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👉 *IMPORTANT 661* 👈 *Some info about aetiology of idiopathic thrombocytopenic purpara ( ITP )* It is thought that ITP is an autoimmune disorder resulting in antibodies produced to target against individual’s own platelets, leading to thrombocytopenia. This in turn results in petechiae and in rarer cases more severe bleeding. Furthermore, ITP can be primary or secondary. Primary ITP occurs when there is isolated thrombocytopenia is found with no co-existing conditions. Secondary ITP is associated with co-existing conditions. These include: Rheumatological diseases CLL Lymphoma Viral infections Various pharmacological agents Good Luck

👉 *IMPORTANT 660* 👈 *Important points in the management of sarcoidosis* *Indications for steroids* patients with chest x-ray stage 2 or 3 disease who have moderate to severe or progressive symptoms. Patients with asymptomatic and stable stage 2 or 3 disease who have only mildly abnormal lung function do not require treatment hypercalcaemia eye, heart or neuro involvement Prognosis *Factors associated with poor prognosis* insidious onset, symptoms > 6 months absence of erythema nodosum extrapulmonary manifestations: e.g. lupus pernio, splenomegaly CXR: stage III-IV features black people Good Luck

👉 *IMPORTANT 659* 👈 *Important clinical features of sarcoidosis* acute: erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, polyarthralgia insidious: dyspnoea, non-productive cough, malaise, weight loss skin: lupus pernio hypercalcaemia: macrophages inside the granulomas cause an increased conversion of vitamin D to its active form (1,25-dihydroxycholecalciferol) the Kveim test (where part of the spleen from a patient with known sarcoidosis is injected under the skin) is no longer performed due to concerns about cross-infection Good Luck

👉 *IMPORTANT 658* 👈 *Important investigations for sarcoidosis* There is no one diagnostic test for sarcoidosis and hence diagnosis is still largely clinical. ACE levels have a sensitivity of 60% and specificity of 70% and are therefore not reliable in the diagnosis of sarcoidosis although they may have a role in monitoring disease activity. Routine bloods may show hypercalcaemia (seen in 10% if patients) and a raised ESR A chest x-ray may show the following changes: stage 0 = normal stage 1 = bilateral hilar lymphadenopathy (BHL) stage 2 = BHL + interstitial infiltrates stage 3 = diffuse interstitial infiltrates only stage 4 = diffuse fibrosis spirometry: may show a restrictive defect tissue biopsy: non-caseating granulomas gallium-67 scan - not used routinely Good Luck

👉 *IMPORTANT 657* 👈 *Few syndromes associates with Sarcoidosis* Sarcoidosis is a multisystem disorder of unknown aetiology characterised by non-caseating granulomas. It is more common in young adults and in people of African descent *Lofgren's syndrome* is an acute form of the disease characterised by bilateral hilar lymphadenopathy (BHL), erythema nodosum, fever and polyarthralgia. It usually carries an excellent prognosis In *Mikulicz syndrome* there is enlargement of the parotid and lacrimal glands due to sarcoidosis, tuberculosis or lymphoma this term is now considered outdated and unhelpful by many as there is a confusing overlap with Sjogren's syndrome *Heerfordt's syndrome (uveoparotid fever* ) there is parotid enlargement, fever and uveitis secondary to sarcoidosis Good Luck

👉 *IMPORTANT 656* 👈 *Important complications of Psoriasis* Psoriatic arthropathy (around 10%) Increased incidence of metabolic syndrome Increased incidence of cardiovascular disease Increased incidence of venous thromboembolism Psychological distress Good Luck

