pace your MRCP-PACES

ANNOUNCEMENT Hello n salam everyone Regarding our *Aug-Sep 2022 online course for PACES MRCP (UK) ( duration 15 days ).* starting from *22 Aug* till *7 Sep* Only *1 Active slot is available* Listener slot available too. Interested candidates may send a personal message for details. WhatsApp No: 00923346036496. Email: drtanzeelbukhari@gmail.com GOOD LUCK.

*Few words about Chronic plaque psoriasis by courtesy of Dr Toqeer Bhatti. Thanks a lot dr :* *Clinical features* Erythematous plaques covered with a silvery-white scale Typically on the extensor surfaces such as the elbows and knees. Also common on the scalp, trunk, buttocks and periumbilical area Clear delineation between normal and affected skin Plaques typically range from 1 to 10 cm in size If the scale is removed, a red membrane with pinpoint bleeding points may be seen (Auspitz's sign) Good Luck

*Few words about prognosis of SAH by the courtesy of Dr Toqeer Bhatti. Thanks a lot dr* If SAH is untreated the prognosis is often poor: around 50% within 1 month of the haemorrhage, and of those who survive the first month, 50% will remain dependent for help with activities of daily living. However, survival improves to 85% in patients with confirmed SAH admitted to a specialist neurosurgical unit. Good Luck

*Few complications of aneurysmal SAH by the courtesy of Dr Toqeer Bhatti. Thanks a lot dr* Re-bleeding (in around 30%) Vasospasm (also termed delayed cerebral ischaemia), typically 7-14 days after onset Hyponatraemia (most typically due to syndrome inappropriate anti-diuretic hormone (SIADH)) Seizures Good Luck

ANNOUNCEMENT Hello n salam everyone We are pleased to announce admissions for our *Aug-Sep 2022 online course ( 15 days ) for PACES MRCP (UK).* We will start from *22 August and finish on 7 September.* *Only 2 Active slots available on first come--first served basis.* Listener slot available too. *60 Important exam cases ( including recent diets cases ) will be practiced and discussed as we do in our weekly general 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.

*Few lines about treatment of Subarchanoid Haemorrhage by courtesy of Dr Toqeer Bhatti. Thanks a lot Dr* The treatment in spontaneous SAH is in accordance with the causative pathology Intracranial aneurysms are at risk of rebleeding and therefore require prompt intervention, preferably within 24 hours Most intracranial aneurysms are now treated with a coil by interventional neuroradiologists, but a minority require a craniotomy and clipping by a neurosurgeon Until the aneurysm is treated, the patient should be kept on strict bed rest, well controlled blood pressure and should avoid straining in order to prevent a re-bleed of the aneurysm Vasospasm is prevented using a 21-day course of nimodipine (a calcium channel inhibitor targeting the brain vasculature) and treated with hypervolaemia, induced-hypertension and haemodilution Hydrocephalus is temporarily treated with an external ventricular drain (CSF diverted into a bag at the bedside) or, if required, a long-term ventriculo-peritoneal shunt Good Luck

*Few investigations for the diagnosis of Subarchanoid Haemorrhage by courtesy of Dr Toqeer Bhatti. Thanks a lot Dr* *Confirmation of SAH:* Computed tomography (CT) head Acute blood (hyperdense/bright on CT) is typically distributed in the basal cisterns, sulci and in severe cases the ventricular system. CT is negative for SAH (no blood seen) in 7% of cases. Lumbar puncture (LP) Used to confirm SAH if CT is negative. LP is performed at least 12 hours following the onset of symptoms to allow the development of xanthochromia (the result of red blood cell breakdown). Xanthochromia helps to distinguish true SAH from a ‘traumatic tap’ (blood introduced by the LP procedure) Referral to neurosurgery to be made as soon as SAH is confirmed After spontaneous SAH is confirmed, the aim of investigation is to *identify a causative pathology* that needs urgent treatment: CT intracranial angiogram (to identify a vascular lesion e.g. aneurysm or AVM) +/- digital subtraction angiogram (catheter angiogram) Good Luck

*Few Clinical features of Subarchanoid Haemorrhage by courtesy of Dr Toqeer Bhatti. Thanks a lot Dr* Classical presenting features include: Headache: typically sudden-onset (‘thunderclap’ or ‘baseball bat’), severe (‘worst of my life’) and occipital Nausea and vomiting Meningism (photophobia, neck stiffness) Coma Seizures Sudden death ECG changes including ST elevation may be seen Good Luck

ANNOUNCEMENT Hello n salam everyone We are pleased to announce admissions for our *Aug-Sep 2022 online course ( 15 days ) for PACES MRCP (UK).* We will start from *22 August and finish on 7 September.* 8 Active slots available on first come--first served basis. Listener slot available too. *60 Important exam cases ( including recent diets cases ) will be practiced and discussed as we do in our weekly general 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.

*Few causes of Subarchnoid Haemorrhage by courtesy of Dr Toqeer Bhatti. Thanks a lot dear dr* The most common cause of SAH is head injury and this is called traumatic SAH . In the absence of trauma, SAH is termed spontaneous SAH . The rest of this note focuses on spontaneous SAH. Intracranial aneurysm* (saccular ‘berry’ aneurysms): this accounts for around 85% of cases. Conditions associated with berry aneurysms include adult polycystic kidney disease, Ehlers-Danlos syndrome and coarctation of the aorta Arteriovenous malformation Pituitary apoplexy Arterial dissection Mycotic (infective) aneurysms Perimesencephalic (an idiopathic venous bleed) Good Luck

*Few causes of weight gain by courtesy of Dr Toqeer Bhatti. Thanks a lot dear dr* Depression Hypothyroidism Corticosteroids: side-effects Chronic heart failure Polycystic ovarian syndrome Chronic kidney disease Sulfonylureas: side-effects Cushing's disease Focal segmental glomerulosclerosis Membranous glomerulonephritis Minimal change disease Good Luck

*Brief management of Wilson,s disease by courtesy of Dr Toqeer Bhatti. Thanks a lot dear dr* penicillamine (chelates copper) has been the traditional first-line treatment trientine hydrochloride is an alternative chelating agent which may become first-line treatment in the future Zinc has also been used. tetrathiomolybdate is a newer agent that is currently under investigation Good Luck

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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ANNOUNCEMENT Hello n salam everyone We are pleased to announce admissions for our *Aug-Sep 2022 online course ( 15 days ) for PACES MRCP (UK).* We will start from *22 August and finish on 7 September.* 8 Active slots available on first come--first served basis. Listener slot available too. *60 Important exam cases ( including recent diets cases ) will be practiced and discussed as we do in our weekly general 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.

*Announcement for Online Session No 63* *14 August 2022* DEAR DOCTORS : MAY I HAVE YOUR ATTENTION PLEASE : *Today we will have an online session on Zoom discussing 1 station 2 ( History Taking )* regarding our preparation for MRCP PACES ( UK ) TIMINGS : Saudia Arabia: 4 pm Pakistan : 6 pm Bangladesh : 7 pm India : 6 30 pm Singapore : 9 pm Hong Kong : 9 pm Malaysia : 9 pm Egypt : 3 pm Libya : 3 pm Bahrain : 4 pm Burma ( Myanmar ) :7 30 pm Sudan : 3 pm UAE : 5 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 ( please Google for your local time zones to avoid any inconvenience ) Zoom meeting link will be shared 5 minutes before start time. The candidate for today,s session has been selected. GOOD LUCK.

The candidate for tomorrow,s session has been selected. Thanks and regards