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, September 24, 2007

What'd Be Your Unifying Diagnosis?



It's been a while since our last 'casual' life blogs.

I saw this lady during my combined antenatal and medical follow-up.

She had a congenital cardiac lesion which is corrected. Clinically she is pink on air and there is no finger clubbing.

What would you expect the lesion to be and what would be your diagnosis?

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10 Comments:

At 9/25/2007 12:12:00 AM, Blogger Hospital Slave said...

This comment has been removed by the author.

 
At 9/25/2007 12:14:00 AM, Blogger Hospital Slave said...

Subtle...subtle..

Looking at the curved little finger, I wonder if this is clinodactyly secondary to Trisomy 21. The hand is also smaller than the doctor's hand (I presume the top one belongs to the patient, the bottom the doc).

 
At 9/25/2007 01:00:00 AM, Blogger Axonopathic said...

Hosp slave,

Thanks for the comment. Yep it's quite a difficult one.

What if i tell u that both hands belong to the same patient? :)

 
At 9/25/2007 02:34:00 AM, Anonymous Anonymous said...

dr.salem,wasting of the 1st dor.inteross.hyperextension of 4th,5th p.i.p.joints and flexion of 5th t.i.p.joint.?lt.claw hand [partial].

 
At 9/25/2007 01:24:00 PM, Blogger Axonopathic said...

Partial claw hand is not the answer.

Try correlate with the cardiac lesion.

Any takers?

 
At 9/25/2007 03:46:00 PM, Anonymous Hon Liang said...

Shorten 5th digit of left hand. This patient had a Blalock Taussig shunt for congential heart disease, most commonly Tetralogy of Fallots.

 
At 9/25/2007 09:36:00 PM, Blogger alok said...

Endocardial cushion defects (muscular part of the septum)leading to VSD and short and curved little finger with a simian crease, probably down's. However the possibility of Pseudopseudo hypoparathyroidism is there but cardiac lesion unlikely.

 
At 9/26/2007 12:44:00 AM, Anonymous Anonymous said...

holt oram syndrome
probably asd

 
At 9/26/2007 12:46:00 AM, Anonymous Anonymous said...

holt oram syndrome
corrected atrial septal defect

 
At 9/26/2007 09:05:00 PM, Blogger Axonopathic said...

Yep. It's Holt-Oram syndrome.

She doesn't have a murmur as her ASD was closed.

Well done bloggers :)

 

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