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.


Wednesday, September 26, 2007

A Tale of Scar. Again?!


My friend got this in his exam recently in London.

He was asked : what are the likely cause of this scar ?

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19 Comments:

At 9/26/2007 10:26:00 PM, Blogger azizul said...

liver transplantation as evidenced by presence of mercedes benz scar.

 
At 9/26/2007 10:29:00 PM, Anonymous Anonymous said...

may be this is the scar of liver transplantation

 
At 9/27/2007 04:14:00 PM, Blogger Wuchereria said...

Ok, but any other differential diagnosis ?

 
At 9/27/2007 05:46:00 PM, Anonymous Anonymous said...

liver & renal transplant as evidenced by mercedes benz scar

 
At 9/27/2007 09:23:00 PM, Blogger Giant Eagle said...

Adrenalectomy scar?

 
At 9/27/2007 11:31:00 PM, Anonymous Anonymous said...

could this scar be due to partial hepatectomy?

 
At 9/27/2007 11:33:00 PM, Anonymous Anonymous said...

patient looks pigmented.may be hepatic transplantation was done for haemochromatosis.

 
At 9/28/2007 07:18:00 AM, Anonymous Anonymous said...

bilateral adrenelectomy with Nelson's syndrome?

 
At 9/28/2007 10:24:00 PM, Blogger Wuchereria said...

ok, any other causes ?

 
At 9/29/2007 06:47:00 AM, Blogger sadik108 said...

Primary Proliferative polycythemia with thromboembolic complication likes Budd chiari syndrome.....

 
At 10/04/2007 01:54:00 PM, Blogger Puneet said...

Whipples procedure for Ca pancreas

 
At 10/04/2007 10:09:00 PM, Blogger alok said...

Chevron (Roof Top) Modification of a standard Kochers incision :

The incision may be continued across the midline into a double Kocher incision or roof top
approach (Chevron Incision) which
provides excellent access to the upper abdomen; looks like a mercedes benz sign;particularly in those with a broad costal margin
This is useful in carrying out total gastrectomy, operations
for renovascular hypertension, total oesophagectomy, liver transplantation, extensive
hepatic resections, and bilateral adrenalectomy etc

 
At 10/04/2007 10:11:00 PM, Blogger alok said...

This approach gives excellent access to the upper abdominal viscera and, in particular to all the diaphragmatic
hiatuses

 
At 10/04/2007 11:05:00 PM, Blogger LMS said...

liver transplant scar

 
At 10/22/2007 09:50:00 AM, Anonymous pinkfeets said...

so what's the answer?

 
At 2/19/2008 06:48:00 AM, Anonymous Anonymous said...

Roof Top Scar of liver transplant

 
At 3/16/2008 01:49:00 PM, Blogger asimgabir said...

patient looks pigmented may be haemochromatosis I would look for arthropathy and artificial jts examine CVS and urine for sugar.The rooftop scar may be due to partial hepatectomy due to hepatocellular carcinoma or liver trnsplant

 
At 1/05/2009 12:28:00 AM, Anonymous Anonymous said...

The Mercedes Benz Modification : Variant of this incision consists of bilateral low Kocher's incision with an upper midline limb up to and through the xiphisternum.
This gives excellent access to the upper abdominal viscera and, in particular to all the diaphragmatic hiatuses.
The rectus muscle can be divided transversely. Its anterior and posterior sheaths are closed without any serious weakening of the abdominal muscle
the incision passes between adjacent nerves without injuring them. The rectus muscle has a segmental nerve supply, so there is no risk of a transverse incision depriving the distal part of the rectus muscle of its innervation. Healing of the scar, in effect, simply results in the formation of a man made additional fibrous intersection in the muscle.

http://www.indmedica.com/journals.php?journalid=8&issueid=32&articleid=393&action=article

http://mrcppreview.blogspot.com/2008/06/scaragain.html

 
At 6/20/2010 04:04:00 AM, Anonymous vicki said...

I had a patient with a mercedes-benz style scar in my PACES 2010/2,the patient was jaundiced, cachectic, tremulous, with spider naevi, tattoos & palmar erythema & he was itching like mad. However there was some tubing of some description in the patients LIF too which really threw me. Am now wondering if it was a PD catheter, although is it not a bit mad to put a PD catheter in a patient with the potential for decompensation, ascites formation & SBP. I wonder if I actually should have said what I thought?!

 

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