how was Paces exam 2010/1 so far

[Paces_2010]

hi

any one sat for paces diet 2010/1 ????????

hope it`s fine

waiting for your comments

[Guest]

HOW PATHETIC THE DOCTOR SOCIETY

230 READING & NO ONE WANT TO ADD EVEN A WORD

PLEAS KEEP THE WISDOM GEM FOR YOUR SELF

[Guest bradford UK]

My exame was not bad:

1-H/o Taking : young male presented with 3 episodes of collapse , one of them he ate sandwitch and felt better ? tricky, his mCV was 105, BM was 5.4(normal).
2- communication skills breaking bad news of young male , end stage hear failure and you have to break bad news metastatic renal Ca, his concerns was a-how tell his partner, b-he likes gardening is it ok if keeps doing that, c-has plans to trave for holiday .

3-Cardi(MG with hear failure (venvlon, breathless at rest),Cns : CVA

4-hepatosplenomegally , Resp was bronchiactesis

5- station 5 was short stature (aged 22 concerned about height)
, the 2nd one was derma 20 years facial rash involving nose , descoid lesion on the Rt temporal , nodular lesion on scalp
concerns was is it malignanat , treatment , diagnosis D/D ? descoid ? drugs ? sarcodiosis.

[Guest bradford UK]

Sorry , the derma one was 52 years old lady who got that rash for almost 20 years.

[guest18]

Thanks for the post, Guest bradford UK.

[guest18]

Guest bradford UK

Could you also post how you tackled, D/D'ed the cases that you got. What you did and what questions you got during discussion?

and what is 'MG' in MG with heart failure?

[Guest bradford UK]

I meant Mitral regurg.
Regarding the history taking staions, i asked about Epilepsy , was no tongue bitting , no urine incont, no f/H epilepsy , so i asked about the details , he said 2 of them witnessed by wife was shaking , fitting for 4 mints.
no chest pain , no plapitation , has not lost any wt , or gained any wt , alcohol drinking he told me he drinks only 3 pints /week ends , had high MCV, so i was trying hard to fine clue from the history , at the end he told me his dad died at age of 40 (brain Hge), so realy was tricky , then the examiner asked me what do you think now , i sadi will conside Av malformation , will request MRi brain , my DD was neurogenic or cradiogenic cause of collapse so Ech , ECG , CT brain , 24 ECG ETC, some bloods as well.
Then the examiner told me what is the diagnosis whic you could put money on .what do you think guys?

[Guest]

I feel it may b a AV malformation.. which causes the seizures(?pressure effect) and the high mcv may b co-incidental?

[guest18]

I would put my money on AV malformation as well. I agree high MCV might be incidental. Father dying of ICH at young age is a strong point in favour.

[Guest]

An AVM wouldn't have been my first differential I have to say. If he was having small bleeds from the AVM then wouldn't there be a history of headache?? Beury aneursym would certainly need consideration.

I would have been more interested in the history which seems to suggest that he had a hypoglycaemic event as there was resolution following eating. ??insulinoma

High MCV suggests alcohol, but his social unit consumtion makes this unlikely - I guess the other differentials would be B12/folate deficiency, hypothryoid and myeloproliferatve. The high MCV may have been a red herring, but would need investigating and therefore would need to be quite high up on differentials.

I think I would have been concerned about
1) possible Insulinoma 2y to pancreatitis 2y to alcohol
2) A brain SOL
3)Berry anerusym.
Might have waffled on about possible MEN1 as something to consider. Not sure would have put AVM as number one - if that was the history.

Natasha

[RNA]

yes natasha u r right

[Guest bradford UK]

Yes Natasha i agree, i sadi all that to the patient , but when the examiner was looking for one certain diagnosis i felt my self in the middle of no where.
Another candidate on the same station mentioned HOCKM, and he told me the examiner was happy with that ?? iam not convinced.

[guest18]

A typo, I actually meant Berry aneurysm, not AV malformation. I agree.

[guest4]

hi
was wondering what the short stature patient was? was it a genetic cause of short stature?

thanks

[Guest]

It was Hypopitiutarism.

[guest4]

sounds like some difficult cases
where did u sit ur exam

[bmc paces]

Hello,Guest Bradford UK

What did you ask to reach to the diagnosis of hypopit & how did you address the pts concern ?

Metastatic renal cell ca wth end stage renal disease(I guess) - what was your opinion about travelling ?

Thnx so much for the post.

[Guest]

No the case was breaking bad news to some one who already got end stage heart failure under care of cardiology.
I think i did not address that concer very well, we should advised about risk of PEs, and insurance issues as well.

Regarding the Short stature , her main concern was her hight, shyness, so u need to take h/o , i told her that we cant help with the hight as too late she is 22 years , but wil help with other problems like periods , if the ovaries not fibrosed we could start hormonal therapy , arnot we?

[guest_scotland]

Hi All,
Great to see a vibrant community to deal with PACES! Has anyone done theirs at Edinburgh's Western General Hospital? I have mine there soon and would appreciate any info on cases.

I will be posting what they through at me in due course!

Anyone out there done theirs at this Hosp?

[bmc paces]

Yes, we cant help wth ht but adrenal,thyroid,gonadal hormone replacement can be done & help wth fertility issues are possible.

Regarding station four-will his health insurance cover him if he travels abroad & gets very sick ? Also will some other EU nation treat him anyway ?