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.
Saturday, June 23, 2007
Gait Quiz 2
Observe and describe the gait. Then, proceed with the necessary neurological examination.
Proceed by looking for pyramidal tract weakness in both upper and lower limbs. Look for a R homonymous hemianopia and dysphasia (assuming she has a dominant L hemisphere). Check for sensory and visual inattention.
Tell the examiners that you want to listen for carotid bruit and check her pulse for AF.
Thus,in order to have an adequate clearance from the ground,patient compensate by shifting her centre of gravity to her left and tilting her pelvis to her left. There seems to be a weakness of the right hip flexion as well as I would expect a high stepping gait for foot drop.
I will proceed to map out the level of lesion,firstly differentiating an upper and lower motor neurone with a Babinski.
Then,I will proceed to test tone and power particularly the hip flexor and dorsiflexion. Ankle jerk and knee jerk would be tested as well.
I will then proceed to perform a sensory examination, focusing particularly on the lower leg and the area surrounding it.
If patient does have weakness of the hip flexor or dorsiflexion, a heel-shin coordination test would be unhelpful as it could be due to the weakness of the muscle rather than lack of coordination
Hemiplegic gait.
ReplyDeleteProceed by looking for pyramidal tract weakness in both upper and lower limbs.
Look for a R homonymous hemianopia and dysphasia (assuming she has a dominant L hemisphere).
Check for sensory and visual inattention.
Tell the examiners that you want to listen for carotid bruit and check her pulse for AF.
right hemiparesis,the right foot has everted with poor right hand swing.
ReplyDeleteDr Sadiq
Patient has a right-sided foot drop.
ReplyDeleteThus,in order to have an adequate clearance from the ground,patient compensate by shifting her centre of gravity to her left and tilting her pelvis to her left. There seems to be a weakness of the right hip flexion as well as I would expect a high stepping gait for foot drop.
I will proceed to map out the level of lesion,firstly differentiating an upper and lower motor neurone with a Babinski.
Then,I will proceed to test tone and power particularly the hip flexor and dorsiflexion. Ankle jerk and knee jerk would be tested as well.
I will then proceed to perform a sensory examination, focusing particularly on the lower leg and the area surrounding it.
If patient does have weakness of the hip flexor or dorsiflexion, a heel-shin coordination test would be unhelpful as it could be due to the weakness of the muscle rather than lack of coordination
cute doc:Rt arm flexed, Rt leg stiff semicircle with toes attach floor first and Rt side pelvis tilts up with each step
ReplyDeleteHemiplegic gait
UMNL
Buddies, the answer is revealed!
ReplyDeleteShe is a stroke patient with right hemiplegic gait.
yes.. its right she has rt sided hemiplegic gait...
ReplyDeleteit is a hemiplegic gait
ReplyDeletei will look for signs of pyramidaltract lesion
R hemiplegic gait, classic from Ryder.
ReplyDeletehemiplegic ataxia
ReplyDelete