pace your MRCP-PACES

*IMPORTANT 34* Please remember For Clinical consultation In a case of *antiphospholipid antibody syndrome conventional anticoagulants ( heparin and warfarin ) are still preferred for anticoagulation* otherwise now a days NOACS are preferred for anticoagulation whenever required. pace your MRCP-PACES...

*IMPORTANT 36* Please remember *For Breaking Bad News in Communication Station * Always give a warning shot before telling the bad news to the patient Always say I am sorry I have something concernig to tell you , Or the results have not come as we were expecting, Or I am afraid we have something serious to discuss. pace your MRCP-PACES...

Photo from Dr Tanzeel Bukhari

Photo from Dr Tanzeel Bukhari

Photo from Dr Tanzeel Bukhari

*🩺 Symptom Snapshot 23 – Tremor* *(by pace your MRCP – Dr Tanzeel Bukhari)* *1️⃣ Essential Tremor* Action or postural tremor (worse on movement) Often bilateral, affects hands and head Improves transiently with alcohol *2️⃣ Parkinson’s Disease* Resting “pill-rolling” tremor Associated with bradykinesia, rigidity, reduced arm swing Typically asymmetric at onset *3️⃣ Drug- or Metabolic-Induced Tremor* Fine tremor due to β-agonists, lithium, caffeine May be seen in thyrotoxicosis Improves with treatment of underlying cause

*🧠 Mnemonic 4 Causes of Shock* *(by pace your MRCP – Dr Tanzeel Bukhari)* *🔑 Mnemonic: SHOCK* S – Septic → Infection-related vasodilation and capillary leak causing hypotension. H – Hypovolaemic → Blood or fluid loss (GI bleed, trauma, dehydration). O – Obstructive → PE, cardiac tamponade, tension pneumothorax impairing cardiac output. C – Cardiogenic → MI, severe cardiomyopathy, arrhythmias causing pump failure. K – anaphylactiK (Anaphylactic) → IgE-mediated vasodilation, bronchospasm, and capillary leak. ________________________________________

*🩺 Management Essential 17 – Type 2 Respiratory Failure* *by pace your MRCP – Dr Tanzeel Bukhari* *(Hypercapnic respiratory failure)* *Definition* • PaO₂ <8 kPa with raised PaCO₂ *Immediate priorities* • Controlled oxygen: target SpO₂ 88–92% • Identify cause (COPD, obesity hypoventilation, neuromuscular disease) *Initial managemen* t • Controlled oxygen via Venturi mask • Treat precipitating cause (infection, bronchospasm) *Ventilatory support* • Early NIV (BiPAP) if: o pH <7.35 o Rising CO₂ or increasing work of breathing *Key safety pearls* • Excess oxygen worsens CO₂ retention • Drowsiness may reflect CO₂ narcosis • Early escalation saves intubation

* IMPORTANT 24 * Please remember *INR ( International normalized ratio )* is a _Jargon_ so be careful while using it in exam especially when asking for the follow up of anticoagulants, always tell your patient that **WE WILL / WE NEED TO CHECK YOUR BLOOD THINNING LEVEL ( OR LEVEL OF BLOOD THINNING ) during this therapy.. pace your MRCP-PACES..

IMPORTANT 23 Please remember VOMITING is a common ENGLISH word but it may be considered as a Jargon by some of the examiners so be careful while using it in exam and always say HAVE YOH EVER THROWN UP/ DO YOU EVER THROW UP to your patient pace your MRCP-PACES..

IMPORTANT 22 Please remember NAUSEA is a commn ENGLISH word but it may be considered as Jargon by some of the examiners so be careful while using it in exam and always say DO YOU FEEL SICK / OR ANY FEELING OF SICKNESS to your patient pace your MRCP-PACES..

Photo from Dr Tanzeel Bukhari

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IMPORTANT 21 Please remember INFLAMMATION is a controversial word and may be considered as Jargon by some of the examiners so be careful and always say IRRITATION OR SORENESS to your patient pace your MRCP-PACES..