At one of the UK examination centres an unusual case had been include in the eye station

The patient had Horner’s syndrome

After making the diagnosis of Horner’s syndrome the candidates had been asked to look at the patient’s neck and then they were questioned on the underlying diagnosis

The patient had Klippel-Feil syndrome with syringomyelia

This had been a difficult diagnosis

However if one had followed first principles one may have had a chance

Horner’s syndrome may be due to lesions at various levels (hemisphere, brainstem, cervical cord, chest, neck see ACES for PACES page 489)

Bearing this in mind if one were asked to examine the neck the possibilities are narrowed down to syringomyelia and cord tumours

When examining the neck if one were to stick to first principles and examine structure and function (ACES for PACES chapter 5 page 27) one may have noticed that the neck was short and one may have remembered the association between Klippel-Feil syndrome and syringomyelia (ACES for PACES page 499)