pace your MRCP-PACES

👉 *IMPORTANT 70* 👈 *Important for Station 4* While explaining any medical condition to the patient, please avoid mentioning exact figures and percentages. Good luck.

👉 *IMPORTANT 69* 👈 *Hands in GIT station* Please look for *1.Clubbing* *2.leuconychia* (whitening of the nails due to hypoalbuminaemia) *3.koilonychia* (‘spooning’ of the nails due to iron, B12, or folate deficiency) *4.Muehrcke’s lines* (transverse white lines due to hypoalbuminaemia) *5.blue lunulae* (bluish discolouration seen in Wilson’s disease) *6.Palmar erythema* (chronic liver disease, pregnancy) *7.Dupuytren’s contracture* (thickening and fibrous contraction of palmar fascia ( most likely alcoholic liver disease) *8.Hepatic flap/asterixis* (hepatic encephalopathy, uraemia from renal disease) Good luck.

👉 *IMPORTANT 68* 👈 *Important for respiratory station* Please remember For chest drain scars: always look in the triangle of safety (under the axilla between the pectoralis and lat dorsi muscles) they usually indicate previous pleural effusions or pneumothorax. Good luck.

👉 *IMPORTANT 67* 👈 *Some Info about Sputum* • *Black carbon specks* suggests smoking: commonest cause of increased sputum. • *Yellow/green sputum* suggests infection, eg bronchiectasis, pneumonia. • *Pink frothy sputum* suggests pulmonary oedema. • *Bloody sputum (haemoptysis)* may be due to malignancy, TB, infection, or trauma, and requires investigation for these causes. • *Clear sputum* is probably saliva. Good luck..

👉 *IMPORTANT 66* 👈 *Important for respiratory station* Please remember Thoracotomy scars are very important but easily missed. They can be anterolateral or posterolateral. Associated typically with operation like wedge resections, lobectomy, pneumonectomy, decortication, single lung transplant. Good luck.

👉 *IMPORTANT 65* 👈 *Important for respiratory station* If you see Horner’s syndrome while inspecting the face, never miss to check for wasting of the small muscles of the hand. Good luck.

👉 *IMPORTANT 64* 👈 *Important for station 2 n 5* To rule out Congenital Heart problems while taking history, ask a closed ended question to your patient *Any History of sudden death in the family* Rather than asking Any disease that runs in the family. Good luck.

👉 *IMPORTANT 63* 👈 *Important for station 5* *Diagnostic criteria of hereditary haemorrhagic telangiectasia* The four clinical diagnostic criteria are as follows 1. Episttaxis specially at night 2. Telangiectasia 3. Visceral lesions 4. Positive family history ( a first degree relative with HHT ) *If 3 or 4 present* : Definite diagnosis *If 2 are present* : Possible/ Suspected diagnosis *If less then 2 are present* : Diagnosis unlikely. Good luck.

*Info by courtesy of Dr Hafsa Rasheed* *Acromegaly investigation [updated]* ======================= [ *[confirm the diagnosis]]* Serum IGF-1 levels have now overtaken the oral glucose tolerance test (OGTT) with serial GH measurements as the first-line test. According to Endocrine Society, Investigation include measurement of a serum insulin-like growth factor-1 (IGF-1) concentration as the first step An unequivocally elevated serum IGF-1 concentration in a patient with typical clinical manifestations of acromegaly confirms the diagnosis of acromegaly. A normal serum IGF-1 concentration is strong evidence that the patient does not have acromegaly. If the serum IGF-1 concentration is equivocal, OGTT should be done A pituitary MRI may demonstrate a pituitary tumour. Visual field testing should be performed if there is optic chiasmal compression noted on the MRI or if the patient has complaints of reduced peripheral vision *[[look for complication]]* ECG, echocardiogram and chest radiograph: if cardiomyopathy is suspected. Oral glucose tolerance test: used to make the diagnosis, but also to establish the presence of associated impaired glucose tolerance/diabetes mellitus. Nerve conduction studies: if an associated carpal tunnel syndrome is suspected. Sleep studies: if obstructive sleep apnoea is suspected. Colonoscopy: surveillance for polyps and colorectal malignancies, a recognised complication of acromegaly. Bone profile : should be performed in patients with a history of hypogonadism or fracture to exclude osteoporosis *[[look for association]]* pituitary hormonal profile The presence of hypercalcemia should prompt an evaluation for primary hyperparathyroidism and, if present, consideration of MEN 1 genetic test should be taken in account

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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✌️✌️ *HEARTIEST CONGRATULATIONS* ✌️✌️ To *Dr Qurban Hussain* For passing *PACES MRCP UK from Pakistan* He has been a keen member of our PACES group. We wish him the best for his future.

*Announcement for Online Session No 70* *16 Oct 2022* DEAR DOCTORS : MAY I HAVE YOUR ATTENTION PLEASE : *Today we will have an online session on Zoom discussing 2 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 : 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 ( 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.

✌️✌️ *HEARTIEST CONGRATULATIONS* ✌️✌️ To *Dr Usman* For passing *MRCP UK PART 1* He has been a keen member of our part 1 group. We wish him the best for his future.

*Announcement for Online Session No 70* *16 Oct 2022* 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 : 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 ( please Google for your local time zones to avoid any inconvenience ) Zoom meeting link will be shared 5 minutes before start time. Any interested candidate may send a personal message to take the case GOOD LUCK.

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

✌️✌️ *HEARTIEST CONGRATULATIONS* ✌️✌️ To *Dr Hasseb* For passing *MRCP UK PART 1* He has been a keen member of our part 1 group. We wish him the best for his future.