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, August 10, 2007
Some Drills On Station 5 (Part 5)
Common and readily available case for PACES. Look at this patient's extremities and proceed.
What are your findings? What are the possible differential diagnoses?
I would like to complete my Ex by checking her 1)BP 2)Dipstick the urine for hematuria and proteinuria (SLE, HSP, IE) 3)Funduscope to look for haemorrhage/ cytoid body/ Roth spot 4)Complete physical Ex for other systems involvement
Diff 1)CTD- SLE!!!, systemic sclerosis 2)RA 3)HSP ( if purpura over extensors of the LL) 4)Drug reaction 5)IE ........
the lesions over the palmar aspect of the hand and plantar aspect of the feet appears targetoid with a red centre surrounded by a pale circular area which in turn is surrounded by a circular red area
i would proceed to examine the eyes,buccal mucosa and genitalia for involvement
my dx is erythema multiforme and the differentials are: 1) vasculitic rashes 2) drug eruptions
ok sorry pals, late reply. Have been busy with the PACES course.
This lady in fact has MCTD with +ve anti-RNP. She also shows cutaneous stigmata of scleroderma upon palpation.
Panhypopit is right on the right track for the differentials.
Nope, it's not syphilitic rash for sure. And HHT won't have this confluent form of erythematous patches. Plus, it's the wrong place to look for HHT cutaneous signs!
I'll see some of you all in the upcoming PACES course!! Surprises are in store for the participants:)
erythematous pathces.infective ebdocarditis sguld be ruled out.raynoulds phenomenon and due to vasculitic etilogy is a differntial diagnosis
ReplyDeleteThere is vasculitic rash over the extremities.
ReplyDeleteI would like to complete my Ex by checking her
1)BP
2)Dipstick the urine for hematuria and proteinuria (SLE, HSP, IE)
3)Funduscope to look for haemorrhage/ cytoid body/ Roth spot
4)Complete physical Ex for other systems involvement
Diff
1)CTD- SLE!!!, systemic sclerosis
2)RA
3)HSP ( if purpura over extensors of the LL)
4)Drug reaction
5)IE ........
anyone think of osler-weber-rendu disease??? (Hereditary Haemorrhagic Telangectasia)
ReplyDeleteI suppose there could be a family history of nosebleeds, haemoptysis or GI haemorrhage. Check her tongue for telangectasia!
is there a possibility of syphilis?
ReplyDeleteI saw a vasculitic rash on legs up to knees in an abdo exam in a patient with ?hepatosplenomegally
ReplyDeleteHow does this tie in?? is it sautoimmune disease or haematological
what is the correct diagnosis (& DDx) then? How to proceed for the teaching point of view?Thanks
ReplyDeletethe lesions over the palmar aspect of the hand and plantar aspect of the feet appears targetoid with a red centre surrounded by a pale circular area which in turn is surrounded by a circular red area
ReplyDeletei would proceed to examine the eyes,buccal mucosa and genitalia for involvement
my dx is erythema multiforme and the differentials are:
1) vasculitic rashes
2) drug eruptions
ok sorry pals, late reply. Have been busy with the PACES course.
ReplyDeleteThis lady in fact has MCTD with +ve anti-RNP. She also shows cutaneous stigmata of scleroderma upon palpation.
Panhypopit is right on the right track for the differentials.
Nope, it's not syphilitic rash for sure. And HHT won't have this confluent form of erythematous patches. Plus, it's the wrong place to look for HHT cutaneous signs!
I'll see some of you all in the upcoming PACES course!! Surprises are in store for the participants:)