pace your MRCP-PACES

👉 *IMPORTANT 623* 👈 *A brief introduction of Hodgkin Lymphoma* Hodgkin’s lymphoma is a rare haematological malignancy (accounts for<1% of all cancers in the UK) caused by the uncontrolled proliferation of B-lymphocytes. These cells travel through the lymphatic system and build up in the lymph nodes causing lymphadenopathy. They can also spread to other organs such as the spleen or bone marrow. Hodgkin’s lymphoma is differentiated from non-Hodgkin’s lymphoma based on its histological appearance of huge multinucleated lymphocytes called Reed-Sternberg cells. Chemotherapy +/- radiotherapy are the main treatments of Hodgkin's lymphoma, and overall patients have a good prognosis with a 5-year survival rate of 80-90% in the early stages and 40-80% in the advanced stages. Good Luck

Dear coalleagues We will start again from tomorrow. Thanks for your patience. Good luck

ANNOUNCEMENT Hello n salam everyone We are pleased to announce admissions for our *May 2023 online course ( 15 days ) for PACES MRCP (UK) current pattern.* We will start from *8 May and finish on 24 May* *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 *May 2023 online course ( 15 days ) for PACES MRCP (UK) current pattern.* We will start from *8 May and finish on 24 May* *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 *May 2023 online course ( 15 days ) for PACES MRCP (UK) current pattern.* We will start from *8 May and finish on 24 May* *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 Coalleagues I will be travelling for a couple of days so excuse me till Sunday. We will start again from Monday ( 8th of May ) I am sorry for any inconvenience

ANNOUNCEMENT Hello n salam everyone We are pleased to announce admissions for our *May 2023 online course ( 15 days ) for PACES MRCP (UK) current pattern.* We will start from *8 May and finish on 24 May* *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.

✌️✌️ *HEARTIEST CONGRATULATIONS* ✌️✌️ To *Dr Nurul Islam* For passing *MRCP UK PACES from India* We wish him the best for his future.

👉 *IMPORTANT 625* 👈 *METHOTREXATE 3* *Monitoring while Prescribing methotrexate* Methotrexate is a drug with a high potential for patient harm. It is therefore important that you are familiar with guidelines relating to its use Methotrexate is taken weekly, rather than daily FBC, U&E and LFTs need to be regularly monitored. The Committee on Safety of Medicines recommend 'FBC and renal and LFTs before starting treatment and repeated weekly until therapy stabilised, thereafter patients should be monitored every 2-3 months' Folic acid 5mg once weekly should be co-prescribed, taken more than 24 hours after methotrexate dose The starting dose of methotrexate is 7.5 mg weekly (source: BNF) Only one strength of methotrexate tablet should be prescribed (usually 2.5 mg) Good Luck

👉 *IMPORTANT 624* 👈 *METHOTREXATE 2* *Adverse effects* Mucositis Myelosuppression Pneumonitis Pulmonary fibrosis Liver fibrosis *Contraindications:* Pregnancy Women should avoid pregnancy for at least 6 months after treatment has stopped The BNF also advises that men using methotrexate need to use effective contraception for at least 6 months after treatment *Interactions* Avoid prescribing trimethoprim or co-trimoxazole concurrently - increases risk of marrow aplasia High-dose aspirin increases the risk of methotrexate toxicity secondary to reduced excretion Good Luck

👉 *IMPORTANT 623* 👈 *METHOTREXATE 1* *Mechanism of action* Inhibits dihydrofolate reductase *Indications* Inflammatory arthritis, especially rheumatoid arthritis Psoriasis Some chemotherapy acute lymphoblastic leukaemia Good Luck

✌️✌️ *HEARTIEST CONGRATULATIONS* ✌️✌️ To *Dr kadhaum ibrahem* For passing *MRCP UK PACES from India* We wish him the best for his future.

✌️✌️ *HEARTIEST CONGRATULATIONS* ✌️✌️ To *Dr Inayut* For passing *MRCP UK PACES from India* We wish him the best for his future.

✌️✌️ *HEARTIEST CONGRATULATIONS* ✌️✌️ To *Dr Susovan Mitra* For passing *MRCP UK PACES from India* We wish him the best for his future.

ANNOUNCEMENT Hello n salam everyone We are pleased to announce admissions for our *May 2023 online course ( 15 days ) for PACES MRCP (UK) current pattern.* We will start from *8 May and finish on 24 May* *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 622* 👈 *Few conditions associated with a positive RF* Other conditions associated with a positive RF include Sjogren's syndrome (around 100%) Felty's syndrome (around 100%) infective endocarditis (= 50%) SLE (= 20-30%) systemic sclerosis (= 30%) general population (= 5%) rarely: TB, HBV, EBV, leprosy Good Luck

