Aid to the MRCP Short Cases

Robert E. J. Ryder is the author of An Aid to the MRCP Short Cases, 2nd Edition, published by Wiley. M. Afzal Mir is the author of An Aid to the MRCP Short Cases, 2nd Edition, published by Wiley.

• Preface to the second edition ixPreface to the first edition xiIntroduction xiiiSection 1: Preparation 1Section 2: Examination Routines 71 Heart 102 Abdomen 143 Fundi 184 Hands 205 Legs 246 Chest 287 Spot diagnosis 318 Eyes 359 Face 3710 Arms 3811 Neck 4212 Ask questions 4313 Pulse 4614 Visual fields 4815 Skin 4916 Gait 5117 Rash 5318 Legs and arms 5419 Cranial nerves 5520 Thyroid status 58Section 3: 200 Short Case Records 611 Diabetic retinopathy 652 Hepatosplenomegaly 693 Mitral stenosis (lone) 714 Rheumatoid hands 735 Mixed mitral valve disease 766 Dullness at the lung base 787 Splenomegaly (without hepatomegaly) 808 Optic atrophy 829 Chronic liver disease 8410 Polycystic kidneys 8611 Paget’s disease 8712 Psoriatic arthropathy/psoriasis 9013 Other combinations of mitral and aortic valve disease 9314 Mixed aortic valve disease 9415 Systemic sclerosis/CRST syndrome 9616 Exophthalmos 9817 Hepatomegaly (without splenomegaly) 10118 Spastic paraparesis 10219 Fibrosing alveolitis 10320 Aortic incompetence (lone) 10421 Hemiplegia 10622 Old tuberculosis 10823 Acromegaly 10924 Aortic stenosis (lone) 11225 Graves’ disease 11426 Ocular palsy 11727 Mitral incompetence (lone) 12128 Motor neurone disease 12329 Goitre 12630 Ulnar nerve palsy 12931 Visual field defect 13132 Peripheral neuropathy 13433 Hypertensive retinopathy 13634 Resuscitation Annie 13835 Cerebellar syndrome 14236 Retinitis pigmentosa 14437 Carcinoma of the bronchus 14538 Parkinson’s disease 14839 Chronic bronchitis and emphysema 15040 Hypothyroidism 15241 Osler–Weber–Rendu syndrome 15542 Abdominal mass 15743 Dystrophia myotonica 15944 Bronchiectasis 16145 Wasting of the small muscles of the hand 16246 Generalized lymphadenopathy 16547 Papilloedema 16648 Diabetic foot 16849 Nystagmus 17150 Old choroiditis 17451 Neurofibromatosis (von Recklinghausen’s disease) 17652 Erythema nodosum 17853 Horner’s syndrome 18054 Old polio 18255 Ankylosing spondylitis 18456 Abnormal gait 18657 Irregular pulse 18958 Single palpable kidney 19059 Ascites 19160 Sturge–Weber syndrome 19361 Necrobiosis lipoidica diabeticorum 19562 Ventricular septal defect 19763 Lower motor neurone VIIth nerve palsy 19864 Clubbing 20165 Retinal vein thrombosis 20366 Eisenmenger’s syndrome 20567 Crohn’s disease 20768 Mitral valve prolapse 20969 Cervical myelopathy 21170 Patent ductus arteriosus 21371 Tricuspid incompetence 21472 Purpura 21573 Xanthomata 21874 Drug-induced extrapyramidal syndrome 22075 Bilateral parotid enlargement/Mikulicz’s syndrome 22176 Primary biliary cirrhosis 22277 Lupus pernio 22478 Muscular dystrophy 22679 Prosthetic valves 22880 Addison’s disease 22981 Cushing’s syndrome 23182 Friedreich’s ataxia 23483 Peutz–Jeghers syndrome 23684 Systemic lupus erythematosus 23785 Superior vena cava obstruction 23986 Vasculitis 24187 Deep venous thrombosis/Baker’s cyst/cellulitis 24488 Cor pulmonale 24789 Myelinated nerve fibres 24890 Charcot–Marie–Tooth disease 24991 Cataracts 25192 Idiopathic haemochromatosis 25393 Chest infection/consolidation/pneumonia 25594 Coarctation of the aorta 25695 Bulbar palsy 25796 Choreoathetosis 25897 Dysarthria 26098 Dysphasia 26199 Ehlers–Danlos syndrome 263100 Erythema ab igne 265101 Marfan’s syndrome 267102 Myasthenia gravis 269103 Osteoarthrosis 272104 Raised jugular venous pressure 274105 Pretibial myxoedema 275106 Retinal artery occlusion 277107 Vitiligo 279108 Tophaceous gout 282109 Fallot’s tetralogy with a Blalock shunt 284110 Slow pulse 285111 Guillain–Barré syndrome (acute inflammatory demyelinating polyradiculopathy) 286112 Pneumonectomy/lobectomy 288113 Obesity/pickwickian syndrome 290114 Dermatomyositis 293115 Hypopituitarism 295116 Swollen knee 297117 Pseudobulbar palsy 299118 Pemphigus/pemphigoid 300119 Syringomyelia 303120 Tuberculosis/apical consolidation 305121 Rheumatoid lung 307122 Tuberous sclerosis/adenoma sebaceum 308123 Proximal myopathy 310124 Pseudoxanthoma elasticum 311125 Radiation burn on the chest 313126 Subacute combined degeneration of the cord 314127 Holmes–Adie–Moore syndrome 315128 Peripheral vascular disease 316129 Transplanted kidney 318130 Glaucoma/peripheral field loss 320131 Nephrotic syndrome 