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.

Monday, May 01, 2006

Ptosis for PACES (2)

Axonopathic, thank you for your comment. Ptosis with normal pupils is worth for a special discussion. What is the differential diagnosis? The clue starts from the moment you shake the patient's hand!

1. Myotonic dystrophy
* Bilateral ptosis
* Myotonia with hatchet look
* Wasting of temporalis, facial muscles, masseter, sternomastoids

Myopathic facies

2. Myasthenia gravis
* Unilateral/bilateral ptosis
* Fatiguibility
* Variable strabismus/diplopia
* Bulbar symtoms (though not all)

MG patient in respiratory distress

3. Facioscapulohumeral dystrophy
* Bilateral ptosis
* Wasting of facial muscles,sternomastoids and limb-girdle muscles.
* Winging of scapula
* Foot drop - classical case has weakness of anterior tibialis

Foot drop

4. Chronic Progressive External Ophthalmoplegia(Kearns-Sayre Syndrome)
* Bilateral ptosis
* Symmetric ophthalmoplegia
* Look for retinitis pigmentosa

Bilateral ptosis with severely decreased motility in all directions of gaze

5. Oculopharyngeal muscular dystrophy
*Scenario may suggest history of dysphagia
*Extraocular weakness
*Distal limb weakness



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