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Station 5 ( New Station):

Your role : You are the medical doctor on call.

Patient name: Ms Lee – age 23 years

This lady was admitted to your ward due to fever with cough.

She was noticed by your house officer to have skin lesion over his lower limbs and he mentioned to you about this skin lesion. He mentioned to you that the patient is worried about the skin lesion.

Your task is to assess the patient’s problems and address any questions or concerns raised by the patient

( Source: Patient.co.uk)

Discussion:

There are 5 steps to answer well station 5 in MRCP PACES. Remember these 5 steps as below,

1)Do proper physical examination- for you to be able to do a proper physical examination, you need to know the causes of Erythema Nodosum- besides examining the skin lesion. You need to go further to find out the underlying cause if possible

2)Get relevant, proper history- Since you know that the diagnosis is Erythema Nodosom and the causes- ask relevant history to find out the underlying cause of Erythema Nodosum in this lady. Mneumonics to remember causes of Erythema Nodosum is DIPS OUT - Drugs (sulphonamides), Infections ( Streptococcal ),Pregnancy, Sarcoidosis, Oral contraceptive pills, Ulcerative colitis, Tuberculosis.

3)Inform the patient the diagnosis and the underlying cause if possible or just inform her that she is having Erythema Nodosum and there are a few possible reasons causing this,

4)Inform her the next course of action- I will inform her that a few more investigations may be needed such as chest x ray etc,

5)Answer her questions- During your MRCP PACES, patient usually ask you question- Answer them well!For example ,in this case, she might ask you that she is worried that she is getting SLE because her friend told her that SLE patients get reddish skin rash.

Popular questions examiners might ask you during your MRCP PACES,

1) What do you look for in the CXR if you think this lady has sarcoidosis?

2) How do you manage this lady?

Extra points:

Interesting Images in Clinical Medicine.

Case History:

    Mr L is a 15-year old Malay gentleman who has a congenital heart disease since early childhood. He came in with reduced effort tolerance.CXR is done. What is the abnormality you see and what can you comment about the CXR??

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