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.
Thursday, August 09, 2007
How Would You Proceed?
Spotted this patient while doing ward round. What is the clinical sign?
Ascertain gum hypertrophy/gingivitis... Most likely hypertrophy in exam. Firstly stratify what is most likely- haemato/nephro/neuro/nutritional status ie skin. If any is most likely- proceed with that system. Haemato ie AMML? Proceed to examine haematological system. Nephro as in cyclosporin use in transplant- Hirsutism/tremor/renal transplant scar then abdomen. Check for dysmorphism and gross sign of mental retardation/neurological signs. Also notice for any evidence of malnutrition in particular any perifollicular haemorrhage. Lastly request to ask for drug history ie phenytoin/cyclosporin.
this pt with purpuric rash and gum hyperplasia most likely case of acute myeloid leukemia , as scurvey do not cause gum hypertrophy , drugs can cause gum hypertrophy but not the purpura
gum hypertrophy / sec to drugs like phenytoin or cyclosporine. we should loo for signs of pheytoin toxicity like ataxia and nystagmes. also look for a-v fistula on upper limb, and renal transplant scar
Ascertain gum hypertrophy/gingivitis... Most likely hypertrophy in exam. Firstly stratify what is most likely- haemato/nephro/neuro/nutritional status ie skin. If any is most likely- proceed with that system. Haemato ie AMML? Proceed to examine haematological system. Nephro as in cyclosporin use in transplant- Hirsutism/tremor/renal transplant scar then abdomen. Check for dysmorphism and gross sign of mental retardation/neurological signs. Also notice for any evidence of malnutrition in particular any perifollicular haemorrhage. Lastly request to ask for drug history ie phenytoin/cyclosporin.
ReplyDeletedrug-induced gum hypertrophy
ReplyDeleteGingival swelling/redness
ReplyDeleteCauses:
Infection / Gingivitis
Scurvy
Side effect of some drugs
Poor toothbrushing technique
Pregnancy
gingival hypeertrophy.drug induced,,amml,cyclosprin treat ment etc should be ruled out
ReplyDeletethis pt with purpuric rash and gum hyperplasia most likely case of acute myeloid leukemia , as scurvey do not cause gum hypertrophy , drugs can cause gum hypertrophy but not the purpura
ReplyDeletescurvy
ReplyDeletegum hypertrophy / sec to drugs like phenytoin or cyclosporine.
ReplyDeletewe should loo for signs of pheytoin toxicity like ataxia and nystagmes. also look for a-v fistula on upper limb, and renal transplant scar
gumm hypertrophy due to either cyclosporine , phynetoin,
ReplyDelete