Clinical picture quiz series has been popular among medical students. With lot of changes in medical education of late, it is still a valuable guidance. In my medical school days, I was very fond of this series and found it very useful in clinical settings and learning. One such picture quiz photo was of a man who had a port wine stain with description of seizure disorder and mental retardation. The answer on the back pages of the book for this quiz was ‘Sturge Weber Syndrome’. We had built up a thorough discussion on this problem among our group.

Sturge Weber Syndrome:

A neurological condition with seizures accompanying a large port wine stain birth mark on the forehead and upper eye lid of one side of the face. The pathology involves loss of nerve cells and calcification of tissue in the cerebral cortex of the brain on the same side. There is accompanying muscle weakness on same side and convulsions on the opposite side of the body. There are developmental delays, mental retardation and glaucoma leading to buphthalmos.

Personal experience while in training:

While working in a psychiatric hospital of Republic of Ireland, I came across a patient with these characteristics whom I spot diagnosed as suffering from Sturge Weber Syndrome. Many a times, when on emergency duty, I was called upon to review and manage the patient. He had marked similarity to the picture I saw as a medical student.

Experience of a colleague appearing in MRCPsych examination:

I along with four other colleagues was sitting the membership examination in that year. We all had to go to different hospitals in the United Kingdom for clinical examination. When we returned to our base, we sat and discussed each others’ exam experience. One of our colleagues was very upset with his experience. According to him, the case was very difficult; he had a stain on forehead and appeared mentally retarded as was evident by the history. Because of the fact that the candidate was not aware of this clinical condition, it was difficult to sail smoothly during the process of that clinical examination. I took my colleague to that department/unit where my favourite patient was admitted. At the first look my colleague screamed “That patient looked similar”. He then realized the mistake that why he was so careless in ignoring this patient in terms of diagnosis and management.

Such presentations are not seen very often especially in psychiatric units. Moreover, in those days, cases like Major Depression, Bipolar Disorder and Schizophrenia etc. became part of clinical examination. Cases like the one encountered in the examination are rarely selected unless they have significant psychiatric morbidity. Having said this, it seems appropriate for the candidate to remain prepared for such situations.

Message:

It is important to have a sound knowledge in psychiatry and psychiatric aspects of neurology in order to perform the best in examinations. Learning through picture quiz is a good method as its visual impact can enhance learning from a psychological point of view.