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*Announcement for Online Session No 104* *22 Oct 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 Clinical Consultation 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 Zimbabwe : 3 00 pm ( please Google for your local time zones to avoid any inconvenience ) Zoom meeting link will be shared 5 minutes before start time. The candidate for this session has been selected. GOOD LUCK.

*Announcement for Online Session No 104* *22 Oct 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 Clinical Consultation 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 Zimbabwe : 3 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 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. paceUrMRCP.

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. paceUrMRCP.

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) paceUrMRCP.

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") paceUrMRCP.

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. paceUrMRCP.

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. paceUrMRCP.

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

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

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

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 paceUrMRCP.

IMPORTANT 204 Some drugs causing raised prolactin Metoclopramide Haloperidol Methyldopa Eestrogens Ecstasy/MDMA Antipsychotics paceUrMRCP.

IMPORTANT 203 Some physiological causes of raised prolactin Pregnancy Breastfeeding Stress Acute rises occur post-orgasm paceUrMRCP.

IMPORTANT 202 Always suspect pituitary apoplexy if there is an acute onset of headache, meningism, decreased GCS, ophthalmoplegia/visual field defect, especially in a known case of pituitary tumour (it may present like subarachnoid haemorrhage). paceUrMRCP.

*IMPORTANT 201* Please remember that in any case involving pituitary gland try to rule out 3 types of symptoms 1.the symptoms caused by local pressure, 2. The symtoms caused by oversecretion of hormones (eg galactorrhoea) 3. The symtoms caused by hypopituitarism paceUrMRCP.

*IMPORTANT 199* *Some medicines which may cause impotence* digoxin, B-blockers, diuretics, antipsychotics, antidepressants, oestrogens, finasteride, narcotics. paceUrMRCP.