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, April 30, 2006

Ptosis for PACES

Ptosis is often missed by PACES candidates. The sign is subtle especially if it is a partial ptosis. In PACES, ptosis carries a lot of weight in reaching the correct diagnosis in neurology station.
The common scenario would be: Please examine the patient's eyes.

1. Look at the level of the eyelid, look for asymmetry
  • Unilateral/bilateral
  • Partial/complete

2. Then, proceed to check the pupil, look for anisocoria (unequal pupil)

  • dilated in 3rd nerve palsy
  • constricted in Horner's syndrome
  • normal size pupil in MG, CPEO, dystrophy myotonica

3. Look for eye position, any strabismus

  • looking downward and outward in 3rd nerve palsy
  • variable strabismus in MG


Right 3CN palsy

Left Horner's syndrome

Myasthenia Gravis with bilateral partial ptosis


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2 Comments:

At 5/01/2006 01:37:00 AM, Blogger Axonopathic said...

Thanks eMRCPian for the ptosis tips. Just want to share. I had a short case earlier on:

50y/o lady, bilateral partial ptosis, normal pupils and normal EOM, wasting of the temporalis and frontal balding. But couldn't elicit myotonia clinically.

I thought of dystrophia myotonica straightaway. Differential being MG but less likely.

Verdict:
Fascioscapulohumeral Muscular Dystrophy

Tips: Must check upper limbs and lower limbs and look particularly for winging of scapula

 
At 5/02/2006 12:26:00 AM, Blogger eMRCPian said...

more discussion in Ptosis (2)

 

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