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An Aid to the MRCP Paces
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Table of Contents

Preface vii Preface to the third edition xi Preface to the second edition xiii Preface to the first edition xv Introduction xvii Section A: Preparation 1 Section B: Examination Routines 7 1 Pulse 11 2 Heart 12 3 Chest 17 4 Abdomen 21 5 Visual fields 26 6 Cranial nerves 27 7 Arms 30 8 Legs 34 9 Legs and arms 38 10 Gait 39 11 Ask some questions 40 12 Fundi 43 13 Eyes 47 14 Face 49 15 Hands 51 16 Skin 55 17 Rash 57 18 Neck 58 19 Thyroid status 60 20 Knee 62 21 Hip 64 22 What is the diagnosis? 65 Section C: Short Case Records 69 Station 1 Respiratory 73 1 Interstitial lung disease (fibrosing alveolitis) 74 2 Pneumonectomy/lobectomy 77 3 Chronic bronchitis and emphysema 79 4 Bronchiectasis 81 5 Dullness at the lung base 83 6 Rheumatoid lung 85 7 Old tuberculosis 86 8 Chest infection/consolidation/pneumonia 87 9 Yellow nail syndrome 89 10 Kyphoscoliosis 90 11 Stridor 92 12 Marfan's syndrome 93 13 Carcinoma of the bronchus 94 14 Klippel-Feil syndrome 97 15 Kartagener's syndrome 98 16 Lung transplant 99 17 Cystic fi brosis 101 18 Obesity/Pickwickian syndrome 103 19 Pneumothorax 107 20 Corpulmonale 109 21 Collapsed lung/atelectasis 110 22 Superior vena cava obstruction 112 23 Tuberculosis/apical consolidation 113 24 Normal chest 115 Station 1 Abdominal 117 1 Transplanted kidney 118 2 Polycystic kidneys 120 3 Chronic liver disease 121 4 Hepatosplenomegaly 124 5 Hepatomegaly (without splenomegaly) 126 6 Splenomegaly (without hepatomegaly) 127 7 Ascites 129 8 Abdominal mass 131 9 Crohn's disease 133 10 Polycythaemia rubra vera 135 11 Normal abdomen 136 12 PEG tube 138 13 Single palpable kidney 139 14 Generalized lymphadenopathy 140 15 Hereditary spherocytosis 142 16 Idiopathic haemochromatosis 143 17 Primary biliary cirrhosis 145 18 Carcinoid syndrome 147 19 Motor neurone disease 149 20 Nephrotic syndrome 150 21 Pernicious anaemia 152 22 Pyoderma gangrenosum 153 23 Felty's syndrome 154 Station 3 Cardiovascular 155 1 Prosthetic valves (mechanical) 156 2 Mitral incompetence (lone) 157 3 Mixed mitral valve disease 159 4 Aortic incompetence (lone) 161 5 Aortic stenosis (lone) 163 6 Mixed aortic valve disease 165 7 Mitral stenosis (lone) 167 8 Irregular pulse 169 9 Other combinations of mitral and aortic valve disease 171 10 Mitral valve prolapse 172 11 Tricuspid incompetence 174 12 Ventricular septal defect 175 13 Marfan's syndrome 176 14 Pulmonary stenosis 177 15 Ankylosing spondylitis 178 16 Atrial septal defect 179 17 Ebstein's anomaly 181 18 Raised jugular venous pressure 183 19 Down's syndrome 184 20 Hypertrophic cardiomyopathy 185 21 Dextrocardia 186 22 Rheumatoid arthritis 187 23 Fallot's tetralogy with a Blalock shunt 188 24 Normal heart 189 25 Cannon waves 190 26 Coarctation of the aorta 191 27 Eisenmenger's syndrome 193 28 Infective endocarditis 195 29 Patent ductus arteriosus 198 30 Pulmonary incompetence 199 31 Slow pulse 201 Station 3 Central Nervous System 203 1 Peripheral neuropathy 205 2 Myotonic dystrophy (dystrophia myotonica) 207 3 Parkinson's disease 209 4 Charcot-Marie-Tooth disease (hereditary motor and sensory neuropathy) 212 5 Abnormal gait 214 6 Spastic paraparesis 217 7 Cerebellar syndrome 218 8 Hemiplegia 220 9 Muscular dystrophy 222 10 Multiple sclerosis 224 11 Motor neurone disease 226 12 Friedreich's ataxia 229 13 Visual fi eld defect 231 14 Ulnar nerve palsy 233 15 Old polio 235 16 Ocular palsy 236 17 Spinal cord compression 240 18 Ptosis 243 19 Guillain-Barre syndrome (acute inflammatory demyelinating polyradiculopathy) 247 20 Choreoathetosis 249 21 Bulbar palsy 251 22 Lateral popliteal (common peroneal) nerve palsy 252 23 Proximal myopathy 254 24 Absent ankle jerks and extensor plantars 255 25 Cerebellopontine angle lesion 256 26 Cervical myelopathy 257 27 Myasthenia gravis 259 28 Normal central nervous system 263 29 Syringomyelia 264 30 Diabetic foot/Charcot's joint 266 31 Holmes-Adie-Moore syndrome 267 32 Nystagmus 269 33 Carpal tunnel syndrome 272 34 Drug-induced extrapyramidal syndrome 274 35 Lower motor neurone VIIth nerve palsy 275 36 Dysarthria 279 37 Subacute combined degeneration of the cord 280 38 Argyll Robertson pupils 281 39 Congenital syphilis 282 40 Dysphasia 284 41 Horner's syndrome 286 42 Infantile hemiplegia 288 43 Jugular foramen syndrome 290 44 Lateral medullary syndrome (Wallenberg's syndrome) 292 45 Polymyositis 294 46 Pseudobulbar palsy 295 47 Psychogenic/factitious 296 48 Radial nerve palsy 298 49 Subclavian-steal syndrome 299 50 Tabes 301 51 Thalamic syndrome 303 52 Wasting of the small muscles of the hand 304 Appendices 307 1 Checklists 309 2 Examination frequency of MRCP PACES short cases 313 3 Texidor's twinge and related matters 317 4 Abbreviations 319 Index 321

About the Author

Robert E.J. Ryder is Consultant Physician and Clinical IT Lead at City Hospital NHS Trust, Birmingham, and Honorary Senior Lecturer in Medicine at the University of Birmingham. Dr M. Afzal Mir is Senior Lecturer and Consultant Physician at University Hospital of Wales, Cardiff Dr Anne Freeman is Consultant Physician at Royal Gwent Hospital, Newport, and Clinical Adviser and Chairwoman of the Welsh Stroke Alliance

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