pace your MRCP-PACES

Investigation Pearl 12 – Hyponatraemia: Volume Status First (by pace your MRCP – Dr Tanzeel Bukhari) Key Principle: Management depends on volume status (hypo/eu/hypervolaemic). Treating sodium without assessing volume can worsen the condition (e.g., fluids in SIADH). Exam tip: Clinical assessment comes first.

Dear colleagues due to sour throat we have to cancel our tomorrow's session, as i need to get some voice rest.I regret any inconvenience,

*🩺 Symptom Snapshot 10 – Wheeze* *(by pace your MRCP – Dr Tanzeel Bukhari)* *1️⃣ Asthma* Episodic wheeze with chest tightness and breathlessness Often worse at night or early morning Triggers include allergens, exercise, cold air *2️⃣ COPD* Persistent wheeze with chronic cough and sputum Usually in smokers or ex-smokers Progressive and less reversible than asthma *3️⃣ Cardiac Asthma (Left Ventricular Failure)* Wheeze due to pulmonary oedema Associated with orthopnoea and PND Improves with diuretics, not bronchodilators

*🩺 Symptom Snapshot 11 – Stridor* *(by pace your MRCP – Dr Tanzeel Bukhari)* *1️⃣ Upper Airway Obstruction (Tumour / Foreign Body)* High-pitched inspiratory noise Often associated with voice change or dysphagia Red flag → urgent ENT assessment *2️⃣ Anaphylaxis / Laryngeal Oedema* Acute onset stridor with facial or lip swelling May have hypotension, urticaria Medical emergency → adrenaline immediately *3️⃣ Post-intubation or Tracheal Stenosis* Progressive exertional stridor History of prolonged intubation or tracheostomy Fixed upper airway narrowing

*🩺 Symptom Snapshot 12 – Exercise Intolerance* *(by pace your MRCP – Dr Tanzeel Bukhari)* *1️⃣ Heart Failure* Reduced ability to perform physical activity Associated with breathlessness, fatigue, ankle swelling Progressive decline over time *2️⃣ Chronic Lung Disease (COPD / ILD)* Early fatigue and breathlessness on exertion May have chronic cough or crackles Oxygen desaturation on exertion *3️⃣ Anaemia* Generalised fatigue and reduced exercise capacity May have pallor, tachycardia Confirmed on full blood count

Investigation Pearl 8 – ABG Red Flag: Normal PaCO₂ in Acute Breathlessness Key Principle: Acute breathlessness usually causes hyperventilation → low PaCO₂. Normal PaCO₂ suggests fatigue and impending ventilatory failure; raised PaCO₂ suggests established failure. Exam tip: Low CO₂ = compensation; normal CO₂ = danger; high CO₂ = failure.

Investigation Pearl 7 – ESR vs CRP Key Principle: CRP changes quickly; ESR rises slowly and stays elevated longer. CRP is better for acute inflammation/infection and response to treatment; ESR useful in chronic inflammatory burden (e.g., PMR/GCA). Pitfalls: ESR affected by age, anaemia, pregnancy, malignancy. Exam tip: Don’t treat ESR and CRP as interchangeable.

*Investigation Pearl 6 – Troponin: Interpret with Dynamics and Context* *Key Principle* : Troponin indicates myocardial injury, not MI alone. Diagnose ACS using rise/fall pattern + symptoms + ECG changes. *Non‑ACS causes* : CKD, HF, sepsis, PE, myocarditis, tachyarrhythmias. *Exam tip* : A single raised troponin ≠ ACS.

Dear colleagues due to sour throat we have to cancel our tomorrow's session. I regret any inconvenience,

dear colleagues do to some inevitable circumstances I am unable to share daily info in the group. I am sorry for this inconvenience, hopefully we wiill start again soon, regards

Please join

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*🟢 ONLINE COURSE NO. 66 – ADMISSIONS OPEN!* 📅 *26 Jan – 13 Feb 2026* 🎯 PACES MRCP (UK) & CLINICAL EXAM MRCPI 🚨 At a very affordable fee ✅ 15-Day Intensive Online Course ✅ Covers ALL 7 SKILLS in detail (as in our weekly free sessions) ✅ Practice & discussion of 90+ exam cases (including recent diets), covering:  • 45 cases of consultations  • 45 cases of communications. ✅ Personalized feedback to sharpen weak areas ✅ Ideal for beginners & upcoming exam candidates 🎓 Slots Available: 🔹 Active participation – First come, first served 🔹 Listener slots also available 📩 Join Us! 📱 WhatsApp: +92 334 6036496 📧 Email: drtanzeelbukhari@gmail.com 🚀 Join, Learn, Practice & Succeed! GOOD LUCK

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*🟢 ONLINE COURSE NO. 66 – ADMISSIONS OPEN!* 📅 *26 Jan – 13 Feb 2026* 🎯 PACES MRCP (UK) & CLINICAL EXAM MRCPI 🚨 At a very affordable fee ✅ 15-Day Intensive Online Course ✅ Covers ALL 7 SKILLS in detail (as in our weekly free sessions) ✅ Practice & discussion of 90+ exam cases (including recent diets), covering:  • 45 cases of consultations  • 45 cases of communications. ✅ Personalized feedback to sharpen weak areas ✅ Ideal for beginners & upcoming exam candidates 🎓 Slots Available: 🔹 Active participation – First come, first served 🔹 Listener slots also available 📩 Join Us! 📱 WhatsApp: +92 334 6036496 📧 Email: drtanzeelbukhari@gmail.com 🚀 Join, Learn, Practice & Succeed! GOOD LUCK

*🟢 ONLINE COURSE NO. 66 – ADMISSIONS OPEN!* 📅 *26 Jan – 13 Feb 2026* 🎯 PACES MRCP (UK) & CLINICAL EXAM MRCPI 🚨 At a very affordable fee ✅ 15-Day Intensive Online Course ✅ Covers ALL 7 SKILLS in detail (as in our weekly free sessions) ✅ Practice & discussion of 90+ exam cases (including recent diets), covering:  • 45 cases of consultations  • 45 cases of communications. ✅ Personalized feedback to sharpen weak areas ✅ Ideal for beginners & upcoming exam candidates 🎓 Slots Available: 🔹 Active participation – First come, first served 🔹 Listener slots also available 📩 Join Us! 📱 WhatsApp: +92 334 6036496 📧 Email: drtanzeelbukhari@gmail.com 🚀 Join, Learn, Practice & Succeed! GOOD LUCK

Photo from Dr Tanzeel Bukhari