Aid to the MRCP PACES, Volume 3

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, CardiffDr Anne Freeman is Consultant Physician at Royal Gwent Hospital, Newport, and Clinical Adviser and Chairwoman of the Welsh Stroke AllianceDr Edward Fogden is Consultant Physician and Gastroenterologist at Sandwell and West Birmingham Hospitals NHS Trust

• Preface ixIntroduction xiiiSection G: Examination Routines 11 Pulse 72 Heart 83 Chest 134 Abdomen 175 Visual fields 226 Cranial nerves 237 Arms 268 Legs 309 Legs and arms 3410 Gait 3511 Ask some questions 3612 Fundi 3913 Eyes 4314 Face 4515 Hands 4716 Skin 5117 Rash 5318 Neck 5419 Thyroid status 5620 Knee 5821 Hip 6022 What is the diagnosis? 61Section H: Integrated Clinical Assessment 65Station 5 Scenarios by specialty 75Dermatology1 Non-resolving leg ulcer: pyoderma gangrenosum 772 Generalized rash: psoriasis 813 Dermatomyositis and falls 85Rheumatology4 Systemic sclerosis and Raynaud’s syndrome 905 Rheumatoid arthritis and effects on activities of daily living (ADL) 946 Psoriatic arthropathy 987 Ankylosing spondylitis: short notes 1018 Gout: short notes 1029 Steroid toxicity: short notes 103Endocrine10 Thyroid eye disease 10511 Acromegaly 10912 Diabetes mellitus and Charcot joint 11213 Diabetes mellitus: foot ulcer and diabetes control 11614 Goitre and weight loss 119Eyes15 Retinitis pigmentosa 12516 Optic atrophy 12817 Visual blurring in a patient with diabetes mellitus 132Gastroenterology18 Iron deficiency anaemia 13719 Haematemesis 14120 Elevated liver function tests: non-alcoholic fatty liver disease (NAFLD) 14621 Elevated liver function tests and hepatitis B serology 15122 Crohn’s disease/inflammatory bowel disease 15523 Dysphagia and weight loss 15824 Diarrhoea: recent antibiotics 16225 Weight loss 16626 Gastrointestinal bleed: significant bleed 169Haematology27 Anaemia 17328 Easy bruising/idiopathic thrombocytopenic purpura 17629 Epistaxis/elevated international normalized ratio (INR) 18030 Neutropenic sepsis 184Cardiology31 Young syncope 18832 Angina/chest pain 19333 Palpitations ?atrial fibrillation 19734 Breathlessness/congestive cardiac failure 20135 Syncope/aortic stenosis 20536 Syncope (orthostatic) 208Respiratory37 Chronic obstructive pulmonary disease (COPD) 21138 Asthma 21439 Pleural effusion 21740 Short of breath ?pulmonary embolism 22141 Rheumatoid arthritis/breathlessness 22642 Haemoptysis 229Neurology43 Headache: progressive/memory issues 23344 Headache: migraine 23645 Subarachnoid haemorrhage 24046 Transient ischaemic attack: loss of vision 24347 Left-sided weakness in a young woman 24748 Parkinson’s disease/falls in an elderly woman 25049 Cranial nerve VI palsy: sudden onset 25450 Blackout: first fit 25851 Essential tremor 26352 Temporal arteritis 26753 Carpal tunnel syndrome 27054 Multiple sclerosis/diplopia 27455 Peripheral neuropathy 279Miscellaneous cases56 Urinary tract infection: male/sexual history 28357 Swollen calf in a young woman 28758 Deep venous thrombosis (DVT) secondary to neoplasia: elderly patient 29159 Deterioration in renal function 29560 Fever in the returning traveller 299Section I: Short Case Records 305Station 5 Skin 3091 Systemic sclerosis/CREST syndrome 3112 Neurofibromatosis (von Recklinghausen’s disease) 3123 Osler–Weber–Rendu