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.

Sunday, February 12, 2006

"Possibilities for Abdomen"

You must try to score clear pass for abdomen station. It's a gift because there are only 3 main diagnoses that you need to consider i.e. liver problems, kidney problems or hematological problems.

The abdomen case that I had in UK was a case of kidney transplant. The theme for that case was the patient complaint of lethargy for 2/52. Clinically, she was not Cushingoid. She was pale and there was no AVF. Abdomen examination showed multiple abdominal scars and one of them was a RIF surgical scar. There was a mass under the RIF scar. There was no fistula noted over the abdomen.
I was confused by the multiple abdominal scars and the history of lethargy. I concluded that the possible diagnosis would include Crohn's ds or kidney transplant. The examiner challeged me and asked which one was the most possible diagnosis. I chose the wrong one.
Retrospectively, I missed an ulcer over the right foot. At the end of the exam, I met the lady and she told me she was a case of ESRF secondary to diabetic nephropathy with kidney transplant done 6 years ago. She was not Cushingoid because she was only on low dose of steroid. The abdominal scars were due to previous CAPD and she was not on HD before.

This case taught me to think simple for abdomen case. Just focus on the three main diagnoses and look for the signs that support or eliminate each one of them. It is very unlikely to be a case of Crohn's ds because they are too ill to appear in PACES!



At 8/09/2007 05:27:00 AM, Anonymous Anonymous said...

i am sorry but there are too many abbreviations in this post that i couldnt understand much! would u please rewrite the post removing abbreviations and writing the actual words so i may read it again, i couldnt make sense of it.

thank u


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