An Aid to the MRCP Short Cases, 2nd Edition

Preface to the second edition ix

Preface to the first edition xi

Introduction xiii

Section 1: Preparation 1

Section 2: Examination Routines 7

1 Heart 10

2 Abdomen 14

3 Fundi 18

4 Hands 20

5 Legs 24

6 Chest 28

7 Spot diagnosis 31

8 Eyes 35

9 Face 37

10 Arms 38

11 Neck 42

12 Ask questions 43

13 Pulse 46

14 Visual fields 48

15 Skin 49

16 Gait 51

17 Rash 53

18 Legs and arms 54

19 Cranial nerves 55

20 Thyroid status 58

Section 3: 200 Short Case Records 61

1 Diabetic retinopathy 65

2 Hepatosplenomegaly 69

3 Mitral stenosis (lone) 71

4 Rheumatoid hands 73

5 Mixed mitral valve disease 76

6 Dullness at the lung base 78

7 Splenomegaly (without hepatomegaly) 80

8 Optic atrophy 82

9 Chronic liver disease 84

10 Polycystic kidneys 86

11 Paget’s disease 87

12 Psoriatic arthropathy/psoriasis 90

13 Other combinations of mitral and aortic valve disease 93

14 Mixed aortic valve disease 94

15 Systemic sclerosis/CRST syndrome 96

16 Exophthalmos 98

17 Hepatomegaly (without splenomegaly) 101

18 Spastic paraparesis 102

19 Fibrosing alveolitis 103

20 Aortic incompetence (lone) 104

21 Hemiplegia 106

22 Old tuberculosis 108

23 Acromegaly 109

24 Aortic stenosis (lone) 112

25 Graves’ disease 114

26 Ocular palsy 117

27 Mitral incompetence (lone) 121

28 Motor neurone disease 123

29 Goitre 126

30 Ulnar nerve palsy 129

31 Visual field defect 131

32 Peripheral neuropathy 134

33 Hypertensive retinopathy 136

34 Resuscitation Annie 138

35 Cerebellar syndrome 142

36 Retinitis pigmentosa 144

37 Carcinoma of the bronchus 145

38 Parkinson’s disease 148

39 Chronic bronchitis and emphysema 150

40 Hypothyroidism 152

41 Osler–Weber–Rendu syndrome 155

42 Abdominal mass 157

43 Dystrophia myotonica 159

44 Bronchiectasis 161

45 Wasting of the small muscles of the hand 162

46 Generalized lymphadenopathy 165

47 Papilloedema 166

48 Diabetic foot 168

49 Nystagmus 171

50 Old choroiditis 174

51 Neurofibromatosis (von Recklinghausen’s disease) 176

52 Erythema nodosum 178

53 Horner’s syndrome 180

54 Old polio 182

55 Ankylosing spondylitis 184

56 Abnormal gait 186

57 Irregular pulse 189

58 Single palpable kidney 190

59 Ascites 191

60 Sturge–Weber syndrome 193

61 Necrobiosis lipoidica diabeticorum 195

62 Ventricular septal defect 197

63 Lower motor neurone VIIth nerve palsy 198

64 Clubbing 201

65 Retinal vein thrombosis 203

66 Eisenmenger’s syndrome 205

67 Crohn’s disease 207

68 Mitral valve prolapse 209

69 Cervical myelopathy 211

70 Patent ductus arteriosus 213

71 Tricuspid incompetence 214

72 Purpura 215

73 Xanthomata 218

74 Drug-induced extrapyramidal syndrome 220

75 Bilateral parotid enlargement/Mikulicz’s syndrome 221

76 Primary biliary cirrhosis 222

77 Lupus pernio 224

78 Muscular dystrophy 226

79 Prosthetic valves 228

80 Addison’s disease 229

81 Cushing’s syndrome 231

82 Friedreich’s ataxia 234

83 Peutz–Jeghers syndrome 236

84 Systemic lupus erythematosus 237

85 Superior vena cava obstruction 239

86 Vasculitis 241

87 Deep venous thrombosis/Baker’s cyst/cellulitis 244

88 Cor pulmonale 247

89 Myelinated nerve fibres 248

90 Charcot–Marie–Tooth disease 249

91 Cataracts 251

92 Idiopathic haemochromatosis 253

93 Chest infection/consolidation/pneumonia 255

94 Coarctation of the aorta 256

95 Bulbar palsy 257

96 Choreoathetosis 258

97 Dysarthria 260

98 Dysphasia 261

99 Ehlers–Danlos syndrome 263

100 Erythema ab igne 265

101 Marfan’s syndrome 267

102 Myasthenia gravis 269

103 Osteoarthrosis 272

104 Raised jugular venous pressure 274

105 Pretibial myxoedema 275

106 Retinal artery occlusion 277

107 Vitiligo 279

108 Tophaceous gout 282

109 Fallot’s tetralogy with a Blalock shunt 284

110 Slow pulse 285

111 Guillain–Barré syndrome (acute inflammatory demyelinating polyradiculopathy) 286

112 Pneumonectomy/lobectomy 288

113 Obesity/pickwickian syndrome 290

114 Dermatomyositis 293

115 Hypopituitarism 295

116 Swollen knee 297

117 Pseudobulbar palsy 299

118 Pemphigus/pemphigoid 300

119 Syringomyelia 303

120 Tuberculosis/apical consolidation 305

121 Rheumatoid lung 307

