pace your MRCP-PACES

👉 *IMPORTANT 564* 👈 *The most common causes of CKD in the UK are* diabetes (24%), Glomerulonephritis (13%) Increased BP/renovascular disease (11%). paceUrMRCP.

👉 *IMPORTANT 563* 👈 *Certain systemic diseases which may cause CKD* Diabetes amyloidosis sarcoidosis Heart failure TTP Alport syndrome Fabry disease paceUrMRCP.

👉 *IMPORTANT 562* 👈 *Possible complications of Renal Replacement Therapy:* Risks of dialysis catheter insertion and maintenance Procedural hypotension Bleeding due to the requirement for anticoagulation Altered nutrition and drug clearance. paceUrMRCP.

👉 *IMPORTANT 561* 👈 *Possible indications for renal replacement therapy:* Fluid overload unresponsive to medical treatment. Severe/prolonged acidosis. Recurrent/persistent hyperkalaemia despite medical treatment. Uraemia eg pericarditis, encephalopathy (more common in CKD). paceUrMRCP.

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Announcement for Online Session No 118 *19 May 2024 *DEAR DOCTORS : MAY I HAVE YOUR ATTENTION PLEASE: Today we will have an online session on Zoom discussing 1 Clinical Consultation Station regarding our preparation for MRCP PACES ( UK ) and MRCPI ( Ireland ) WE WILL NOT RECORD THIS SESSION The Candidate for today,s session has been selected. 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 : 3 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 China ( Beijing ) : 9 00 pm Australia ( Sydney) : 11 00 pm Burundi : 3 00 pm Rwanda : 3 00 pm Morocco : 1 00 pm French Guiana : 10 00 am ( Please Google for your local time zones to avoid any inconvenience ) Zoom meeting link will be shared 5 minutes before start time. GOOD LUCK.

Announcement for Online Session No 118 19 May 2024 DEAR DOCTORS : MAY I HAVE YOUR ATTENTION PLEASE: Tomorrow we will have an online session on Zoom discussing 1 Clinical Consultation Station regarding our preparation for MRCP PACES ( UK ) and MRCPI ( Ireland ) WE WILL NOT RECORD THIS SESSION The Candidate for tomorrow’s session has been selected. 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 : 3 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 China ( Beijing ) : 9 00 pm Australia ( Sydney) : 11 00 pm Burundi : 3 00 pm Rwanda : 3 00 pm Morocco : 1 00 pm French Guiana : 10 00 am ( Please Google for your local time zones to avoid any inconvenience ) Zoom meeting link will be shared 5 minutes before start time. GOOD LUCK.

👉 *IMPORTANT 560* 👈 *Few important points about treatment of hyperkalemia* Treat K>6.5mmol/L or any with ECG changes 1.10mL of 10% calcium chloride (or 30mL of 10% calcium gluconate) IV via a big vein over 5-10min, repeated if necessary and if ECG changes persist. This is cardioprotective (for 30-60min) but does not treat K level. 2. Intravenous insulin (10u soluble insulin) in 25g glucose (50mL of 50% or 125mL of 20% glucose). Insulin stimulates intracellular uptake of K, lowering serum K by 0.65-10mmol/L over 30-60min. Monitor hourly for hypoglycaemia which may be delayed in renal impairment (up to 6 hours after infusion). 3. Salbutamol also causes an intracellular K shift but high doses are required (10-20mg via nebulizer) and tachycardia can limit use (10mg dose in IHD, avoid in tachyarrhythmias). 4. Definitive treatment requires K' removal. If the underlying pathology cannot be corrected renal replacement may be indicated. paceUrMRCP.

👉 *IMPORTANT 559* 👈 *ECG changes on hyperkalemia* In order: tall 'tented' T waves increased PR interval small or absent P wave widened QRS complex sine wave' pattern asystole. There is considerable inter-individual susceptibility. paceUrMRCP.

👉 *IMPORTANT 558* 👈 *Commonly used criteria for Acidosis* Mild = pH 7.30-7.36 (~bicarbonate >20mmol/L). Moderate pH 7.20-7.29 (~bicarbonate 10-19mmol/L). Severe = pH <7.2 (~bicarbonate <10mmol/L) paceUrMRCP.

👉 *IMPORTANT 557* 👈 Please remember JVP does not reflect intravascular volume if there is right-sided heart disease/failure. paceUrMRCP.

👉 *IMPORTANT 556* 👈 *Few signs of fluid overload:* High BP, raised JVP, lung crepitations, peripheral oedema, gallop rhythm. paceUrMRCP.

👉 *IMPORTANT 555* 👈 *Few signs of Hypovolaemia:* low BP, decreased urine volume, non-visible JVP, poor tissue turgor, rapid pulse, weight loss. paceUrMRCP.

👉 *IMPORTANT 554* 👈 *Refer in AKI if* AKI not responding to treatment AKI with complications: increased K, acidosis, fluid overload stage 3 AKI AKI with difficult fluid balance (eg hypoalbuminaemia, heart failure, pregnancy) AKI due to possible intrinsic renal disease AKI with hypertension. paceUrMRCP.

👉 *IMPORTANT 553* 👈 *Scoring systems for liver cirrhosis* For many years the Child-Pugh classification was used to classify the severity of liver cirrhosis. However, in recent years the Model for End-Stage Liver Disease (MELD) has been increasingly used, particularly patient's who are on a liver transplant waiting list paceUrMRCP.

👉 *IMPORTANT 552* 👈 In WPW avoid : (ABCD) Adenosine Beta blockers Calcium channel blockers Digoxin. paceUrMRCP.

👉 *IMPORTANT 551* 👈 In any patient presenting with inferior MI please remember these 3 points: 1- Do V3R and V4R to exclude right ventricular infarction . If there RVI avoid SL or IV nitrate. 2- Do V7,V8,and V9 to exclude posterior MI 3- Take a careful history and do detailed examination to exclude any possible associated Aortic dissection ( unequal BP , AR murmer , neurological symptom or signs , back pain ) .In this case , urgent echo and No thrombolysis until situation is clarified. paceUrMRCP.

👉 *IMPORTANT 550* 👈 Avoid contact sports for 8 weeks in Infectious Mononucleosis. paceUrMRCP.