It's sad that the clinical part of the MRCPath (Haematology) exam has all but departed. It enabled examiner and examinee to engage in an enjoyable competition of exposing each other's ignorance. It was perhaps unfair of us to put up a case with cerebellar secondaries, but, in truth, the signs were so gross that even a haematologist could spot them. The intention tremor as she undid the buttons on her cardigan fair shook the building. I asked the candidate what tests he knew for demonstrating cerebellar dysfunction. He volunteered Romberg and dysdiadokokinesis. One tip for examiners is always to ask what the candidate does not suggest, so I requested a demonstration of the finger nose test. At first he did this very well, getting the patient to follow his moving finger with increasing inaccuracy and overshoot.
“Anything else?” I asked.
“Would you close your eyes, please?” The patient complied. “Now, touch your nose and then my finger.”
But instead of keeping his finger in the same place he proceeded to make it wander in a wide arc in front of the patient’s face.
“And what precisely are you testing now?” I enquired. “Extrasensory perception?”
In the same year my co-examiner introduced a patient as “one of our colleagues”. He was, in fact a local GP with polycythemia.
“Would you examine the abdomen?” There was an easily palpable spleen to feel.
Now this candidate was behind on points, having already missed acanthosis nigricans while making a vain search for lymph nodes when asked to examine the axilla, and this time was determined to leave nothing out. She drew back the sheet and stood staring at the man’s belly for fully sixty seconds. Then, with a sudden lunge, like an eagle swooping on its prey, she leaned forwards, grabbed the GP’s testicles and squeezed. Hard.