pace your MRCP-PACES

👉 *IMPORTANT 81* *Nutshell Dyspnea for Station 5* Ask about Fever, cough and chest pain consider risk of COVID-19. Vital sign measurements; pulse oximetry. Cardiac and chest examination. Chest radiography and arterial blood gas measurement. Good luck.

👉 *IMPORTANT 80* *Some info about Intention tremor* worst on movement, seen in cerebellar disease, with past pointing and dysdiadochokinesis No effective drug has been found. 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☝️☝️☝️

%y*#kJY4

Here is the recording of yesterday'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☝️☝️☝️

Plz join

072413

*Announcement for Online Session No 71* *23 Oct 2022* DEAR DOCTORS : MAY I HAVE YOUR ATTENTION PLEASE : *Today we will have an online session on Zoom discussing 2 station 5 ( BCC )* 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 : 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 ( please Google for your local time zones to avoid any inconvenience ) Zoom meeting link will be shared 5 minutes before start time. The candidates for this session have been selected. GOOD LUCK.

*Announcement for Online Session No 71* *23 Oct 2022* DEAR DOCTORS : MAY I HAVE YOUR ATTENTION PLEASE : *Tomorrow we will have an online session on Zoom discussing 2 station 5 ( BCC )* 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 : 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 ( please Google for your local time zones to avoid any inconvenience ) Zoom meeting link will be shared 5 minutes before start time. The candidates for this session have been selected. GOOD LUCK.

👉 *IMPORTANT 79* Please remember : Parkinson disease is the most common cause of *resting tremers* in exam. The tremors are worst at rest with bradykinesia and rigidity; They are more resistant to treatment than other symptoms. They are usually slow tremors (frequency of 3–5Hz), typically ‘pill-rolling’ of the thumb over a finger. Good luck.

👉 *IMPORTANT 78* *Some causes of Paraesthesiae* It is described as ‘Pins and needles’, numbness/tingling, which can hurt or ‘burn’ (dysaesthesia). Common Causes may include : *Metabolic* reduced Ca2+ (mostly perioral); increased PaCO2; myxoedema; neurotoxins (tick bite; sting). *Vascular* : Raynaud’s; DVT; high plasma viscosity. *Anti body-mediated* : paraneoplastic; SLE; ITP. *Infection* : Lyme; rabies. *Drugs* : ACE-i. *Brain* : thalamic/parietal lesions. *Cord* : MS; myelitis/HIV; decreased B12, *Plexopathy/mononeuropathy* : cervical rib; carpal tunnel; sciatica. *Peripheral neuropathy* : DM; CKD. *If paroxysmal* : migraine; epilepsy; phaeochromocytoma. *If travel history* is positive : consider infection, eg strongyloides. Good luck..

👉 *IMPORTANT 77* 👈 *Some drugs causing muscle cramps* Diuretics ( from reduced K+), domperidone, salbutamol/terbutaline, ACE I, telmisartan,celecoxib, lacidipine, ergot alkaloids, levothyroxine. Good luck.

👉 *IMPORTANT 76* 👈 *The Abbreviated Mental Test Score (AMTS)* is a commonly used screening questionnaire for cognitive impairment ( unlikey to be asked in exam, please remember for academic interest ) Ask the patient about the following .Each question has a score of 1. 1 Tell patient an address to recall at the end 2 Age 3 Time (to nearest hour) 4 What year is it? 5 Recognize 2 people (eg doctor & nurse) 6 Date of birth 7 Dates of the Second World War 8 Name of current president/prime minister 9 Where are you now? (Which hospital?) 10 Count backwards from 20 to 1 A score of ≤6 suggests poor cognition, acute (delirium), or chronic (dementia). AMTS correlates well with the more detailed Mini-Mental State Examination (MMSE) Be careful deaf, dysphasic, depressed, and uncooperative patients, as well as those who do not understand English, will also get low scores. Good luck.

👉 *IMPORTANT 75* 👈 *Important for abdomen station* *Some features differentiating spleen from kidney* You cannot get above spleen (ribs overlie the upper border of the spleen) It is dull to percussion (kidney is usually resonant because of overlying bowel) It moves towards RIF with inspiration (kidney tends to move downwards) It may have palpable notch on its medial side. Good luck.

👉 *IMPORTANT 74* 👈 *Important for station 2 and 4* While asking about illicit drugs ( cocaine etc ) never ask straight away to the patient : Do you use any illicit drugs, it seems quite offensive. Be polite and always ask your patient *DO YOU USE ANY PARTY DRUGS OR ANYTHING FOR RECREATION.* Good luck.

👉 *IMPORTANT 73* 👈 *Important for Abdomen station* Some signs of chronic liver disease in the hands Asterixis (liver flap) Bruising Clubbing Dupuytren’s contracture Erythema (palmar) Leuconychia ( white nails ) Good luck.

👉 *IMPORTANT 72* 👈 *Important causes of massive Splenomegaly* If massive splenomegaly, think of chronic myeloid leukaemia myelofibrosis malaria (or leishmaniasis). Good luck.

👉 *IMPORTANT 71* 👈 *Important for Station 4* While explaining *GB Sydrome* to the patient or his relatives, consider unpredictibility. Focus on the good prognosis mostly, but never miss to mention that in some patients lungs and breathing muscles may get involved and they may need ICU admission and may need breathing support and never miss to mention that some patients may even get parmenant weakness of the legs. Good luck.