322132 Jugular foramen syndrome 323133 Herpes zoster 325134 Henoch–Schönlein purpura 327135 Polymyositis 329136 Argyll Robertson pupils 330137 Congenital syphilis 331138 Carpal tunnel syndrome 333139 Cerebellopontine angle lesion 335140 Dextrocardia 336141 Down’s syndrome 337142 Gynaecomastia 338143 Absent ankle jerks and extensor plantars 340144 Lichen planus 341145 Lateral popliteal (common peroneal) nerve palsy 343146 Ptosis 345147 Osteogenesis imperfecta 348148 Pulmonary stenosis 349149 Raynaud’s phenomenon 350150 Turner’s syndrome 352151 Mycosis fungoides 354152 Morphoea 356153 Laurence–Moon–Bardet–Biedl syndrome 358154 Short stature 360155 Pseudohypoparathyroidism 362156 AIDS related 365157 Porphyria 368158 Lupus vulgaris 370159 Cannon waves 372160 Polycythaemia rubra vera 373161 Asteroid hyalosis 374162 Pernicious anaemia 375163 Dermatitis herpetiformis 377164 Urticaria pigmentosa (mastocytosis) 379165 Pneumothorax 380166 Tabes 381167 Tylosis 383168 Klippel–Feil syndrome 385169 Pendred’s syndrome 387170 Secondary syphilis 389171 Ectodermal dysplasia 391172 Old rickets 393173 Partial lipodystrophy 395174 Fabry’s disease 397175 Subclavian-steal syndrome 399176 Reiter’s syndrome/keratoderma blenorrhagica 401177 Carcinoid syndrome 403178 Infantile hemiplegia 404179 Pulmonary incompetence 406180 Hereditary spherocytosis 408181 Juvenile chronic arthritis 409182 Cystic fibrosis 411183 Infective endocarditis 413184 Malignant melanoma 415185 Leg oedema 417186 Acanthosis nigricans 419187 Drusen 422188 Yellow nail syndrome 423189 Klinefelter’s syndrome/hypogonadism 424190 Keratoacanthoma 428191 Thalamic syndrome 429192 Atrial septal defect 430193 Pyoderma gangrenosum 431194 Multiple sclerosis 433195 Felty’s syndrome 435196 Hypertrophic obstructive cardiomyopathy 436197 Radial nerve palsy 437198 Lateral medullary syndrome (Wallenberg’s syndrome) 438199 Psychogenic/factitious 440200 Normal 444Section 4: Experiences AnecdotesTips Facts and Figures Quotations 445Experiences 447The power and range of the candidate’s observations 449The candidate’s examination technique 451The clinical competence of the candidate 453Common errors 454Look first 455Double pathology 456Tell them of the expert that told you 456Apologies accepted 457‘Even though I didn’t mean to say it—I did’ 457Invigilator’s diaries 458Fly on the wall—complete accounts 460Ungentlemanly clinical methods 466Some experiences written in the first person 466Miscellaneous ‘pass’ experiences 467You never know you’ve failed until the list is published 479Survivors of the storm 483Some ‘fail’ experiences 486Downward spirals 491Anecdotes 493Some anecdotes in the first person 498Useful tips 501Facts and figures 502Quotations 503Adopt good bedside manners 503Practise clinical examination and presentation 504Get it right 505Listen obey and do not stray 505One wrong does not make one fail 506If you say less they want more 506If you know it—say it 506Humility is more persuasive than self-righteousness 507Keep cool: agitation generates aggression 507Simple explanations raise simple questions 507Think straight look smart and speak convincingly 508You have seen it all before 508Use your eyes first and most 508Doing and forgetting 509Examiners are different 509Appendices 5111 Checklists 5132 Examination frequency of MRCP short cases 5173 Examination frequency of examiners’ instructions 5224 Pocket Snellen’s chart 5245 Texidor’s twinge and related matters 5256 Colour photographs of some MRCP short cases 5277 Detailed contents of Section 4 544Index 547

"...this is an excellent book, giving good advice on how to become a skilled, thoughtful and knowledgeable physician and hence how to become a MRCP (UK)" Journal of the Royal College of Physicians of London, on the previous edition"The case-by-case approach is useful in preparing for Medicine finals. Together with the examination routines, the book becomes a kind of alternative textbook to conventional clinical examination books such as McCleods."2nd Opinion, The Magazine of the Scottish Medical Schools"...an invaluable companion to undergraduates in medical finals. It is easy to filter out the more obscure cases but this being said, the vast majority of the information is relevant to House Officers-to-be. This book is excellent value for money; the buy is well worth it."Leech Y Gelen, University of Wales College of Medicine Gazette