Pre PACES podcast

Doctors outside formal internal medicine training can demonstrate equivalent competence through an alternative certificate. Requirements include relevant post-foundation experience, an eligible certifying consultant, structured workplace assessments and organised portfolio evidence, including patient logs and completed audit cycles.

Chronic liver disease can produce portal hypertension and ascites without jaundice or encephalopathy. Examination establishes the clinical syndrome rather than its cause, while the serum–ascites albumin gradient and further investigations help identify complications and guide management.

AI can support repeated spoken histories and examination rehearsal, but convincing simulation does not equal complete assessment; de-skilling, never-skilling and mis-skilling remain risks, and communication skills and physical examination still require practice with patients or colleagues.

Vertigo assessment should use onset, duration, symptom-free intervals, hearing changes and vascular clues to separate peripheral from central causes, while recognising that a normal CT cannot exclude a small cerebellar stroke when clinical concern persists.

Sudden speech disturbance should be separated into impaired articulation, voice production, language or attention. Listening from the first greeting and then testing naming, staged comprehension, repetition, reading and writing helps distinguish dysarthria, dysphonia, dysphasia and delirium.

Symmetry, distribution and the dominant neurological deficit should be described before assigning a cause. A typical distal sensory-predominant diabetic pattern directs foot assessment and focused investigation, while rapid progression, asymmetry or motor involvement warrants further testing.

Respiratory, acute medicine and infectious-diseases learners get a practical review of chronic productive cough, coarse crackles and recurrent exacerbations. HRCT, sputum microbiology, investigation of the underlying cause, airway-clearance techniques and targeted antibiotics form the core assessment and management pathway.

Neurology, geriatric medicine and examination-focused learners get a structured assessment of bradykinesia, rigidity, tremor and gait change. The episode distinguishes parkinsonism from idiopathic Parkinson’s disease and reviews Parkinson-plus syndromes, vascular and drug-induced causes, targeted investigations and early multidisciplinary support.

Medical education and human-factors readers get a PACES communication-skills update. The episode focuses on open questions, patient-centred agenda setting, clear signposting, plain-language explanation, empathy, structured closure and concise examiner presentations without over-rehearsed or insincere stock phrases.

A clinical-reasoning item for exertional breathlessness when respiratory treatment has not helped. It uses angina, heart failure, valvular disease, arrhythmia, mechanical-valve complications and congenital shunts to guide focused cardiovascular history, examination and selected investigations.