PACES Channel (HELPING HANDS MEDICAL EDUCATION CENTRE)

1. Bilat thenar muscle wasting 2. Dx - Bilateral median nerve palsy most probably bilat carpel tunnel S 3. PE >>Median nerve function testing - pen touching test, finger opposition (distal thumb flexion, wrist flexion, forearm pronation to differentiate proximal lesion from carpel tunnel S) >>Sensory examination >>If CTS - Tinnel's sign, Phalen's sign look for underlying causes 4. Etiologies of CTS (please check in photo below)

Thank you so much for your answers. 😊

What abnormality have you noted? What is your diagnosis? What physical examination will you do? What are possible etiologies?

So, to apply for exam scenarios, it is difficult for a normal doctor to mention a single time frame for air travel restriction for pilot. Just explained that he is not fit to fly now as a pilot and he need to inform to CAA & need assessment by aviation doctor for fittness for medical certificate.

This is duration of air travel restriction for pilot.

For Pilot who is most important person for the safety of all people on plane, Rule is Different. To understand better, we need to know general idea of qualification of pilot. To be a pilot in commercial airline, it is necessary to have both pilot license and medical certificate. Pilot license issued from CAA - Civil Aviation Authority. Aviation medical examiner or Aviation doctor or Aero doctor assess pilot for medical certificate.

Air passenger - safe to take flight after 2 wk of resolution of pneumothorax

Thank you so much for the answers.

Any ideas for question 2 ??

1. Bulbar palsy refers to bilateral impairment of function of the lower cranial nerves IX, X, XI and XII resulting in weakness of oropharyngeal muscles and tongue. 2. Causes - (see in photo) 3. Most important part is patients don't have safe swallowing so need other artificial means of nutrition - NGT for short term and PEG tube for long term

FYI 2024 Diet1 PACES exam application opens from 9 Oct to 16 Oct.

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QUESTION TIME !!! Question 2 1. How long do we need to wait for safe air travel after pneumothorax? 2. Is there any difference in timing for pilot to restart flying after pneumothorax?

QUESTION TIME !!! Question 1 1. What is bulbar palsy? 2. What are causes of bulbar palsy? 3. What is the most important part of management?

Scapula winging >>>Why occur? due to weakness of MUSCLES that stabilize scapula or damage of NERVES that supply these muscles >>>What muscles and nerves are involved? 1 Serratus anterior muscles (main) - supplied by long thoracic nerve 2. Trapezius muscle - supplied by spinal accessory nerve (CN XI) 3. Rhomboid muscle - supplied by dorsal scapula nerve >>>How many types of scapula winging? MEDIAL Vs LATERAL Medial - serratus anterior muscles Lateral - Trapezius and rhomboid muscles UNILATERAL Vs BILATERAL Unilateral - local cause of muscle and nerve problem Bilateral - systemic diseases that affect shoulde girdle muscles like - Muscular dystrophy (facioscapulohumeral MD and limb girdle MD) - Spinal muscular atrophy (Scapuloparoneal SMA) (***For PACES exam - systemic diseases that cause bilateral scapula winging are more important) Thanks for your interest! 😊

The obvious abnormality is scapula winging - bilateral in Photo 1 and unilateral in Photo 2.