pace your MRCP-PACES

*True or False Round 1 – Heart Failure* (by pace your MRCP – Dr Tanzeel Bukhari) Decide whether each statement is True (T) or False (F): 1️⃣ S3 heart sound indicates rapid ventricular filling and is typical of heart failure. 2️⃣ BNP levels are usually low in decompensated heart failure. 3️⃣ ACE inhibitors reduce mortality in systolic heart failure. 4️⃣ Loop diuretics are first-line drugs for acute pulmonary oedema. 5️⃣ Ejection fraction > 50 % rules out heart failure completely.

*Match the Pairs Puzzle 1 – Cardiology Murmurs* (by pace your MRCP – Dr Tanzeel Bukhari) Match A–E with 1–5 A. Aortic regurgitation B. Atrial septal defect C. Mitral stenosis D. Mitral regurgitation E. Aortic stenosis 1. Mid-diastolic rumble with opening snap and malar flush 2. Fixed split S2 with ejection systolic murmur at pulmonary area 3. Pansystolic murmur at apex radiating to axilla 4. Early diastolic decrescendo murmur with collapsing pulse 5. Ejection systolic murmur radiating to carotids with slow-rising pulse

Photo from Dr Tanzeel Bukhari

*🩺 Mini Quiz 1 – Spot Diagnosis* *Answer: Constrictive Pericarditis* 📘 Clues: Raised JVP with ascites + pericardial knock = impaired diastolic filling from a thickened, non-compliant pericardium.

🩺 Mini Quiz 1 – Spot Diagnosis (by pace your MRCP – Dr Tanzeel Bukhari) A 60-year-old man presents with progressive shortness of breath and swelling of both legs. On examination: JVP elevated, bilateral ankle oedema, hepatomegaly, and ascites. Heart sounds are distant; there is a pericardial knock. ❓What is the most likely diagnosis?

👉 IMPORTANT 758👈 Causes of headache in Acromegaly Pituitary tumor. Obstructive sleep apnea. Hypertension pace your MRCP-PACES

👉 IMPORTANT 757👈 For explaining OPACITY in the lungs to the patient always say SHADOW in the lung to the patient. pace your MRCP-PACES

👉 IMPORTANT 756👈 Please remember that PROGNOSIS can be a jargon for some examiners so always say RESULT or OUTLOOK of the disease while explaining to the patient. pace your MRCP-PACES

Mnemonic 1 – Causes of Syncope (by pace your MRCP – Dr Tanzeel Bukhari) Remember the five major causes of syncope with the mnemonic “V-PASS” 💡 V – Vasovagal → Reflex hypotension and bradycardia after pain or stress. P – Postural (Orthostatic) → Failure of autonomic reflexes on standing. A – Arrhythmia / Aortic stenosis → Sudden drop in cardiac output. S – Situational → Cough, micturition, defecation, swallow syncope. S – Subclavian steal / Seizure mimic → Vertebro-basilar insufficiency or post-ictal confusion.

*💊 Management Essentials 1 – Syncope* (by pace your MRCP – Dr Tanzeel Bukhari) *1️⃣ Immediate Assessment* → Check airway, breathing, circulation; monitor vitals; place patient supine with legs elevated. *2️⃣ Identify the Trigger* → Review recent exertion, posture, emotional stress, or medications (β-blockers, nitrates). *3️⃣ Targeted Management* → Vasovagal: Reassure, avoid triggers, maintain hydration. Cardiac: Admit for ECG monitoring ± pacemaker if arrhythmia. Orthostatic: Review antihypertensives, encourage gradual position change.

Photo from Dr Tanzeel Bukhari

Photo from Dr Tanzeel Bukhari

Photo from Dr Tanzeel Bukhari

*🩺 Symptom Snapshot 1 – Chest Pain* (by pace your MRCP – Dr Tanzeel Bukhari) *1️⃣ Stable Angina* → Exertional discomfort, relieved by rest, due to fixed coronary stenosis. *2️⃣ Myocardial Infarction (NSTEMI/STEMI)* → Persistent pain not relieved by rest, raised troponins. *3️⃣ Pericarditis* → Sharp pleuritic pain, relieved by sitting forward, often post-viral or post-MI.

*🚀 New Series Announcement* > From today, I’ll be sharing a brand-new series called *Symptom Snapshots!* Each post will cover a common symptom and its 3 key differentials — short, high-yield, and relevant for all stages of MRCP (Part 1, Part 2 & PACES). Perfect for daily quick learning and concept reinforcement! Good luck.