I don’t think this is a particularly useful venue for clinical preparation. Most of the work is practising bedside short cases, the occasional long case, and the highest yield is in presenting these cases to FACEMs with an interest.

My advice would be to make a checklist of short case examination points (there are a few floating around) and practise, practise, practise with each other, patients, your significant other, children or dog. The long case is similar but with a broader checklist – remember social history, impact on patient/family.

Remember not to forget important emergency differentials such as polio and scleroderma. While these may seem ridiculous for an ED short case, think what the examiners must do:

• find a large number of short cases who meet the following criteria
• willing
• available / can travel
• have relatively stable clinical signs
• are well enough to last the day
• can adequately co-operate with the exam

If you have ever looked for cases for colleagues, you will find that they are not all that common. The approach is not so unlike the VAQs where you are expected to identify salient abnormalities, identify relevant positives and negatives, and propose a likely diagnosis and differential.

Things that are commonly found are therefore similar to what is in the physicians’ exams but possibly broader (we see more diseases!). Think CVA, Bell’s palsy, hypertensive or diabetic retinopathy, B/CRAO or B/CRVO, cerebellar dysfunction, Wernicke’s unlikely (consent issues for exam but I’m not sure if being in a teaching hospital trumps this), opthalmoplegias, peripheral neuropathy, proximal myopathy, VP shunt, hydrocephalus (less likely unless just admitted with shunt dysfunction), thyroid lump (and eye changes), neck lump, Horner’s, myaesthenia, all adult and child murmurs, heart failure, COPD, asthma, bronchiectasis, pneumonia (less likely, signs often very transient), pleural effusion, pericardial effusion, lobectomy, Parkinson’s, spinal cord lesions including spina bifida, pressure ulcers, vascular ulcers, abdominal organomegaly / tumour, lymphadenopathy, rheumatoid, SLE, OA, psoriasis/arthropathy, melanoma, ascites, ALD, pancreatitis complications (pseudocyst, post Whipple’s), PKCD, transplanted kidney, CKD with PD / HD, heart or lung transplant, hernia, oedema states, PVD, endocarditis, post-polio changes, scleroderma (including linear), CREST, facies: hypothyroid, hyperthyroid, Down’s, Cushingoid; Marfan’s, wrist drop, foot drop, peripheral neuropathies, dextrocardia / situs inversus, myotonic dystrophy, pacemakers, insulin pumps, indwelling catheters (stomach, venous, bladder), hemihypertrophy, diseases of prematurity, stomas (bowel, bladder, gallbladder), burns, external fixation (halo, frame), post fasciotomy, scoliosis, AAA, craniectomy, knee ligaments, Charcot joint, recurrent haemoarthrosis deformity, petechial / purpuric rash and causes for adult / child, exopthalmos. Less likely but possible: breast lump / post mastectomy.

Things they can’t / shouldn’t do: rectal / vaginal / genital examination, shingles/chickenpox, scarlet fever, pulmonary TB, chemotherapy.

None of the above should be very difficult! If there is anything there that you couldn’t identify the condition, examination findings (relevant + and – ), cause, complications, differential for, then learn it.

Lists requiring some memorisation and a sensible approach:

• murmurs (adult and congenital HD)
• causes of
• AF
• pleural effusion
• pericardial effusion
• ascites
• oedema
• splenomegaly
• hepatomegaly
• renomegaly
• lymphadenopathy
• clubbing
• petechial / purpuric rash
• joint deformity
• skin signs / changes
• EOM disorders
• Brainstem rules of four
• spinal cord syndromes
• condition, cause, complications for
• CVA
• peripheral neuropathy  / mononeuropathy
• Rheumatic heart disease
• SLE
• RA
• collagen vascular / hypermobility
• Diabetes
• CKD
• immunosuppression
• COPD
• Horner’s
• acute monoarthritis
• endocarditis
• all murmurs
• ascites
• oedema
• heart failure