PACES MRCP UK - Where MRCPians Meet Since 2006: Spot diagnosis: Cushing's syndrome

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.

Thursday, June 15, 2006

Spot diagnosis: Cushing's syndrome

Cushing's syndrome is another popular spot diagnoses in PACES. The candidate is usually asked to "Look at the patient's face".

There are 3 main steps in dealing with this case:

First, be able to recognise all the striking features of Cushing's syndrome.
** Typical moon-face with plethora, hirsutism and acne.
** Truncal obesity with interscapular and supraclavicular fad pads.
** Purple striae over the abdomen, around the shoulders and breasts and thighs.
** Thin skin and easy brusing commonly found over limbs
** Proximal myopathy (shoulders & hips) and spinal tenderness (osteoporosis)

Then, you must always look out for the possible underlying diagnosis as it is not enough for a PACES candidate to get the diagnosis of Cushing’s syndrome only in MRCP.

Lastly, please complete your examination by mentioning that you would like to measure the BP and test the urine for sugar.

Points to remember: The commonest cause is still iatrogenic i.e. secondary to steroid. So, please look for RA hands, gouty arthritis, nephrotic syndrome and etc.