122 Tuberous sclerosis/adenoma sebaceum 308

123 Proximal myopathy 310

124 Pseudoxanthoma elasticum 311

125 Radiation burn on the chest 313

126 Subacute combined degeneration of the cord 314

127 Holmes–Adie–Moore syndrome 315

128 Peripheral vascular disease 316

129 Transplanted kidney 318

130 Glaucoma/peripheral field loss 320

131 Nephrotic syndrome 322

132 Jugular foramen syndrome 323

133 Herpes zoster 325

134 Henoch–Schönlein purpura 327

135 Polymyositis 329

136 Argyll Robertson pupils 330

137 Congenital syphilis 331

138 Carpal tunnel syndrome 333

139 Cerebellopontine angle lesion 335

140 Dextrocardia 336

141 Down’s syndrome 337

142 Gynaecomastia 338

143 Absent ankle jerks and extensor plantars 340

144 Lichen planus 341

145 Lateral popliteal (common peroneal) nerve palsy 343

146 Ptosis 345

147 Osteogenesis imperfecta 348

148 Pulmonary stenosis 349

149 Raynaud’s phenomenon 350

150 Turner’s syndrome 352

151 Mycosis fungoides 354

152 Morphoea 356

153 Laurence–Moon–Bardet–Biedl syndrome 358

154 Short stature 360

155 Pseudohypoparathyroidism 362

156 AIDS related 365

157 Porphyria 368

158 Lupus vulgaris 370

159 Cannon waves 372

160 Polycythaemia rubra vera 373

161 Asteroid hyalosis 374

162 Pernicious anaemia 375

163 Dermatitis herpetiformis 377

164 Urticaria pigmentosa (mastocytosis) 379

165 Pneumothorax 380

166 Tabes 381

167 Tylosis 383

168 Klippel–Feil syndrome 385

169 Pendred’s syndrome 387

170 Secondary syphilis 389

171 Ectodermal dysplasia 391

172 Old rickets 393

173 Partial lipodystrophy 395

174 Fabry’s disease 397

175 Subclavian-steal syndrome 399

176 Reiter’s syndrome/keratoderma blenorrhagica 401

177 Carcinoid syndrome 403

178 Infantile hemiplegia 404

179 Pulmonary incompetence 406

180 Hereditary spherocytosis 408

181 Juvenile chronic arthritis 409

182 Cystic fibrosis 411

183 Infective endocarditis 413

184 Malignant melanoma 415

185 Leg oedema 417

186 Acanthosis nigricans 419

187 Drusen 422

188 Yellow nail syndrome 423

189 Klinefelter’s syndrome/hypogonadism 424

190 Keratoacanthoma 428

191 Thalamic syndrome 429

192 Atrial septal defect 430

193 Pyoderma gangrenosum 431

194 Multiple sclerosis 433

195 Felty’s syndrome 435

196 Hypertrophic obstructive cardiomyopathy 436

197 Radial nerve palsy 437

198 Lateral medullary syndrome (Wallenberg’s syndrome) 438

199 Psychogenic/factitious 440

200 Normal 444

Section 4: Experiences Anecdotes

Tips Facts and Figures Quotations 445

Experiences 447

The power and range of the candidate’s observations 449

The candidate’s examination technique 451

The clinical competence of the candidate 453

Common errors 454

Look first 455

Double pathology 456

Tell them of the expert that told you 456

Apologies accepted 457

‘Even though I didn’t mean to say it—I did’ 457

Invigilator’s diaries 458

Fly on the wall—complete accounts 460

Ungentlemanly clinical methods 466

Some experiences written in the first person 466

Miscellaneous ‘pass’ experiences 467

You never know you’ve failed until the list is published 479

Survivors of the storm 483

Some ‘fail’ experiences 486

Downward spirals 491

Anecdotes 493

Some anecdotes in the first person 498

Useful tips 501

Facts and figures 502

Quotations 503

Adopt good bedside manners 503

Practise clinical examination and presentation 504

Get it right 505

Listen obey and do not stray 505

One wrong does not make one fail 506

If you say less they want more 506

If you know it—say it 506

Humility is more persuasive than self-righteousness 507

Keep cool: agitation generates aggression 507

Simple explanations raise simple questions 507

Think straight look smart and speak convincingly 508

You have seen it all before 508

Use your eyes first and most 508

Doing and forgetting 509

Examiners are different 509

Appendices 511

1 Checklists 513

2 Examination frequency of MRCP short cases 517

3 Examination frequency of examiners’ instructions 522

4 Pocket Snellen’s chart 524

5 Texidor’s twinge and related matters 525

6 Colour photographs of some MRCP short cases 527

7 Detailed contents of Section 4 544

Index 547