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ROYAL COLLEGES OF PHYSICIANS OF THE UNITED KINGDOM

MRCP (UK) Part 2 Clinical Examination (PACES)Examiners Calibration Record

STATION THREE: Neurological Examination

Each examiner should record agreed physical signs and case specific marking criteria for each clinical skill assessed anduse the record as a personal aide-memoire during the subsequent cycle.

Examiner Number 1234 Examination Centre Number 5678

Patient Name Mr Hamilton

Physical signs agreed to be present

1 Reduced fine touch and pain sensation below the level of the knees

2 Knee jerks present

3 Ankle jerks absent

4

What performance criteria have you agreed?

Clinical Skill Marking criteria

Physical Examination (A)Maintaining Patient Welfare (G)

See marksheetSee marksheet

Identifying Physical Signs (B) What physical signs should a satisfactory candidatedetect?

Those of a peripheral neuropathy

Reduced fine touch and pain sensation below the

level of the kneesKnee jerks present

Ankle jerks absent

Differential Diagnosis (D) What diagnoses should a satisfactory candidateconsider?

Peripheral neuropathy due to diabetes mellitus,

alcohol.

Vitamin B12 or folate deficiency less likely

Clinical Judgement (E) What key steps in management should asatisfactory candidate consider?

Ix : Glucose; HbA1c; B12, folate, MCV?

Rx : Gabapentin/Carbamazepine/TCAD

Tight glycaemic control

Foot care