An Aid to the MRCP PACES, Volume 3

Preface ix Introduction xiii Section G: Examination Routines 1 1 Pulse 7 2 Heart 8 3 Chest 13 4 Abdomen 17 5 Visual fields 22 6 Cranial nerves 23 7 Arms 26 8 Legs 30 9 Legs and arms 34 10 Gait 35 11 Ask some questions 36 12 Fundi 39 13 Eyes 43 14 Face 45 15 Hands 47 16 Skin 51 17 Rash 53 18 Neck 54 19 Thyroid status 56 20 Knee 58 21 Hip 60 22 What is the diagnosis? 61 Section H: Integrated Clinical Assessment 65 Station 5 Scenarios by specialty 75 Dermatology 1 Non-resolving leg ulcer: pyoderma gangrenosum 77 2 Generalized rash: psoriasis 81 3 Dermatomyositis and falls 85 Rheumatology 4 Systemic sclerosis and Raynaud’s syndrome 90 5 Rheumatoid arthritis and effects on activities of daily living (ADL) 94 6 Psoriatic arthropathy 98 7 Ankylosing spondylitis: short notes 101 8 Gout: short notes 102 9 Steroid toxicity: short notes 103 Endocrine 10 Thyroid eye disease 105 11 Acromegaly 109 12 Diabetes mellitus and Charcot joint 112 13 Diabetes mellitus: foot ulcer and diabetes control 116 14 Goitre and weight loss 119 Eyes 15 Retinitis pigmentosa 125 16 Optic atrophy 128 17 Visual blurring in a patient with diabetes mellitus 132 Gastroenterology 18 Iron deficiency anaemia 137 19 Haematemesis 141 20 Elevated liver function tests: non-alcoholic fatty liver disease (NAFLD) 146 21 Elevated liver function tests and hepatitis B serology 151 22 Crohn’s disease/inflammatory bowel disease 155 23 Dysphagia and weight loss 158 24 Diarrhoea: recent antibiotics 162 25 Weight loss 166 26 Gastrointestinal bleed: significant bleed 169 Haematology 27 Anaemia 173 28 Easy bruising/idiopathic thrombocytopenic purpura 176 29 Epistaxis/elevated international normalized ratio (INR) 180 30 Neutropenic sepsis 184 Cardiology 31 Young syncope 188 32 Angina/chest pain 193 33 Palpitations ?atrial fibrillation 197 34 Breathlessness/congestive cardiac failure 201 35 Syncope/aortic stenosis 205 36 Syncope (orthostatic) 208 Respiratory 37 Chronic obstructive pulmonary disease (COPD) 211 38 Asthma 214 39 Pleural effusion 217 40 Short of breath ?pulmonary embolism 221 41 Rheumatoid arthritis/breathlessness 226 42 Haemoptysis 229 Neurology 43 Headache: progressive/memory issues 233 44 Headache: migraine 236 45 Subarachnoid haemorrhage 240 46 Transient ischaemic attack: loss of vision 243 47 Left-sided weakness in a young woman 247 48 Parkinson’s disease/falls in an elderly woman 250 49 Cranial nerve VI palsy: sudden onset 254 50 Blackout: first fit 258 51 Essential tremor 263 52 Temporal arteritis 267 53 Carpal tunnel syndrome 270 54 Multiple sclerosis/diplopia 274 55 Peripheral neuropathy 279 Miscellaneous cases 56 Urinary tract infection: male/sexual history 283 57 Swollen calf in a young woman 287 58 Deep venous thrombosis (DVT) secondary to neoplasia: elderly patient 291 59 Deterioration in renal function 295 60 Fever in the returning traveller 299 Section I: Short Case Records 305 Station 5 Skin 309 1 Systemic sclerosis/CREST syndrome 311 2 Neurofibromatosis (von Recklinghausen’s disease) 312 3 Osler–Weber–Rendu syndrome 314 4 Psoriasis 316 5 Rash of uncertain cause 318 6 Dermatomyositis 319 7 Xanthomata 321 8 Vitiligo 324 9 Adenoma sebaceum in tuberous sclerosis complex 