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, August 02, 2006

Peripheral Neuropathy

Here is an Indian gentleman who complaints of feeling shaky on walking for the past 3 years. The onset is insidious and his condition gradually worsen for the period mentioned.



There is trophic changes noted over the lower limbs i.e. the skin is shinny, smooth and loss of hair. There is hyperpigmented skin lesions suggestive of diabetic dermopathy. There is no muscle wasting and the power is normal.
There is impairment of sensation to vibration sense, joint position and pinprick over a stocking distribution ( from foot up to knee level). The reflexes are absent.

There is sensory ataxia as evidenced by positive Romberg's sign and stamping gait (broad based gait, foot stamping on the floor)

In conclusion, he has a peripheral neuropathy predominantly involving the sensory component. Functionally, he has sensory ataxia due to impaired joint position sense. The likely cause would be diabetes mellitus in view of the diabetic dermopathy.

I would like to complete my examination by:
1. Checking the upper limbs (sensory loss over a glove distribution)
2. Palpating the peripheral pulses (peripheral arterial disease due to the trophic skin changes)
3. Examine the fundus for diabetic retinopathy.
4. Checking the urine for sugar.


What are the other causes for sensory peripheral neuropathy?

related posts...

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7 Comments:

At 8/05/2006 12:53:00 AM, Blogger saramin said...

A nice article, though:
1-the shin is prominant suggesting wasting of the anterolateral compartment, yet the "candidate" told us that therte is no wasting!.
2- nothing was mantioned about any trophic ulcers, or Charcot's joint(s),as the pictures is one of a severe sensory loss in both lower limbs for 3 years.
3- i would add "doing fundoscopy".
4- this was written:"In conclusion, he has a peripheral neuropathy predominantly involving the sensory component". the examiner may understand that this is a sensori-motor one with a predomiant sensory component; yet, the "candidate" told us that there are no wasting or weakness!
5- which reflexes were absent? (ankles, kness,cremasteric...etc!) besides, where was no comment about the planters!
Thank you eMRCPian for your kind work, and please continue.
Dr. O Amin
Neurologist

 
At 8/05/2006 01:05:00 AM, Blogger saramin said...

A nice article, though:
1-the shin is prominant suggesting wasting of the anterolateral compartment, yet the "candidate" told us that therte is no wasting!.
2- nothing was mantioned about any trophic ulcers, or Charcot's joint(s),as the pictures is one of a severe sensory loss in both lower limbs for 3 years.
3- i would add "doing fundoscopy".
4- this was written:"In conclusion, he has a peripheral neuropathy predominantly involving the sensory component". the examiner may understand that this is a sensori-motor one with a predomiant sensory component; yet, the "candidate" told us that there are no wasting or weakness!
5- which reflexes were absent? (ankles, kness,cremasteric...etc!) besides, where was no comment about the planters!
Thank you eMRCPian for your kind work, and please continue.
Dr. O Amin
Neurologist

 
At 8/05/2006 01:03:00 PM, Blogger eMRCPian said...

Thx for your comments. Ya, a fundoscopy is mandatory in this case!

 
At 8/06/2006 09:31:00 PM, Blogger Raymond Hee said...

Noticed u hv Wuchereria Bancrofti as one of your interests,u do tropical med-one of my interest hehe

 
At 8/06/2006 09:50:00 PM, Blogger eMRCPian said...

Nope...I practice western medicine :)

 
At 8/07/2006 10:34:00 PM, Blogger Raymond Hee said...

I didnt know Wuchereria Bancroft is a traditional med :)

 
At 11/08/2008 03:47:00 AM, Anonymous drrizvanahmed said...

I agree with saramin,there appears to be wasting of muscles more onleft than right and i thinkthere is pescavus. wecanthink of charcot marie tooth disesae inthis case.

 

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