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

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*Announcement for Online Session No 88* *21 May 2023* DEAR DOCTORS : MAY I HAVE YOUR ATTENTION PLEASE : *Today we will have an online session on Zoom discussing 1 station 4 ( Communication Skills )* regarding our preparation for MRCP PACES ( UK ) TIMINGS : Saudia Arabia: 4 00 pm Pakistan : 6 00 pm Bangladesh : 7 00 pm India : 6 30 pm Singapore : 9 00 pm Hong Kong : 9 00 pm Malaysia : 9 00 pm Egypt : 4 00 pm Libya : 3 00 pm Bahrain : 4 00 pm Burma ( Myanmar ) :7 30 pm Sudan : 3 00 pm UAE : 5 00 pm UK : 2 00 pm Ireland ( Dublin ) : 2 00 pm Afghanistan : 5 30 pm Kenya : 4 00 pm Germany ( Berlin ) : 3 00 pm Nigeria : 2 00 pm Japan ( Tokyo ) : 10 00 pm Denmark : 3 00 pm Qatar : 4 00 pm Oman : 5 00 pm Italy : 3 00 pm Indonesia : 8 00 pm Mauritius : 5 00 pm Iraq : 4 00 pm Texas Usa : 8 00 am Kuwait : 4 00 pm ( please Google for your local time zones to avoid any inconvenience ) Zoom meeting link will be shared 5 minutes before start time. The candidate for today's session has been selected. GOOD LUCK.

*✌✌ HEARTIEST CONGRATULATIONS ✌✌* To *Dr Hanadi* For passing CLINICAL MRCP Ireland from Musqat. We wish her the best for her future.

*Announcement for Online Session No 88* *21 May 2023* DEAR DOCTORS : MAY I HAVE YOUR ATTENTION PLEASE : *Tomorrow we will have an online session on Zoom discussing 1 station 4 ( Communication Skills )* regarding our preparation for MRCP PACES ( UK ) TIMINGS : Saudia Arabia: 4 00 pm Pakistan : 6 00 pm Bangladesh : 7 00 pm India : 6 30 pm Singapore : 9 00 pm Hong Kong : 9 00 pm Malaysia : 9 00 pm Egypt : 4 00 pm Libya : 3 00 pm Bahrain : 4 00 pm Burma ( Myanmar ) :7 30 pm Sudan : 3 00 pm UAE : 5 00 pm UK : 2 00 pm Ireland ( Dublin ) : 2 00 pm Afghanistan : 5 30 pm Kenya : 4 00 pm Germany ( Berlin ) : 3 00 pm Nigeria : 2 00 pm Japan ( Tokyo ) : 10 00 pm Denmark : 3 00 pm Qatar : 4 00 pm Oman : 5 00 pm Italy : 3 00 pm Indonesia : 8 00 pm Mauritius : 5 00 pm Iraq : 4 00 pm Texas Usa : 8 00 am Kuwait : 4 00 pm ( please Google for your local time zones to avoid any inconvenience ) Zoom meeting link will be shared 5 minutes before start time. Interested candidate may send a personal message to take the case GOOD LUCK.

*✌✌ HEARTIEST CONGRATULATIONS ✌✌* To *Dr Stalin P John Benz* For passing MRCP UK part 1. We wish him the best for his future.

*✌✌ HEARTIEST CONGRATULATIONS ✌✌* To *Dr Pei Shing* For passing MRCP UK part 1. We wish her the best for her future.

*👉 IMPORTANT 655 👈* *Important points in the management of Psoriasis* Regular emollients may help to reduce scale loss and reduce pruritus First-line: NICE recommend a potent corticosteroid applied once daily plus vitamin D analogue applied once daily for up to 4 weeks as initial treatment These should be applied separately, one in the morning and the other in the evening Second-line: if no improvement after 8 weeks then offer a vitamin D analogue twice daily Third-line: if no improvement after 8-12 weeks then offer either: A potent corticosteroid applied twice daily for up to 4 weeks or A coal tar preparation applied once or twice daily Short-acting dithranol can also be used Good Luck

*👉 IMPORTANT 654 👈* *Few words about Chronic plaque psoriasis* Clinical features Erythematous plaques covered with a silvery-white scale Typically on the extensor surfaces such as the elbows and knees. Also common on the scalp, trunk, buttocks and periumbilical area Clear delineation between normal and affected skin Plaques typically range from 1 to 10 cm in size If the scale is removed, a red membrane with pinpoint bleeding points may be seen (Auspitz's sign) Good Luck