pace your MRCP-PACES

✌️✌️ *HEARTIEST CONGRATULATIONS* ✌️✌️ To *Dr Sowndhariya* For passing *MRCP UK PART 1* Dr Sowndhariya has been a keen member of our part 1 group. We wish you the best for your future.

✌️✌️ *HEARTIEST CONGRATULATIONS* ✌️✌️ To *Dr Fatema* For passing *MRCP UK PART 1* She was a keen member of our part 1 group. We wish her the best for her future.

✌️✌️ *HEARTIEST CONGRATULATIONS* ✌️✌️ To *Dr.Asifa* For passing *MRCP UK PART 1* She was a keen member of our part 1 group. We wish her the best for her future.

✌️✌️ *HEARTIEST CONGRATULATIONS* ✌️✌️ To *Dr Shabbir Ahmed* For passing *MRCP UK PART 1* He was a keen member of our part 1 group. We wish him the best for his future.

👉 *IMPORTANT 79* Please remember : Parkinson disease is the most common cause of *resting tremers* in exam. The tremors are worst at rest with bradykinesia and rigidity; They are more resistant to treatment than other symptoms. They are usually slow tremors (frequency of 3–5Hz), typically ‘pill-rolling’ of the thumb over a finger. Good luck.

👉 *IMPORTANT 78* *Some causes of Paraesthesiae* It is described as ‘Pins and needles’, numbness/tingling, which can hurt or ‘burn’ (dysaesthesia). Common Causes may include : *Metabolic* reduced Ca2+ (mostly perioral); increased PaCO2; myxoedema; neurotoxins (tick bite; sting). *Vascular* : Raynaud’s; DVT; high plasma viscosity. *Anti body-mediated* : paraneoplastic; SLE; ITP. *Infection* : Lyme; rabies. *Drugs* : ACE-i. *Brain* : thalamic/parietal lesions. *Cord* : MS; myelitis/HIV; decreased B12, *Plexopathy/mononeuropathy* : cervical rib; carpal tunnel; sciatica. *Peripheral neuropathy* : DM; CKD. *If paroxysmal* : migraine; epilepsy; phaeochromocytoma. *If travel history* is positive : consider infection, eg strongyloides. Good luck..

👉 *IMPORTANT 77* 👈 *Some drugs causing muscle cramps* Diuretics ( from reduced K+), domperidone, salbutamol/terbutaline, ACE I, telmisartan,celecoxib, lacidipine, ergot alkaloids, levothyroxine. Good luck.

✌️✌️ *HEARTIEST CONGRATULATIONS* ✌️✌️ To *Dr Prasad* For passing *MRCP IRELAND PART 2 CLINICAL* from Malaysia. He has been a keen member of our PACES group. We wish him the best for his future.

👉 *IMPORTANT 223* 👈 *Extraintestinal manifestation of Hepatitis C* by courtesy of Dr Urvashi. Thanks a lot Dr Essential mixed cryoglobulinemia Peripheral neuropathy Porphyria cutanea tarda Lymphoma Autoimmune phenomenon Peripheral nephropathy Diabetes mellitus Good luck.

👉 *IMPORTANT 222* 👈 *Extraintestinal manifestation of Hepatitis B* by courtesy of Dr Urvashi. Thanks a lot Dr Polyarteritis nodosa Glomerulonephritis Nephrotic syndrome Arthritis dermatitis syndrome Palpable purpura Good luck.

👉 *IMPORTANT 221* 👈 Some signs of Acromegaly Increased growth of hands ( may be spade-like), jaw and feet (sole may encroach on the dorsum). Coarsening face; wide nose. Big supraorbital ridges. Macroglossia (big tongue). Widely spaced teeth. Puffy lips, eyelids, and skin (oily and large-pored); also skin tags. Scalp folds (cutis verticis gyrata; due to expanding but tethered skin). Skin darkening. Acanthosis nigricans. Laryngeal dyspnoea (fixed cords). Obstructive sleep apnoea. Goitre ( increased thyroid vascularity). Proximal weakness + arthropathy. Carpal tunnel signs in 50%. Signs from any pituitary mass: hypopituitarism ± local mass effect ( reduced vision; hemianopia); fits. Good luck.

👉 *IMPORTANT 87* 👈 *Upper limb reflexes with their root values* •Biceps (C5,6) •Triceps (C7) •Supinator (C6) Good luck.

👉 *IMPORTANT 86* 👈 *While doing general inspection of upper limbs in CNS station never miss to look for* *Abnormal posturing* *asymmetry* *abnormal movements* (fasciculation/tremor/dystonia/athetosis) *muscle wasting* (especially small muscles of the hand)—symmetrical/asymmetrical? Local/general? Good luck

👉 *IMPORTANT 85* 👈 *Please try to rule out LOCAL CAUSES of pain in any case of headache along with red flags.* These may include : • Neck—cervical disc pathology. • Bone/sinuses—sinusitis, neoplasia. • Eye—glaucoma, iritis, orbital cellulitis,eye strain, AVM. • Temporomandibular joint—arthritis or idiopathic dysfunction (common). • Teeth/gums—caries, broken teeth, abscess, malocclusion. • Ear—otitis media,otitis externa. • Vascular/vasculitis—arteriovenous fistula, aneurysm,or AVM at the cerebellopontine angle, giant cell arteritis, SLE. Good luck.

✌️✌️ *HEARTIEST CONGRATULATIONS* ✌️✌️ To *Dr.Kalyan Nath* For passing *MRCP IRELAND PART 2 CLINICAL* from Oman. He took personal coaching for his exam in May 22. We wish him the best for his future.

Photo from Dr Tanzeel Bukhari

Photo from Dr Tanzeel Bukhari

Photo from Dr Tanzeel Bukhari

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☝️☝️☝️

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