Preparation for MRCP PACES 1/2007

The first patient we saw yesterday had a problem with his hands.
The first step was to through examination of the hands with emphasis on the locomotor system.
We stressed the importance of examining function, as the diagnosis was easily made on inspection alone.
The patient had easily identified rheumatoid deformity of the hands with ulnar deviation at the metacarpophalangeal joints. There was no evidence of active disease. He had quite marked loss of function and was unable to move his interphalangeal joints, metacarpophalangeal joints, make a fist or place his hands in the prayer position or reversed prayer position. Simple activities such as lifting a cup to his lips or unbuttoning his shirt were also impaired.
The diagnosis was inactive, deforming rheumatoid arthritis of the hands and wrists with marked functional impairment.
The second patient had a respiratory problem and we concentrated on getting examination technique right and teaching the system.
The patient was thin, had marked clubbing, pectum carinatum, decreased cardiac and liver dullness on percussion and coarse crepitations at the bases. He had a productive cough.
Diagnosis bronchiectasis
He told us that he had whooping cough as a child hence we were able to deduce the probable aetiology