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.

Tuesday, May 23, 2006

Rheumatoid Arthritis

1. Inspection

*Symmetrical deforming arthropathy
*Involving MCP/PIP joints
*Sparing DIP joints
*Swan neck
*Boutonniere’s deformity
*Z deformity of the thumb
*Ulnar deviation

*Wasting of small muscles of hands

*Palmar Erythema

*Vasculitic nail changes

2. Palpation

*Warmth, redness, tenderness (active ??)
*Bony swellings (suggest subluxation)
*Synovial swellings

3. Percussion

*Carpal tunnel syndrome (Tinel sign)

4. Movement

*Flex/extend wrist

*Check ulnar/median nerve (abduct thumb, abduct fingers)

5. Functions

*Unbutton shirt
*Key holding

6. Check for Rh nodules

7. End examination

*Eyes – scleromalacia, scleritis, Sjogren’s, keratoconjunctivitis sicca
*Lungs – pulm. Fibrosis, nodules
*Hepatosplenomegaly – amyloidosis, Felty
*Leg – Pyoderma gangrenosum
*Cervical – atlantoaxial dislocation

My diagnosis is Rheumatoid arthritis with limited hand function and the disease is currently not active

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