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.


Sunday, August 06, 2006

Tunnel for PACES?!



Where is the tunnel for PACES? Of course, it is not along the PLUS highway in Malaysia!


Here is a lady who came for nerve conduction study. She experience Right hand numbness that disturb her sleep.

Compare the thenar eminence of the Right hand with that of the Left hand and note that it is not as prominent on the Left. It is wasted. This is the result of median nerve entrapment at the flexor retinaculum, leading to carpal tunnel syndrome.

There is weakness of flexion, abduction and opposition of the Right thumb. The sensation also reduced over the lateral three and half fingers.

Then, proceed to elicit Tinel's sign which is positive in this case.



A positive Tinel’s sign for suspected carpal tunnel syndrome results in distribution of paresthesias (shaded area).

1. What is Phalen's maneuver?
2. What is the causes for carpal tunnel syndrome?

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3 Comments:

At 8/07/2006 01:41:00 AM, Blogger saramin said...

Thank you eMRCPian.
1- Phalen's: reproduction of symptoms upon wrist flexion (usually maintained for 1 minutes).
2- Causes: The commonest is idiopathic, with congenitally small C.T. with a familial susceptibility. The list of causes is long like RA, previous wrist fracture, amyloid, acromegaly, pregnancy and ocp...etc, so we should look at these during examination.
3- I would add:
A-CTS is a clinical diagnosis, and a normal NCS does dot rule out it.
B-hypothenar wasting is a late sign.
Thank you
Dr. O Amin
Neurologist

 
At 8/07/2006 10:16:00 AM, Blogger eMRCPian said...

Dr. O Amin, thank you for your kind comments.

 
At 11/08/2008 03:40:00 AM, Anonymous drrizvanahmed said...

IN paces ,if you find that pt has CTS thenu should try tofind out the cause - look for signs of RA,hypothyroidism, Acromegaly , A-V fistula to suggest if pt is on dialysis.

 

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