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YOUR LATEST ISSUE ABOUT MRCP PACES IS HERE! Would you like to examine this gentleman cranial nerves? Discussion: This is a classical case in MRCP PACES station 3. A lot of candidates always feel very worried when faced with cranial nerves examination. You notice that this gentleman has obvious loss of right naso-labial fold. A lot of candidates always ask me the same question, should I examine from the first cranial nerve till the 12th cranial nerve or examine the nerves according to scenario? 1) Eye group- you will be testing cranial nerves II, III, IV and VI. You will be assessing these cranial nerves by checking eye reflexes, fundoscopy, visual acuity, visual field and eye movement. In this case, since you notice this patient has problem mainly due to facial expression and movement, I would examine his V and VII nerves first. You know that he has 7th nerve palsy, the next question you want to ask is whether it is a lower or upper motor 7th nerve palsy. You can differentiate this by observing 2 major upper portion facial muscles namely orbicularis oculi and frontalis muscles. Ask patient to screw his eyes and look upward, If you do this, you notice the following, You notice that he is unable to close his right eye tightly as compare to the left eye. So the diagnosis is obvious now, you are dealing with right lower motor 7th nerve palsy.You can then complete other cranial nerves examination. After your examination, you want to find the possible aetiology for his 7th nerve palsy by doing the following steps, look at external auditory canal for herpes zoster, Common questions examiners would ask you, 1) What are three components of facial nerve? Conclusion: This gentlema has right Bell's palsy. Extra points: 1) Bell's palsy should be treated with combination of steroid and acyclovir.
Examine this patient's respiratory system. Discussion: In MRCP PACES, if you find clubbing in respiratory station, you are dealing with only a few possibilities, the most popular question will be bronchiectasis. Other causes of clubbing because of respiratory system are Lung Cancer, suppurative lung disease ( such as empyema, therefore you would find signs suggesting pleural effusion, however, it is unlikely in MRCP because patients tend to be very ill!) and fibrosing alveolitis. A lot of candidates find it difficult to differentiate lung fibrosis from bronchiectasis. I think there are a few important points to take note... After the examination, suggest to examiners that you would like to look at the temperature chart.. Common questions examiners would ask you, 1) What are the causes of brochiectasis? How would you manage this condition? 2) What are other causes of clubbing? Conclusion: This gentleman has bronchiectasis due to previous tuberculosis. Extra points: 1) In bronchiectasis , remember postural drainage, postural drainage, postural drainage.... To see previous issues, click here! To send a quick comment, click here! |
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