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.
Neurology is a much-feared station for many PACES candidates but it is also one of the most passed stations (maybe because candidates are so worried about it they revise it thoroughly).
It can be unnerving and unclear where to start revision as there are so many conditions, but one useful tip is to break down your revision of neurological conditions into the terms of their origin.
- cranial nerve;
- upper limb;
- lower limb;
Not only does this instantly make your neurological revision more manageable but can help you to work out how to examine your patient in the exam. You will never get the whole neurological system as an examination, because it is impossible to do it properly in the time allotted. You will get part of the system, for example upper limb, and even then there is not enough time to examine both motor and sensory function. It is most likely that you will need to examine motor function but do not neglect the sensory system it is something we rarely do properly in everyday practice outside of the neurological field, but one you should definitely re-learn for PACES.
A potential scenario for the neurology station is ‘examine the hand and then go on from there…’ This is typical for the systemic neurological disorders, and there are only a few that fit this area (such as Parkinson’s disease and cerebellar pathologies). So, for example in Parkinson’s, the resting pill-rolling tremor should tell you all you need to know about what to examine.
Common conditions that occur in the lower limbs include peripheral neuropathy, hereditary motor and sensory neuropathy and an abnormal gait.
Cerebellar pathology usually comes up commonly as cerebellar syndrome, and so you should know all the potential causes.
Systemic conditions include myotonic dystrophy, Parkinson’s disease, hemiplegia, multiple sclerosis and muscular dystrophy.
The main advice for revising and taking the neurological station is break it down into manageable pieces, don’t try and cover everything in the exam (there isn’t time) but do what you need to get the correct diagnosis