An Aid to the MRCP PACES, Volume 3 Station 5

Robert E.J. Ryder is Consultant Physician and Clinical IT Lead at City Hospital NHS Trust, Birmingham, and Honorary Senior Lecturer in Medicine at the University of Birmingham.

Dr M. Afzal Mir is Senior Lecturer and Consultant Physician at University Hospital of Wales, Cardiff

Dr Anne Freeman is Consultant Physician at Royal Gwent Hospital, Newport, and Clinical Adviser and Chairwoman of the Welsh Stroke Alliance

Dr Edward Fogden is Consultant Physician and Gastroenterologist at Sandwell and West Birmingham Hospitals NHS Trust 

Preface

Introduction

Section G: Examination Routines 0

1 Pulse

2 Heart

3 Chest

4 Abdomen

5 Visual fields

6 Cranial nerves

7 Arms

8 Legs

9 Legs and arms

10 Gait

11 Ask some questions

12 Fundi

13 Eyes

14 Face

15 Hands

16 Skin

17 Rash

18 Neck

19 Thyroid status

20 Knee

21 Hip

22 What is the diagnosis?

Section H: Integrated Clinical Assessement 000

Station 5 Scenarios by speciality

Dermatology

1 Pyoderma gangrenosum

2 Psoriasis

3 Dermatomyositis

Rheumatology

4 systemic sclerosis and raynauds with digital ulceration

5 RA (NB fx on ADL)

6 Psoriatic arthropathy (rash and joints) – pitting / rash

7 Ankylosing spondylitis – short notes

8 Gout – short notes

9 Steroid toxicity – short notes

Endocrine

10 Thyroid eye disease

11 Acromegaly

12 Charcot joint

13 DM foot and DM control

14 Goitre / other neck swelling

Eyes

15 Retinitis pigmentosa

16 Diabetic retinopathy

17 Optic atrophy

Gastroenterology 

18 Male with IDA

19 GI bleed - MW tear; hx; Rockall & Blatchford; early OP OGD.

20 Elevated LFT  - Raised LFT and alcohol history

21 Elevated LFT and hep B serology

22 Crohn’s Disease / IBD - diarrhoea weight loss urgency rectal bleeding

23 Dysphagia weight loss - cancer risk

24 Diarrhoea – recent foreign travel or antibiotics

25 Weight loss

26 GI bleed – significant bleed (DU/NSAID)

Haematology   

27 Anaemia – hb 7 mcv 68 menorrhagia

28 Easy bruising / ITP

29 High INR epistaxis

30 Neutropenic patient on chemo – results just phoned back

Cardiology

31 Young syncope

32 Angina / chest pain

33 Palpitations ? AF

34 Breathlessness / CCF

35 Syncope / AS

36 Syncope / orthostatic

Respiratory

37 COPD / “breathlessness”

38 Asthma

39 Pleural effusion

40 SOB in normal ?PE

41 RA / fibrosis ?? SOB

42 Haemoptysis

Neurology

43 Headache – progressive / memory issues

44 Headache – migraine

45 Headache - ?SAH

46 TIA – loss of vision

47 left sided weakness in young female whilst at hairdresser with FHx stroke

48 PD – falls elderly

49 CN palsy – VI sudden

50 Blackout - First Fit

51 Essential Tremor:

52 GCA / temporal arteritis – painful to brush hair

53 Carpal tunnel

54 MS diplopia

55 Peripheral neuropathy

Miscellaneous

56 UTI – male / sexual history

57 Swollen calf – young

58 DVT – older secondary to neoplasia

59 Deterioration in UE

60 Fever in the returning traveller

Section I: Short Case Records

[Ed – names in red have been changed from last edition – please check all contents short case names match the actual short cases! Alert me to any discrepancies – thanks]

