pace your MRCP-PACES

*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 paceUrMRCP.

*ANNOUNCEMENT* Hello n salam everyone We are pleased to announce admissions for our *Aug-Sep 2023 online course ( 15 days ) for PACES MRCP (UK) new pattern PACES23 and CLINICAL EXAM MRCPI .* We will start from *28th of Aug and finish on 15 Sep* *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 81* *Nutshell Dyspnea for Clinical Consultation* Ask about Fever, cough and chest pain consider risk of COVID-19. Vital sign measurements; pulse oximetry. Cardiac and chest examination. Chest radiography and arterial blood gas measurement. paceUrMRCP.

*IMPORTANT 80* *Some info about Intention tremor* worst on movement, seen in cerebellar disease, with past pointing and dysdiadochokinesis No effective drug has been found. paceUrMRCP.

*IMPORTANT 79* Please remember : Parkinson disease is the most common cause of *resting tremers* in exam. The tremors are worst at rest with bradykinesia and rigidity; They are more resistant to treatment than other symptoms. They are usually slow tremors (frequency of 3–5Hz), typically ‘pill-rolling’ of the thumb over a finger. paceUrMRCP.

Please join

969162

*ANNOUNCEMENT* Hello n salam everyone We are pleased to announce admissions for our *Aug-Sep 2023 online course ( 15 days ) for PACES MRCP (UK) new pattern PACES23 and CLINICAL EXAM MRCPI .* We will start from *28th of Aug and finish on 15 Sep* *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 for Online Session No 97* *20 Aug 2023* *WE WILL NOT RECORD THIS SESSION* DEAR DOCTORS : MAY I HAVE YOUR ATTENTION PLEASE : *Today we will have an online session on Zoom discussing 1 Clinical Consultation* regarding our preparation for MRCP PACES ( UK ) and MRCPI ( Ireland ) TIMINGS : Saudia Arabia: 4 00 pm Pakistan : 6 00 pm Bangladesh : 7 00 pm India : 6 30 pm Singapore : 9 00 pm Hong Kong : 9 00 pm Malaysia : 9 00 pm Egypt : 4 00 pm Libya : 3 00 pm Bahrain : 4 00 pm Burma ( Myanmar ) :7 30 pm Sudan : 3 00 pm UAE : 5 00 pm UK : 2 00 pm Ireland ( Dublin ) : 2 00 pm Afghanistan : 5 30 pm Kenya : 4 00 pm Germany ( Berlin ) : 3 00 pm Nigeria : 2 00 pm Japan ( Tokyo ) : 10 00 pm Denmark : 3 00 pm Qatar : 4 00 pm Oman : 5 00 pm Italy : 3 00 pm Indonesia : 8 00 pm Mauritius : 5 00 pm Iraq : 4 00 pm Texas Usa : 8 00 am Kuwait : 4 00 pm Sri Lanka : 6 30 pm Somalia : 4 00 pm ( please Google for your local time zones to avoid any inconvenience ) Zoom meeting link will be shared 5 minutes before start time. Interested candidate may send a personal message to take the case. GOOD LUCK.

*Announcement for Online Session No 97* *20 Aug 2023* *WE WILL NOT RECORD THIS SESSION* DEAR DOCTORS : MAY I HAVE YOUR ATTENTION PLEASE : *Tomorrow we will have an online session on Zoom discussing 1 Clinical Consultation* regarding our preparation for MRCP PACES ( UK ) and MRCPI ( Ireland ) TIMINGS : Saudia Arabia: 4 00 pm Pakistan : 6 00 pm Bangladesh : 7 00 pm India : 6 30 pm Singapore : 9 00 pm Hong Kong : 9 00 pm Malaysia : 9 00 pm Egypt : 4 00 pm Libya : 3 00 pm Bahrain : 4 00 pm Burma ( Myanmar ) :7 30 pm Sudan : 3 00 pm UAE : 5 00 pm UK : 2 00 pm Ireland ( Dublin ) : 2 00 pm Afghanistan : 5 30 pm Kenya : 4 00 pm Germany ( Berlin ) : 3 00 pm Nigeria : 2 00 pm Japan ( Tokyo ) : 10 00 pm Denmark : 3 00 pm Qatar : 4 00 pm Oman : 5 00 pm Italy : 3 00 pm Indonesia : 8 00 pm Mauritius : 5 00 pm Iraq : 4 00 pm Texas Usa : 8 00 am Kuwait : 4 00 pm Sri Lanka : 6 30 pm Somalia : 4 00 pm ( please Google for your local time zones to avoid any inconvenience ) Zoom meeting link will be shared 5 minutes before start time. Interested candidate may send a personal message to take the case. GOOD LUCK.

