pace your MRCP-PACES

*⚠️ Examination Sequence Mistake 1 – Respiratory Exam* (by pace your MRCP – Dr Tanzeel Bukhari) *❌ Common Mistake:* Jumping straight to auscultation without completing inspection → palpation → percussion first. *✅ Correct Sequence* : *1️⃣ Inspection* – respiratory rate, chest shape, scars, use of accessory muscles *2️⃣ Palpation* – chest expansion, tracheal position, tactile fremitus *3️⃣ Percussion* – dull / resonant / hyperresonant *4️⃣ Auscultation* – breath sounds + added sounds *5️⃣ Vocal Resonance* – whisper pectoriloquy if needed *💡 PACES Tip:* Examiners award marks for sequence, not just technique. Breaking the order signals poor structure — even if your findings are correct.

*📋 Mini OSCE Checklist 1 – Respiratory Examination* (by pace your MRCP – Dr Tanzeel Bukhari) *✅ 1. Introduction & Safety* Introduce yourself, confirm patient identity Gain consent Wash/sanitise hands Expose chest appropriately Ensure patient comfort (sitting at 45°) --- *✅ 2. General Inspection* Respiratory rate, use of accessory muscles Cyanosis, pallor, cachexia Chest wall shape (barrel chest, pectus deformities) Any medical devices (O₂, neb mask, sputum pot) --- *✅ 3. Hands & Arms* Tar staining, clubbing Peripheral cyanosis Flap for CO₂ retention Pulse (rate, rhythm) Resp rate (count visibly) --- *✅ 4. Face & Neck* Conjunctival pallor Central cyanosis JVP Trachea position Lymph nodes --- *✅ 5. Chest Examination* Inspection → Palpation → Percussion → Auscultation Chest expansion (symmetry) Tactile vocal fremitus Percussion note (resonant / dull / hyperresonant) Breath sounds (vesicular / bronchial) Added sounds (crackles, wheeze, pleural rub) Vocal resonance --- *✅ 6. Posterior Chest* Repeat the above steps (many signs are clearer posteriorly). --- *✅ 7. End the Examination* Examine legs for edema / DVT signs if relevant Thank the patient Summarise findings to examiner Suggest further tests (CXR, ABG, spirometry, CT)

Photo from Dr Tanzeel Bukhari

🟢 ONLINE CRASH COURSE FOR PACES – ADMISSIONS OPEN! 📅 24 Nov – 05 Dec 2025 🎯 PACES MRCP (UK) & CLINICAL EXAM MRCPI 🚨 At a very affordable fee ✅ 10-Day Intensive Online Course ✅ Covers ALL 7 SKILLS in detail (as in our weekly free sessions) ✅ Practice & discussion of 60 exam cases (including recent diets), covering:  • 30 cases of consultations  • 30 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

Photo from Dr Tanzeel Bukhari

Photo from Dr Tanzeel Bukhari

🟢 ONLINE CRASH COURSE FOR PACES – ADMISSIONS OPEN! 📅 24 Nov – 05 Dec 2025 🎯 PACES MRCP (UK) & CLINICAL EXAM MRCPI 🚨 At a very affordable fee ✅ 10-Day Intensive Online Course ✅ Covers ALL 7 SKILLS in detail (as in our weekly free sessions) ✅ Practice & discussion of 60 exam cases (including recent diets), covering:  • 30 cases of consultations  • 30 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

*👀 Common Physical Sign 1 – Xanthelasma* (by pace your MRCP – Dr Tanzeel Bukhari) *🔸 What you see:* Yellowish, soft, cholesterol-rich plaques around the eyelids — usually medial canthus. *🔸 What it suggests:* Hyperlipidaemia (most common association) Familial dyslipidaemias Cholestatic liver disease (e.g., PBC) Type 2 diabetes Sometimes seen in normal lipid levels but still clinically important *🔸 Why examiners care:* It is a subtle sign that should immediately prompt you to: Check cardiovascular risk factors Assess for arcus senilis, tendon xanthomas Ask about pruritus or fatigue (if suspecting PBC) Review medications affecting lipids *💡 PACES Tip:* Candidates often miss xanthelasma. Spotting it early can lead you straight toward a cardiovascular or hepatobiliary differential even before touching the patient.

*🩺 Focused Examination Tip 1 – Cardiovascular System (CVS)* (by pace your MRCP – Dr Tanzeel Bukhari) *🔹 Start with the “Big 3” overview* In any PACES cardiovascular exam, ALWAYS begin with these three observations before touching the patient chest : *1️⃣ General Appearance* Breathlessness? Cyanosis? Pallor? Discomfort or pain? *2️⃣ Hands & Pulses* Warm or cold? Capillary refill Radial pulse: rate, rhythm, character Collapsing pulse (AR) Radio–femoral delay (CoA) *3️⃣ Neck & JVP* Height Waveform Hepato-jugular reflux These three alone can give you up to 50% of the diagnosis before even placing the stethoscope.

*🔷 Medical Flowchart 1 – Acute Coronary Syndrome (ACS)* (by pace your MRCP – Dr Tanzeel Bukhari) *🔵 Step 1: Symptoms* → Suspect ACS Chest pain Radiation Sweating Nausea ➡️ Think ACS immediately --- *🔵 Step 2: Do an ECG* *ST Elevation* → STEMI *ST Depression / T Inversion* → NSTEMI / Unstable Angina *Normal ECG* → Repeat + Troponin --- *🔵 Step 3: Troponin* *High* → NSTEMI *Normal* → Unstable Angina (if symptoms typical) --- *🔵 Step 4: Immediate Management* Aspirin + Ticagrelor Oxygen if hypoxic Nitrates Morphine (if needed) LMWH Beta-blocker (if no contraindication) --- *🔵 Step 5: Definitive Plan* *STEMI:* Primary PCI *NSTEMI:* Risk scoring → Early invasive strategy *Unstable Angina:* Optimise meds + cardiology review

*🌱 Mini Reflection 1 – The Value of Pausing* (by pace your MRCP – Dr Tanzeel Bukhari) One of the most powerful skills in PACES is knowing when to pause. Most candidates rush because they fear silence — but silence is not a weakness. *💡 Lesson:* A 2–3 second pause allows you to: Organise your thoughts Avoid saying the wrong thing Sound calm and confident Show the examiner you are thinking safely In the exam, a pause is often the difference between a rushed guess and a structured, high-scoring answer.