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✌️✌️ *HEARTIEST CONGRATULATIONS* ✌️✌️
To
*Dr Malik Dilaver*
For passing *PACES MRCP ( UK )* from India ( Kolkata) .
Dr Dilaver has been a keen member of our PACES group.
We wish him the best for his future.
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*👉 IMPORTANT 315 👈*
Hereditary Haemochromatosis if cirrhotic then screen for HCC with ultrasound ± AFP twice-yearly.
Good luck.
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*👉 IMPORTANT 314 👈*
In Hereditary Haemochromatosis joints, liver, heart, pancreas, pituitary, adrenals, and skin are most commonly affected so focus on symptoms associated with these organs in your history taking.
Good luck.
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*👉 IMPORTANT 313 👈*
*Hidden agenda in a case of Haemochromatosis.*
Please notice that patients with haemochromatosis should avoid uncooked seafood as it may contain bacteria that thrive on
increased plasma iron concentrations, eg Listeria monocytogenes, Vibrio vulnificus so there is an increased risk of infection from these bacteria.
Good luck.
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*👉 IMPORTANT 312 👈*
*Hidden agenda in a case of Haemochromatosis.*
Please notice that patient with haemochromatosis may be taking over the counter multivitamins. You must stop these as they may contain Iron.
Failure in doing so will result in less score in Clinical Judgement.
Good luck.
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*👉 IMPORTANT 311 👈*
Newly diagnosed Diabetes in a young male with sexual dysfunction should prompt your mind to think about Haemochromatosis.
Good luck.
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*👉 IMPORTANT 310 👈*
*Treatment options for Wilson,s disease*
1. Life long pencillamine
2. Liver transplant ( if required )
Good luck.
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*👉 IMPORTANT 309 👈*
*Few general measures to be mentioned in the anagement of Wislon,s disease*
Avoid foods with high copper content (eg liver, chocolate, nuts, mushrooms, legumes, and shellfish).
Check water sources (eg wells, pipes) for copper.
Good luck.
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*👉 IMPORTANT 308 👈*
*A few investigations for Wilson,s Disease*
Urine: 24h copper excretion is high, eg >100mcg/24h (normal <40mcg).
Raised LFT
Serum copper: typically <11μmol/L.
Low Serum caeruloplasmin: <200mg/L (<140mg/L is pathognomonic)—beware of incidental low values in protein-deficiency states (eg nephrotic syndrome, malabsorption)
Molecular genetic testing can confirm the diagnosis.
Slit lamp exam: KF rings: in iris/Descemet’s membrane
Liver biopsy: increased Hepatic copper (copper >250mcg/g dry weight); hepatitis; cirrhosis.
MRI: degeneration in basal ganglia, fronto-temporal, cerebellar, and brainstem
Good luck.
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*👉 IMPORTANT 307 👈*
Please remember
To rule out *Wilson,s disease* in any young patient getting new onset of
1.CNS signs: ( tremor; dysarthria, dysphagia; dyskinesias; dystonias; dementia; Parkinsonism; ataxia/clumsiness )
and
2.Liver disease ( liver disease (hepatitis, cirrhosis, fulminant liver failure )
Good luck.
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*👉 IMPORTANT 306 👈*
Please remember
To use the word *PINS AND NEEDLES* to explain *TINGLING* to the patient.
Good luck.
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*👉 IMPORTANT 305 👈*
Please remember
To use the word *IMAGING* for all the *SCANS* *( CT SCAN, MRI, PET SCAN etc )*
Always tell the patient that we will arrange imaging for you to gain more info about your health condition.
Good luck.
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*👉 IMPORTANT 304 👈*
Please remember
*BIOPSY*
might be considered as a Jargon by some examiners so please avoid using it.
Always tell the patient that we will do your *SNIP TEST/WE WILL TAKE SNIP FROM YOUR BODY PART* ( eg to send it to lab )
Good luck.
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*👉 IMPORTANT 303 👈*
Please remember
*FIBROSIS*
might be considered as a Jargon by some examiners so please avoid using it.
Always tell the patient that you have *SCARRING*
of your body part ( eg lungs )
Good luck.
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*👉 IMPORTANT 302 👈*
Please remember
*ECG*
might be considered as a Jargon by some examiners so please avoid using it.
Always tell the patient that we will do *TRACING OF YOUR HEART BEAT*
Good luck.
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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☝️☝️☝️
