LONG CASE

 

This exam is not about knowledge – its about patient management and there’s a lot of luck involved. You need to allocate you time correctly (35 mins max history, 15 examination, 10-15 management). Try and practice on some outpatients as they will be the patients in the exam primarily. Don’t be fooled into thinking that the patients in the exam will be fantastic historians, the organisers will only limited effort into hand-picking good patients. Last year there was even an encephalopathic patient as a long case, as well as a number of patients who didn’t know any details of their hospital admissions.

 

The big question everyone wants answered is how do I present the case?

 

Here is a format I have found particularly useful

 

“I examined Mr X, a 52 yr old mechanic from Wagga Wagga who presents with PCP pneumonia on the background of active problems of AIDS, kaposi’s sarcoma, accommodation issues and inactive problems of psoarisis and Sjorgens syndrome”.

 

Now detail the presenting complaint in detail. The move onto the underlying background condition be that HIV/ CRF/ RA – remember the examiners are human too and they don’t want a long chronological list of events but rather a summary usually with a general overview and a few highlights of the illness

 

The move through all the other medical issues, mentioning what medication they are on now for each one.

 

Then summarise the meds and allergies, before moving onto the social and family history.

 

In the examination, give a general opening statement, e.g. “On examination, Mr X was sitting comfortably in the bed, and was alert and co-operative” before describing each system in detail. Use of the phrase “unremarkable” is useful when there really is nothing to find. Learn how to do a quick neurological “screening” exam and practice it before the big day.

 

Then give a concluding statement which should be a synthesis of the underlying issues e.g. “In conclusion Mr X is currently recovering from PCP but faces on going medical issues related to his Kaposis sarcoma and a diffcult social situation in the short term”.

 

You will usually be stopped but if you are not go onto list the acute and chronic issues you would like to manage and prepare a list of management points for each.

 

Another big question is what books do I need? If you don’t know the basics get Talley and O’Connors “Clinical Examination”, otherwise the obvious is Talley and O’Conners “Examination Medicine” but I also found Rohan Jayasinghe’s book “An aid to The Medical Long case” useful reading towards the end for practice.