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*Announcement for Online Session No 99* *10 Sep 2023* *WE WILL NOT RECORD THIS SESSION* DEAR DOCTORS : MAY I HAVE YOUR ATTENTION PLEASE : *Today we will have an online session on Zoom discussing 1 Communication Station* regarding our preparation for MRCP PACES ( UK ) and MRCPI ( Ireland ) 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 Sri Lanka : 6 30 pm Somalia : 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.

*Announcement for Online Session No 99* *10 Sep 2023* *WE WILL NOT RECORD THIS SESSION* DEAR DOCTORS : MAY I HAVE YOUR ATTENTION PLEASE : *Tomorrow we will have an online session on Zoom discussing 1 Communication Station* regarding our preparation for MRCP PACES ( UK ) and MRCPI ( Ireland ) 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 Sri Lanka : 6 30 pm Somalia : 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.

*IMPORTANT 122* *Some signs of Mitral Stenosis* Malar flush on cheeks low-volume pulse AF is common Tapping, non-displaced, apex beat palpable S1 RV heave loud S1 Opening snap Rumbling mid-diastolic murmur (heard best in expiration, with patient on left side) paceUrMRCP.

*IMPORTANT 121* *Some signs of Mitral Regurgitation:* AF displaced, hyperdynamic apex pansystolic murmur at apex radiating to axilla soft S1 split S2, loud P2 (pulmonary hypertension). paceUrMRCP.

*IMPORTANT 120* *Grading of hypertensive retinopathy* 1.Tortuous arteries with thick shiny walls (silver or copper wiring ) 2.AV nipping (narrowing where arteries cross veins ). 3.Flame haemorrhages and cotton-wool spots. 4. Papilloedema, paceUrMRCP.

*ANNOUNCEMENT* Hello n salam everyone We are pleased to announce admissions for our *Sep-Oct 2023 online course ( 15 days ) for PACES MRCP (UK) new pattern PACES23 and CLINICAL EXAM MRCPI .* We will start from *18th of Sep and finish on 06th Oct* *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 119* *New York classification of heart failure* I. Heart disease present, but no undue dyspnoea from ordinary activity. II. Comfortable at rest; dyspnoea during ordinary activities. III. Less than ordinary activity causes dyspnoea, which is limiting. IV. Dyspnoea present at rest; all activity causes discomfort. paceUrMRCP.

*IMPORTANT 118* Please remember some non-cardiac causes of arrythmias Caffeine Smoking Alcohol Pneumonia Drugs ( beta 2-agonists, digoxin, L-dopa, tricyclics, doxorubicin) Metabolic imbalance (K+, Ca2+, Mg2+, hypoxia, hypercapnia, metabolic acidosis, thyroid disease) phaeochromocytoma. paceUrMRCP.

*IMPORTANT 117* Some features of pain making it cardiac pain unlikely • Stabbing, shooting pain • Pain lasting <30s, however intense • Well-localized, left sub-mammary pain • Pains of continually varying location. paceUrMRCP.

*IMPORTANT 116* Just because smoking advice does not always work, do not stop giving it paceUrMRCP.

*IMPORTANT 115* *Cerebellar Signs* *DASHING* : *D* ysdiadochokinesis, *A* taxia, *S* lurred speech, *H* ypotonia and reduced power, *I* ntention tremor, *N* ystagmus, *G* ait Broad based paceUrMRCP.

*IMPORTANT 114* Some questions to detect urinary outflow obstruction eg prostatic hyperplasia; stricture, stone. • On trying to pass water, is there delay before you start? (Hesitancy) • Does the flow stop and start? Do you go on dribbling when you think you’ve stopped. • Is your stream getting weaker? (Poor stream) • Is your stream painful and slow/‘drop-by-drop’? (eg from bladder stone) • Do you feel the bladder is not empty after passing water? • Do you ever pass water when you do not want to? • On feeling an urge to pass water, do you have to go at once? (Urgency) • Do you urinate often at night? (Nocturia) if yes how often? paceUrMRCP.

*IMPORTANT 113* *Some causes of unilateral clubbing* Hemiplegia Vascular lesions, eg upper-limb artery aneurysm, Takayasu’s arteritis, brachial arteriovenous malformations (including haemodialysis fistulas). paceUrMRCP.

*IMPORTANT 112* *Some cardiovascular causes of clubbing* Cyanotic congenital heart disease Endocarditis Atrial myxoma Aneurysms Infected grafts. paceUrMRCP.

*IMPORTANT 111* *Some GIT causes of clubbing* Inflammatory bowel disease (especially Crohn’s) Cirrhosis GI lymphoma Malabsorption, eg coeliac. paceUrMRCP.

*IMPORTANT 110* *Some thoracic causes of clubbing* Bronchial cancer Chronic lung suppuration: • Empyema, abscess • Bronchiectasis • Cystic fibrosis Fibrosing alveolitis Mesothelioma TB. paceUrMRCP.

*IMPORTANT 109* *Some ECG facts* *ST-segment elevation* : indicates transmural injury and can be diagnostic of an acute infarct *Q waves* : Evidence for necrosis (specific) *ST-segment depression* : usually indicates subendocardial injury paceUrMRCP.