328 10 Pseudoxanthoma elasticum 330 11 Lichen planus 333 12 Yellow nail syndrome 335 13 Gouty tophi 336 14 Alopecia areata 337 15 Eczema 339 16 Pretibial myxoedema 342 17 Clubbing 343 18 Necrobiosis lipoidica diabeticorum 345 19 Lupus pernio 347 20 Tinea 350 21 Koilonychia 352 22 Raynaud’s phenomenon 353 23 Erythema nodosum 355 24 Sturge–Weber syndrome 358 25 Purpura 360 26 Peutz–Jeghers syndrome 363 27 Vasculitis 364 28 Ehlers–Danlos syndrome 366 29 Livedo reticularis 368 30 Pemphigus/pemphigoid 370 31 Radiation burn on the chest 373 32 Herpes zoster 374 33 Henoch–Schönlein purpura 376 34 Mycosis fungoides 378 35 Morphoea 380 36 Kaposi’s sarcoma (AIDS) 382 37 Porphyria 385 38 Lupus vulgaris 387 39 Dermatitis herpetiformis 389 40 Urticaria pigmentosa (mastocytosis) 391 41 Palmoplantar keratoderma (tylosis) 393 42 Secondary syphilis 395 43 Ectodermal dysplasia 397 44 Partial lipodystrophy 399 45 Fabry’s disease 401 46 Reiter’s syndrome/reactive arthritis/keratodermablennorrhagica 403 47 Malignant melanoma 405 48 Acanthosis nigricans 407 49 Keratoacanthoma 410 50 Pyoderma gangrenosum 411 51 Psychogenic/factitious 413 Station 5 Locomotor 415 1 Rheumatoid arthritis 416 2 Psoriatic arthropathy 422 3 Systemic sclerosis/CREST syndrome 425 4 Diabetic foot/Charcot’s joint 428 5 Tophaceous gout 431 6 Ankylosing spondylitis 433 7 Paget’s disease 435 8 Osteoarthritis 437 9 Marfan’s syndrome 439 10 Vasculitis 441 11 Proximal myopathy 442 12 One leg shorter and smaller than the other 443 13 Radial nerve palsy 444 14 Arthropathy associated with infl ammatory bowel disease 445 15 Polymyositis 447 16 Systemic lupus erythematosus 448 17 Old rickets 450 18 Juvenile idiopathic arthritis 452 19 Swollen knee 454 Station 5 Endocrine 457 1 Exophthalmos 458 2 Acromegaly 461 3 Graves’ disease 464 4 Goitre 467 5 Hypothyroidism 470 6 Cushing’s syndrome 473 7 Addison’s disease 478 8 Hypopituitarism 481 9 Pretibial myxoedema 483 10 Gynaecomastia 485 11 Turner’s syndrome 488 12 Klinefelter’s syndrome/hypogonadism 490 13 Bitemporal hemianopia 494 14 Diabetic foot/Charcot’s joint 495 15 Necrobiosis lipoidica diabeticorum 496 16 Short stature 497 17 Pseudohypoparathyroidism 499 18 Pendred’s syndrome 502 Station 5 Eyes 505 1 Diabetic retinopathy 506 2 Retinitis pigmentosa 511 3 Optic atrophy 512 4 Ocular palsy 514 5 Visual field defect 515 6 Retinal vein occlusion 516 7 Old choroiditis 518 8 Papilloedema 520 9 Cataracts 522 10 Myasthenia gravis 524 11 Albinism 525 12 Exophthalmos 526 13 Myelinated nerve fibres 527 14 Hypertensive retinopathy 528 15 Glaucoma/peripheral fi eld loss 530 16 Retinal artery occlusion 532 17 Asteroid hyalosis 533 18 Drusen 534 19 Laurence–Moon–Bardet–Biedl syndrome 535 20 Cytomegalovirus choroidoretinitis (AIDS) 537 21 Normal fundus 540 Station 5 Other 541 1 Bilateral parotid enlargement/Mikulicz’s syndrome 542 2 Deep venous thrombosis (DVT)/Baker’s cyst/cellulitis 543 3 Peripheral vascular disease 546 4 Osteogenesis imperfecta 548 5 Down’s syndrome 549 6 Pernicious anaemia 550 7 Klippel–Feil syndrome 552 8 Leg oedema 554 Appendices 557 1 Checklists 559 2 Examination frequency of MRCP PACES short cases 563 3 Texidor’s twinge and related matters 567 4 Abbreviations 569 Index 572