, is liable to change depending on events occurring out of our control. (Don't you just love medical training?)

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This week Sam was joined by consultant cardiologist at St George's Hospital in London, Dr Rajan Sharma. Rajan is a subspecialist in cardiac imaging including complex echocardiography and gave us a fantastic insight into mitral regurgitation in PACES. Rajan tackles 1980s music as his Quiz the Consultant topic!

Writing credit goes to Dr Alice Watson

Music:

Chase & Superepic by Alexander Nakarada | https://www.serpentsoundstudios.com Music promoted by https://www.free-stock-music.com Attribution 4.0 International (CC BY 4.0) https://creativecommons.org/licenses/by/4.0/

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We love our returning guests on the show and this week, Consultant Nephrologist Dr Revathi Whittaker-Jain joined Sam again to discuss polycystic kidney disease in PACES. This station 1 classic is covered in comprehensive detail and as always covers examination, investigations and management of this important station. We hope you enjoy it!

Timestamps:

Examination: 20:30

Presentation and DDx: 31:45

Investigations: 39:30

Management 44:20

Examiner Qs: 50:55

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Peeking behind the magician's cloth is only reserved for the wonderfully select audience of the Pre PACES podcast. In this episode Dr Ashley Nisbet gives us her experience as a PACES examiner including how the day normally plays out for PACES examiners. Ashley also gives her best advice on the common pitfalls for candidates that don't pass, and the features which are often found in really outstanding candidates!

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Hosted on Acast. See acast.com/privacy for more information.