pace your MRCP-PACES

👉 *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. Good luck.

This is our group link, if you have any other coalleagues who want to join please feel free to share the link with them

👉 *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. Good luck.

👉 *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. Good luck.

👉 *IMPORTANT 116* 👈 Just because smoking advice does not always work, do not stop giving it Good luck.

✌️✌️ *HEARTIEST CONGRATULATIONS* ✌️✌️ To *Dr Pooja* For passing *PACES MRCP UK* from the UK. She was with us in our batch for online prepration of PACES in June 22 We wish her the best for her future.

👉 *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 Good luck.

👉 *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? Good luck.

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

👉 *IMPORTANT 112* 👈 *Some cardiovascular causes of clubbing* Cyanotic congenital heart disease Endocarditis Atrial myxoma Aneurysms Infected grafts. Good luck.

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

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

👉 *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 Good luck.

👉 *IMPORTANT 108* 👈 *Please be aware of right ventricular infarct* It will present with inferior ECG changes, hypotension, elevated jugular venous pressure, hepatomegaly, and clear lungs. It is preload dependent so *do NOT administer nitrates or diuretics* as these can cause cardiovascular collapse. Good luck.

👉 *IMPORTANT 107* 👈 The combination of substernal chest pain persisting for longer than 30 minutes and diaphoresis strongly suggests acute MI. Never ignore 👈 Good luck.

👉 *IMPORTANT 106* 👈 The most common cause of Dupuytren’s contracture ( fibrosis and contracture of palmar fascia ) is liver disease but it may also occur in trauma, epilepsy, and ageing Good luck.

👉 *IMPORTANT 105* 👈 *Palmar erythema* Common causes cirrhosis hyperthyroidism rheumatoid arthritis polycythaemia chronic liver disease chemotherapy pregnancy. Good luck.

👉 *IMPORTANT 104* 👈 Please remember Papilloedema (bilaterally swollen discs) is most commonly due to increase in ICP e,g. tumour and idiopathic intracranial hypertension in exam but other causes may include cavernous sinus thrombosis, abscess, encephalitis, hydrocephalus or any retro-orbital lesion. Good luck.

Here is the recording of today's session. Please try to listen the recording in 1 day as Zoom provides limited space and it automatically deletes the old recordings to keep space for new ones ..so the recording will not be available after 1 day☝️☝️☝️