*IMPORTANT 78* *Some causes of Paraesthesiae* It is described as ‘Pins and needles’, numbness/tingling, which can hurt or ‘burn’ (dysaesthesia). Common Causes may include : *Metabolic* reduced Ca2+ (mostly perioral); increased PaCO2; myxoedema; neurotoxins (tick bite; sting). *Vascular* : Raynaud’s; DVT; high plasma viscosity. *Anti body-mediated* : paraneoplastic; SLE; ITP. *Infection* : Lyme; rabies. *Drugs* : ACE-i. *Brain* : thalamic/parietal lesions. *Cord* : MS; myelitis/HIV; decreased B12, *Plexopathy/mononeuropathy* : cervical rib; carpal tunnel; sciatica. *Peripheral neuropathy* : DM; CKD. *If paroxysmal* : migraine; epilepsy; phaeochromocytoma. *If travel history* is positive : consider infection, eg strongyloides. paceUrMRCP.

*IMPORTANT 77* *Some drugs causing muscle cramps* Diuretics ( from reduced K+), domperidone, salbutamol/terbutaline, ACE I, telmisartan,celecoxib, lacidipine, ergot alkaloids, levothyroxine. paceUrMRCP.

*IMPORTANT 76* *The Abbreviated Mental Test Score (AMTS)* is a commonly used screening questionnaire for cognitive impairment ( unlikey to be asked in exam, please remember for academic interest ) Ask the patient about the following .Each question has a score of 1. 1 Tell patient an address to recall at the end 2 Age 3 Time (to nearest hour) 4 What year is it? 5 Recognize 2 people (eg doctor & nurse) 6 Date of birth 7 Dates of the Second World War 8 Name of current president/prime minister 9 Where are you now? (Which hospital?) 10 Count backwards from 20 to 1 A score of ≤6 suggests poor cognition, acute (delirium), or chronic (dementia). AMTS correlates well with the more detailed Mini-Mental State Examination (MMSE) Be careful deaf, dysphasic, depressed, and uncooperative patients, as well as those who do not understand English, will also get low scores. paceUrMRCP.

*ANNOUNCEMENT* Hello n salam everyone We are pleased to announce admissions for our *Aug-Sep 2023 online course ( 15 days ) for PACES MRCP (UK) new pattern PACES23 and CLINICAL EXAM MRCPI .* We will start from *28th of Aug and finish on 15 Sep* *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 75* *Important for abdomen station* *Some features differentiating spleen from kidney* You cannot get above spleen (ribs overlie the upper border of the spleen) It is dull to percussion (kidney is usually resonant because of overlying bowel) It moves towards RIF with inspiration (kidney tends to move downwards) It may have palpable notch on its medial side. paceUrMRCP.

*IMPORTANT 74* *Important for History taking* While asking about illicit drugs ( cocaine etc ) never ask straight away to the patient : Do you use any illicit drugs, it seems quite offensive. Be polite and always ask your patient *DO YOU USE ANY PARTY DRUGS OR ANYTHING FOR RECREATION.* paceUrMRCP.

*IMPORTANT 73* *Important for Abdomen station* Some signs of chronic liver disease in the hands Asterixis (liver flap) Bruising Clubbing Dupuytren’s contracture Erythema (palmar) Leuconychia ( white nails ) paceUrMRCP

*ANNOUNCEMENT* Hello n salam everyone We are pleased to announce admissions for our *Aug-Sep 2023 online course ( 15 days ) for PACES MRCP (UK) new pattern PACES23 and CLINICAL EXAM MRCPI .* We will start from *28th of Aug and finish on 15 Sep* *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 72* *Important causes of massive Splenomegaly* If massive splenomegaly, think of chronic myeloid leukaemia myelofibrosis malaria (or leishmaniasis). paceUrMRCP.