pace your MRCP-PACES

*🩺 Symptom Snapshot 23 – Tremor* *(by pace your MRCP – Dr Tanzeel Bukhari)* *1️⃣ Essential Tremor* Action or postural tremor (worse on movement) Often bilateral, affects hands and head Improves transiently with alcohol *2️⃣ Parkinson’s Disease* Resting “pill-rolling” tremor Associated with bradykinesia, rigidity, reduced arm swing Typically asymmetric at onset *3️⃣ Drug- or Metabolic-Induced Tremor* Fine tremor due to β-agonists, lithium, caffeine May be seen in thyrotoxicosis Improves with treatment of underlying cause

*🧠 Mnemonic 4 Causes of Shock* *(by pace your MRCP – Dr Tanzeel Bukhari)* *🔑 Mnemonic: SHOCK* S – Septic → Infection-related vasodilation and capillary leak causing hypotension. H – Hypovolaemic → Blood or fluid loss (GI bleed, trauma, dehydration). O – Obstructive → PE, cardiac tamponade, tension pneumothorax impairing cardiac output. C – Cardiogenic → MI, severe cardiomyopathy, arrhythmias causing pump failure. K – anaphylactiK (Anaphylactic) → IgE-mediated vasodilation, bronchospasm, and capillary leak. ________________________________________

*🩺 Management Essential 17 – Type 2 Respiratory Failure* *by pace your MRCP – Dr Tanzeel Bukhari* *(Hypercapnic respiratory failure)* *Definition* • PaO₂ <8 kPa with raised PaCO₂ *Immediate priorities* • Controlled oxygen: target SpO₂ 88–92% • Identify cause (COPD, obesity hypoventilation, neuromuscular disease) *Initial managemen* t • Controlled oxygen via Venturi mask • Treat precipitating cause (infection, bronchospasm) *Ventilatory support* • Early NIV (BiPAP) if: o pH <7.35 o Rising CO₂ or increasing work of breathing *Key safety pearls* • Excess oxygen worsens CO₂ retention • Drowsiness may reflect CO₂ narcosis • Early escalation saves intubation

* IMPORTANT 24 * Please remember *INR ( International normalized ratio )* is a _Jargon_ so be careful while using it in exam especially when asking for the follow up of anticoagulants, always tell your patient that **WE WILL / WE NEED TO CHECK YOUR BLOOD THINNING LEVEL ( OR LEVEL OF BLOOD THINNING ) during this therapy.. pace your MRCP-PACES..

IMPORTANT 23 Please remember VOMITING is a common ENGLISH word but it may be considered as a Jargon by some of the examiners so be careful while using it in exam and always say HAVE YOH EVER THROWN UP/ DO YOU EVER THROW UP to your patient pace your MRCP-PACES..

IMPORTANT 22 Please remember NAUSEA is a commn ENGLISH word but it may be considered as Jargon by some of the examiners so be careful while using it in exam and always say DO YOU FEEL SICK / OR ANY FEELING OF SICKNESS to your patient pace your MRCP-PACES..

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IMPORTANT 21 Please remember INFLAMMATION is a controversial word and may be considered as Jargon by some of the examiners so be careful and always say IRRITATION OR SORENESS to your patient pace your MRCP-PACES..

IMPORTANT 20 Please remember DEHYDRATED/ DEHYDRATION May be considered as Jargons by some of the examiners so always say REDUCED AMOUNT OF WATER/FLUIDS/LIQUIDS IN YOUR BODY to your patient pace your MRCP-PACES..

IMPORTANT 19 Please remember while taking history: HEADACHE & VISION are TWINS Which means they must be asked together. So , never miss to ask any vision problem in a patient of headache and any headache in a patient of vision problem, this can give you important clues in the very beginning... pace your MRCP-PACES..

🧠 Mnemonic 3 – Causes of Acute Pulmonary Oedema (by pace your MRCP – Dr Tanzeel Bukhari) 🔑 Mnemonic: FLASH-P F – Fluid overload → Excess IV fluids, renal failure, missed dialysis. L – Left ventricular failure → Acute MI, decompensated cardiomyopathy. A – Arrhythmias → AF with fast ventricular rate, VT causing sudden LV decompensation. S – Severe hypertension → Hypertensive emergency leading to acute LV failure. H – Heart valve disease → Acute MR, severe AS causing sudden rise in LV filling pressures. P – Pregnancy-related / Pulmonary causes (non-cardiogenic) → Pre-eclampsia, ARDS, neurogenic pulmonary oedema.

🩺 *Management Essential 16 – Type 1 Respiratory Failure* *(Hypoxaemic respiratory failure)* *Definition* • PaO₂ <8 kPa with normal or low PaCO₂ *Immediate priorities* • ABCDE approach • Identify and treat the underlying cause (pneumonia, PE, pulmonary oedema) *Oxygen strategy* • High-flow oxygen to maintain SpO₂ 94–98% • Continuous pulse oximetry *Investigations* • ABG (baseline and response) • CXR, ECG • Bloods: FBC, CRP, U&E ± cultures *Escalation* • Failure to maintain oxygenation → consider: o CPAP / HFNO o Early ICU referral *Key safety pearl* s • Oxygen treats hypoxia, not the cause • Worsening hypoxia despite oxygen = urgent escalation

*Investigation Pearl 18* – Procalcitonin: Support, Not Replace, Clinical Judgement Procalcitonin rises in bacterial infections and may be low in viral/inflammatory states. It can support antibiotic decisions (start/stop) in some settings, but is not a stand‑alone diagnostic test. *False elevation* : surgery, trauma, burns; interpret carefully in renal impairment. *Exam tip* : Adjunct only—clinical assessment first