pace your MRCP-PACES

Photo from Dr Tanzeel Bukhari

Photo from Dr Tanzeel Bukhari

*🗣️ Communication Scenario 2 – Explaining a New Diagnosis of Type 2 Diabetes* (by pace your MRCP – Dr Tanzeel Bukhari) *🧠 Scenario:* You are seeing a 52-year-old patient whose blood tests confirm Type 2 Diabetes. The patient looks worried and asks: > “Does this mean my life is going to change completely?” --- *✅ How to explain it (safe, empathetic, structured — without making it a bad news)* *1️⃣ Start with reassurance — soften the emotional impact* “Firstly, I want to reassure you — this is not bad news, and it does not mean something serious or dangerous has happened today.” *2️⃣ Acknowledge feelings* “It’s natural to feel worried when you hear the word diabetes, and I completely understand.” *3️⃣ Give simple, positive, balanced information* “Your blood test shows Type 2 Diabetes, which means your body is not using insulin as effectively as it should. But the important point is: It is very manageable, Many people lead completely normal lives, And we will work together to control it step by step.” *4️⃣ Outline a clear plan (gives control and reduces fear)* Improving diet and activity Starting metformin if needed Monitoring HbA1c every 3–6 months Annual eye, kidney, and foot checks *5️⃣ Address the patient’s fear directly* “This diagnosis does not mean your life will drastically change. You won’t lose your routine or freedom — we just need some gradual adjustments.” *6️⃣ Check understanding & explore concerns* “Can you share what worries you the most so I can help clarify it?” --- *💡 PACES Tip:* When giving a diagnosis like Type 2 Diabetes, always combine: Reassurance + Normalisation + Clear plan, so the patient never feels it is a “bad news conversation.”

Photo from Dr Tanzeel Bukhari

*🩺 Case of the Week 2 – Neurology* (by pace your MRCP – Dr Tanzeel Bukhari) *🧠 Scenario:* A 45-year-old man presents with progressive unilateral facial weakness over 24 hours. He cannot close his right eye fully, struggles to smile, and reports altered taste. No limb weakness, no fever, and no ear pain. *O/E:* Right LMN facial palsy Forehead involved No other cranial nerve deficits Limb exam normal --- *❓ Question:* What is the most likely diagnosis, and what key steps are needed in immediate management? --- *✅ Answer:* 🔹 Most likely diagnosis: Bell’s palsy (LMN facial nerve palsy) *🔹 Key management steps:* 1️⃣ Prednisolone within 72 hours 2️⃣ Eye care: lubricating drops + eye patch at night 3️⃣ Check for red flags (rash, vesicles → consider Ramsay Hunt) 4️⃣ Safety-net: return if worse or no improvement in 3 weeks --- *💡 PACES Tip:* Always differentiate between UMN vs LMN facial palsy: Forehead spared → UMN Forehead involved → LMN (Bell’s palsy)

🩺 Case Discussion 2 – Sudden Shortness of Breath (by pace your MRCP – Dr Tanzeel Bukhari) 🧠 Scenario: A 62-year-old woman presents with sudden onset shortness of breath while walking to the bathroom. She describes pleuritic chest pain, mild cough, and feels anxious. O/E: RR 28/min, HR 112/min, BP 128/82, SpO₂ 90% on air; chest is clear, calves slightly tender. ❓ Question: What are the top differentials, and what is the best next investigation? --- ✅ Answer: 🔹 Most likely diagnosis: Pulmonary embolism (PE) — sudden dyspnoea + pleuritic pain + tachycardia + calf tenderness 🔹 Other differentials: Pneumothorax (less likely: chest clear, stable BP) Pneumonia (no fever, cough mild) Anxiety/hyperventilation (SpO₂ too low for this) 🔹 Best next investigation: CT Pulmonary Angiography (CTPA) If unstable → bedside Echocardiography for RV strain 💡 PACES Tip: For sudden breathlessness + clear chest, always think PE first.