Station 5 Skin

1 Systemic sclerosis/CRST syndrome

2 Neurofibromatosis (von Recklinghausen’s disease)

3 Osler–Weber–Rendu syndrome

4 Psoriasis

5 Rash of uncertain cause

6 Dermatomyositis

7 Xanthomata

8 Vitiligo

9 Adenoma sebaceum in tuberous sclerosis complex

10 Pseudoxanthoma elasticum

11 Lichen planus

12 Yellow nail syndrome

13 Gouty tophi

14 Alopecia areata

15 Eczema

16 Pretibial myxoedema

17 Clubbing

18 Necrobiosis lipoidica diabeticorum

19 Lupus pernio

20 Tinea

21 Koilonychia

22 Raynaud’s phenomenon

23 Erythema nodosum

24 Sturge–Weber syndrome

25 Purpura

26 Peutz–Jeghers syndrome

27 Vasculitis

28 Ehlers–Danlos syndrome

29 Livedo reticularis

30 Pemphigus/pemphigoid

31 Radiation burn on the chest

32 Herpes zoster

33 Henoch–Schönlein purpura

34 Mycosis fungoides

35 Morphoea

36 Kaposi’s sarcoma (AIDS)

37 Porphyria

38 Lupus vulgaris

39 Dermatitis herpetiformis

40 Urticaria pigmentosa (mastocytosis)

41 Palmoplantar keratoderma (tylosis)

42 Secondary syphilis

43 Ectodermal dysplasia

44 Partial lipodystrophy

45 Fabry’s disease

46 Reiter’s syndrome/reactive arthritis/keratoderma blenorrhagica

47 Malignant melanoma

48 Acanthosis nigricans

49 Keratoacanthoma

50 Pyoderma gangrenosum

51 Psychogenic/factitious

Station 5 Locomotor

1 Rheumatoid arthritis

2 Psoriatic arthropathy

3 Systemic sclerosis/CRST syndrome

4 Diabetic foot/Charcot’s joint

5 Tophaceous gout

6 Ankylosing spondylitis

7 Paget’s disease

8 Osteoarthritis

9 Marfan’s syndrome

10 Vasculitis

11 Proximal myopathy

12 One leg shorter and smaller than the other

13 Radial nerve palsy

14 Arthropathy associated with inflammatory bowel disease

15 Polymyositis

16 Systemic lupus erythematosus

17 Old rickets

18 Juvenile idiopathic arthritis

19 Swollen knee

Station 5 Endocrine

1 Exophthalmos

2 Acromegaly

3 Graves’ disease

4 Goitre

5 Hypothyroidism

6 Cushing’s syndrome

7 Addison’s disease

8 Hypopituitarism

9 Pretibial myxoedema

10 Gynaecomastia

11 Turner’s syndrome

12 Klinefelter’s syndrome / hypogonadism

13 Bitemporal hemianopia

14 Charcot’s joint

15 Necrobiosis lipoidica diabeticorum

16 Short stature

17 Pseudohypoparathyroidism

18 Pendred’s syndrome

Station 5 Eyes

1 Diabetic retinopathy

2 Retinitis pigmentosa

3 Optic atrophy

4 Ocular palsy

5 Visual field defect

6 Retinal vein occlusion

7 Old choroiditis

8 Papilloedema

9 Cataracts

10 Myasthenia gravis

11 Albinism

12 Exophthalmos

13 Myelinated nerve fibres

14 Hypertensive retinopathy

15 Glaucoma/peripheral field loss

16 Retinal artery occlusion

17 Asteroid hyalosis

18 Drusen

19 Laurence–Moon–Bardet–Biedl syndrome

20 Cytomegalovirus choroidoretinitis (AIDS)

21 Normal fundus

Station 5 Other

1 Bilateral parotid enlargement/Mikulicz’s syndrome

2 Deep venous thrombosis/Baker’s cyst/cellulitis

3 Peripheral vascular disease

4 Osteogenesis imperfecta

5 Down’s syndrome

6 Pernicious anaemia

7 Klippel–Feil syndrome

8 Leg oedema

Appendices

1 Checklists

2 Texidor’s twinge and related matters

3 Abbreviations

Index

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