[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 has attended A&E with non-specific chest pain.  Please assess him.”

[/ultimate_heading][vc_empty_space image_repeat=”no-repeat”][vc_video link=”https://vimeo.com/149509056″][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=”8″ 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=”2″ 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 Marfan syndrome.

The clinical signs exhibited in this video include:

  • Long fingers and toes;
  • Tall stature;
  • High arched palate.

[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Discussion”][vc_column_text]This patient has Marfan syndrome which has the following clinical features:

  • Disproportionately long limbs (including the fingers and toes) with a decreased upper-to-lower body segment ratio
  • High arched palate
  • Scoliosis
  • Pectus excavatum or pectus carinatum
  • Ectopia lentis
  • Dilation of the aortic root which leads to aortic regurgitation
  • Aneurysm or dissection of the aorta
  • Striae of the skin
  • Dural ectasia

Dolichostenomelia is the presence of unusually long limbs.

Marfan’s syndrome is a genetic disorder of the connective tissue caused by mutation in the Fibrillin-1 gene that encodes for a glycoprotein Fibrillin. It presents with structural defects involving the eyes, heart, valves, aorta and skeletal system. Patients are extraordinary tall, thin with long limbs and fingers and hyper mobile joints.  The criterion used for diagnosis in adults is called Ghent criteria. Eye features include lens dislocation and subluxation presenting with blurred vision or visual loss and myopia. Cardiac defects include mitral valve prolapse which presents with holosystolic murmur, aortic aneurysm and aortic regurgitation. The most life-threatening complication is aortic dissection which is a surgical emergency. There is no specific management, however treatment should be given according to the symptoms and regular checkups should be done to look for complications. Cardiac symptoms should be controlled with beta blockers, ACE inhibitors or ARBs.[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Specimen case presentation”][vc_column_text]”This patient has Marfan syndrome.  He is tall with a high arched palate and arachnodactyly.”[/vc_column_text][/vc_accordion_tab][/vc_accordion][/vc_column][/vc_row]