pace your MRCP-PACES

✌️✌️ *HEARTIEST CONGRATULATIONS* ✌️✌️ To *Dr Steffin Methai Kattor* For passing *PACES MRCP UK* from India. He was with us in our batch for online prepration for PACES in May 22 We wish him the best for his future.

✌️✌️ *HEARTIEST CONGRATULATIONS* ✌️✌️ To *Dr Cyrin* For passing *PACES MRCP UK* from India. She was with us in our batch for online prepration for PACES in Aug-Sep 22 We wish her the best for her future.

✌️✌️ *HEARTIEST CONGRATULATIONS* ✌️✌️ To *Dr Farhat Nazneen* For passing *PACES MRCP UK* from India. She was with us in our batch for online prepration for PACES in Sep 22 We wish her the best for her future.

✌️✌️ *HEARTIEST CONGRATULATIONS* ✌️✌️ To *Dr Meenal* For passing *PACES MRCP UK* from India. She has been a keen member of our groups for online prepration for PACES. We wish her the best for her future.

👉 *IMPORTANT 217* 👈 *Some info about Irritable Bowel Syndrome ( IBS ) :* *The Rome IV criteria for the diagnosis of irritable bowel syndrome (IBS)* ( earlier it was Rome 111 ) Patients have had recurrent abdominal pain on average at least 1 day per week during the previous 3 months that is associated with two or more of the following • Related to defecation (may be increased or unchanged by defecation) . Associated with a change in stool frequency • Associated with a change in stool form or appearance Good luck.

👉 *IMPORTANT 216* 👈 *Some info about Irritable Bowel Syndrome ( IBS ) This is a clinical diagnosis, and a diagnosis of exclusion. All laboratory test results are normal, and no mucosal lesions are found on sigmoidoscopy. Good luck.

👉 *IMPORTANT 215* 👈 *Some info about Irritable Bowel Syndrome ( IBS ) :* *Common Clinical Features of IBS* 1. Change in frequency/consistency of stool diarrhea, constipation (or alternating diarrhea and constipation) 2. Cramping abdominal pain (relieved by defecation)-location varies widely, 3. Bloating or feeling of abdominal distention Good luck.

👉 *IMPORTANT 214* 👈 *Some info about Irritable Bowel Syndrome ( IBS ) :* Symptoms are exacerbated by stress and irritants in the intestinal lumen ( some foods ) Symptoms should be present for at least 3 months to diagnose IBS. Good luck.

👉 *IMPORTANT 213* 👈 *Some info about Irritable Bowel Syndrome ( IBS ) :* IBS refers to an idiopathic disorder associated with an intrinsic bowel motility dysfunction (abnormal resting activity of GI tract). Common associated findings with IBS may include depression, anxiety, and somatization. Psychiatric symptoms often precede bowel symptoms. Good luck.

👉 *IMPORTANT 212* 👈 *Some info about Hemochromatosis :* *Treatment* 1. Perform repeated phlebotomies this is the treatment of choice and improves survival dramatically if initiated early in the course of the disease. 2. Iron chelators 3. Treat any complications (e.g., CHF, diabetes, hypothyroidism, arthritis). 4. Consider liver transplantation in advanced cases. Good luck.

✌️✌️ *HEARTIEST CONGRATULATIONS* ✌️✌️ To *Dr Adil* For passing *PACES MRCP UK* from Egypt. He has been a keen member of our online group for prepration for PACES. We wish him the best for his future.

👉 *IMPORTANT 211* 👈 *Some info about Hemochromatosis :* *Diagnosis* 1. Markedly elevated serum iron and serum ferritin 2. Elevated iron saturation (transferrin saturation) 3. Decreased total iron-binding capacity (TIBC) 4. Liver biopsy 5. Genetic testing for etiologic mutations (gold standard for diagnosis) Good luck.

👉 *IMPORTANT 210* 👈 *Some info about Hemochromatosis :* *Common Complications* 1. Cirrhosis a. Cirrhosis increases the risk of HCC by 200-fold. b. The presence of liver disease is a primary factor in determining the prognosis. 2. Cardiomyopathy CHF Arrhythmias 3. Diabetes mellitus due to iron deposition in the pancreas 4. Arthritis most common sites are the second and third metacarpophalangeal joints, hips, and knees. 5. Hypogonadism Impotence Amenorrhea Loss of libido 6. Hypothyroidism 7. Hyperpigmentation of skin (resembles suntan, "bronzelike") Good luck.

👉 *IMPORTANT 209* 👈 *Some info about Hemochromatosis :* *Affected organs* a. Liver (primary affected organ) b. Pancreas c. Heart d. Joints e. Skin f. Thyroid, gonads, hypothalamus. *Clinical Features* 1. Most patients are asymptomatic initially. 2. Findings may include signs of liver disease, fatigue, arthritis, impotence/amenorrhea, abdominal pain, and cardiac arrhythmias. Good luck.

👉 *IMPORTANT 208* 👈 *Some info about Hemochromatosis :* An autosomal recessive disease of iron absorption Excessive iron absorption in the intestine leads to increased accumulation of iron (as ferritin and hemosiderin) in various organs. Over many years, fibrosis in involved organs occurs secondary to hydroxyl free radicals that are generated by the excess iron. 3. This is an inherited disease, so screen the patient's siblings. Early diagnosis and treatment before development of complications (primarily cirrhosis, but also heart disease and diabetes) improve survival. Good luck.

👉 *IMPORTANT 207* 👈 Be aware of prolactinomas in pregnancy as during pregnancy they have an increased risk of expansion, so offer regualar follow ups, Good luck.

👉 *IMPORTANT 206* 👈 *Major treatment options for prolactinomas* Are 1. Dopamine agonists ( Bromocriptine , Cabergoline) Please notice that Bromocriptine is contraindicated in pregnancy. 2. Surgery. Good luck.

👉 *IMPORTANT 205* 👈 *Common symtoms due to raised prolactin* *In Females:* Amenorrhoea or oligomenorrhoea, infertility; galactorrhoea, reduced libido, increased weight, dry vagina. *In Males :* Erectile dysfunction, reduced facial hair, galactorrhoea. May present late with osteoporosis or local pressure effects from the tumour Good luck.

👉 *IMPORTANT 204* 👈 *Some drugs causing raised prolactin* Metoclopramide Haloperidol Methyldopa Eestrogens Ecstasy/MDMA Antipsychotics Good luck.

👉 *IMPORTANT 203* 👈 *Some physiological causes of raised prolactin* Pregnancy Breastfeeding Stress Acute rises occur post-orgasm Good luck.