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, March 21, 2008

Some Drills On Station 5 (Part 5)

Station stem:
This patient presents with intensely itchy skin lesions on both lower limbs for a short duration. Please examine and lay down your differential diagnoses. What are the questions would you like to ask?

Above picture on the shin, and the following picture is on the anteromedial aspect of another leg:

And a close-up:



At 3/22/2008 10:00:00 AM, Anonymous Anonymous said...

I put my bet on Granuloma annulare.

A patch of annular lesion, with multiple small papular lesions at the border.

can be associated with DM, TB, HIV


Necrobiosis lipoidica diabeticorum
-cant really see the typical waxy surdface, with telangiectasia. Usually not multiple.

Lichen Planus
- site not typical. no lacy white lines at surface

Cutaneous Sarcoid

Lichen Amyloidosis

At 3/22/2008 10:27:00 AM, Anonymous Anonymous said...

This pruritic erythematous lesion on the legs have clusters pf papules.My fiest differential will be lichen planus.So will exam his mouth for the lacy patch and the nails for ridging.Iwill also exam the head and the inner side of the wrists.My second differential will be urticaria.And i will ask for history of allergy and contact with an allergen.The last possibility are scabies but this is not the usual sites.but i will examine his hands and natal cleft.And then insect bite.

At 3/22/2008 03:16:00 PM, Blogger Axonopathic said...

Anymore takers? :)

At 3/22/2008 07:24:00 PM, Anonymous Anonymous said...

I think Dermatitis herpetiformis and scabies infestation would be two possible differential diagnoses.

At 3/23/2008 11:23:00 PM, Blogger King Solomon said...

There is papular eruptions on erythematous skin and central clearing of the lesion. both lesions in the shin and the thigh appear to take specific shape. So my DD is contact dermatitis. other DD are urticaria, Eczema. I'dlike to ask the patient about istory of allergy, history of wearing or contacting these areas with metal, perfumes or detergants.

At 3/24/2008 12:25:00 AM, Blogger King Solomon said...

Papular eruptions on an erythematous skin there some vesicles also. My DD is Contact dermatits, eczema and allergy to insect bite.

At 3/24/2008 01:42:00 AM, Anonymous Anonymous said...

there is erythematous papulo-vesicular lesions, so most likley i will put first dermatitis herpitiformis, then also papular articaria,also, atopic or contact dermatitis..also ?lichen planus.
in the history i will ask about precipitant agent like gluten containing diet, also about oral ulcers, bone pain(osteomalacia ),also h/o allergy like asthma, hay fever, eczema or hay fever or allergic rhinitis.also, iwill ask about drug history.

At 3/24/2008 01:48:00 AM, Anonymous Anonymous said...

descrition of the lesions:
there is erythematous papulo-vesicular rash.
i will consider the following in the differential diaggnosis:
-dermatitis herpitiformis.
-contact or atopic dermatitis.
-papular urticaria.
-?lichen planus
points in the history:
onset, distribution of the rash, oral ulcers, precipitating agents like gluten containg diet.also any triggering factor.h/o insect bites
drug history.
past history of allergy like allergic rhinitis, hay fever, eczema, & asthma.

At 3/24/2008 04:37:00 AM, Anonymous Anonymous said...

it looks like the herald patch but it is not on the trunk

At 3/27/2008 09:38:00 AM, Anonymous Anonymous said...

this is an intensively itchy rash with erythematous borders in an irregular pattern, one forming a ring shaped pattern with few erythematous papules nearby.

2) larva cutaneous migrans
3)lichen planus

would like to ask the patient:
1) if he has the rash anywhere else on the body
2) if he has been walking around barefoot outdoors
3) any white patch on the buccal mucosa
4) history of atopy

At 3/28/2008 04:29:00 PM, Blogger Axonopathic said...

Dear all,

Thanks for taking part in the quiz. All are relevant differetials.

The answer is that this patient had severe vesiculating contact dermatitis which was localised to the lower limbs. He had tried his new bath scrubs days ago before developing these lesions.

He responded partially to topical steroids, needing a short course of oral steroids. The lesions eventually cleared off. He had put the bath scrubs in the rubbish bin for good after this :)

At 3/30/2008 05:46:00 AM, Blogger lesfu said...

The correct diagnosis for this case is urticaria pegmentosa

At 3/30/2008 05:47:00 AM, Blogger lesfu said...

the correct diagnosis for this case is urticaria pegmentosa


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