*🟢 ONLINE COURSE NO. 64 – ADMISSIONS OPEN!* *📅 08 Dec – 26 Dec 2025* 🎯 PACES MRCP (UK) & CLINICAL EXAM MRCPI 🚨 At a very affordable fee ✅ 15-Day Intensive Online Course ✅ Covers ALL 7 SKILLS in detail (as in our weekly free sessions) ✅ Practice & discussion of 90+ exam cases (including recent diets), covering:  • 45 cases of consultations  • 45 cases of communications. ✅ Personalized feedback to sharpen weak areas ✅ Ideal for beginners & upcoming exam candidates 🎓 Slots Available: 🔹 Active participation – First come, first served 🔹 Listener slots also available 📩 Join Us! 📱 WhatsApp: +92 334 6036496 📧 Email: drtanzeelbukhari@gmail.com 🚀 Join, Learn, Practice & Succeed! GOOD LUCK

*🩺 Management Essential 2 – Acute Severe Asthma (Adult)* (by pace your MRCP – Dr Tanzeel Bukhari) Acute severe asthma is a medical emergency. Early structured management saves lives. *🔹 Immediate Management* (ABCDE-based) 1️⃣ High-flow oxygen to maintain SpO₂ 94–98% 2️⃣ Continuous nebulised salbutamol (or back-to-back nebs) 3️⃣ Add ipratropium nebuliser every 20–30 min 4️⃣ Give IV hydrocortisone (or oral prednisolone if able) 5️⃣ Consider IV magnesium sulphate if poor response 6️⃣ Start frequent PEFR monitoring 7️⃣ Assess for exhaustion (silent chest, rising CO₂ → life-threatening) *🔹 Investigations* Peak flow ABG if no improvement Chest X-ray (if complications suspected) *🔹 When to admit to HDU/ICU* Persistent hypoxia Rising PaCO₂ Silent chest Altered consciousness Failure to respond to initial therapy *💡 PACES Tip:* Always mention oxygen, bronchodilators, steroids, magnesium, and admission criteria. This shows structured emergency management.

*🧠 Mnemonic 2 – Causes of Hypercalcaemia (CHIMPANZEES)* (by pace your MRCP – Dr Tanzeel Bukhari) Use the classic mnemonic CHIMPANZEES to recall the major causes of hypercalcaemia: C – Calcium supplements H – Hyperparathyroidism (primary/tertiary) I – Iatrogenic (thiazides, lithium) M – Milk-alkali syndrome P – Paget’s disease A – Acromegaly / Addison’s disease N – Neoplasms (myeloma, bone mets) Z – Zollinger–Ellison syndrome E – Excess vitamin D E – Excess vitamin A S – Sarcoidosis / granulomatous diseases --- *💡 PACES Tip:* When a patient presents with bones, stones, groans, or psychiatric overtones, always think hypercalcaemia and quote CHIMPANZEES.

Photo from Dr Tanzeel Bukhari

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Photo from Dr Tanzeel Bukhari

Photo from Dr Tanzeel Bukhari

*🟢 ONLINE COURSE NO. 64 – ADMISSIONS OPEN!* *📅 08 Dec – 26 Dec 2025* 🎯 PACES MRCP (UK) & CLINICAL EXAM MRCPI 🚨 At a very affordable fee ✅ 15-Day Intensive Online Course ✅ Covers ALL 7 SKILLS in detail (as in our weekly free sessions) ✅ Practice & discussion of 90+ exam cases (including recent diets), covering:  • 45 cases of consultations  • 45 cases of communications. ✅ Personalized feedback to sharpen weak areas ✅ Ideal for beginners & upcoming exam candidates 🎓 Slots Available: 🔹 Active participation – First come, first served 🔹 Listener slots also available 📩 Join Us! 📱 WhatsApp: +92 334 6036496 📧 Email: drtanzeelbukhari@gmail.com 🚀 Join, Learn, Practice & Succeed! GOOD LUCK

Photo from Dr Tanzeel Bukhari

Photo from Dr Tanzeel Bukhari

Photo from Dr Tanzeel Bukhari