An Aid to the MRCP PACES, Volume 3

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