pace your MRCP-PACES

✌️✌️ *HEARTIEST CONGRATULATIONS* ✌️✌️ To *Dr Thanuja Alahakoon* For passing *MRCP UK PACES from Sri Lanka* She has been keen member of our PACES group. We wish her the best for her future.

👉 *IMPORTANT 532* 👈 *Pharmacology pearls important for clinical judgement* Avoid Sotalol, Adenosine, Verapamil and Digoxin in WPW Good Luck

👉 *IMPORTANT 531* 👈 *Pharmacology pearls* Avoid Nitrates, ACE inhibitors and Inotropes in HOCM Good Luck

👉 *IMPORTANT 530* 👈 *Important steps in management of AKI* Treat sepsis Stop nephrotoxic medication—NSAIDS, ACE-i, ARB, aminoglycosides Stop drugs that may increase complications: diuretics (especially K+-sparing), metformin, antihypertensives Check all drug dosages are appropriate for renal impairment Consider gastroprotection (H2 antagonist, PPI) and nutritional support Avoid radiological contrast Good Luck

👉 *IMPORTANT 529* 👈 *Important investigations in AKI* Urine dipstick (pre-catheter) and quantification of any proteinuria. Haematuria/proteinuria may suggest intrinsic renal disease USS within 24 hours (unless cause obvious or AKI improving). Small kidneys (<9cm) suggest CKD. Asymmetry may suggest renal vascular disease Check liver function (hepatorenal) Check platelets—if low need blood fi lm to check for haemolysis (HUS/TTP) Investigate for intrinsic renal disease if indicated: immunoglobulins, paraprotein, complement, autoantibodies (ANA, ANCA, anti-GBM) Good Luck

👉 *IMPORTANT 528* 👈 Please monitor in AKI • Fluid balance—consider urinary catheter and hourly urine output • K+ —check response to treatment and at least daily until creatinine falls • Observations—minimum every 4 hours • Lactate if signs of sepsis • Daily creatinine until starts decreasing (the levels lag ~24 hours behind clinical response) Good Luck

👉 *IMPORTANT 527* 👈 Please examine in AKI Heart rate BP JVP capillary refill palpate for bladder Good Luck

👉 *IMPORTANT 526* 👈 *Post-renal causes of AKI can be :* *Pathophysiology :::::: Examples* Within renal tract : Stone, renal tract malignancy, stricture, clot Extrinsic compression : Pelvic malignancy, prostatic hypertrophy, retro-peritoneal fibrosis Good Luck

👉 *IMPORTANT 525* 👈 *Renal causes of AKI can be :* *Pathophysiology :::::: Examples* Glomerular : Glomerulonephritis, ATN (prolonged renal hypo-perfusion causing intrinsic renal damage) Interstitial : Drug reaction, infection, infiltration (eg sarcoid) Vessels : Vasculitis, HUS, TTP, DIC Good Luck

👉 *IMPORTANT 524* 👈 *Prerenal causes of AKI can be :* *Pathophysiology :::::: Examples* Reduced Vascular volume : Haemorrhage, D&V, burns, pancreatitis Decreased cardiac output : Cardiogenic shock, MI Systemic vasodilation : Sepsis, drugs Renal vasoconstriction : NSAIDs, ACE-i, ARB, hepatorenal syndrome Good Luck

Here is the recording of today's session. Please try to listen the recording in 1 day as Zoom provides limited space and it automatically deletes the old recordings to keep space for new ones ..so the recording will not be available after 1 day☝️☝️☝️

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*Announcement for Online Session No 82* *19 March 2023* DEAR DOCTORS : MAY I HAVE YOUR ATTENTION PLEASE : *Today 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.

*Announcement for Online Session No 82* *19 March 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 523* 👈 *Commonest causes of AKI :* Sepsis. Major surgery. Cardiogenic shock. Other hypovolaemia. Drugs. Hepatorenal syndrome. Obstruction. Good Luck

👉 *IMPORTANT 522* 👈 The Kidney Diseases: Improving Global Outcomes (KDIGO) guidelines define AKI as: • rise in creatinine >26μmol/L within 48h. • rise in creatinine >1.5 ≈ baseline (ie before the AKI) within 7 days. • urine output <0.5mL/kg/h for >6 consecutive hours. Good Luck