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.
Tuesday, July 03, 2007
Some Drills On Station 5 (Part 4)
Station stem: Please examine this lady's hands and proceed accordingly.
1) What is your diagnosis? 2) What other systems would you like to examine? 3) How would you treat this lady?
1. Systemic sclerosis. If the skin involvement extends above the elbow, then this is the diffuse variant. Otherwise it is the limited type, previously known as CREST.
2. Examine the lungs for pulmonary fibrosis and look for evidence of pulmonary hypertension. Check the BP, as the patients are at risk of malignant hypertension. Don't forget this could be mixed connective tissue disease, in which case look for other signs eg gottron's papule (dermatomyositis), butterfly rash (SLE)
3. Hand warmers/ avoid cold/ Calcium channel blocker for Raynaud. Consider sympathectomy or prostacyclin analogue for resistant cases. ACE inhibitor for hypertension Promotility agent for dysphagia
Hyperpigmentation of palmar creases-Nelson syndrome due to high ACTH,probably can be seen in Addison's.
A vitiligo on the hands dorsum can be expected in Addison's disease.
I would like the patient for other associated disease such as Grave's Disease and T1DM. I would like to examine the patient's thyroid and cardiovascular system.
For management of Addison's,I would commence the patient on long term steroid replacement.
The palmar creases are not hyperpigmented at all. Based on the Hx, I'll place my bet on systemic sclerosis. BTW would you mind telling us the race of this pt?
Some hypopigmentation macules over the dorsum of both hands.
ReplyDelete? Vitiligo
Hyperpigmentation of palm crease
?Addison's ds
Axon, your pics are too small for us to comment on the details:)
Ya pics were too small to define details.
ReplyDeleteBig clue: This patient presents with tightening of skin for 3 months duration.
i think its scleroderma..and i would like to examine respiratory system as well as joints and in volvement of kidneys.
ReplyDeletecute doctor: crest
ReplyDeleteThis patient as post inflmmatory depigmentation,shinning skin and pale palm.This patient may have raynaud phenomenon with sclerodermal.I.e CREST SYN
ReplyDelete1. Systemic sclerosis. If the skin involvement extends above the elbow, then this is the diffuse variant. Otherwise it is the limited type, previously known as CREST.
ReplyDelete2. Examine the lungs for pulmonary fibrosis and look for evidence of pulmonary hypertension. Check the BP, as the patients are at risk of malignant hypertension.
Don't forget this could be mixed connective tissue disease, in which case look for other signs eg gottron's papule (dermatomyositis), butterfly rash (SLE)
3. Hand warmers/ avoid cold/ Calcium channel blocker for Raynaud. Consider sympathectomy or prostacyclin analogue for resistant cases.
ACE inhibitor for hypertension
Promotility agent for dysphagia
Hyperpigmentation of palmar creases-Nelson syndrome due to high ACTH,probably can be seen in Addison's.
ReplyDeleteA vitiligo on the hands dorsum can be expected in Addison's disease.
I would like the patient for other associated disease such as Grave's Disease and T1DM. I would like to examine the patient's thyroid and cardiovascular system.
For management of Addison's,I would commence the patient on long term steroid replacement.
The palmar creases are not hyperpigmented at all. Based on the Hx, I'll place my bet on systemic sclerosis. BTW would you mind telling us the race of this pt?
ReplyDeleteAnswer: Systemic sclerosis
ReplyDeleteThis patient has diffuse type of ss. She is from Indian ethnic origin.
Well done guys!