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, September 14, 2006

Wallenberg's Syndrome


This Malay gentleman presented with 2 days history of dizziness. He cannot walk steadily without assistance.

Examination of the LL shows hemisensory loss up to neck region over RIGHT side. The muscle power is preserved. The propioception is intact. He is ataxic and there is tendency to fall to LEFT side. The heel shin test is impaired over LEFT side.

Further examination shows LEFT facial numbness with intact corneal reflex. There is signs consistent with LEFT Horner's syndrome i.e. partial ptosis and constricted pupil. The 9th and 10th CNs are intact. The eye movement is normal and there is no diplopia.

He has a LEFT lateral medullary syndrome.

Questions:
1. Where is the lesion?

2. What are the other clinical features?

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3 Comments:

At 5/08/2007 01:33:00 AM, Blogger sadik108 said...

why X & IX has spared

 
At 5/08/2007 04:15:00 PM, Blogger Axonopathic said...

Hi sadik,

Not all patients will exhibit the full textbook description of a particular clinical syndrome. In fact, in daily clinical practice, most will present only with a part of the clinical signs listed.

 
At 6/06/2007 11:15:00 PM, Blogger Dr. David Teoh (eMRCPian) said...

Ya, it is called PICA-like syndrome.

 

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