pace your MRCP-PACES

*Announcement for Online Session No 90* *11 June 2023* 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 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 ( 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 691 👈* *Causes of Acute abdomen* *A* appendicitis *B* biliary obstruction *D* diverticulitis *O* ovarian disease *M* malignancy *I* intestinal obstruction/ ischaemic bowl *N* nephritic syndrome *A* acute pancreatitis *L* liquor *P* porphyria *A* Acid peptic disease *I* infectious peritonitis *N* non infectious peritonitis - hemoperitoneum *paceUrMRCP.*

*👉 IMPORTANT 690 👈* *Certain causes of hepatomegaly* *Malignancy* : Metastatic or primary (usually craggy, irregular edge). *Hepatic congestion:* Right heart failure—may be pulsatile in tricuspid incompetence, hepatic vein thrombosis ( Budd–Chiari syndrome, rare but has appeared in exam ) *Anatomical* : Riedel’s lobe (normal variant). *Infection* : Infectious mononucleosis (glandular fever), hepatitis viruses, malaria, schistosomiasis, amoebic abscess, hydatid cyst. *Haematological* : Leukaemia, lymphoma, myeloproliferative disorders (eg myelofibrosis), sickle-cell disease, haemolytic anaemias. Fatty liver, porphyria, amyloidosis, glycogen storage disorders. *paceUrMRCP.*

*👉 IMPORTANT 689 👈* *Acromegaly investigation 3* *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 *paceUrMRCP.*

*👉 IMPORTANT 688 👈* *Acromegaly investigation 2* *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 *paceUrMRCP.*

*👉 IMPORTANT 687 👈* *Acromegaly investigation 1* *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 *paceUrMRCP.*

*👉 IMPORTANT 686 👈* *Some info about Stress echocardiography* 1.Performed before and immediately after exercise. 2.Exercise-induced ischemia is evidenced by wall motion abnormalities (e.g., akinesis or hypokinesis) not present at rest. This study is less reliable in patients with existing wall motion abnormalities or lowered EF. 3.Favored by many cardiologists over stress ECG. It is more sensitive in detecting ischemia, can assess LV size and function, can diagnose valvular disease, and can be used to identify CAD in the presence of pre-existing ECG abnormalities. Ideally patients with a positive test result should undergo cardiac catheterization. *paceUrMRCP.*

*👉 IMPORTANT 685 👈* *Few etiologies of dyspnoea by timing of onset* *Acute* Foreign body Pneumothorax Pulmonary embolus Acute pulmonary oedema *Subacute* Asthma Parenchymal disease,eg alveolitis pneumonia, Effusion *Chronic* COPD and chronic parenchymal diseases Non-respiratory causes, eg cardiac failure, anaemia Good luck.

*👉 IMPORTANT 684 👈* *MRC Dyspnoea Scale* 1.Not troubled by breathlessness except on strenuous exercise. 2.Short of breath when hurrying or walking up a slight hill 3.Walks slower than contemporaries on level ground because of breathlessness or has to stop for breath when walking at own pace 4.Stops for breath after walking about 100m or after a few minutes on level ground 5.Too breathless to leave house or breathless when dressing Good luck.

*👉 IMPORTANT 683 👈* *Few DVT Risk Factors:* *Hematological* • Thrombophilia: e.g. Activated protein C resistance, protein C and S deficiency • Polycythemia • Paroxysmal nocturnal hemoglobinuria • Hyperviscosity syndrome *Autoimmune* • Antiphospholipid syndrome • Behcet's *Drugs* • Combined oral contraceptive pill • Antipsychotics (especially olanzapine) have recently been shown to be a risk factor Other conditions • Homocystinuria Good luck.

Dear coalleagues We will start our academic activities from tomorrow. Thanks for your patience Regards and best wishes

*✌✌ HEARTIEST CONGRATULATIONS ✌✌* To *Dr Bushra* For passing MRCP UK part 2 Written. We wish her the best for her future.

*ANNOUNCEMENT* Hello n salam everyone We are pleased to announce admissions for our *June 2023 online course ( 15 days ) for PACES MRCP (UK) current pattern.* We will start from *7 June and finish on 27 June* *IT WILL BE OUR LAST COURSE OF OLD PATTERN. FROM JULY 23 WE WILL START SESSIONS ACCORDING TO THE NEW PATTERN.* *Active slots available on first come--first served basis.* Listener slot available too. *Atleast 90 Important exam cases ( including recent diets cases ) will be practiced and discussed as we do in our weekly Sunday sessions.* After the performance a detailed feedback will be given to elaborate the weak skills. It is equally beneficial for those who are beginners or have exam in coming diet. Interested candidates may send a personal message for details. WhatsApp No: 00923346036496. Email: drtanzeelbukhari@gmail.com GOOD LUCK.

*ANNOUNCEMENT* Hello n salam everyone We are pleased to announce admissions for our *June 2023 online course ( 15 days ) for PACES MRCP (UK) current pattern.* We will start from *7 June and finish on 27 June* *IT WILL BE OUR LAST COURSE OF OLD PATTERN. FROM JULY 23 WE WILL START SESSIONS ACCORDING TO THE NEW PATTERN.* *Active slots available on first come--first served basis.* Listener slot available too. *Atleast 90 Important exam cases ( including recent diets cases ) will be practiced and discussed as we do in our weekly Sunday sessions.* After the performance a detailed feedback will be given to elaborate the weak skills. It is equally beneficial for those who are beginners or have exam in coming diet. Interested candidates may send a personal message for details. WhatsApp No: 00923346036496. Email: drtanzeelbukhari@gmail.com GOOD LUCK.

