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.

Friday, March 17, 2006

"When Michael J Fox meet Muhammad Ali"

What will happen when actor Michael J. Fox meet the former heavyweight boxing champion Muhammad Ali?
Answer: Both men with Parkinson's disease are discussing about raising funds for research and increasing awareness about this degenerative nerve condition.
Parkinson's disease is common in our daily practice as a physician. In fact, it is the main focus of a short case in 3% of attempts at PACES station 3, CNS.
The common PACES scenario would be:
  1. Talk to the patient and proceed - monotonous speech
  2. This patient has unsteady gait. Please examine.- festinant, shuffling gait

By one look, you will notice the patient has expressionless, unblinking face. Then, look for hand tremor. Take a pillow and REST the elbow on the pillow to demonstrate resting tremor. Proceed by checking the presence of rigidity and bradykinesia. Once you demonstrated the 3 signs of Parkisonism, don't stop at this stage. As a physician, you need to assess the possibility of Parkinson's plus syndromes.

  • Olivopontocerebellar degeneneration: check for cerebellar signs
  • Steele-Richardson-Olszewski disease: check for gaze palsy and pyramidal signs
  • Progressive autonomic failure(Shy-Drager syndrome): check for postural hypotension



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