pace your MRCP-PACES

☝️ IMPORTANT 1☝️ FEVER is considered as a Jargon by most of the examiners , so avoid it and say HIGH BODY TEMPERATURE. Good luck.

Risk factors for gestational diabetes

*A brief Introduction of Primary hyperaldosteronism by courtesy of Dr Toqeer Bhatti.. Thanks a lot dear Dr* Primary hyperaldosteronism was previously thought to be most commonly caused by an adrenal adenoma, termed Conn's syndrome. However, recent studies have shown that bilateral idiopathic adrenal hyperplasia is the cause in up to 70% of cases. Differentiating between the two is important as this determines treatment. Adrenal carcinoma is an extremely rare cause of primary hyperaldosteronism. Good Luck

*Important points about Hypokalaemic periodic paralysis by courtesy of Dr Toqeer Bhatti.. Thanks a lot dear Dr* *Symptoms* Limb weakness (unilateral) (40%) Arm weakness (unilateral) (40%) *Signs* Proximal muscle weakness (40%) *Investigations* Hypokalaemia (85%): The potassium is typically low during attacks Good Luck

*Management of Addison,s disease by courtesy of Dr Toqeer Bhatti.. Thanks a lot dear Dr* Patients who have Addison's disease are usually given both glucocorticoid and mineralocorticoid replacement therapy. This usually means that patients take a combination of: hydrocortisone: usually given in 2 or 3 divided doses. Patients typically require 20-30 mg per day, with the majority given in the morning dose fludrocortisone Patient education is important: emphasise the importance of not missing glucocorticoid doses consider MedicAlert bracelets and steroid cards discuss how to adjust the glucocorticoid dose during an intercurrent illness (see below) Management of intercurrent illness in simple terms the glucocorticoid dose should be doubled the Addison's Clinical Advisory Panel have produced guidelines detailing particular scenarios Good Luck

*Investigations of Addison's disease by courtesy of Dr Toqeer Bhatti. Thanks a lot dear Dr* In a patient with suspected Addison's disease the definite investigation is an ACTH stimulation test (short Synacthen test). Plasma cortisol is measured before and 30 minutes after giving Synacthen 250ug IM. Adrenal autoantibodies such as anti-21-hydroxylase may also be demonstrated. If an ACTH stimulation test is not readily available (e.g. in primary care) then sending a 9 am serum cortisol can be useful: > 500 nmol/l makes Addison's very unlikely < 100 nmol/l is definitely abnormal 100-500 nmol/l should prompt a ACTH stimulation test to be performed Associated electrolyte abnormalities are seen in around one-third of undiagnosed patients: hyperkalaemia hyponatraemia hypoglycaemia metabolic acidosis Good Luck

*Clinical features of Addison's disease by courtesy of Dr Toqeer Bhatti. Thanks a lot dear Dr* lethargy, weakness, anorexia, nausea & vomiting, weight loss, 'salt-craving' hyperpigmentation (especially palmar creases), vitiligo, loss of pubic hair in women, hypotension, hypoglycaemia hyponatraemia and hyperkalaemia may be seen crisis: collapse, shock, pyrexia Good Luck

*Pathophysiology of Addison's disease by courtesy of Dr Toqeer Bhatti. Thanks a lot dear Dr* Autoimmune destruction of the adrenal glands is the commonest cause of primary hypoadrenalism in the UK, accounting for 80% of cases. This is termed Addison's disease and results in reduced cortisol and aldosterone being produced. *Other causes of hypoadrenalism* Primary causes tuberculosis metastases (e.g. bronchial carcinoma) meningococcal septicaemia (Waterhouse-Friderichsen syndrome) HIV antiphospholipid syndrome *Secondary causes* pituitary disorders (e.g. tumours, irradiation, infiltration) Exogenous glucocorticoid therapy Good Luck

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*Announcement for Online Session No 60* *17 July 2022* DEAR DOCTORS : MAY I HAVE YOUR ATTENTION PLEASE : *Today we will have an online session on Zoom discussing 1 station 2 ( History taking )* 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 : 1 00 pm Japan ( Tokyo ) : 10 00 pm Denmark : 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. *Please notice that we will not be able to record the session so make sure you attend it.* GOOD LUCK.

✌️✌️ *HEARTIEST CONGRATULATIONS* ✌️✌️ To *Dr. Faiz Mashood* For passing *CLINICAL EXAM MRCP ( IRELAND )* from Malaysia. He was with us in our batch of January 22 online course for PACES. We wish him the best for his future.

*Announcement for Online Session No 60* *17 July 2022* DEAR DOCTORS : MAY I HAVE YOUR ATTENTION PLEASE : *Tomorrow we will have an online session on Zoom discussing 1 station 2 ( History taking )* 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 : 1 00 pm Japan ( Tokyo ) : 10 00 pm Denmark : 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. *Please notice that we will not be able to record the session so make sure you attend it.* GOOD LUCK.

Dear coalleagues I regret to inform you that there is some issue with my telegram since a week, this is the reasons most of the posts are not uploaded or uploaded late. Please excuse me for this

*Some options for management of polycythemia vera by courtesy of Dr Toqeer Bhatti. Thanks a lot dear Dr* Phlebotomy – To keep hematocrit below 45% Aspirin – 81 mg daily Cytoreductive therapy – For patients at high risk for thrombosis Splenectomy in patients with painful splenomegaly or repeated episodes of splenic infarction Hydroxyurea is the most commonly used cytoreductive agent. If hydroxyurea is not effective or not tolerated, alternatives include the following: Interferon alfa Busulfan – In patients older than 65 years Ruxolitinib Fedratinib Good Luck.

*WHO criteria for Polycythemia Vera by courtesy of Dr Toqeer Bhatti.. Thanks a lot dear dr* *Major* Hemoglobin > 16.5 g/dL in men and > 16 g/dL in women, or hematocrit > 49% in men and > 48% in women, or red cell mass > 25% above mean normal predicted value Bone marrow biopsy showing hypercellularity for age with trilineage growth (panmyelosis) including prominent erythroid, granulocytic, and megakaryocytic proliferation with pleomorphic, mature megakaryocytes (differences in size) Presence of JAK2V617F or JAK2 exon 12 mutation The *minor* WHO criterion is as follows: Serum erythropoietin level below the reference range for normal Good luck

*Some possible findings in ploycythemia vera by courtesy of Dr Toqeer Bhatti.. Thanks a lot dear dr* Splenomegaly (75% of patients) Hepatomegaly (30%) Plethora Hypertension Good luck

*Symptoms of polycythemia vera by courtesy of Dr Toqeer Bhatti.. Thanks a lot dear dr* Impaired oxygen delivery due to sludging of blood may lead to the following symptoms: Headache Dizziness Vertigo Tinnitus Visual disturbances Angina pectoris Intermittent claudication Good luck

👉 *IMPORTANT 139* 👈 *Heart and Polyarteritis nodosa* You may find in Polyarteritis nodosa : Small and medium vessel vasculitis Angina Myocardial Infarction Arrhythmias Congestive cardiac Failure Pericarditis Conduction defects. Good luck.