Study for MRCP PACES - Study for Clinical Exam - Study for Clinical Exam

An exciting new study aid designed to acceleratelearning for the PACES component of theMRCP(UK)

Accelerate your Learning

Studying for the PACES is unlikeany of the previous examinationsencountered. Clinical knowledgeis essential, but moreimportantly, you need to be ableto recall key information ondemand. Thinkflash cards aredesigned to reinforce andstrengthen your learning thusimproving your chances of rapidrecall in the examination.

Types of Cards

• Clinical Signs and findings Card

Revisit the most important signs in adult medicinein their clinical context. These cards also outlineimportant differentials for common findings.

Examination Method card

Examine proficiently and with confidence. Outlines theexamination method for the major short cases includingCardiovascular, Respiratory, Abdominal, Neurological(Upper/Lower limbs and CNS), Speech, Thyroid and Hands

Disease and Pathology Card

Review clinically relevant information on pathologyencountered in the exam

The Clinical Examination

Preparing for the PACES requires excellentcompetency in a large variety of skills rangingfrom history taking, examination,communication and ethics. The Thinkflashpalm cards focus on the examination ofsystems and interpretation of signs, a keyaspect of the clinical examination process.Cards are kept up-to-date with informationfrom a wide variety of sources includinginformation from leading textbooks such as250 Cases in Clinical Medicine (Baliga) andExamination Medicine (Tally and O’Connor).

Wasting and Weakness – Hands

Examination of hands is verycommon in PACES setting. Youmay encounter the hands inlocomotor substation orneurology station. There are notmany differentials that you needto memorize but you need tohave a mind mapping about theapproach especially in neurologystation.

1 st case is a 40 years old man with insidious distalweakness for > 12 years. 3 out of his 8 siblings areaffected. He has wasting of small muscles of the handsresulting in guttering of the dorsum of the hands. Thereis generalized areflexia and glove pattern of sensoryloss. He came for nerve conduction test which showreduced conduction velocity. The diagnosis is Charcot-Marie-Tooth disease.

2nd case is a middle aged manwho had progressive weaknessof hands for 10 months. He haswasting and weakness of smallmuscles of the hands. Thehypothenar and thenareminences are wasted with leftmore severe than right. Thereis fasciculation seen and thereflexes are brisk. Thesensation is normal. MRIcervical spine and NCS arenormal. The diagnosis is motorneuron disease (MND).

• 3rd case is a 30-year-old lady with a syringomyeladeveloped painless ulcers of the palms and fingers.Other possible skin signs are edema and hyperhydrosisdue to interruption of central autonomic pathways.

Confuse? Don't get panic. Just remember severalpoints:

1. We should localize the lesion as LMN i.e. the lesion isat C8-T1 level including the cord, anterior horn cell,nerve roots and peripheral nerves.2. NMJ is not included because it does not causewasting. Muscular disorder is not included because itdoes not usually cause distal weakness.3. Sensory examination is VERY important in localizingthe lesion. For example, if there is sensory loss thenMND is excluded from your differential lists.

Contact Us

• We would love to get your feedback on thisinnovative, new aid to accelerate your learning. Weare especially interested in topics you think would begood to cover in future card versions. Please contactus via this page. Alternatively you may emailteam@thinkflash.co.uk directly.

http://thinkflash.co.uk/