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Case ID: 1
Created: 10 July 2007

You are the SHO in charge of Renal ward.

Subject:Mr Lee, 50 years old

Mr Lee is a diabetic patient who is recently diagnosed to have end stage renal failure. He presented to your hospital with uraemic encephalopathy and recovered well after a few sessions of acute dialyisis. He was diagnosed to have diabetes mellitus 15 years ago. He is not compliant to medications and his last HbA1c 1 year ago was 10.2%. He is a chronic smoker and has a bypass surgery done 4 years ago. His wife, Mrs Lee is keen to donate her kidney to Mr Lee.Your task is to counsel Mr Lee about kidney transplantation.

You have 14 min until the patient leaves the room followed by 1 min for reflection before the discussion with the examiners



     This is a case in MRCP PACES to test your knowledge about kidney transplantation.Dr. Joseph Murray and the medical team at Boston's Peter Bent Brigham Hospital perform the first successful long-term organ transplant, Dec. 23, 1954. Ever since then, kidney transplantation has become one of the options as long term renal replacement therapy.Since Mrs Lee is keen to donate her kidney to your patient, there are a few issues to discuss with Mr Lee,

1) His understanding about his illness- what Mr Lee knows about end stage renal failure and what is his expectation towards his illness.

2) Options available for renal replacement therapy and briefly discuss about haemodialysis, peritoneal dialysis and kidney transplantation. Ask him about his understanding about kidney transplantation.

3) Inform Mr Lee that you know that his wife is keen to donate her kidney to him. Explain to him some contraindications to become a kidney donor and ask a brief medical history about Mrs Lee.Also explain to him that Mrs Lee motive to donate her kidney should be entirely altruistic and this will be assessed further by social worker and psychologist.

4) Briefly explain to Mr Lee what kidney transplantation is and possible short term and long term complications- surgical related, infection and side effects of medications.

5) Explain to him that he may need to come to hospital quite often initially after transplantation for monitoring of his kidney function and his visits to hospital will be reduced subsequently.

6) Explain about the importance about drug compliance and he should consult doctors immediately if he develops any side effects or fever. Inform him as well that you will update his Family Physician about his medications later.

7) Take a few minutes to talk about his diabetes control and advise to stop smoking. Emphasize to him even after transplantataion, he needs to take every step to control his medical problems so that his new kidney is well protected.

Common questions examiners would ask you,

1) What are the common drugs used in kidney transplantation?

2) What are the possible complications after kideny transplantation?

3) What are the absolute contraindications to kidney transplantation?

Extra points:

1) Get more information about Kidney Transplantation here

arrow Kidney Foundation

Case ID:2
Created: 10 July 2007

Look at this gentleman and proceed . ( Station 5)

Acromegaly for MRCP


    Easy and classical case in your MRCP PACES examination.No candidate will miss the diagnosis.This is an easy case and make sure you score 4/4 for this case in your MRCP. You should thank me if you get this case in your examination. I do not think I need to discuss further about this case. If you still do not know the diagnosis. I think you better study for another 1 year before you make your first attempt in MRCP PACES. I will show a few more pictures of acromegaly here.

acromegaly for MRCP 2

acromegaly for MRCP 3

OK, let me summarise all the features of acromegaly in one picture as shown below, ( from Atlas of Clinical Diagnosis by M. Afzal Mir)

acromegaly for MRCP 4

Common questions examiners would ask you,

1) What are the common presentations of patients with acromegaly?

( The above patient presented to our hospital with headache and hypertension)

2) How do you manage this patient?


This gentleman has acromegaly


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