pace your MRCP-PACES

*✌✌ 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.

*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.

Hello dear colleagues I am travelling for a couple of days so please excuse me for some time. I am sorry for any inconvenience

*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.

*IMPORTANT 48* *For clinicalconsultations* Please remember For confirmation of diagnosis of seronegative spondylarthropathies presence of HLA B27 is mandatory ( alongwith negative automimune profile) so always mention it in investigation of these conditions as we may have patients having conditions mimicking them without HLA but we don't classify them as seronegative spondyarthropathy. PaceUrMRCP.

*IMPORTANT 47* *HAS-BLED Score* Hypertension (systolic blood pressure >160 mmHg) 1 Abnormal renal and liver function* (1 point each) 1 or 2 Stroke 1 Bleeding tendency/predisposition* 1 Labile INRs (if on warfarin)* 1 Elderly (eg, age >65 y) 1 Drugs or alcohol (1 point each)* 1 or 2 A HAS-BLED score of ≥3 indicates that caution is warranted when prescribing oral anticoagulation and regular review is recommended. *Abnormal renal function is classified as the presence of chronic dialysis, renal transplantation, or serum creatinine ≥200 mmolL. Abnormal liver function is defined as chronic hepatic disease (eg, cirrhosis) or biochemical evidence of significant hepatic derangement (bilirubin 2 to 3 times the upper limit of normal, in association with aspartate aminotransferase/alanine aminotransferase/alkaline phosphatase 3 times the upper limit normal, etc), history of bleeding or predisposition (anemia), labile INR (ie, time in therapeutic range <60%), concomitant antiplatelets or nonsteroidal anti-inflammatory drugs, or excess alcohol. PaceUrMRCP.

*IMPORTANT 46* *Some info about heart sounds* *The 1st heart sound (S1)* Represents closure of mitral and tricuspid valves. Splitting in inspiration may be heard and is normal. • *Loud S1* In mitral stenosis, because the narrowed valve orifice limits ventricular filling, there is no gradual decrease in flow towards the end of diastole. The valves are, therefore, at their maximum excursion at the end of diastole, and so shut rapidly leading to a loud S1 (the ‘tapping’ apex). S1 is also loud if diastolic filling time is shortened, eg if the PR interval is short, and in tachycardia. • *Soft S1* occurs if the diastolic filling time is prolonged, eg prolonged PR interval, or if the mitral valve leaflets fail to close properly (ie mitral incompetence). *The intensity of S1 is variable* in AV block, AF, and nodal or ventricular tachycardia. 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.

*IMPORTANT 45* *Please remember for clinical consultations* *Massive pulmonary embolism can cause fainting* and has appeared quite often as a cause of fainting. So plz be alert and always try to get hints from the history. PaceUrMRCP

*IMPORTANT 44* *Some abnormalities of the JVP* • *Raised JVP with normal waveform* : Fluid overload, right heart failure. • *Fixed raised JVP with absent pulsation* : SVC obstruction. • *Large a wave* : Pulmonary hypertension, pulmonary stenosis. • *Cannon a wave* : When the right atrium contracts against a closed tricuspid valve, large ‘cannon’ a waves result. Causes—complete heart block, single chamber ventricular pacing, ventricular arrhythmias/ectopics. • *Absent a wave* : Atrial fibrillation. • *Large v waves* : Tricuspid regurgitation—look for earlobe movement. • *Constrictive pericarditis* : High plateau of JVP (which rises on inspiration—Kussmaul’s sign) with deep x and y descents. • *Absent JVP* : When lying flat, the jugular vein should be filled. If there is reduced circulatory volume (eg dehydration, haemorrhage) the JVP may be absent. PaceUrMRCP.

*IMPORTANT 43* Regarding JVP the pulsation is venous if it is • Usually impalpable, and obliterated by finger pressure on the vessel. • Rises transiently with pressure on abdomen (abdominojugular reflux) or on liver(hepatojugular reflux), and alters with posture and respiration (disappears when patient sits from lying flat). • Usually has a double pulse for every arterial pulse. ( Concomitantly palpate the arterial pulse ) paceUrMRCP .

Please join