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, May 22, 2007

A Neck Scar In Abdomen Station

Parathyroidectomy scar is smaller than thyroidectomy scar.
It is located higher than post-tracheostomy scar (sternal notch).

Here is a post by Experience in PACES forum.

"Abdomen station: Examiner introduced a middle aged thin lady having tiredness and SOBE."

I introduced myself, positioned and stood at the foot side. She had sallow complexion, a midline / right iliac fossa and right lumber scar on the abdomen. Examination of hands was unremarkable. On left arm there was a AV fistula with palpable vibrations/hum. Above this was a small scar. She had pale conjunctiva. A transverse about 3cm scar on the thyroid. On abdominal palpation there was palpable and ballotable mass 15cm x 6cm with irregular surface in left lumber region. No other masses were palpable in the abdomen and there was no venous hum on auscultation. No sacral or pedal oedema and there were no lymph nodes anywhere. I expected a transplant in LIF scar but there was none.

Examiner asked what is the diagnosis after I presented the case. I said 'These findings are suggestive of APKD and patient has right nephrectomy. She has ESRF and is on renal replacement therapy'

Only then, examiner reminded me of thyroid scar and asked is it related to her present condition. I was stressed since the scar was much smaller than usual thyroidectomy scar. Then I suddenly realised that this patient had 'parathyroidectomy' and a small scar on the left arm was due to one of the parathyroid transplant in the arm.

Take home messages:
1. Neck scar in abdomen station = suspected parathyroidectomy scar

2. Be prepared to recognise the reasons behind the scars in abdomen station



At 7/10/2007 11:00:00 PM, Anonymous Anonymous said...

well done david. thanks


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