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YOUR LATEST ISSUE ABOUT MRCP PACES IS HERE! Look at this lady and proceed. Discussion:: A very popular question in MRCP PACES exams. This case can be used as a case in skin as well as locomotor sub-stations. You notice that this lady has tight skin over her face with multiple telangiectasia (arrows). You can see clearly that her mouth appears to be tight. ( Demonstrate by asking the patient to put 3 fingers into her mouth).Describe the nose and proceed to do the following, - check for dry eye because Sjogren's syndrome can be associated with scleroderma.
Common questions examiners will ask you, 1) what types of autoantibodies can be present? (ANA,anticentromer and anti-topoisomerase) Conclusion: This lady has systemic sclerosis. Extra points, 1) Prednisolone has no role in treating systemic sclerosis.
Examine this gentleman's leg. Discussion: My friend got this case in his MRCP PACES in 2005. It is an easy case if you know how to approach this case. You can see obviouly two small swellings over this gentleman's first toe and little toe. Although books describe chronic tophaceous gout as 'chalky 'material, sometimes you would just notice a swelling such as in this case.After you feel, palpate and move the relevant joints, you should look at other sites for similiar swelling. These sites include helices of the ears, olecranon bursae, tendons of hands and Achilles tendon. Another diagnosis that you may confuse with swelling over tendons is tendon xanthomata! Also suggest to examiners that you would look at the urine for haematuria and you are very interested to know about this patient's renal function. Common questions examiners would ask you, 1) What factors can precipitate acute gouthy arthritis? Conclusion: This gentleman has chronic tophaceous gout. Extra points: 1)Clinical presentations of gout include asymptomatic hyperuricemia, acute arthritis, chronic arthritis and chronic tophaceous gout. To see previous issues, click here! To send a quick comment, click here! |
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