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, June 29, 2007
Quiz CVS
A consultoid cardiologist took me for a short case 1 hour ago.
This man had a clear cut mitral valve replacement ! However the question was what was the other scar due to ??
Answer : L sided pericardial window and the smaller scars for the drains. All those were good thoughts. I also initially thought it was mitral valvotomy in the past.
The other scar is for either previous valvulostomy or correction of coarctation of the aorta.And the small scars for drains.
ReplyDeletePneumectomy for localized infection 2nd to septic emboli from mitral valve IE??
ReplyDeleteoppss.. sorry.. mitral IE doesnt embolized to the lungs.. maybe co-existing lesions on the right side?
ReplyDeleteGood. Keep up the pace!
ReplyDeleteSo far none hit the diagnosis yet ;)
Tip: Look at the scars closely
scar of lobectomy.pt might have had bronchiectasis with severe haemoptysis..and infective endocarditis..whihc was not getting resolved
ReplyDeletehoracotomy scar for open lung biopsy?
ReplyDeleteClue : Think Cardiac, not respiratory !
ReplyDeleteCould this patient have had lutembercher'syn i.e ASD with mitral stenosis and the scars are for mital valve replacement and ASD closure.
ReplyDeleteThis is a wild guess..
ReplyDeleteCoronay artery bypass with left lateral chest wall entry??
A number of small scars for endoscopic harvesting of arteries and perhaps also for drainage??
Hmm..seems like no one is getting any closer to the answer.
ReplyDeleteBigger clue: The lateral scars were made 1/52 after the midline scar.
C'mon you guys can do it!
Tough, tough, tough!
ReplyDeleteis it empyema ..post cardiac sugery and stipping off pleura
ReplyDeleteAnswer : L sided pericardial window and the smaller scars for the drains.
ReplyDeleteAll those were good thoughts. I also initially thought it was mitral valvotomy in the past.
Yep. It's open pericardial drainage by thoracotomy approach. This patient's MVR was complicated by post-op pericardial effusion.
ReplyDeleteHere's a good review link for thoracoscopic pericardial window:
http://www.ctsnet.org/sections/clinicalresources/thoracic/expert_tech-32.html
this could be aortic valve replacement for a bicuspid aortic valve with repair of associated coarcitation of the aorta
ReplyDeletethe lateral thoracotomy scar my be done for mitral valvoplasy in the past before the median sternotomy inscition which may be later done for CABG
ReplyDeletemidsterniotomy scar is for MVR.
ReplyDeleteThe lateral thoracotomy scar almost is previous mitral valvuplasty.