Each station in the PACES has cases that occur more commonly than others. This is due to a number of factors that include the number of patients with the conditions, being able to elicit decent clinical signs and create a ‘story’ out of very little history or background information.
In the abdominal station there is a finite number of conditions that can come up. The abdominal station is primarily a tactile station with lots of visual clues. So make sure you look at everything. Take your time and inspect thoroughly. Remember to pull up the sleeves or you will miss the all important fistula.
A tip I was given when doing any station that works particularly well for the abdominal station is to trace the line of the scar with your finger. Then if you forget to mention the scar when you give your presentation, at least during the examination you have shown the examiners that you spotted it.
By far the most common case for this station which you should learn off-by-heart (and maybe do a mental dance if you get it in the exam – but not an actual dance in the exam) is the transplanted kidney. An old fistula (may still be humming – does so over a year after it has been stopped being used) in a Cushingoid individual with a lump in their right or left iliac fossa is the most wonderful patient. The entire case is there for the taking, and you should not fail the station. Remember, PACES is about finding the story that fits all of the clinical signs.
Other common conditions though do appear such as polycystic kidney disease (so do not forget to ballot the kidneys), isolated hepatomegaly or splenomegaly and chronic liver disease. Also, the duo of hepatosplenomegaly commonly appears.
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