PACES Channel (HELPING HANDS MEDICAL EDUCATION CENTRE)

What are important legal issues when we deal with an incompetent patient (eg, confused or unconscious or severe dementia)?

These are scratch marks. We need to search medical conditions that can cause itchiness.

What are these skin lesions in front of neck and chest? What would be possible underlying medical conditions?

This is AV fistula site infection, commonly appeared scenario in PACES exam. Common organism - Staphylococcus Need to assess >>>Signs of inf - redness, swelling, warmth, tenderness, discharge >>>functioning or not - check thrill, bruit >>>fluid overload and uraemic symptoms >>>Signs of septicemia, shock and DIC - vital signs including Temperature, bleeding manifestations >>> ask frequency of dialysis, last dialysis and when will next time dialysis due Management Investigations CBC - neutrophil leucocutosis ESR, CRP Blood C&S Wound swab C&S if overlying skin break Doppler USG of AVF site - latency and flow PT/INR APTT Ddimer Fibronogen if DIC suspected Electrolytes and renal function Liver function tests Treatment IV Antibiotic to cover Staph eg IV flucloxacillin, IV vancomycin, IV linezolid Cannot use infected AVF for dialysis so arrange for emergency CVC insertion for continuing dialysis Involved nephrologist, vascular surgeon, infectious specialist, ICU specialist if necessary

What is your diagnosis? How will you manage?

Diet 2/2024 Question collections

FYI Diet 3/2024 can be applied between 17th June and 24th June.

When we encounter endocrine cases (eg Cushing, thyroid), rheumato cases (eg systemic sclerosis, Ankylosing spondylitis), and others (eg Marfan's S), It is important to approach the case to be able to identify -reasons of main presenting complaints -features of specific situations -complications and associations

Complications and associations - Hypertension, Hyperglycaemia - CVD risks - Obstructive sleep apnoea - Carpel tunnel S - increased risk of CA colon - mass effects - increased ICP and HA, Bitemporal hemianopia

This is acromegalic face.

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What is spot diagnosis? What complications and associations would you like to look for?

Diet 2-2024 Q

Try to ask salient points to differentiate them within short time. Acne and hirsutism + >>Cushing ... central obesity, stretch mark, abN fat deposition, proximal myopathy, easy bruising, steroid use >>PCOS ... menstrual irregularity Facial appearance change and shoe size change + >>Acromegaly ... HA, sweating, skin tag, snoring, hand pain, vision changes