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, May 03, 2006

Dystrophia Myotonica

I joined the neurology PACES course in TTSH in Singapore last year. One of the consultant told me that they like to show up "clinic cases" in PACES exam. One of their favourites is dystrophia myotonica that is uncommon in general practice . Remember this face for PACES!

The key features are bilateral ptosis with marked wasting of temporalis, facial muscles, sternomastoids. (no frontal balding in female)

There are features of myotonia i.e. when she shake hands there is a delay before she release her grip. Percussion myotonia is also demonstrable after tapping on the thenar eminence. Always warn them that the hit would be painful! The alternative site would be over the extensor digitorum.

Hit HARD over the thenar eminence!

This results in prolonged contraction of flexor pollicis brevis

Look for pacemaker in dystrophia myotonica patient because they are at risk for dysrythmias 2nd to cardiomyopathy. Practically, we do yearly ECG for screening purposes during follow up.

Remember the pacemaker!



At 3/08/2010 05:30:00 PM, Anonymous amar salah said...

it is not enough to impress the examiners by saying it is dystrophia you have to show them the signs by asking the patient to clinch his teeth , to close his eyes tightly and to make agrip with quick release . gyenecomastia , DM and cardiomypathy are known asocciations . FH of similar conditions and side effects of phenytoin .


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