Preface ix
Introduction xiii
Section G: Examination Routines 1
1 Pulse 7
2 Heart 8
3 Chest 13
4 Abdomen 17
5 Visual fields 22
6 Cranial nerves 23
7 Arms 26
8 Legs 30
9 Legs and arms 34
10 Gait 35
11 Ask some questions 36
12 Fundi 39
13 Eyes 43
14 Face 45
15 Hands 47
16 Skin 51
17 Rash 53
18 Neck 54
19 Thyroid status 56
20 Knee 58
21 Hip 60
22 What is the diagnosis? 61
Section H: Integrated Clinical Assessment 65
Station 5 Scenarios by specialty 75
Dermatology
1 Non-resolving leg ulcer: pyoderma gangrenosum 77
2 Generalized rash: psoriasis 81
3 Dermatomyositis and falls 85
Rheumatology
4 Systemic sclerosis and Raynauds syndrome 90
5 Rheumatoid arthritis and effects on activities of daily living (ADL) 94
6 Psoriatic arthropathy 98
7 Ankylosing spondylitis: short notes 101
8 Gout: short notes 102
9 Steroid toxicity: short notes 103
Endocrine
10 Thyroid eye disease 105
11 Acromegaly 109
12 Diabetes mellitus and Charcot joint 112
13 Diabetes mellitus: foot ulcer and diabetes control 116
14 Goitre and weight loss 119
Eyes
15 Retinitis pigmentosa 125
16 Optic atrophy 128
17 Visual blurring in a patient with diabetes mellitus 132
Gastroenterology
18 Iron deficiency anaemia 137
19 Haematemesis 141
20 Elevated liver function tests: non-alcoholic fatty liver disease (NAFLD) 146
21 Elevated liver function tests and hepatitis B serology 151
22 Crohns disease/inflammatory bowel disease 155
23 Dysphagia and weight loss 158
24 Diarrhoea: recent antibiotics 162
25 Weight loss 166
26 Gastrointestinal bleed: significant bleed 169
Haematology
27 Anaemia 173
28 Easy bruising/idiopathic thrombocytopenic purpura 176
29 Epistaxis/elevated international normalized ratio (INR) 180
30 Neutropenic sepsis 184
Cardiology
31 Young syncope 188
32 Angina/chest pain 193
33 Palpitations ?atrial fibrillation 197
34 Breathlessness/congestive cardiac failure 201
35 Syncope/aortic stenosis 205
36 Syncope (orthostatic) 208
Respiratory
37 Chronic obstructive pulmonary disease (COPD) 211
38 Asthma 214
39 Pleural effusion 217
40 Short of breath ?pulmonary embolism 221
41 Rheumatoid arthritis/breathlessness 226
42 Haemoptysis 229
Neurology
43 Headache: progressive/memory issues 233
44 Headache: migraine 236
45 Subarachnoid haemorrhage 240
46 Transient ischaemic attack: loss of vision 243
47 Left-sided weakness in a young woman 247
48 Parkinsons disease/falls in an elderly woman 250
49 Cranial nerve VI palsy: sudden onset 254
50 Blackout: first fit 258
51 Essential tremor 263
52 Temporal arteritis 267
53 Carpal tunnel syndrome 270
54 Multiple sclerosis/diplopia 274
55 Peripheral neuropathy 279
Miscellaneous cases
56 Urinary tract infection: male/sexual history 283
57 Swollen calf in a young woman 287
58 Deep venous thrombosis (DVT) secondary to neoplasia: elderly patient 291
59 Deterioration in renal function 295
60 Fever in the returning traveller 299
Section I: Short Case Records 305
Station 5 Skin 309
1 Systemic sclerosis/CREST syndrome 311
2 Neurofibromatosis (von Recklinghausens disease) 312
3 OslerWeberRendu syndrome 314
4 Psoriasis 316
5 Rash of uncertain cause 318
6 Dermatomyositis 319
7 Xanthomata 321
8 Vitiligo 324
9 Adenoma sebaceum in tuberous sclerosis complex 328
