Preface to the second edition ix
Preface to the first edition xi
Introduction xiii
Section 1: Preparation 1
Section 2: Examination Routines 7
1 Heart 10
2 Abdomen 14
3 Fundi 18
4 Hands 20
5 Legs 24
6 Chest 28
7 Spot diagnosis 31
8 Eyes 35
9 Face 37
10 Arms 38
11 Neck 42
12 Ask questions 43
13 Pulse 46
14 Visual fields 48
15 Skin 49
16 Gait 51
17 Rash 53
18 Legs and arms 54
19 Cranial nerves 55
20 Thyroid status 58
Section 3: 200 Short Case Records 61
1 Diabetic retinopathy 65
2 Hepatosplenomegaly 69
3 Mitral stenosis (lone) 71
4 Rheumatoid hands 73
5 Mixed mitral valve disease 76
6 Dullness at the lung base 78
7 Splenomegaly (without hepatomegaly) 80
8 Optic atrophy 82
9 Chronic liver disease 84
10 Polycystic kidneys 86
11 Paget’s disease 87
12 Psoriatic arthropathy/psoriasis 90
13 Other combinations of mitral and aortic valve disease 93
14 Mixed aortic valve disease 94
15 Systemic sclerosis/CRST syndrome 96
16 Exophthalmos 98
17 Hepatomegaly (without splenomegaly) 101
18 Spastic paraparesis 102
19 Fibrosing alveolitis 103
20 Aortic incompetence (lone) 104
21 Hemiplegia 106
22 Old tuberculosis 108
23 Acromegaly 109
24 Aortic stenosis (lone) 112
25 Graves’ disease 114
26 Ocular palsy 117
27 Mitral incompetence (lone) 121
28 Motor neurone disease 123
29 Goitre 126
30 Ulnar nerve palsy 129
31 Visual field defect 131
32 Peripheral neuropathy 134
33 Hypertensive retinopathy 136
34 Resuscitation Annie 138
35 Cerebellar syndrome 142
36 Retinitis pigmentosa 144
37 Carcinoma of the bronchus 145
38 Parkinson’s disease 148
39 Chronic bronchitis and emphysema 150
40 Hypothyroidism 152
41 Osler–Weber–Rendu syndrome 155
42 Abdominal mass 157
43 Dystrophia myotonica 159
44 Bronchiectasis 161
45 Wasting of the small muscles of the hand 162
46 Generalized lymphadenopathy 165
47 Papilloedema 166
48 Diabetic foot 168
49 Nystagmus 171
50 Old choroiditis 174
51 Neurofibromatosis (von Recklinghausen’s disease) 176
52 Erythema nodosum 178
53 Horner’s syndrome 180
54 Old polio 182
55 Ankylosing spondylitis 184
56 Abnormal gait 186
57 Irregular pulse 189
58 Single palpable kidney 190
59 Ascites 191
60 Sturge–Weber syndrome 193
61 Necrobiosis lipoidica diabeticorum 195
62 Ventricular septal defect 197
63 Lower motor neurone VIIth nerve palsy 198
64 Clubbing 201
65 Retinal vein thrombosis 203
66 Eisenmenger’s syndrome 205
67 Crohn’s disease 207
68 Mitral valve prolapse 209
69 Cervical myelopathy 211
70 Patent ductus arteriosus 213
71 Tricuspid incompetence 214
72 Purpura 215
73 Xanthomata 218
74 Drug-induced extrapyramidal syndrome 220
75 Bilateral parotid enlargement/Mikulicz’s syndrome 221
76 Primary biliary cirrhosis 222
77 Lupus pernio 224
78 Muscular dystrophy 226
79 Prosthetic valves 228
80 Addison’s disease 229
81 Cushing’s syndrome 231
82 Friedreich’s ataxia 234
83 Peutz–Jeghers syndrome 236
84 Systemic lupus erythematosus 237
85 Superior vena cava obstruction 239
86 Vasculitis 241
87 Deep venous thrombosis/Baker’s cyst/cellulitis 244
88 Cor pulmonale 247
89 Myelinated nerve fibres 248
90 Charcot–Marie–Tooth disease 249
91 Cataracts 251
92 Idiopathic haemochromatosis 253
93 Chest infection/consolidation/pneumonia 255
94 Coarctation of the aorta 256
95 Bulbar palsy 257
96 Choreoathetosis 258
97 Dysarthria 260
98 Dysphasia 261
99 Ehlers–Danlos syndrome 263
100 Erythema ab igne 265
101 Marfan’s syndrome 267
102 Myasthenia gravis 269
103 Osteoarthrosis 272
104 Raised jugular venous pressure 274
105 Pretibial myxoedema 275
106 Retinal artery occlusion 277
107 Vitiligo 279
108 Tophaceous gout 282
109 Fallot’s tetralogy with a Blalock shunt 284
110 Slow pulse 285
111 Guillain–Barre syndrome (acute inflammatory demyelinating polyradiculopathy) 286
112 Pneumonectomy/lobectomy 288
113 Obesity/pickwickian syndrome 290
114 Dermatomyositis 293
115 Hypopituitarism 295
116 Swollen knee 297
117 Pseudobulbar palsy 299
118 Pemphigus/pemphigoid 300
119 Syringomyelia 303
120 Tuberculosis/apical consolidation 305
121 Rheumatoid lung 307
122 Tuberous sclerosis/adenoma sebaceum 308
