PACES MRCP UK - Where MRCPians Meet Since 2006

MRCP is well establised as an entry exam for advanced specialist training in many countries including Malaysia. It consists of 3 paper i.e. Part1, Part2(written tests) and PACES. PACES in full means Practical Assessment of Clinical Examination Skills. It is the third part and the candidate is assessed by fellows of RCP. I passed my PACES in 2005. I am glad that many seniors had guided me throughout my preparation for PACES and I wish to share my experiences with PACES candidates via this blog.

Wednesday, August 27, 2008

Frank's sign

Spotted this recent post by Wuchereria in his new blog. I learnt a new sign - Frank's sign. He highlighted that this is a great sign to impress the examiner!

"I just got back from Hong Kong recently for a holiday.During a morning of breakfast, while I looked around I noticed this man who was sitting eating 'Tim Sum' and I am sure he has coronary artery disease.
There was obvious Frank's sign.

Frank's sign is a diagonal crease in the lobule of the auricle :
Grade 3 - a deep cleft across the whole earlobe
Grade 2a - crease more than halfway across the lobe
Grade 2b - crease across the lobe, but superficial
Grade 1 - lesser degree of wrinkling

Ear lobe creases are associated statistically with coronary artery disease in most of the population groups."


Wednesday, July 30, 2008

Optic atrophy

Look for:

  • in young patient, mention you like to examine the eyes for internuclear ophthalmoplegia and cerebellar sign for multiple sclerosis
  • Signs of Cushing's syndrome in SLE pts on steroid
  • in old patient, look for evidence of vascular diseases such as prominent temporal artery (or old scar indicating temporal artery biopsy) and carotid bruit

  • (or endarterectomy scar)


If congenital, it is usually hereditary with an onset of deterioration in childhood and may be accompanied by nystagmus. Leber's Hereditary Optic Neuropathy, (LHON) or Leber Optic Atrophy is hereditary, but typically has its onset in 20-30 year old males. This is due to a mutation of the mitochondrial genome and hence is passed exclusively through the mothers. Dominant optic atrophy or Kjer's optic neuropathy has autosomal dominant inheritance. It usually presents in early childhood. There are numerous less common genetically related syndromes.[2]

Alternatively, congenital optic atrophy can be caused by a lack of oxygen during pregnancy, labour or in the early days of a child's life. Some drugs taken during pregnancy are also associated with optic atrophy.


The acquired type of optic atrophy may be due to blood supply changes in the eye or optic nerve (anterior ischemic optic neuropathy or posterior ischemic optic neuropathy), may be secondary to inflammation or swelling within the optic nerve (optic neuritis), may be a result of pressure against the optic nerve (such as from a tumour), or may be related to metabolic diseases (e.g., diabetes mellitus), trauma, glaucoma, or toxicity (caused by methanol, tobacco, or other poisons). It is also seen in vitamin B12 deficiency and Paget's disease of the bone.


Saturday, July 26, 2008

Googling to save lives?

In a clinical case discussion published on New England Journal of Medicine (July 3, 2008), medical experts opined that "Internet search engines, such as Google, are proving to be an invaluable diagnostic tool", given the rapidly growing body of medical knowledge.

An internet-based study revealed that Google searches may arrive at the correct diagnosis in ~58% of cases. Will this mean physicians may no longer be needed in the future?

Also available at


Tuesday, July 15, 2008

2nd MRCP PACES Preparatory Course

The 2nd MRCP PACES Preparatory Course is finally in place. The organiser, wuchereria would like to take this opportunity to welcome participation from all.

Click here to download the course brochure (great design by wuchereria :) & the registration form.

The link will also be mirrored here.

If sending by mail, please address it to:

C/O Professor Richard Loh/ Dr TT Lim
2nd MRCP PACES Preparatory Course
Penang Medical College
No 4 Sepoy Lines,
10450 Penang


Monday, June 02, 2008

Upcoming 2nd MRCP PACES Preparatory Course

I am pleased to say that recently there has been ample of emails and personal calling-ins to enquire for the 2nd MRCP PACES preparatory course.

The 1st MRCP PACES Preparatory Course which was held September last year had been a really fruitful one, with candidates passing rate of approaching 60%! Our heart-felt thanks to all the great teachers in our midst.

Unfortunately, I'd most probably be away in the next few months, hence wouldn't be able to host this course again this year. Our associate author, Wuchereria, will tentatively be planning for one.

We'll keep you all informed about the progress. Thanks again for the support!


PS: The comic is just a joke to cheer you all up :)