pace your MRCP-PACES

👉 *IMPORTANT 96* 👈 Please remember In the examination of lower limbs if you are limited for time, gait is the most useful test to start with. Good luck.

👉 *IMPORTANT 95* 👈 Lower limb reflexes with their root values • Knee (L3,4) • Ankle (L5,S1) • Plantar reflexes (L5, S1, S2) Good luck.

ANNOUNCEMENT Hello n salam everyone We are pleased to announce admissions for our *Nov 2022 online course ( 15 days ) for PACES MRCP (UK).* We will start from *7 Nov and finish on 23 Nov.* *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 *Nov 2022 online course ( 15 days ) for PACES MRCP (UK).* We will start from *7 Nov and finish on 23 Nov.* *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.

Dear all Thanks for you patience, We will restart our academic activities from tomorrow Good luck

Dear all, unfortunately I had an emergency at home, so our academic activities will be suspended for a couple of day,,please excuse me and I am sorry for the inconvenience

👉 *IMPORTANT 94* 👈 Please remember The symptoms of hypermagnesiumia can mimic Botulism. Good luck.

👉 *IMPORTANT 93* 👈 *Be careful while eliciting Clonus in lower limbs* Plantar flex the foot then quickly dorsiflex and hold. More than 3 beats of plantar flexion is sustained clonus and is abnormal. Clonus can also be elicited at the patella with rapid downward movement of patella but please don,t do it in PACES. Hypertonia and clonus suggest an upper motor neuron lesion. Good luck.

👉 *IMPORTANT 92* 👈 Please remember: While inspecting lower limbs in a case of lower limb examination, always check either any of the limb is smaller as compared to the other one. This may happen in POLIO which is not uncommon in PACES specially in some asian centers. Good luck.

👉 *IMPORTANT 91* 👈 *Few things never to be missed while examining GAIT* 1.Ask patient to walk a few metres, turn, and walk back to you. 2.Note use of walking aids, symmetry, size of paces, arm swing. 3.Ask patient to ‘walk heel-to-toe as if on a tightrope’ to exaggerate any instability. 3.Ask patient to walk on tiptoes, then on heels. ( Inability to walk on tiptoes indicates S1 or gastrocnemius lesion. Inability to walk on heels indicates L4,5 lesion or foot drop ) And always be ready to support the patient if he fumbles. Good luck.

👉 *IMPORTANT 90* 👈 *A few causes of absent apical impulse* • Obesity/emphysema • Right pneumonectomy with displacement • Pericardial effusion or constriction • Dextrocardia ( never forget to palpate on right side of chest if you can,t find it ) Good luck.

👉 *IMPORTANT 89* 👈 Please consider admission in a case of palpitations associated with : syncope or near syncope, particularly when the patient is aged 75 years or older and has an abnormal ECG, hemaotocrit less than 30%, shortness of breath, respiratory rate higher than 24/min,,or a history of HF. Good luck.

👉 *IMPORTANT 88* 👈 Please remeber that A stress test is generally considered positive if the patient develops any of the following during exercise: ST-segment depression, chest pain, hypotension, or significant arrhythmias. Good luck.

👉 *IMPORTANT 87* 👈 *Upper limb reflexes with their root values* •Biceps (C5,6) •Triceps (C7) •Supinator (C6) Good luck.

👉 *IMPORTANT 86* 👈 *While doing general inspection of upper limbs in CNS station never miss to look for* *Abnormal posturing* *asymmetry* *abnormal movements* (fasciculation/tremor/dystonia/athetosis) *muscle wasting* (especially small muscles of the hand)—symmetrical/asymmetrical? Local/general? Good luck

👉 *IMPORTANT 85* 👈 *Please try to rule out LOCAL CAUSES of pain in any case of headache along with red flags.* These may include : • Neck—cervical disc pathology. • Bone/sinuses—sinusitis, neoplasia. • Eye—glaucoma, iritis, orbital cellulitis,eye strain, AVM. • Temporomandibular joint—arthritis or idiopathic dysfunction (common). • Teeth/gums—caries, broken teeth, abscess, malocclusion. • Ear—otitis media,otitis externa. • Vascular/vasculitis—arteriovenous fistula, aneurysm,or AVM at the cerebellopontine angle, giant cell arteritis, SLE. Good luck.

👉 *IMPORTANT 84* 👈 *Poor prognostic factors for HOCM* : 1.Syncope. 2.Young age at presentation. 3.Family history of HOCM and sudden death. 4.Non-sustained ventricular tachycardia on 24 or 48-hour Holter monitoring. 5.Abnormal blood pressure changes on exercise (drop of BP during peak exercise on stress testing). 6.An increased septal wall thickness ˃ 3 cm. Copied. Good luck.

👉 *IMPORTANT 83* 👈 *Drugs to avoid in HOCM* : 1. Nitrates 2. ACE-inhibitors 3. Inotropes Good luck.

paceUrMRCP-PACES HALL OF FAME We are thankful to our respected coalleagues who have made us proud by their success in PACES MRCP ( UK ). We believe that this number will keep on increasing 52.Dr Amna 51. Dr Nandhakumar 50. Dr Ew Ju Vern 49. Dr Mohamed Muslim 48. Dr Jerry John 47. Dr Majid Iqbal 46. Dr Phoebe 45. Dr Aimi N Zainudin 44.Dr Tahseen Azim 43.Dr Samina 42.Dr Suzi 41.Dr Samia 40.Dr Tan 39.Dr Kalpesh Kondalkar 38.Dr Sunil Abhishek 37.Dr Faiz Mashood ( MRCPI ) 36.Dr Sharalaa Engatramana 35.Dr Prasad ( MRCPI ) 34.Dr Kalyan Nath ( MRCPI ) 33.Dr Reshma Thalikan 32.Dr Aneesa Shahul 31.Dr Arooj 30.Dr Esraa Soliman 29.Dr Amitave Chatterjee 28.Dr Malik Dilaver 27.Dr Ravi 26.Dr Priya 25.Dr Mujtaba Waris 24.Dr Shaheen Noman 23.Dr Apoorv Tiwari 22.Dr Niaz 21.Dr Janaki 20.Dr Lavanya Devi Palaniswamy 19.Dr Waqas 18.Dr Sadaf Hammad 17.Dr Osama Abdelaziz 16.Dr Rajeev Sharma 15.Dr Nehal Kunjomoidu 14.Dr Steffy 13.Dr Mustafizur Rahman (MRCPI) 12.Dr Vareeja Kasibian 11.Dr Niya Jamaludheen 10.Dr Farook Abdelgioum 9.Dr Kamran Ali 8.Dr Anik Rahman 7.Dr Manoj Dodiyah 6.Dr Madhusha 5.Dr Komal Zahid 4.Dr Hina Shaikh 3.Dr Sameer Abdus Samad 2.Dr Saurabh Gaba 1.Dr Rithik Mohan

👉 *IMPORTANT 82* Never ignore palpitations in patients having : Risk factors at history Family history of significant arrhythmias Personal or family history of syncope or sudden death History of myocardial infarction (and likely scarred myocardium) Palpitations that occur during sleep anatomic abnormalities Structural heart disease such as dilated or hypertrophic cardiomyopathies Valvular disease (stenotic or regurgitant) ECG findings Long QT syndrome Bradycardia Second- or third-degree heart block Sustained ventricular arrhythmias Good luck.