123 Proximal myopathy 310
124 Pseudoxanthoma elasticum 311
125 Radiation burn on the chest 313
126 Subacute combined degeneration of the cord 314
127 Holmes–Adie–Moore syndrome 315
128 Peripheral vascular disease 316
129 Transplanted kidney 318
130 Glaucoma/peripheral field loss 320
131 Nephrotic syndrome 322
132 Jugular foramen syndrome 323
133 Herpes zoster 325
134 Henoch–Schonlein purpura 327
135 Polymyositis 329
136 Argyll Robertson pupils 330
137 Congenital syphilis 331
138 Carpal tunnel syndrome 333
139 Cerebellopontine angle lesion 335
140 Dextrocardia 336
141 Down’s syndrome 337
142 Gynaecomastia 338
143 Absent ankle jerks and extensor plantars 340
144 Lichen planus 341
145 Lateral popliteal (common peroneal) nerve palsy 343
146 Ptosis 345
147 Osteogenesis imperfecta 348
148 Pulmonary stenosis 349
149 Raynaud’s phenomenon 350
150 Turner’s syndrome 352
151 Mycosis fungoides 354
152 Morphoea 356
153 Laurence–Moon–Bardet–Biedl syndrome 358
154 Short stature 360
155 Pseudohypoparathyroidism 362
156 AIDS related 365
157 Porphyria 368
158 Lupus vulgaris 370
159 Cannon waves 372
160 Polycythaemia rubra vera 373
161 Asteroid hyalosis 374
162 Pernicious anaemia 375
163 Dermatitis herpetiformis 377
164 Urticaria pigmentosa (mastocytosis) 379
165 Pneumothorax 380
166 Tabes 381
167 Tylosis 383
168 Klippel–Feil syndrome 385
169 Pendred’s syndrome 387
170 Secondary syphilis 389
171 Ectodermal dysplasia 391
172 Old rickets 393
173 Partial lipodystrophy 395
174 Fabry’s disease 397
175 Subclavian-steal syndrome 399
176 Reiter’s syndrome/keratoderma blenorrhagica 401
177 Carcinoid syndrome 403
178 Infantile hemiplegia 404
179 Pulmonary incompetence 406
180 Hereditary spherocytosis 408
181 Juvenile chronic arthritis 409
182 Cystic fibrosis 411
183 Infective endocarditis 413
184 Malignant melanoma 415
185 Leg oedema 417
186 Acanthosis nigricans 419
187 Drusen 422
188 Yellow nail syndrome 423
189 Klinefelter’s syndrome/hypogonadism 424
190 Keratoacanthoma 428
191 Thalamic syndrome 429
192 Atrial septal defect 430
193 Pyoderma gangrenosum 431
194 Multiple sclerosis 433
195 Felty’s syndrome 435
196 Hypertrophic obstructive cardiomyopathy 436
197 Radial nerve palsy 437
198 Lateral medullary syndrome (Wallenberg’s syndrome) 438
199 Psychogenic/factitious 440
200 Normal 444
Section 4: Experiences Anecdotes
Tips Facts and Figures Quotations 445
Experiences 447
The power and range of the candidate’s observations 449
The candidate’s examination technique 451
The clinical competence of the candidate 453
Common errors 454
Look first 455
Double pathology 456
Tell them of the expert that told you 456
Apologies accepted 457
‘Even though I didn’t mean to say it—I did’ 457
Invigilator’s diaries 458
Fly on the wall—complete accounts 460
Ungentlemanly clinical methods 466
Some experiences written in the first person 466
Miscellaneous ‘pass’ experiences 467
You never know you’ve failed until the list is published 479
Survivors of the storm 483
Some ‘fail’ experiences 486
Downward spirals 491
Anecdotes 493
Some anecdotes in the first person 498
Useful tips 501
Facts and figures 502
Quotations 503
Adopt good bedside manners 503
Practise clinical examination and presentation 504
Get it right 505
Listen obey and do not stray 505
One wrong does not make one fail 506
If you say less they want more 506
If you know it—say it 506
Humility is more persuasive than self-righteousness 507
Keep cool: agitation generates aggression 507
Simple explanations raise simple questions 507
Think straight look smart and speak convincingly 508
You have seen it all before 508
Use your eyes first and most 508
Doing and forgetting 509
Examiners are different 509
Appendices 511
1 Checklists 513
2 Examination frequency of MRCP short cases 517
3 Examination frequency of examiners’ instructions 522
4 Pocket Snellen’s chart 524
5 Texidor’s twinge and related matters 525
6 Colour photographs of some MRCP short cases 527
7 Detailed contents of Section 4 544
Index 547
