pace your MRCP-PACES

*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.

*IMPORTANT 71* *Important for Communication Station* While explaining *GB Sydrome* to the patient or his relatives, consider unpredictibility. Focus on the good prognosis mostly, but never miss to mention that in some patients lungs and breathing muscles may get involved and they may need ICU admission and may need breathing support and never miss to mention that some patients may even get parmenant weakness of the legs. paceUrMRCP.

*IMPORTANT 70* *Important for Communication Station* While explaining any medical condition to the patient, please avoid mentioning exact figures and percentages. paceUrMRCP

*IMPORTANT 69* *Hands in GIT station* Please look for *1.Clubbing* *2.leuconychia* (whitening of the nails due to hypoalbuminaemia) *3.koilonychia* (‘spooning’ of the nails due to iron, B12, or folate deficiency) *4.Muehrcke’s lines* (transverse white lines due to hypoalbuminaemia) *5.blue lunulae* (bluish discolouration seen in Wilson’s disease) *6.Palmar erythema* (chronic liver disease, pregnancy) *7.Dupuytren’s contracture* (thickening and fibrous contraction of palmar fascia ( most likely alcoholic liver disease) *8.Hepatic flap/asterixis* (hepatic encephalopathy, uraemia from renal disease) PaceUrMRCP

*IMPORTANT 68* *Important for respiratory station* Please remember For chest drain scars: always look in the triangle of safety (under the axilla between the pectoralis and lat dorsi muscles) they usually indicate previous pleural effusions or pneumothorax. PaceUrMRCP.

*IMPORTANT 67* *Some Info about Sputum* • *Black carbon specks* suggests smoking: commonest cause of increased sputum. • *Yellow/green sputum* suggests infection, eg bronchiectasis, pneumonia. • *Pink frothy sputum* suggests pulmonary oedema. • *Bloody sputum (haemoptysis)* may be due to malignancy, TB, infection, or trauma, and requires investigation for these causes. • *Clear sputum* is probably saliva. PaceUrMRCP.

*IMPORTANT 66* *Important for respiratory station* Please remember Thoracotomy scars are very important but easily missed. They can be anterolateral or posterolateral. Associated typically with operation like wedge resections, lobectomy, pneumonectomy, decortication, single lung transplant. PaceUrMRCP.

*IMPORTANT 65* *Important for respiratory station* If you see Horner’s syndrome while inspecting the face, never miss to check for wasting of the small muscles of the hand. PaceUrMRCP.

*IMPORTANT 64* *Important for clinical consultation station* To rule out Congenital Heart problems while taking history, ask a closed ended question to your patient *Any History of sudden death in the family* Rather than asking Any disease that runs in the family. PaceUrMRCP.

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*Announcement for Online Session No 96* *13 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 Communication Station* 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* After successful conduction of courses for PACES, paceUrMRCP is taking an initiative for MRCP 1 candidates. We are pleased to announce that we will regularly conduct online courses for MRCP part 1 from the third diet 2023.we will try to have a one month course before every upcoming diet to revise all the important and basic themes for the exam. *THE DATES AND TIME FOR OUR FUTURE COURSES WILL BE ANNOUNCED PRIOR TO EVERY UPCOMING DIET* Our *PACES COURSES* will continue as before. So far paceUrMRCP has helped in the success of 56 candidates for part 1, 69 candidates for part 2 and 154 candidates for PACES. Good luck.

*Announcement for Online Session No 96* *13 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 Communication Station* 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 63* *Important for Clinical Consultation station* *Diagnostic criteria of hereditary haemorrhagic telangiectasia* The four clinical diagnostic criteria are as follows 1. Episttaxis specially at night 2. Telangiectasia 3. Visceral lesions 4. Positive family history ( a first degree relative with HHT ) *If 3 or 4 present* : Definite diagnosis *If 2 are present* : Possible/ Suspected diagnosis *If less then 2 are present* : Diagnosis unlikely. PaceUrMRCP.

*IMPORTANT 62* *Important for Clinical Consultation stations* Always rule out congenital cardiac anamolies in a case of syncope ( even it is a clear case of Vasovagal syncope ) in a young patient as it is a hot cake in PACES. Either the candidate is going to ask it in his concerns or the examiner is going to ask you while discussing DD. PaceUrMRCP.

*IMPORTANT 61* *Back pain criteria for diagnosing ankylosing spondylitis* ( very common in station 5 ) 1. Age of onset < 45 years 2. Insidious onset 3. Improvement of back pain with exercise 4.No improvement of back pain with rest 5.Pain at night ( with improvement on getting up ) The presence of four of the five criteria suggests ankylosing spondylitis with 80 % sensitivity. PaceUrMRCP.