pace your MRCP-PACES

*IMPORTANT 198* In any case of Impotence always remember the big three ( along with other causes ) 1.Smoking 2.Alcohol 3.Diabetes paceUrMRCP.

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*Announcement for Online Session No 103* *15 Oct 2023* *WE WILL NOT RECORD THIS SESSION* DEAR DOCTORS : MAY I HAVE YOUR ATTENTION PLEASE : *Today 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. The candidate for this session has been selected. GOOD LUCK.

*Announcement for Online Session No 103* *15 Oct 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 196* *Some factors that can trigger attack of phaeochromocytoma* straining, exercise, stress, abdominal pressure, surgery, or agents such as p-blockers, IV contrast agents, or the tricyclics. paceUrMRCP.

*IMPORTANT 197* *Some causes of gynaecomastia* Causes: Hypogonadism Liver cirrhosis (toestrogens) Hyperthyroidism Tumours (oestrogen-producing, eg testicular, adrenal; HCG-producing, eg testicular, bronchial); Drugs: oestrogens, spironolactone, digoxin, marijuana. paceUrMRCP.

*IMPORTANT 195* *Always think of Conn's in these contexts:* • Hypertension associated with hypokalaemia. • Refractory hypertension, eg despite more than 3 antihypertensive drugs. • Hypertension occurring before 40yrs of age (especially in women). paceUrMRCP.

IMPORTANT 194 Classic triad of phaeochromocytoma Episodic headache sweating tachycardia With increased BP. paceUrMRCP.

IMPORTANT 193 the 10% rule for phaeochromocytomas 10% are malignant 10% are extra-adrenal 10% are bilateral 10% are familial. paceUrMRCP.

IMPORTANT 192 In any patient taking long term steroids , never miss to warn him against abruptly stopping steroids. paceUrMRCP.

*IMPORTANT 191* In any patient taking long term steroids , never miss 1. Bracelet 2. Advise him to increase dose in acute illness paceUrMRCP.

*IMPORTANT 190* Please remember that all patients of Addison,s should be followed up yearly with BP and U&E paceUrMRCP.

*IMPORTANT 189* Always think of Addison's in all with unexplained abdominal pain or vomiting. paceUrMRCP.

IMPORTANT 188 Some causes of primary adrenocortical insufficiency: 80% are due to autoimmunity in the UK. TB (commonest cause worldwide), Adrenal metastases (eg from lung, breast, renal cancer) Lymphoma Opportunistic infections in HIV (eg CMV, Mycobacterium avium ) Adrenal haemorrhage (Waterhouse-Friderichsen syndrome antiphospholipid syndrome;SLE), Congenital (late-onset congenital adrenal hyperplasia). paceUrMRCP.

IMPORTANT 187 Nelson's syndrome: It resembles too much with the Cushing but there will be scars on the back of the patient and increased skin pigmentation due to increased ACTH from an enlarging pituitary tumour, as adrenalectomy removes -ve feedback. It responds well to pituitary radiation. paceUrMRCP.

IMPORTANT 186 Please remember to ask about steroids intake specifically in medicine history of any case of Cushing Syndrome. paceUrMRCP.

IMPORTANT 185 Indicators for MEN in the family history or PHx - FHX or PHX of colon cancer - could indicate acromegaly - FHX or PHX of resistant peptic ulcer - ZES - FHX or PHX of neck surgery - MTC ==> and in the context of all 3, confirm your suspicion of MEN by asking about hyperCalcemia symptoms paceUrMRCP.

IMPORTANT 184 Autoimmune polyendocrine syndrome 2 Features: Addison's disease. Type 1 diabetes mellitus. Autoimmune thyroid disease-hypothyroidism or Graves' disease. Also associated with primary hypogonadism, vitiligo, alopecia, pernicious anaemia, chronic atrophic gastritis, coeliac disease, dermatitis herpetiformis. paceUrMRCP.