pace your MRCP-PACES

*👉 IMPORTANT 455👈* *Tip for a case of renal transplant* To comment that the graft is (or is not) working Comment on signs of uraemia the patient is euvolaemic or oedematous, and If there are other current alternative methods of RRT Good Luck.

*👉 IMPORTANT 454👈* *Tip for a case of renak transplant* When you have identified a renal transplant, to impress the examiners and get full marks, you should comment on five things: 1. Is the graft working? 2. Evidence of previous renal replacement therapy modes. 3. Signs of immunosuppression. 4. Complications of patient’s renal disease. 5. Identifiable possible cause for the patient’s renal disease. Good Luck.

*👉 IMPORTANT 453👈* *Few stigmata of Chronic Liver Disease* Temporalis wasting Enlarged parotids Clubbing Leukonychia Dupuytren’s contracture Palmar erythema Flapping Tremors Multiple spider nevi Fetor hepaticas Good Luck.

*👉 IMPORTANT 452👈* *Features of enlarged kidney* Hand can get between mass & costal Margin Limited movement downwards on inspiration No Notch Percussion note resonant Ballotable Good Luck.

Dear Coalleagues Unfortunately my Aunt has died so we have to postpone our today's session. I regret any inconvenience. Please pray. May the departed soul rest in peace. Ameen.

*Announcement for Online Session No 82* *19 Feb 2023* DEAR DOCTORS : MAY I HAVE YOUR ATTENTION PLEASE : *Tomorrow we will have an online session on Zoom discussing 1 station 4 ( Communication skills )* regarding our preparation for MRCP PACES ( UK ) TIMINGS : Saudia Arabia: 4 pm Pakistan : 6 pm Bangladesh : 7 pm India : 6 30 pm Singapore : 9 pm Hong Kong : 9 pm Malaysia : 9 pm Egypt : 3 pm Libya : 3 pm Bahrain : 4 pm Burma ( Myanmar ) :7 30 pm Sudan : 3 pm UAE : 5 pm UK : 1 00 pm Ireland ( Dublin ) : 1 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 ( 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 451👈* *Features of enlarged Spleen* Cannot get above mass Moves downwards & medially with inspiration Splenic Notch Percussion note Dull Not Ballotable Good Luck.

*👉 IMPORTANT 450👈* *Common scars in abdomen* (Stretch the abdomen skin if the patient is obese to see the scars) Lt. Subcostal = Splenectomy= Cr.H.A (Chronic Hemolytic Anaemia) Rt.Subcostal = Cholecystectomy = Cr.H.A Laparoscopy = Cholecystectomy = Chr.H.A, Crohn`s disease Ascites Tapping scars Peritoneal Dialysis Rt. Illiac Fossa Scar = Renal Transplant /Appendectomy Mid Line Scar/Multiple Scars =Crohns Mercedes Benz Scar = Liver Transplantation Good Luck.

*👉 IMPORTANT 449👈* Always remember to feel for Dupuyterin`s Contracture or its scar in a case of CLD. Good Luck.

ANNOUNCEMENT Hello n salam everyone We are pleased to announce admissions for our *Feb-March 2023 online course ( 15 days ) for PACES MRCP (UK).* We will start from *20 Feb and finish on 8 March.* *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 448👈* *Hepatomegaly – causes:* Cirrhosis Congestive cardiac failure Cancer (liver, metastatic, haematological) Infection (hepatitis, hydatid cyst, amoebic pyogenic abscess ) Infiltration (sarcoidosis, amyloidosis, storage diseases) Alcoholic hepatitis Good Luck.

*👉 IMPORTANT 447👈* *Causes of CLD:* Metabolic causes, e.g. Wilson’s, haemochromatosis, α-1 antitrypsin deficiency Alcohol Nonalcoholic fatty liver disease Drugs, e.g. phenytoin, isoniazide, methotrexate Infections, e.g. bacterial (Staphylococcus aureus)/parasitic (amoebiasis,hydatid disease) Viral hepatitis, e.g. hepatitis B and C Autoimmune causes, e.g. autoimmune hepatitis, primary biliary cirrhosis, primary sclerosing cholangitis Good Luck.

*👉 IMPORTANT 446👈* *Causes of decompensation of CLD* • Electrolyte imbalances • Bleeding • Infection • Drugs and alcohol • Constipation. Good Luck.

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

ANNOUNCEMENT Hello n salam everyone We are pleased to announce admissions for our *Feb-March 2023 online course ( 15 days ) for PACES MRCP (UK).* We will start from *20 Feb and finish on 8 March.* *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 445👈* *Consequences of CLD* • Portal hypertension and variceal/upper gastrointestinal bleed. • Liver dysfunction and failure, failure of protein production, coagulopathy and encephalopathy. • Infection of developed ascites (spontaneous bacterial peritonitis. • Cancer (hepatocellular carcinoma) Good Luck.

*👉 IMPORTANT 444👈* *Few signs of decompensation of CLD: (and how to check for them)* Jaundice (skin and sclera) Ascites (abdominal distension, fluid wave,shifting dullness) Splenomegaly/caput medusa Encephalopathy (make sure you check for hepatic flap) Good Luck.

*👉 IMPORTANT 443👈* In every case of chronic liver disease , please try to comment • whether the disease is compensated or decompensated Good Luck.

*👉 IMPORTANT 442👈* *most common pathogens causing infective exacerbations in COPD patients* • Haemophilus influenza • Streptococcus pneumonia • Moraxella catarrhalis. Good Luck.

*👉 IMPORTANT 441👈* *Scar for lung transplant* If the trachea is not deviated to the scar site, and the breath sounds are normal on the scar side, whereas you can identify abnormal breathing sounds on the other side, consider single lung transplant. Good Luck.