👉 *IMPORTANT 621* 👈 *Few extraocular complications of rheumatoid arthritis (RA)* A wide variety of extra-articular complications occur in patients with rheumatoid arthritis (RA): respiratory: pulmonary fibrosis, pleural effusion, pulmonary nodules, bronchiolitis obliterans, methotrexate pneumonitis, pleurisy ocular: keratoconjunctivitis sicca (most common), episcleritis, scleritis, corneal ulceration, keratitis, steroid-induced cataracts, chloroquine retinopathy osteoporosis ischaemic heart disease: RA carries a similar risk to type 2 diabetes mellitus increased risk of infections depression Less common Felty's syndrome (RA + splenomegaly + low white cell count) amyloidosis Good Luck

👉 *IMPORTANT 620* 👈 *The management of rheumatoid arthritis (RA)* The management of rheumatoid arthritis (RA) has been revolutionised by the introduction of disease-modifying therapies in the past decade. Patients with evidence of joint inflammation should start a combination of disease-modifying drugs (DMARD) as soon as possible. Other important treatment options include analgesia, physiotherapy and surgery. *Initial therapy* In 2018 NICE updated their rheumatoid arthritis guidelines. They now recommend DMARD monotherapy +/- a short-course of bridging prednisolone. In the past dual DMARD therapy was advocated as the initial step. *Monitoring response to treatment* NICE recommends using a combination of CRP and disease activity (using a composite score such as DAS28) to assess response to treatment *DMARDs* methotrexate is the most widely used DMARD. Monitoring of FBC & LFTs is essential due to the risk of myelosuppression and liver cirrhosis. Other important side-effects include pneumonitis sulfasalazine leflunomide hydroxychloroquine *TNF-inhibitors* the current indication for a TNF-inhibitor is an inadequate response to at least two DMARDs including methotrexate etanercept: recombinant human protein, acts as a decoy receptor for TNF-α, subcutaneous administration, can cause demyelination, risks include reactivation of tuberculosis infliximab: monoclonal antibody, binds to TNF-α and prevents it from binding with TNF receptors, intravenous administration, risks include reactivation of tuberculosis adalimumab: monoclonal antibody, subcutaneous administration *Rituximab* anti-CD20 monoclonal antibody, results in B-cell depletion two 1g intravenous infusions are given two weeks apart infusion reactions are common *Abatacept* fusion protein that modulates a key signal required for activation of T lymphocytes leads to decreased T-cell proliferation and cytokine production given as an infusion not currently recommend by NICE 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 128.Dr Bhavesh Kaswala 127.Dr Rashid Ali Khan 126.Dr Bisma 125.Dr Samiah 124.Dr Madiha Mahmood 123.Dr Ratan Kumar 122.Dr Dilfuza Usmanova 121.Dr Mohd Hafiz 120.Dr Colin Cheah 119.Dr Kuan Yau Yeh 118.Dr Satesh Ramasundram 117.Dr Calvin 116.Dr Wan Mohamad 115.Dr Aravinthan Balakrishnan 114.Dr Athirah Azizol 113.Dr Massum 112.Dr Rafa Faaria Alam 111.Dr Benojeer Akter 110.Dr Sonal Karpe 109.Dr Shahla 108.Dr Muhammad Faizal 107.Dr Aisha Sohail 106.Dr Sheetal 105.Dr Anand Kumar 104.Dr Paul 103.Dr Ehsan Ul Haq 102.Dr Amna Gardezi 101.Dr Muhammad Rahib 100.Dr Shilpa 99.Dr Nagaraj Patil 98.Dr Vincent Jose ( MRCPI ) 97.Dr Hana Abdalla Adam Mohamed ( MRCPI ) 96.Dr Thanuja Alahakoon 95.Dr Farehah ( MRCPI ) 94.Dr Sankar Nath Jha ( MRCPI ) 93.Dr Saadia Khan 92.Dr Montasir Elmobark 91.Dr Kiran 90.Dr Ai Yun Loh 89.Dr Eow 88.Dr Lim 87.Dr Lalitha 86.Dr Ashwin Mathew 85.Dr Kasthuri 84.Dr Rohit 83.Dr Sangshaptak Saha 82.Dr Hira Jamil 81.Dr Santa Subhra Chatterjee 80.Dr Shishir 79.Dr Rubeya Ahmad 78.Dr Javaria Imran 77.Dr Rishi Gopalakrishnan 76.Dr Ramandeep Kaur 75.Dr Shakeel 74.Dr Shamla 73.Dr Murtaza 72.Dr Urvashi 71.Dr Urmimala Bhattacharjee 70.Dr Jayalakshmi 69.Dr Steffin Methai Kattor 68.Dr Yew 67.Dr Cyrin 66.Dr Farhat Nazneen 65.Dr Meenal 64.Dr Adil 63.Dr Umar Iftikhar 62.Dr Sohail ( MRCPI ) 61.Dr Amarnath duraikannan 60.Dr Maha 59.Dr Samar 58.Dr Sidra German 57.Dr Mahmood Akhtar 56.Dr Muhammad Hashim 55.Dr Manmohan 54.Dr Pooja 53.Dr Haithem Alghebra ( MRCPI ) 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

ANNOUNCEMENT Hello n salam everyone We are pleased to announce admissions for our *May 2023 online course ( 15 days ) for PACES MRCP (UK) current pattern.* We will start from *8 May and finish on 24 May* *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.