syndrome 3144 Psoriasis 3165 Rash of uncertain cause 3186 Dermatomyositis 3197 Xanthomata 3218 Vitiligo 3249 Adenoma sebaceum in tuberous sclerosis complex 32810 Pseudoxanthoma elasticum 33011 Lichen planus 33312 Yellow nail syndrome 33513 Gouty tophi 33614 Alopecia areata 33715 Eczema 33916 Pretibial myxoedema 34217 Clubbing 34318 Necrobiosis lipoidica diabeticorum 34519 Lupus pernio 34720 Tinea 35021 Koilonychia 35222 Raynaud’s phenomenon 35323 Erythema nodosum 35524 Sturge–Weber syndrome 35825 Purpura 36026 Peutz–Jeghers syndrome 36327 Vasculitis 36428 Ehlers–Danlos syndrome 36629 Livedo reticularis 36830 Pemphigus/pemphigoid 37031 Radiation burn on the chest 37332 Herpes zoster 37433 Henoch–Schönlein purpura 37634 Mycosis fungoides 37835 Morphoea 38036 Kaposi’s sarcoma (AIDS) 38237 Porphyria 38538 Lupus vulgaris 38739 Dermatitis herpetiformis 38940 Urticaria pigmentosa (mastocytosis) 39141 Palmoplantar keratoderma (tylosis) 39342 Secondary syphilis 39543 Ectodermal dysplasia 39744 Partial lipodystrophy 39945 Fabry’s disease 40146 Reiter’s syndrome/reactive arthritis/keratodermablennorrhagica 40347 Malignant melanoma 40548 Acanthosis nigricans 40749 Keratoacanthoma 41050 Pyoderma gangrenosum 41151 Psychogenic/factitious 413Station 5 Locomotor 4151 Rheumatoid arthritis 4162 Psoriatic arthropathy 4223 Systemic sclerosis/CREST syndrome 4254 Diabetic foot/Charcot’s joint 4285 Tophaceous gout 4316 Ankylosing spondylitis 4337 Paget’s disease 4358 Osteoarthritis 4379 Marfan’s syndrome 43910 Vasculitis 44111 Proximal myopathy 44212 One leg shorter and smaller than the other 44313 Radial nerve palsy 44414 Arthropathy associated with infl ammatory bowel disease 44515 Polymyositis 44716 Systemic lupus erythematosus 44817 Old rickets 45018 Juvenile idiopathic arthritis 45219 Swollen knee 454Station 5 Endocrine 4571 Exophthalmos 4582 Acromegaly 4613 Graves’ disease 4644 Goitre 4675 Hypothyroidism 4706 Cushing’s syndrome 4737 Addison’s disease 4788 Hypopituitarism 4819 Pretibial myxoedema 48310 Gynaecomastia 48511 Turner’s syndrome 48812 Klinefelter’s syndrome/hypogonadism 49013 Bitemporal hemianopia 49414 Diabetic foot/Charcot’s joint 49515 Necrobiosis lipoidica diabeticorum 49616 Short stature 49717 Pseudohypoparathyroidism 49918 Pendred’s syndrome 502Station 5 Eyes 5051 Diabetic retinopathy 5062 Retinitis pigmentosa 5113 Optic atrophy 5124 Ocular palsy 5145 Visual field defect 5156 Retinal vein occlusion 5167 Old choroiditis 5188 Papilloedema 5209 Cataracts 52210 Myasthenia gravis 52411 Albinism 52512 Exophthalmos 52613 Myelinated nerve fibres 52714 Hypertensive retinopathy 52815 Glaucoma/peripheral fi eld loss 53016 Retinal artery occlusion 53217 Asteroid hyalosis 53318 Drusen 53419 Laurence–Moon–Bardet–Biedl syndrome 53520 Cytomegalovirus choroidoretinitis (AIDS) 53721 Normal fundus 540Station 5 Other 5411 Bilateral parotid enlargement/Mikulicz’s syndrome 5422 Deep venous thrombosis (DVT)/Baker’s cyst/cellulitis 5433 Peripheral vascular disease 5464 Osteogenesis imperfecta 5485 Down’s syndrome 5496 Pernicious anaemia 5507 Klippel–Feil syndrome 5528 Leg oedema 554Appendices 5571 Checklists 5592 Examination frequency of MRCP PACES short cases 5633 Texidor’s twinge and related matters 5674 Abbreviations 569Index 572