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Case ID: 1
Created: 28 Jan 2010

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Station 5 ( New Station):

Your role : You are the medical doctor on call.

Patient name: Mr Ahmad – age 33 years

This gentleman was admitted to seizure.

He was noticed by your house officer to have skin lesion over his face and she mentioned to you about this skin lesion. You were curious about the skin lesion and wanted to assess the lesion.

Your task is to assess the patient’s problems and address any questions or concerns raised by the patient



Since a lot of you are still unsure about the format of new station 5, I hope this case can give you some ideas how this station is being conducted in MRCP PACES. If you are given this case in MRCP PACES station 5, I would get the following history while examining the patient,

arrow1)Briefly describe to me about what happened to him before admission- ask patient to talk about the seizure,

arrow2)How is his seizure control, frequency of attack and medications he is taking,

arrow3)Family history of seizure,

arrow4)His educational background, ( patient might have mental retardation)

However, i always spend one minute asking patient his main concern, in this case, Mr Ahmad might tell you that he notice that his 2 other siblings are also having seizure and he is worried that his children might get seizure as well in future ( He is married with 2 children). Therefore, you have to always address their concern very well. In this case, since Tuberous sclerosis is inherited in an autosomal dominant pattern, you have to briefly explain to him about this!

Some patients with Tuberous sclerosis in the exam might be worried about other issues such as driving licence, pregnancy,side effects of anti-epileptic etc. So the advice for you, be prepared for anything in MRCP PACES!

During your physical examination, examiners might ask you other physical signs associated with Tuberous sclerosis and you might miss subungual fibromas if you just focus on the hand and forget totally about the leg!


Other physical signs include Shagreen patches,Ash-leaf patches and retinal glial hamartomas! Also remember about other associated lesions such as renal angiomyolipomas etc!

Extra points:

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Created: 28 Jan 2010

Interesting Images in Clinical Medicine.



Case History:

    Mr Z is a 65-year old Malay gentleman who has been on desferoxamine treatment for aluminium toxicity. he presented with fever and seizure.MRI brain is done. What is the abnormality you see and what is the probable diagnosis??

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