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, May 31, 2007

EYES ARE THE WINDOW TO THE SOUL

This gentleman presented with giddiness. Please look and proceed



I would like to complete my Ex by checking the fundus for papilloedema or optic atrophy, corneal reflex and the gag reflex. I would also like to Ex the UL and LL for pyramidal signs and finally measuring the BP.

This gentleman has Left Internuclear Opthalmoplegia where by the Left eye is unable to adduct and the right eye has nystagmus with the fast phase towards the right side upon looking to the right. The rest of the cranial nerves are intact.

I would like to consider causes such as stroke or demyelinating disease.

Examiner : What are the other causes of INO?
Pan : Tumour, Drugs such as phenytoin and carbamazapine

Examiner : Where is the lesion?
Pan : Left Medial Longitudinal Fasiculus (connecting 3rd nerve nucleus to
the opposite 6th nerve nucleus) at the brain stem

Examiner : How would you like to investigate this pt?
Pan : I would like to request for a MRI of the brain.

MRI came back as small left pontine infarct

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3 Comments:

At 11/18/2007 07:19:00 AM, Blogger Alex said...

Don't forget the most common cause - multiple sclerosis.

 
At 9/18/2008 06:59:00 PM, Anonymous Anonymous said...

hi guys
how often does INO crop in the exam? actually its is qutie difficult!

 
At 9/18/2008 10:11:00 PM, Blogger Axonopathic said...

Honestly, we don't know. But i suspect it would be quite a 'favourite' case to come out, if the exam centre happens to have an INO as a regular :)

 

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