pace your MRCP-PACES

👉 *IMPORTANT 119* 👈 *New York classification of heart failure* I. Heart disease present, but no undue dyspnoea from ordinary activity. II. Comfortable at rest; dyspnoea during ordinary activities. III. Less than ordinary activity causes dyspnoea, which is limiting. IV. Dyspnoea present at rest; all activity causes discomfort. Good luck.

✌️✌️ *HEARTIEST CONGRATULATIONS* ✌️✌️ To *Dr.Sharalaa Engatramana* For passing *PACES MRCP ( UK )* from Malaysia. She was with us in our batch of April 22 online course for PACES. We wish her the best for her future.

👉 *IMPORTANT 118* 👈 Please remember some non-cardiac causes of arrythmias Caffeine Smoking Alcohol Pneumonia Drugs ( beta 2-agonists, digoxin, L-dopa, tricyclics, doxorubicin) Metabolic imbalance (K+, Ca2+, Mg2+, hypoxia, hypercapnia, metabolic acidosis, thyroid disease) phaeochromocytoma. Good luck.

👉 *IMPORTANT 117* 👈 Some features of pain making it cardiac pain unlikely • Stabbing, shooting pain • Pain lasting <30s, however intense • Well-localized, left sub-mammary pain • Pains of continually varying location. Good luck.

👉 *IMPORTANT 116* 👈 Just because smoking advice does not always work, do not stop giving it Good luck.

✌️✌️ *HEARTIEST CONGRATULATIONS* ✌️✌️ To *Dr. Jeevan kumar* 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.

👉 *IMPORTANT 115* 👈 *Cerebellar Signs* *DASHING* : *D* ysdiadochokinesis, *A* taxia, *S* lurred speech, *H* ypotonia and reduced power, *I* ntention tremor, *N* ystagmus, *G* ait Broad based Good luck.

👉 *IMPORTANT 114* 👈 Some questions to detect urinary outflow obstruction eg prostatic hyperplasia; stricture, stone. • On trying to pass water, is there delay before you start? (Hesitancy) • Does the flow stop and start? Do you go on dribbling when you think you’ve stopped. • Is your stream getting weaker? (Poor stream) • Is your stream painful and slow/‘drop-by-drop’? (eg from bladder stone) • Do you feel the bladder is not empty after passing water? • Do you ever pass water when you do not want to? • On feeling an urge to pass water, do you have to go at once? (Urgency) • Do you urinate often at night? (Nocturia) if yes how often? Good luck.

👉 *IMPORTANT 113* 👈 *Some causes of unilateral clubbing* Hemiplegia Vascular lesions, eg upper-limb artery aneurysm, Takayasu’s arteritis, brachial arteriovenous malformations (including haemodialysis fistulas). Good luck.

✌️✌️ *HEARTIEST CONGRATULATIONS* ✌️✌️ To *Dr. Muhammad usman majeed* 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.

✌️✌️ *HEARTIEST CONGRATULATIONS* ✌️✌️ To *Dr Muhammad shoaib niazi* 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.

*I regret to inform that our tomorrow,s general session will not happen due to an unexpected family issue.* I am sorry for the inconvenience. We will continue on next Sunday

👉 *IMPORTANT 112* 👈 *Some cardiovascular causes of clubbing* Cyanotic congenital heart disease Endocarditis Atrial myxoma Aneurysms Infected grafts. Good luck.

👉 *IMPORTANT 111* 👈 *Some GIT causes of clubbing* Inflammatory bowel disease (especially Crohn’s) Cirrhosis GI lymphoma Malabsorption, eg coeliac. Good luck.

👉 *IMPORTANT 110* 👈 *Some thoracic causes of clubbing* Bronchial cancer Chronic lung suppuration: • Empyema, abscess • Bronchiectasis • Cystic fibrosis Fibrosing alveolitis Mesothelioma TB. Good luck.

✌️✌️ *HEARTIEST CONGRATULATIONS* ✌️✌️ To *Dr Ahmed Abdelakher* 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.

*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 *Copied* Good luck.

*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 *Copied* Good luck.

*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.* *Copied* Good luck.

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