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.

Monday, June 25, 2007

IE Update

This gentleman presents with fever for 3/52. Please Ex his cardiovascular system

I would like to complete my Ex by checking
1) fundus – Roth spot
2) Dipstick the urine for hematuria
3) Temperature chart
4) Abd- spleenomegaly

This gentleman looks thin and he has a brannula at his right wrist. He has stigmata of IE as evidenced by presence of Osler nodes and Janeway lesion. There is no finger clubbing or splinter haemorrhage. There are also IV puncture marks over the cubital fossa.
PR is 90 bpm regularly regular. There is no radial-radial delay and the pulse is not collapsing.
He is pink and not jaundice.
Jugular venous pressure is not elevated.
Apex beat is not displaced and there is no thrill or Left parasternal heave.
There is a PSM best heard at the apex and non radiating

This gentleman has IE currently not in failure. He probably is an IVDU in view of the presence of IV puncture marks.

1) FBC- WCC, normochromic normocytic anaemia
2) ESR
3) Blood C&S- 3x fr different sites over 1 hour time span

1) Antibiotics- IV C. Pen + Genta x 2/52
IV Cloxa + Genta x 2/52 until review C&S
2) Surgery if
a. Persistent Blood C&S/ relapse
b. Abscess
c. Fungal
d. Damaged valve
e. 2nd / 3rd degree heart block secondary to aortic valve vegetation
f. New aneurysm of the sinus of Valsalva

IE prophylaxis for Dental Procedure(Circulation May 8 2007)

1) Prosthetic heart valve

2) Previous IE

3) Congenital heart disease

4) Cardiac transplant patients who develop valvulopathy

give oral amoxy 2g, 30 min before dental procedure

Prophylactic antibiotic for IE not recommended for GU/ GI tract procedure



At 9/07/2007 02:01:00 PM, Anonymous Anonymous said...

What valve was involved in this case? PSM at Apex and non radiating?

At 4/15/2008 08:06:00 PM, Anonymous Anonymous said...

mostly tricuspid valve


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