Monday, April 27, 2009

Parkinson Disease

Picture taken from

For those taking MRCP PArt 1 Ireland (True of False)

The following increases the risk of Parkinson disease
A. Tea
B. Smoking
C. Coffee
D. Low socioeconomic status
E. Physical inactivity

Excellent Neurology book

Congratulations to Dr. Eow and Dr. Samuel for coming out with this excellent book with colours and lots of algorithm with facts for the MRCP candidates, medical students and trainees of Neurology. A 393 pages book.
If there is anyone who is interested, feel free to contact me at

Saturday, April 25, 2009

Spinocerebellar Ataxia

Just a stimulus to all inspired doctors, physicians and neurologists. A very touching video from youtube on spinocerebellar ataxia.
A reminder to those sitting for the next PACES exam. If you see a young man or lady with cerebellar signs and pyramidal signs, always think of 
1) Spinocerebellar ataxia
2) Multiple sclerosis - transverse myelitis with cerebellar involvement (classical MS)
3) Friedrich's ataxia

Friday, April 24, 2009

ECG Quiz

This is a 34 years old man who was admitted with a syncopal attack. ECG shows the above. What is the diagnosis and what would you do next.

This question recently came out in the MRCP PACES exam Part IIa.

Saturday, April 11, 2009

Rheumatology/Endocrine quiz

Would anyone want to comment on these photos which I took of a boy when I was working in Casualty?

Friday, April 10, 2009


This patient has areas of depigmentation around the mouth, the upper limb, legs and trunk. He has vilitigo.

Vitiligo affects 1% of the population. Equal between males and females, although more females present to the skin clinic. Family history in 1/3 of patients.
They have Koebner's phenomenon - lesion appearing on the site of lesion.
When you see a patient like this, look for other features of autoimmune

Thyroid disorder - Hashimoto's thyroiditis, Graves' disease
Pallor - Pernicious anaemia
Pigmentation of buccal, skin crease, hypotension - Addison's disease
Tetany, cramps, paraesthesia, Chvostek's and Trousseau's sign - Idiopathic hypoparathyroidism
Fundus - diabetes mellitus
Lungs (fine crepts) - Fibrosing alveolitis
Jaundice - Chronic active hepatitis
Excoriation marks, xanthalesma, pigmentation - primary biliary cirrhosis
rash, arthritis, prox weakness - SLE, RA, dermatomyositis, polymyositis

Look out for polyglandular autoimmune disease
What are the 2 types ?

Tuesday, April 7, 2009

Skin Quiz

This gentleman complaints of this rash over the face.

Describe the rash.

What is the most likely cause.

What investigation would you do ?

What one question would you ask this patient ?

What treatment would you give to this patient ?