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*IMPORTANT 161* *Thyrotoxicosis in a glimpse* : Hair loss pretibial myxoedema Acropachy bulging eyes (exophthalmos/proptosis) Tachycardia Sweating Palmer erythema Tremers Proximal myopathy Diarrhea paceUrMRCP.

*IMPORTANT 160* *Some causes of bilateral hilar lymphadenopathy* Sarcoidosis Infection, eg TB, mycoplasma Malignancy, eg lymphoma, carcinoma,mediastinal tumours Organic dust disease, eg silicosis, berylliosis Hypersensitivity pneumonitis Histocytosis X (Langerhan’s cell histiocytosis). paceUrMRCP.

*IMPORTANT 159* Be careful in Steroid use in Scleroderma as it is known to precipitate scleroderma renal crisis paceUrMRCP.

*IMPORTANT 158* *Few steps in the mangement of obstructive sleep apnoea* : Weight loss CPAP is first line for moderate and severe OSA Intraoral devices ( Mandibular advancement ) If CPAP is not tolerated Uvulopalatophrngraphy Tracheostomy is last resort paceUrMRCP.

*IMPORTANT 157* Never miss to mention monitoring of Forced Vital Capacity in GBS what ever is the station. paceUrMRCP.

*IMPORTANT 156* Please remember Ideally the patient should avoid smoking,caffeine, or exercise for 30 minutes prior to measurement of blood pressure. paceUrMRCP.

*IMPORTANT 155* *Some drugs associated with weight gain* : Tricyclic antidepressants Insulin and sulfonylurea Contraceptives Glucocorticoids Progestational steroids Mirtazapine and paroxetine Gabapentin and valproate Propranolol paceUrMRCP.

*IMPORTANT 154* *Indications for corticosteroids in Sarcoidosis* : Parenchymal lung disease (symptomatic, static, or progressive). Uveitis. Hypercalcaemia. Neurological or cardiac involvement. paceUrMRCP.

*IMPORTANT 153* Some risk factors for Pulmonary Embolism • Recent surgery, especially abdominal/pelvic or hip/knee replacement. • Thrombophilia, eg antiphospholipid syndrome • Leg fracture. • Prolonged bed rest/reduced mobility. • Malignancy. • Pregnancy/postpartum; combined contraceptive pill; HRT (lower risk) • Previous PE. paceUrMRCP.

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The candidate for tomorrow's session has been selected. Regards

*Announcement for Online Session No 101* *24 Sep 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 Communication 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 152* 👈 *Some prognostic indicators of Coronary artery Disease* 1. *Left ventricular function* (ejection fraction [EF]) Normal >50% If <50%, associated with increased mortality 2.. *Vessel(s) involved* (severity/extent of ischemia) Left main coronary artery—poor prognosis because it supplies approximately two-thirds of the heart Two- or three-vessel CAD—worse prognosis paceUrMRCP.

👉 *IMPORTANT 151* 👈 *Symptoms indicating lower probability of asthma* Prominent dizziness, lightheadedness, tingling Chronic productive cough with no wheeze Normal examination when symptomatic Change in voice Symptoms with colds only Cardiac diseaae Significant smoking history (>20 pack year) Normal PEF when symptomatic paceUrMRCP.

*IMPORTANT 150* *Symptoms indicating increase probability of asthma* Wheeze, SOB, chest tightness Diurnal variation Response to exercise, allergen, cold air Symptoms after aspirin or ß-blocker History of atopy Family history atopy/asthma Widespread wheeze heard on auscultation Unexplained low FEV₁ or PEF Unexplained peripheral blood eosinophilia paceUrMRCP.

Please note *SPIRONOLACTONE DOES NOT CAUSE MYOCARDITIS.* In the previous sharing it was included in the list, please make corrections. My apology for wrong info.

*IMPORTANT 147 updated* *Certain drugs causing myocarditis* Cyclophosphamide trastuzumab penicillin chloramphenicol sulfonamides methyldopa phenytoin carbamazepine paceUrMRCP.

*IMPORTANT 149* *Common causes of Bronchiectasis* : ( very common ) *Congenital* : Cystic fibrosis Young’s syndrome Primary ciliary dyskinesia Kartagener’s syndrome *Post-infection* : Measles Pertussis Bronchiolitis pneumonia TB HIV *Other* : Bronchial obstruction (tumour, foreign body); Allergic bronchopulmonary aspergillosis hypogammaglobulinaemia Rheumatoid arthritis Ulcerative colitis Idiopathic paceUrMRCP.