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.
Labels: Cardiovascular, Quiz series
posted by Wuchereria @ 6/29/2007 11:47:00 PM
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17 Comments:
The other scar is for either previous valvulostomy or correction of coarctation of the aorta.And the small scars for drains.
Pneumectomy for localized infection 2nd to septic emboli from mitral valve IE??
oppss.. sorry.. mitral IE doesnt embolized to the lungs.. maybe co-existing lesions on the right side?
Good. Keep up the pace!
So far none hit the diagnosis yet ;)
Tip: Look at the scars closely
scar of lobectomy.pt might have had bronchiectasis with severe haemoptysis..and infective endocarditis..whihc was not getting resolved
horacotomy scar for open lung biopsy?
Clue : Think Cardiac, not respiratory !
Could this patient have had lutembercher'syn i.e ASD with mitral stenosis and the scars are for mital valve replacement and ASD closure.
This is a wild guess..
Coronay artery bypass with left lateral chest wall entry??
A number of small scars for endoscopic harvesting of arteries and perhaps also for drainage??
Hmm..seems like no one is getting any closer to the answer.
Bigger clue: The lateral scars were made 1/52 after the midline scar.
C'mon you guys can do it!
Tough, tough, tough!
is it empyema ..post cardiac sugery and stipping off pleura
Answer : L sided pericardial window and the smaller scars for the drains.
All those were good thoughts. I also initially thought it was mitral valvotomy in the past.
Yep. It's open pericardial drainage by thoracotomy approach. This patient's MVR was complicated by post-op pericardial effusion.
Here's a good review link for thoracoscopic pericardial window:
http://www.ctsnet.org/sections/clinicalresources/thoracic/expert_tech-32.html
this could be aortic valve replacement for a bicuspid aortic valve with repair of associated coarcitation of the aorta
the lateral thoracotomy scar my be done for mitral valvoplasy in the past before the median sternotomy inscition which may be later done for CABG
midsterniotomy scar is for MVR.
The lateral thoracotomy scar almost is previous mitral valvuplasty.
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