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Case ID: 1
Created: 10 December 2011

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Station 3 ( Neurology Station):

Subject Mr Siva- 35 years old gentleman

Mr Siva is having syncopal attacks and also weakness of both upper limbs. Please inspect and proceed.



This is a popular neurology case in MRCP PACES. If you happen to sit for your MRCP PACES in Malaysia, good luck to you because there are a few patients with this condition waiting to be called for PACES in Kuala Lumpur. So, what is obvious in this gentleman?Yes, you are right. This unfortunate gentleman has frontal baldness,triangular/ myopathic facies and temporalis and masseter wasting.

However, you might also find other features such as gum hypertrophy( due to antiepileptic - pheytoin) but one of the striking clinical sign you want to demonstrate is difficulty opening his fist after shaking. I will show you a video demonstrating this gentleman having difficulty releasing his fist as below,


You should proceed to do the following,

arrow1) Suggest to examiners you would like to check the urine for sugar ( diabetes mellitus)

arrow2) Check for his IQ.

arrow3) Suggest to examiners you would like to check for gynaecomastia and testicular atrophy.

arrow4) Ask about family history since it is inherited as autosomal dominant pattern.

Common Questions in MRCP PACES,

1) What are the other features of dystrophia myotonica?

2) What is the feature of EMG finding for dystrophia myotonica?

Extra points:

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Case ID:2
Created: 10 December 2011

Breaking trial in Clinical Medicine/Nephrology



Background History:

    Statin which is an inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A reductase, has been shown in various trials in improving outcomes of patients in Ischemic heart disease. Dr Nicholls in his article recently published in New England Journal of Medicine ( NEJM) looks at two statins on progression of coronary artery disease.

Click HERE to read the article

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