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, March 13, 2007

Ptosis Revisited

eMRCPian has done a great job describing ptosis in the April posting. I'm trying my best to further describe all the important causes of ptosis.

En. Ramli, 30 year old gentleman was told by his friends that he has abnormal eyes. Please examine the eyes.

What’s the Dx?
*An unequal bilateral ptosis could be easily mistaken to be a unilateral ptosis.


Dystrophia myotonica look ( suspect during hand shake)
Eye looking downward and outward

Look at the pupils

-dilated in surgical 3rd nerve palsy
i. isolated: PCOM aneurysm( check hemiplegia, cerebellar, extrapyramidal signs)
ii. III, IV, V1, VI CN–superior orbital fissure synd( II involved)/cavernous sinus thrombosis

-constricted in Horner's syndrome (common: Pancoast tu, LMS)
i. V, IX, X ( LMS)
ii. Neck ( inspect for scars, thyroid; palpate for LN; auscultate for carotid aneurysm
iii. Percuss Upper zone- Pancoast
iv. UL - small muscle wasting, pronator drift ( MS, syringomyelia)

-normal size pupil in MG, CPEO, dystrophy myotonica, Miller Fisher, medical 3rd nerve( DM, H/T, vasculitis)
i. Eyes
1. Fatigability- upward gaze
2. VARIABLE Strabismus and diplopia in MG( no particular CN opthalmoplegia).
Medical 3rd nerve palsy?

ii. Face
1. V CN
3. Bulbar ( count 1-50)

iii. Muscle
1. Neck Flexion
2. Proximal myopathy
3. Reflex ( ELS, Miller Fisher)

Look for
1) Treatment given: median sternotomy , subclavian line
2) Complication: tracheostomy, gastrostomy
3) Fundus ( CPEO)
4) Ass A/I dis

Ix for MG:
FVC, Edrophonium test, Anti Acetylcholine receptor Ab, EMG, CXR, CT mediastinum

Long acting cholinesterase inhibitor



At 4/14/2007 05:57:00 PM, Blogger gunn.clarke said...


We don't call them 'physicians' for nothing.


At 4/23/2007 05:37:00 AM, Blogger rizwan said...

very nice presentation


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