pace your MRCP-PACES

*IMPORTANT 60* *Some info about Tracheal Tug* In simple words Tracheal tug is the inferior movement of trachea during inspiration which can be felt by resting the fingers on trachea and asking the patient to take deep breaths. Be careful not to pinch deep in the neck of patient. A tracheal tug indicates the presence of significant lung fibrosis or severe airflow obstruction. Oliver's sign is an abnormal downward movement of the trachea during systole that can indicate a dilation or aneurysm of the aortic arch. PaceUrMRCP.

*IMPORTANT 59* *Some info about vasovagal syncope and driving* People having vasovagal syncope and *type 1 license can drive* until and unless they are able to recognize and avoid triggers. People having vasovagal syncope and *type 2 license must stop driving* and inform DVLA. Please note that this info is about vasovagal syncope occuring while standing, which is by far more common in PACES. PaceUrMRCP.

*IMPORTANT 58* Please remember While *inspecting the FACE in respiratory system* Never miss to look for these 1.signs of Horner’s syndrome 2.conjunctival pallor, 3.central cyanosis (please ask patient to stick out tongue), 4.pursed lip breathing PaceUrMRCP.

*IMPORTANT 57* Please remember While *examining for Trachea in respiratory system* Never forget these steps 1. Feel in sternal notch for deviation 2.Assess cricosternal distance in finger-breadths 3. feel for tracheal tug PaceUrMRCP.

*IMPORTANT 56* Please remember *NEPHROLOGIST* might be considered as a Jargon by some of the examiners so be careful while using it in exam and always say *KIDNEY SPECIALIST* to your patient PaceUrMRCP.

*IMPORTANT 55* *In examination of respiratory system* *Inspect the hands for* Tobacco staining , peripheral cyanosis, clubbing,asterixis ( Ask the patient to hold their hands out and cock their wrists back ) signs of systemic disease (systemic sclerosis, rheumatoid arthritis) PaceUrMRCP.

*IMPORTANT 54* *Headache in Acromegaly* Can be due to 1. Pituitary adenoma per se 2. Obstructive sleep apnea. A detiled history specially aggrevating factors will help to demarcate both types of pain. Also vision involvement in history and examination will further clarify. PaceUrMRCP.

*IMPORTANT 53* How to explain *OPACITY IN THE LUNG* in station 4 Always say that you have *abnormal shadow or abnormal finding* in your x ray to your patient PaceUrMRCP.

*IMPORTANT 52* Please remember that *PAIN and TRAUMA are twins* , so always ask them together to your patients in station 2 and 5. PaceUrMRCP.

*✌✌ HEARTIEST CONGRATULATIONS ✌✌* To *Dr Izza* For passing MRCP UK Part 2 Written. We wish her the best for her future.

*✌✌ HEARTIEST CONGRATULATIONS ✌✌* To *Dr Irshad Khan* For passing PACES MRCP UK from UK. We wish him the best for his future.

*✌✌ HEARTIEST CONGRATULATIONS ✌✌* To *Dr Umamah* For passing PACES MRCP UK from UK. We wish her the best for her future.

*IMPORTANT 51* *5 A’ approach* endorsed by the British Thoracic Society about cigratte smoking *Ask* about smoking status *Assess* readiness to quit *Advise* to quit *Assist* in efforts to quit *Arrange* follow-up. PaceUrMRCP.

*IMPORTANT 50* *Some info about GOUT, CKD N DIURETICS* Be careful while using diuretics in gout. If diuretics are being used to treat hypertension an alternative hypertensive should be considered, but they should not be stopped in the presence of CHF. They are not absolutely contraindicated in hyperurecemia in CKD but if possible other options should be used. Steroids can be used in case other medicines used for management of acute gout are not safe.But steroids have their own side effect profile. PaceUrMRCP.

*IMPORTANT 49* Please remember *PROGNOSIS* might be considered as a Jargon by some of the examiners so be careful while using it in exam and always say *OUTLOOK/ OUTCOME/ FINAL RESULT OF THE DISEASE* to your patient PaceUrMRCP.

*ANNOUNCEMENT* Hello n salam everyone We are pleased to announce admissions for our *Aug 2023 online course ( 15 days ) for PACES MRCP (UK) new pattern PACES23 and CLINICAL EXAM MRCPI .* We will start from *7th of Aug and finish on 25 Aug* *Active slots available on first come--first served basis.* Listener slot available too. *Atleast 90 Important exam cases ( including recent diets cases ) will be practiced and discussed as we do in our weekly Sunday sessions.* After the performance a detailed feedback will be given to elaborate the weak skills. It is equally beneficial for those who are beginners or have exam in coming diet. Interested candidates may send a personal message for details. WhatsApp No: 00923346036496. Email: drtanzeelbukhari@gmail.com GOOD LUCK.

*ANNOUNCEMENT* Hello n salam everyone We are pleased to announce admissions for our *Aug 2023 online course ( 15 days ) for PACES MRCP (UK) new pattern PACES23 and CLINICAL EXAM MRCPI .* We will start from *7th of Aug and finish on 25 Aug* *Active slots available on first come--first served basis.* Listener slot available too. *Atleast 90 Important exam cases ( including recent diets cases ) will be practiced and discussed as we do in our weekly Sunday sessions.* After the performance a detailed feedback will be given to elaborate the weak skills. It is equally beneficial for those who are beginners or have exam in coming diet. Interested candidates may send a personal message for details. WhatsApp No: 00923346036496. Email: drtanzeelbukhari@gmail.com GOOD LUCK.

*✌✌ HEARTIEST CONGRATULATIONS ✌✌* To *Dr Ammara Ansar* For passing PACES MRCP UK from UK. We wish her the best for her future.

*ANNOUNCEMENT* Hello n salam everyone We are pleased to announce admissions for our *Aug 2023 online course ( 15 days ) for PACES MRCP (UK) new pattern PACES23 and CLINICAL EXAM MRCPI .* We will start from *7th of Aug and finish on 25 Aug* *Active slots available on first come--first served basis.* Listener slot available too. *Atleast 90 Important exam cases ( including recent diets cases ) will be practiced and discussed as we do in our weekly Sunday sessions.* After the performance a detailed feedback will be given to elaborate the weak skills. It is equally beneficial for those who are beginners or have exam in coming diet. Interested candidates may send a personal message for details. WhatsApp No: 00923346036496. Email: drtanzeelbukhari@gmail.com GOOD LUCK.

*ANNOUNCEMENT* Hello n salam everyone We are pleased to announce admissions for our *Aug 2023 online course ( 15 days ) for PACES MRCP (UK) new pattern PACES23 and CLINICAL EXAM MRCPI .* We will start from *7th of Aug and finish on 25 Aug* *Active slots available on first come--first served basis.* Listener slot available too. *Atleast 90 Important exam cases ( including recent diets cases ) will be practiced and discussed as we do in our weekly Sunday sessions.* After the performance a detailed feedback will be given to elaborate the weak skills. It is equally beneficial for those who are beginners or have exam in coming diet. Interested candidates may send a personal message for details. WhatsApp No: 00923346036496. Email: drtanzeelbukhari@gmail.com GOOD LUCK.