pace your MRCP-PACES

Dear coalleagues I will be travelling for a couple of days so will take a break from medicine. *We will start again on 6th June if all goes well.* I am sorry for any inconvenience. Regards and best wishes.

*👉 IMPORTANT 682 👈* *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.* Good luck.

*👉 IMPORTANT 681 👈* *Some info about Dyspnoea* Subjective sensation of shortness of breath, often exacerbated by exertion. • Lung—airway and interstitial disease. May be hard to separate from cardiac causes; asthma may wake patient, and cause early morning dyspnoea & wheeze. • Cardiac—eg ischaemic heart disease or left ventricular failure (LVF), mitral stenosis, of any cause. LVF is associated with orthopnoea (dyspnoea worse on lying; ‘How many pillows do you use while sleeping?’) and paroxysmal nocturnal dyspnoea (PND;dyspnoea waking one up). Other features include ankle oedema, lung crepitations, and raised JVP. • Anatomical—eg diseases of the chest wall, muscles, pleura. Ascites can cause breathlessness by splinting the diaphragm, restricting its movement. • Others Any shocked patient may also be dyspnoeic—dyspnoea may be shock’s presenting feature. Also anaemia or metabolic acidosis causing respiratory compensation, eg ketoacidosis, aspirin poisoning. Look for other clues—dyspnoea at rest unassociated with exertion, may be psychogenic: prolonged hyperventilation causes respiratory alkalosis. This causes a fall in ionized calcium leading to apparent hypocalcaemia. Features include peripheral and perioral paraesthesiae ± carpopedal spasm. Speed of onset helps diagnosis. Good luck.

*👉 IMPORTANT 680 👈* *Some info about NOACS* The table below summaries the three direct oral anticoagulants (DOACs): dabigatran, rivaroxaban and apixaban. Dabigatran(Pradaxa) Rivaroxaban(Xarelto) Apixaban(Eliquis) DABIGATRIN: ExcretionMajority renal RIVAROXABAN: Majority liver. APIXABAN Majority faecal. NICE indications. Prevention of VTE following hip/knee surgery Treatment of DVT and PE Prevention of stroke in non-valvular AF . Dabigatrin reversal:Idarucizumab RIVORAXABAN and APIXABAN Reversal:Andexanet. NICE stipulate that certain other risk factors should be present. These are complicated and differ between the DOACs but generally require one of the following to be present: prior stroke or transient ischaemic attack age 75 years or older hypertension diabetes mellitus heart failure

*✌✌ HEARTIEST CONGRATULATIONS ✌✌* To *Dr Jesanda sirelkhatim* For passing MRCP UK part 1. We wish her the best for her future.

*ANNOUNCEMENT* Hello n salam everyone We are pleased to announce admissions for our *June 2023 online course ( 15 days ) for PACES MRCP (UK) current pattern.* We will start from *7 June and finish on 27 June* *IT WILL BE OUR LAST COURSE OF OLD PATTERN. FROM JULY 23 WE WILL START SESSIONS ACCORDING TO THE NEW PATTERN.* *Active slots available on first come--first served basis.* Listener slot available too. *Atleast 90 Important exam cases ( including recent diets cases ) will be practiced and discussed as we do in our weekly Sunday sessions.* After the performance a detailed feedback will be given to elaborate the weak skills. It is equally beneficial for those who are beginners or have exam in coming diet. Interested candidates may send a personal message for details. WhatsApp No: 00923346036496. Email: drtanzeelbukhari@gmail.com GOOD LUCK.

Dear coalleagues I hope this group is helpful to you regarding your academics. This group is meant for *MRCP PACES* specially however we do have separate groups for *MRCP Part 1* and *MRCP part 2* so *If any colleague is doing MRCP Part 1 or MRCP Part 2 please let me know by a personal message we can add them in respective groups* Thanks for joining Good luck

*✌✌ HEARTIEST CONGRATULATIONS ✌✌* To *Dr Adil Maqbool* For passing MRCP UK part 1. We wish him the best for his future.

*👉 IMPORTANT 679 👈* Few more *signs of Aortic regurgitation* for academic interest* *Gerhardt Sign* ..... Systolic Pulsation of Spleen *RosenBach Sign* ..... Systolic Pulsation of liver *Becker Sign* .......systolic foundation of Retinal vessels. Good luck.

*👉 IMPORTANT 678 👈* *Some signs of Aortic Regurgitation* *de Musset’s sign* —head nodding . *Müller’s sign* —systolic pulsations of the uvula. *Corrigan’s sign* —visible carotid pulsations. *Quincke’s sign* —capillary nailbed pulsation in the fingers. *Traube’s sign* —‘pistol shot’ femorals, a booming sound heard over the femorals. *Duroziez’s sign* —to and fro diastolic murmur heard when compressing the femorals proximally with the stethoscope. Good luck.

*👉 IMPORTANT 677 👈* *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 Good luck...

*ANNOUNCEMENT* Hello n salam everyone We are pleased to announce admissions for our *June 2023 online course ( 15 days ) for PACES MRCP (UK) current pattern.* We will start from *7 June and finish on 27 June* *IT WILL BE OUR LAST COURSE OF OLD PATTERN. FROM JULY 23 WE WILL START SESSIONS ACCORDING TO THE NEW PATTERN.* *Active slots available on first come--first served basis.* Listener slot available too. *Atleast 90 Important exam cases ( including recent diets cases ) will be practiced and discussed as we do in our weekly Sunday sessions.* After the performance a detailed feedback will be given to elaborate the weak skills. It is equally beneficial for those who are beginners or have exam in coming diet. Interested candidates may send a personal message for details. WhatsApp No: 00923346036496. Email: drtanzeelbukhari@gmail.com GOOD LUCK.

*👉 IMPORTANT 676 👈* *Some info about heart sounds* *4th heart sound (S4)* occurs just before S1. Always abnormal. It represents atrial contraction against a ventricle made stiff by any cause, eg aortic stenosis or hypertensive heart disease. Good luck.

*👉 IMPORTANT 675 👈* *Some info about heart rhythms* *Triple and gallop rhythms* A 3rd or 4th heart sound occurring with a sinus tachycardia may give the impression of galloping hooves. When S3 and S4 occur in a tachycardia, eg with pulmonary embolism, they may summate and appear as a single sound, a summation gallop. Good luck.

*👉 IMPORTANT 674 👈* *Some info about heart sounds* *3rd heart sound (S3)* may occur just after S2. It is low pitched and best heard with the bell of the stethoscope. S3 is pathological over the age of 30yrs. A loud S3 occurs in a dilated left ventricle with rapid ventricular filling (mitral regurgitation, VSD) or poor LV function (post MI, dilated cardiomyopathy). In constrictive pericarditis or restrictive cardiomyopathy it occurs early and is more high pitched (‘pericardial knock’). Good luck.

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