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.


Friday, October 12, 2007

Course/ Mock Exam Cases Drill

Here are some of the cases for the preparatory course/ mock exam.

Case 1: Please examine this lady's hand and tell me your findings.


Case 2: This patient has difficulty in holding objects in her hands. Please examine her.

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16 Comments:

At 10/13/2007 02:35:00 AM, Anonymous Anonymous said...

irst patient has symmetrical deforming polyarthropathy with multiple chronic topaceous gout leading to disuse atrophy as evident by wasting of small muscles of the hand specially the dorsal interossei. function of the hand is limited because of the deformities

2nd patient ahs bony swellings of the distal interphalangeal joint of the left hand calles ad herbedens nodes diagnosis of osteoarthritis in the differtial diagnosis with psoriasis as teh other diagnosis

 
At 10/13/2007 03:10:00 AM, Anonymous Anonymous said...

osteoarthritis involving distal interphalyngeal joints left greater than right

 
At 10/13/2007 03:12:00 AM, Anonymous Anonymous said...

case 1 is classical gouty tophi

 
At 10/13/2007 04:57:00 AM, Blogger Hospital Slave said...

Jaccoud arthrorpathy, as evidenced by the deforming arthropathy affecting the MCP joints but can be corrected voluntarily.

Proceed to look for signs of SLE and rheumatic fever.

 
At 10/13/2007 07:25:00 AM, Anonymous Anonymous said...

1rst patient has deforming polyarthropathy with multiple topaceous gout and reduced function of the hand and also wasting of the small muscles because of disuse atrophy specially of the introssie


2nd patient has bony swellings of the distal interphalngeal joints of the right hand and the little finger of thr right hand probably herbedens nodes

 
At 10/13/2007 11:31:00 AM, Blogger Hospital Slave said...

Haha...I just realised that there are two pairs of hands, belonging to two different patients.

So clearly not Jaccoud.

Which reemphasized the importance of reading the instructions carefully before jumping in to examine the patients

 
At 10/13/2007 07:32:00 PM, Anonymous sumz...zz said...

the first patient has chronic topaceous gout

the second pt has rheumatoid arthritis as evidenced by swan neck and ulnar deviation

 
At 10/13/2007 08:10:00 PM, Anonymous 1st attempt said...

OA in view of herbeden nodes with
possible left ulnar palsy as evident by loss of hypothenar eminence as well as atrophic 4th 5th finger.

 
At 10/13/2007 08:20:00 PM, Anonymous Anonymous said...

2nd hand is it Osteoarthritis or rhemataoid arthritis please whats the answer

 
At 10/13/2007 10:01:00 PM, Blogger Axonopathic said...

Case 1: Chronic tophaceous gout
Case 2: Primary osteoarthritis

Straight-forward cases as in the real PACES :)

One of my colleagues took the mock exam and saw the 2nd case. He was speechless when asked about the possible differential diagnoses for OA. We shouldn't be taken aback by such question as all!

After all, this is what we physicians are trained to be :)

 
At 10/14/2007 06:00:00 AM, Anonymous Anonymous said...

Differential diagnosis of OA:
Psoriatic arthropathy affecting DIPs
Non-classical presentation of RA
Chronic gout
HLA-B27 spondyloarthropathies but will have evidence of other disease process
Infective arthritis

 
At 10/14/2007 11:23:00 AM, Blogger Axonopathic said...

Anonymous: Good differentials. Nicely done :)

As a general rule of thumb, we should have at least 5 causes or differentials for every condition. :D

 
At 10/17/2007 09:18:00 PM, Anonymous Anonymous said...

Well, RA spares distal PIP. And as such should not be one of the differentials. HLA B27 disease is a bit far fetched. I am of opinion not to give such differentials as we may be digging grave for ourselves. Adequate to give psoriatic arthropathy and chronic tophaceous gout I feel.

 
At 10/20/2007 11:20:00 AM, Anonymous Anonymous said...

Case 1: complete joint destruction with juxta athricular nodes and gross wasting of the small muscles of the hands.My differentials are rheumathoid athritis and chroinic typhiceous gouty arthritis.

Case 2: the hands shows swan neck deformity of the left middle and fouth fingers and swelling of the MCPJ.Them showed erythema.this patient has RA.

 
At 10/20/2007 11:27:00 AM, Blogger Axonopathic said...

Yes I agree that to offer good differentials, it's really depend on the specific case that you're dealing with.

RA TYPICALLY spares DIP jt.

Mention the more likely differentials in front, then offer the least likely at the end if you're being pushed.

And to the comment by anonymous right before me. Nope, the diagnosis for case 1 is not RA. And i think you should put chronic tophaceous gout as the 1st diagnosis in case 1.

Regards,
Axonopathic

 
At 10/20/2007 02:44:00 PM, Blogger sadik108 said...

ist case chronic tophaceous gout with chronic renal failure as long term complication of renal urate stones.The evidense of renal failure is ecchymosis with distal gray discoloration of nails{half moon sign}
2nd case primary nodular OA ,heberden nodules at distal phalanges.

 

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