10 Pseudoxanthoma elasticum 330
11 Lichen planus 333
12 Yellow nail syndrome 335
13 Gouty tophi 336
14 Alopecia areata 337
15 Eczema 339
16 Pretibial myxoedema 342
17 Clubbing 343
18 Necrobiosis lipoidica diabeticorum 345
19 Lupus pernio 347
20 Tinea 350
21 Koilonychia 352
22 Raynauds phenomenon 353
23 Erythema nodosum 355
24 SturgeWeber syndrome 358
25 Purpura 360
26 PeutzJeghers syndrome 363
27 Vasculitis 364
28 EhlersDanlos syndrome 366
29 Livedo reticularis 368
30 Pemphigus/pemphigoid 370
31 Radiation burn on the chest 373
32 Herpes zoster 374
33 HenochSchönlein purpura 376
34 Mycosis fungoides 378
35 Morphoea 380
36 Kaposis sarcoma (AIDS) 382
37 Porphyria 385
38 Lupus vulgaris 387
39 Dermatitis herpetiformis 389
40 Urticaria pigmentosa (mastocytosis) 391
41 Palmoplantar keratoderma (tylosis) 393
42 Secondary syphilis 395
43 Ectodermal dysplasia 397
44 Partial lipodystrophy 399
45 Fabrys disease 401
46 Reiters syndrome/reactive arthritis/keratodermablennorrhagica 403
47 Malignant melanoma 405
48 Acanthosis nigricans 407
49 Keratoacanthoma 410
50 Pyoderma gangrenosum 411
51 Psychogenic/factitious 413
Station 5 Locomotor 415
1 Rheumatoid arthritis 416
2 Psoriatic arthropathy 422
3 Systemic sclerosis/CREST syndrome 425
4 Diabetic foot/Charcots joint 428
5 Tophaceous gout 431
6 Ankylosing spondylitis 433
7 Pagets disease 435
8 Osteoarthritis 437
9 Marfans syndrome 439
10 Vasculitis 441
11 Proximal myopathy 442
12 One leg shorter and smaller than the other 443
13 Radial nerve palsy 444
14 Arthropathy associated with infl ammatory bowel disease 445
15 Polymyositis 447
16 Systemic lupus erythematosus 448
17 Old rickets 450
18 Juvenile idiopathic arthritis 452
19 Swollen knee 454
Station 5 Endocrine 457
1 Exophthalmos 458
2 Acromegaly 461
3 Graves disease 464
4 Goitre 467
5 Hypothyroidism 470
6 Cushings syndrome 473
7 Addisons disease 478
8 Hypopituitarism 481
9 Pretibial myxoedema 483
10 Gynaecomastia 485
11 Turners syndrome 488
12 Klinefelters syndrome/hypogonadism 490
13 Bitemporal hemianopia 494
14 Diabetic foot/Charcots joint 495
15 Necrobiosis lipoidica diabeticorum 496
16 Short stature 497
17 Pseudohypoparathyroidism 499
18 Pendreds syndrome 502
Station 5 Eyes 505
1 Diabetic retinopathy 506
2 Retinitis pigmentosa 511
3 Optic atrophy 512
4 Ocular palsy 514
5 Visual field defect 515
6 Retinal vein occlusion 516
7 Old choroiditis 518
8 Papilloedema 520
9 Cataracts 522
10 Myasthenia gravis 524
11 Albinism 525
12 Exophthalmos 526
13 Myelinated nerve fibres 527
14 Hypertensive retinopathy 528
15 Glaucoma/peripheral fi eld loss 530
16 Retinal artery occlusion 532
17 Asteroid hyalosis 533
18 Drusen 534
19 LaurenceMoonBardetBiedl syndrome 535
20 Cytomegalovirus choroidoretinitis (AIDS) 537
21 Normal fundus 540
Station 5 Other 541
1 Bilateral parotid enlargement/Mikuliczs syndrome 542
2 Deep venous thrombosis (DVT)/Bakers cyst/cellulitis 543
3 Peripheral vascular disease 546
4 Osteogenesis imperfecta 548
5 Downs syndrome 549
6 Pernicious anaemia 550
7 KlippelFeil syndrome 552
8 Leg oedema 554
Appendices 557
1 Checklists 559
2 Examination frequency of MRCP PACES short cases 563
3 Texidors twinge and related matters 567
4 Abbreviations 569
Index 572
