Neuroimaging quiz

This 45 years old man presented with a complex partial seizure. What does the MRI scan show and what is the diagnosis ?

MRCP PACES reader !

Dear MRCP/Medical Student readers of this blog,

Thank you for following this blog. It is dedicated to all of you. The short case examination can cause you to have tachycardia during the examination and can also be fun if you have prepared well for it. It is a game and to see how well you play it.......

This year, I have got good news and not so good news. I will start with the not so good news. The not so good news is that I would not be able to organize the 5th MRCP Preparatory Course in Penang this year. I am not sure if anyone else is organizing it.

The good news is that I have compiled the cases in pictorial format into 2 books

1) PACING THE PACES - More than 300 over pages of diagrams, photos including cases of histories and communication skills. High quality paper and notes which is easy to read.

2) The Medical Short Case : An Examination Guide - More than 200 pages with approach and cases. No history or communication skills chapter in the book.

As the preorder for the book, we are selling the books :

Book 1 - RM50/book (excluding postage)

Book 2 - RM35/book (excluding postage)

Total for 2 books RM85 (excluding postage). If you are interested, please email me at thienthienlim@gmail.com to make orders before the price hike. The price is limited to residents in Malaysia only.

If you have finished reading the books, I am sure you will be able to approach the cases well and it will turn out to be a lot of fun.

Rash

What is shown in the picture ?

How would you examine this patient ?

Hand Quiz

This patient presented with epistaxis. Please examine the hands.

What is shown in the picture above ?

What else would you examine ?

What are the associated clinical manifestations ?

What is the diagnosis ?

What is the most likely cause for the epistaxis ?

What are the investigations ?

Outline the management.

Get the latest copy of PACING THE PACES. While stocks last. For more info, please email thienthienlim@gmail.com

The new awaited PACING THE PACES book.......

This book is created for those taking the final year medical student exam and the MRCP PACES exam. Focus on short cases and also history taking and communication station. Also has experiences of PACES candidates...

A must buy book with lots of algorithms and coloured pictures....

The past 4 years of the Penang MRCP PACES course (2007-2010) and more :)

If interested, pls email me at thienthienlim@gmail.com

Station 4 PACES - Break bad news

How a Physician should Break Bad News to a Patient

(Adapted from Ptacekm Eberhardt, 1996), AAN Guideline Summary for Clinicians

Location

• Quiet , comfortable and private

Structure

• In person, face to face
• Convenient time
• Enough time to ensure no rushing or interruptions
• Make eye contact and sit close to patient

Participants

• Have patient's support network available

What is said

• Find out what the patient already knows about the condition
• Ascertain how much the patient wants to know about the disease
• Give a warning comment that bad news is coming
• Acknowledge and explore patient's reaction and allow for emotional expression
• Summarize the discussion verbally, in writing and/or audiotape
• Allow for questions

Reassurance

• Explain whether the complications of the disease are treatable
• Indicate that every attempt will be made to maintain function and patient's decision will be respected
• Reassure that care for the patient will continue
• Discuss opportunities to participate in research treatment protocols
• Acknowledge willingness to get a second opinion if the patient wishes

How it is said

• Emotional manner : warmth, caring, empathy, respect
• Give news at person's pace; allow patient to dictate what he or she is told

Language

• Simple words, yet direct; no euphemisms or medical jargon

Spot diagnosis

This patient is in Station 3. What is shown and what is in your mind ?