[vc_row row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” oblique_section=”no” text_align=”left” css_animation=””][vc_column][ultimate_heading main_heading=”Candidate brief” main_heading_color=”#000000″ sub_heading_color=”#000000″ main_heading_style=”font-weight:bold;” main_heading_font_size=”desktop:36px;”]

“This patient recently had a pleural effusion drained on the ward and has come down to your clinic for assessment.  Please examine their respiratory system and discuss your findings with the examiners.”

[/ultimate_heading][vc_empty_space image_repeat=”no-repeat”][vc_video link=”https://vimeo.com/154699958″][vc_empty_space image_repeat=”no-repeat”][vc_row_inner row_type=”row” type=”full_width” use_row_as_full_screen_section_slide=”no” text_align=”left” css_animation=””][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Station Time” counter_value=”20″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Time for this encounter” counter_value=”10″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Maximum time to examine your patient” counter_value=”6″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Minimum time for discussion and questions” counter_value=”4″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][/vc_row_inner][vc_empty_space image_repeat=”no-repeat”][/vc_column][/vc_row][vc_row row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” oblique_section=”no” text_align=”left” css_animation=””][vc_column][vc_accordion style=”accordion”][vc_accordion_tab title=”Common examiner questions”][vc_column_text]Common examiner questions include the following:

  1. What do you think this patient has?
  2. How would you like to investigate this patient next?
  3. What do you think the underlying cause of this patient’s signs is?

[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Diagnosis and clinical signs”][vc_column_text]This patient has Yellow Nail Syndrome.

The clinical signs exhibited in this video include:

  1. Bibasal bronchiectasis;
  2. Yellowing and onycholysis of the toenails.

The candidate brief also indicates that he has recently had a pleural effusion drained, a common complication of YNS.[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Discussion”][vc_column_text]In this case it is possible to attempt a diagnosis of Yellow Nail Syndrome based on the report of a recently tapped pleural effusion (described in the candidate brief) and the observation of yellowing of the toenails with onycholysis.  The finding of bronchiectasis is certainly consistent with this diagnosis.

The final element of yellow nail syndrome that is not depicted here is lymphoedema, usually of the legs.  This is typically present in around 80% of patients with YNS.

YNS is of unknown aetiology.  It is also very rare, but has been described in PACES exams, partly owing to a small number of enthusiastic patients keen to share their story with training doctors.

It is characterised by the triad of:

  1. Yellow nails
  2. Pleural effusions (or even frank chylothorax);
  3. Lymphoedema.

Not all three features are required for a diagnosis, which is made clinically.[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Specimen case presentation”][vc_column_text]”This patient has recently had a pleural effusion drained and I can hear sounds in keeping with lower zone bronchiectasis.  In addition he has yellowing of his toenails with onycholysis.  Together, these findings are in keeping with Yellow Nail Syndrome.”[/vc_column_text][/vc_accordion_tab][/vc_accordion][/vc_column][/vc_row][vc_row row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” oblique_section=”no” text_align=”left” css_animation=””][vc_column][/vc_column][/vc_row]