*ANNOUNCEMENT* Hello n salam everyone We are pleased to announce admissions for our *June 2023 online course ( 15 days ) for PACES MRCP (UK) current pattern.* We will start from *7 June and finish on 27 June* *IT WILL BE OUR LAST COURSE OF OLD PATTERN. FROM JULY 23 WE WILL START SESSIONS ACCORDING TO THE NEW PATTERN.* *Active slots available on first come--first served basis.* Listener slot available too. *Atleast 90 Important exam cases ( including recent diets cases ) will be practiced and discussed as we do in our weekly Sunday sessions.* After the performance a detailed feedback will be given to elaborate the weak skills. It is equally beneficial for those who are beginners or have exam in coming diet. Interested candidates may send a personal message for details. WhatsApp No: 00923346036496. Email: drtanzeelbukhari@gmail.com GOOD LUCK.

*ANNOUNCEMENT* Hello n salam everyone We are pleased to announce admissions for our *June 2023 online course ( 15 days ) for PACES MRCP (UK) current pattern.* We will start from *7 June and finish on 27 June* *IT WILL BE OUR LAST COURSE OF OLD PATTERN. FROM JULY 23 WE WILL START SESSIONS ACCORDING TO THE NEW PATTERN.* *Active slots available on first come--first served basis.* Listener slot available too. *Atleast 90 Important exam cases ( including recent diets cases ) will be practiced and discussed as we do in our weekly Sunday sessions.* After the performance a detailed feedback will be given to elaborate the weak skills. It is equally beneficial for those who are beginners or have exam in coming diet. Interested candidates may send a personal message for details. WhatsApp No: 00923346036496. Email: drtanzeelbukhari@gmail.com GOOD LUCK.

*ANNOUNCEMENT* Hello n salam everyone We are pleased to announce admissions for our *June 2023 online course ( 15 days ) for PACES MRCP (UK) current pattern.* We will start from *7 June and finish on 27 June* *IT WILL BE OUR LAST COURSE OF OLD PATTERN. FROM JULY 23 WE WILL START SESSIONS ACCORDING TO THE NEW PATTERN.* *Active slots available on first come--first served basis.* Listener slot available too. *Atleast 90 Important exam cases ( including recent diets cases ) will be practiced and discussed as we do in our weekly Sunday sessions.* After the performance a detailed feedback will be given to elaborate the weak skills. It is equally beneficial for those who are beginners or have exam in coming diet. Interested candidates may send a personal message for details. WhatsApp No: 00923346036496. Email: drtanzeelbukhari@gmail.com GOOD LUCK.

Dear coalleagues I will be travelling for a couple of days so will take a break from medicine. *We will start again on 6th June if all goes well.* I am sorry for any inconvenience. Regards and best wishes.

*👉 IMPORTANT 682 👈* *Some risk factors for Ischemic heart disease* *a. Diabetes mellitus* (DM)—worst risk factor *b. Hyperlipidemia* —elevated low-density lipoprotein (LDL) *c. Hypertension* (HTN)—most common risk factor *d. Cigarette smoking* *e. Age* (men >45 years; women >55 years) *f. Family history* of premature coronary artery disease (CAD) or myocardial infarction (MI) in first-degree relative: Men <55 years; women <65 years *g. Low levels of high-density lipoprotein*(HDL) *h.end-stage renal disease* (ESRD) on hemodialysis, *i.human immunodeficiency virus* (HIV) infection, *j.history of mediastinal radiation*. *And never miss to ask about obesity,sedentary lifestyle (lack of physical activity), stress, excess alcohol use.* Good luck.

*👉 IMPORTANT 681 👈* *Some info about Dyspnoea* Subjective sensation of shortness of breath, often exacerbated by exertion. • Lung—airway and interstitial disease. May be hard to separate from cardiac causes; asthma may wake patient, and cause early morning dyspnoea & wheeze. • Cardiac—eg ischaemic heart disease or left ventricular failure (LVF), mitral stenosis, of any cause. LVF is associated with orthopnoea (dyspnoea worse on lying; ‘How many pillows do you use while sleeping?’) and paroxysmal nocturnal dyspnoea (PND;dyspnoea waking one up). Other features include ankle oedema, lung crepitations, and raised JVP. • Anatomical—eg diseases of the chest wall, muscles, pleura. Ascites can cause breathlessness by splinting the diaphragm, restricting its movement. • Others Any shocked patient may also be dyspnoeic—dyspnoea may be shock’s presenting feature. Also anaemia or metabolic acidosis causing respiratory compensation, eg ketoacidosis, aspirin poisoning. Look for other clues—dyspnoea at rest unassociated with exertion, may be psychogenic: prolonged hyperventilation causes respiratory alkalosis. This causes a fall in ionized calcium leading to apparent hypocalcaemia. Features include peripheral and perioral paraesthesiae ± carpopedal spasm. Speed of onset helps diagnosis. Good luck.