Title Details

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

Dr Edward Fogden is Consultant Physician and Gastroenterologist at Sandwell and West Birmingham Hospitals NHS Trust 

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 Raynaud’s 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 Crohn’s 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 Parkinson’s 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 Recklinghausen’s disease) 312

3 Osler–Weber–Rendu 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 Raynaud’s phenomenon 353

23 Erythema nodosum 355

24 Sturge–Weber syndrome 358

25 Purpura 360

26 Peutz–Jeghers syndrome 363

27 Vasculitis 364

28 Ehlers–Danlos syndrome 366

29 Livedo reticularis 368

30 Pemphigus/pemphigoid 370

31 Radiation burn on the chest 373

32 Herpes zoster 374

33 Henoch–Schönlein purpura 376

34 Mycosis fungoides 378

35 Morphoea 380

36 Kaposi’s 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 Fabry’s disease 401

46 Reiter’s 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/Charcot’s joint 428

5 Tophaceous gout 431

6 Ankylosing spondylitis 433

7 Paget’s disease 435

8 Osteoarthritis 437

9 Marfan’s 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 Cushing’s syndrome 473

7 Addison’s disease 478

8 Hypopituitarism 481

9 Pretibial myxoedema 483

10 Gynaecomastia 485

11 Turner’s syndrome 488

12 Klinefelter’s syndrome/hypogonadism 490

13 Bitemporal hemianopia 494

14 Diabetic foot/Charcot’s joint 495

15 Necrobiosis lipoidica diabeticorum 496

16 Short stature 497

17 Pseudohypoparathyroidism 499

18 Pendred’s 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 Laurence–Moon–Bardet–Biedl syndrome 535

20 Cytomegalovirus choroidoretinitis (AIDS) 537

21 Normal fundus 540

Station 5 Other 541

1 Bilateral parotid enlargement/Mikulicz’s syndrome 542

2 Deep venous thrombosis (DVT)/Baker’s cyst/cellulitis 543

3 Peripheral vascular disease 546

4 Osteogenesis imperfecta 548

5 Down’s syndrome 549

6 Pernicious anaemia 550

7 Klippel–Feil syndrome 552

8 Leg oedema 554

Appendices 557

1 Checklists 559

2 Examination frequency of MRCP PACES short cases 563

3 Texidor’s twinge and related matters 567

4 Abbreviations 569

Index 572