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.
This gentleman has multiple similar lesions distributed over face, limbs as well as trunk. Please describe the lesions.
What is the significance of these lesions?
Hint: related to any syndrome?
posted by Dr. David Teoh @ 2/04/2008 09:30:00 AM
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15 Comments:
there is wide spread pigmented macular lesions in the face, trunks & limbs, they are a symmetrical, so may be are multiple navi, the syndrome may be "dysplastic nevus syndrome"
Is a good differential..
Any other thoughts? more related to medical or MRCP...
multiple purpuric rashes all over the body.
diff diagnosis: vasculitic rash, infection (eg.meningococcal), DIC,HSP,hematological(lymphoma/leukemia)
nope, if they are all lentigines..any other thoughts?
there are multiple brown pigmented spots which look like lentigines. The differential would include: myxoma syndromes like LAMB and Carney-complex, also multiple lentigines syndrome (LEOPARD), Peutz-Jeghers (although would be more hamartomas).
LEOPARD syndrome
LEOPARD syndrome
These small pigmented macules , when associated with intestinal polyposis , are suggestive of Peutz-Jeghers syndrome which is an autosomal dominant condition . I would also like to look for signs of anaemia, examine the abdominal system including performing a rectal examination.
Brilliant, jessica!
Need to consider LEOPARD syndrome or LAMB in this case
* L -- lentigines
* E -- electrocardiogram abnormalities
* O -- ocular hyperteleorism
* P -- pulmonary stenosis
* A -- abnormal genitalia
* R -- retardation of growth
* D -- deafness
* L -- lentigines
* AM -- Atrial myxoma
* B -- Blue nevi
This patient has wide spread hyperpigmented macules my first differential is familia atypical mole-melanoma syndrome especially with the involvement of the dorsumof the feet.It is premalignant sopatient needs to be monitor closely for any change.The second differential is patterned inherited lentiginosis.
dysplastic nevus syndrome is a good differential, but all the lesions here are macule..so it is multiple lentigines syndrome eg LEOPARD or LAMB
Fabrys disease
I think peutzz jeghers syndrome should not be considered in this case as it has pigmented macules only in perioral areas, and hands
xeroderma pigmentosa ??
what do you think dav?
pls, let me know ?
cafe au lait of type 1 neurofibromatousis
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