pace your MRCP-PACES

*IMPORTANT 108* *Please be aware of right ventricular infarct* It will present with inferior ECG changes, hypotension, elevated jugular venous pressure, hepatomegaly, and clear lungs. It is preload dependent so *do NOT administer nitrates or diuretics* as these can cause cardiovascular collapse. paceUrMRCP.

Dear coalleagues I regret to inform you that our tomorrow's session is cancelled due to certain family commitments. Our next session will be on 10th of Sep God willing. I am sorry for any inconvenience.

*IMPORTANT 107* The combination of substernal chest pain persisting for longer than 30 minutes and diaphoresis strongly suggests acute MI. Never ignore paceUrMRCP.

*IMPORTANT 106* The most common cause of Dupuytren’s contracture ( fibrosis and contracture of palmar fascia ) is liver disease but it may also occur in trauma, epilepsy, and ageing paceUrMRCP.

*IMPORTANT 105* *Palmar erythema* Common causes cirrhosis hyperthyroidism rheumatoid arthritis polycythaemia chronic liver disease chemotherapy pregnancy. paceUrMRCP.

*✌✌ HEARTIEST CONGRATULATIONS ✌✌* To *Dr Nicholas* For passing PACES MRCP UK from Malaysia, We wish him the best for his future.

*IMPORTANT 104* Please remember Papilloedema (bilaterally swollen discs) is most commonly due to increase in ICP e,g. tumour and idiopathic intracranial hypertension in exam but other causes may include cavernous sinus thrombosis, abscess, encephalitis, hydrocephalus or any retro-orbital lesion. paceUrMRCP.

*IMPORTANT 103* Please remember bitemporal hemianopia is due optic chiasm compression, It is almost always due to pituitary adenoma in exam. However other causes may include craniopharyngioma and internal carotid artery aneurysm. paceUrMRCP.

*IMPORTANT 102* *Drugs that relieve stable angina* include β-blockers Nitrates Calcium channel blockers Ranolazine paceUrMRCP.

*✌✌ HEARTIEST CONGRATULATIONS ✌✌* To *Dr Sashank Chavali* For passing PACES MRCP UK from India. We wish him the best for his future.

*IMPORTANT 101* *Drugs that improve mortality for stable angina* include Aspirin High-intensity statins. paceUrMRCP.

*IMPORTANT 100* There Are Two Conditions Termed Syndrome X 1. Metabolic Syndrome X Any combination of hypercholesterolemia, hypertriglyceridemia, impaired glucose tolerance, diabetes, hyperuricemia, HTN. Key underlying factor is insulin resistance (due to obesity). 2. Syndrome X Exertional angina with normal coronary arteriogram.Patients present with chest pain after exertion but have no coronary stenoses at cardiac catheterization. Exercise testing and nuclear imaging show evidence of myocardial ischemia. Prognosis is excellent. paceUrMRCP.

*IMPORTANT 99* *Drugs that can lead to lymphadenopathy Allopurinol Phenytoin Atenolol Cephalosporins paceUrMRCP.

*✌✌ HEARTIEST CONGRATULATIONS ✌✌* To *Dr G Karthikeyan* For passing PACES MRCP UK from Pondicherry India. We wish him the best for his future.

*✌✌ HEARTIEST CONGRATULATIONS ✌✌* To *Dr Charles Chun* For passing PACES MRCP UK from Malaysia. We wish him the best for his future.

*✌✌ HEARTIEST CONGRATULATIONS ✌✌* To *Dr Johnny Khor* For passing PACES MRCP UK from Malaysia. We wish him the best for his future.

*IMPORTANT 98* Please remember While examining sensory loss of trigeminal nerve always keep in mind the corneal reflex, as it is the first to be lost. paceUrMRCP.

*IMPORTANT 97* Some info about Nystagmus Nystagmus is involuntary, often jerky, eye oscillations. Horizontal nystagmus is often due to a vestibular lesion (acute: nystagmus away from lesion; chronic: towards lesion), or cerebellar lesion (unilateral lesions cause nystagmus towards the affected side). If it is more in whichever eye is abducting, MS may be the cause (internuclear ophthalmoplegia) If also deafness/tinnitus, suspect a peripheral cause (eg VIIIth nerve lesion, barotrauma, Ménière’s). If it varies with head position, suspect benign positional vertigo, If it is up-and-down, ask a neurologist to review,upbeat nystagmus classically occurs with lesions in the midbrain or at the base of the 4th ventricle where as downbeat nystagmus in foramen magnum lesions. Nystagmus lasting ≤2 beats is normal, as is nystagmus at the extremes of gaze. paceUrMRCP.

*IMPORTANT 96* Please remember In the examination of lower limbs if you are limited for time, gait is the most useful test to start with. paceUrMRCP.

*IMPORTANT 95* Lower limb reflexes with their root values • Knee (L3,4) • Ankle (L5,S1) • Plantar reflexes (L5, S1, S2) paceUrMRCP.