pace your MRCP-PACES

ANNOUNCEMENT Hello n salam everyone Regarding our *Oct 2022 online course for PACES MRCP (UK) ( duration 15 days ).* starting from *14 Oct* till *31 Oct* Only *4 Active slots are available* Listener slot available too. Interested candidates may send a personal message for details. WhatsApp No: 00923346036496. Email: drtanzeelbukhari@gmail.com GOOD LUCK.

Dear coalleagues I reget to inform you that due to some family commitments our tomorrow,s session will not happen and it will be cancelled. Our next session will be on 16 Oct 22 if all goes well. I am sorry for the inconvenience

Few more *signs of Aortic regurgitation* for academic interest by *courtesy of Dr Osama Nawar..* Thanks for sharing dear Dr. *Gerhardt Sign* ..... Systolic Pulsation of Spleen *RosenBach Sign* ..... Systolic Pulsation of liver *Becker Sign* .......systolic foundation of Retinal vessels. Good luck.

*Some signs of Aortic Regurgitation* *de Musset’s sign* —head nodding . *Müller’s sign* —systolic pulsations of the uvula. *Corrigan’s sign* —visible carotid pulsations. *Quincke’s sign* —capillary nailbed pulsation in the fingers. *Traube’s sign* —‘pistol shot’ femorals, a booming sound heard over the femorals. *Duroziez’s sign* —to and fro diastolic murmur heard when compressing the femorals proximally with the stethoscope. *Copied* Good luck.

👉 *IMPORTANT 52* 👈 Please remember that *PAIN and TRAUMA are twins* , so always ask them together to your patients in station 2 and 5. Good luck.

ANNOUNCEMENT Hello n salam everyone We are pleased to announce admissions for our *Oct 2022 online course ( 15 days ) for PACES MRCP (UK).* We will start from *14 October and finish on 31 October.* *Active slots available on first come--first served basis.* Listener slot available too. *Atleast 100 Important exam cases ( including recent diets cases ) will be practiced and discussed as we do in our weekly Sunday 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.

👉 *IMPORTANT 51* 👈 *5 A’ approach* endorsed by the British Thoracic Society about cigratte smoking *Ask* about smoking status *Assess* readiness to quit *Advise* to quit *Assist* in efforts to quit *Arrange* follow-up. Good luck.

*Some prognostic indicators of Coronary artery Disease* 1. *Left ventricular function* (ejection fraction [EF]) Normal >50% If <50%, associated with increased mortality 2.. *Vessel(s) involved* (severity/extent of ischemia) Left main coronary artery—poor prognosis because it supplies approximately two-thirds of the heart Two- or three-vessel CAD—worse prognosis *Copied* Good luck...

*Some info about heart rhythms* *Triple and gallop rhythms* A 3rd or 4th heart sound occurring with a sinus tachycardia may give the impression of galloping hooves. When S3 and S4 occur in a tachycardia, eg with pulmonary embolism, they may summate and appear as a single sound, a summation gallop. *Copied* Good luck.

✌️✌️ *HEARTIEST CONGRATULATIONS* ✌️✌️ To *Dr Hina Umar* For passing *MRCP UK PART 2 Written* She has been keen member of our part 2 group. We wish her the best for her future.

ANNOUNCEMENT Hello n salam everyone We are pleased to announce admissions for our *Oct 2022 online course ( 15 days ) for PACES MRCP (UK).* We will start from *14 October and finish on 31 October.* *Active slots available on first come--first served basis.* Listener slot available too. *Atleast 100 Important exam cases ( including recent diets cases ) will be practiced and discussed as we do in our weekly Sunday 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.

*Some info about heart sounds* *4th heart sound (S4)* occurs just before S1. Always abnormal. It represents atrial contraction against a ventricle made stiff by any cause, eg aortic stenosis or hypertensive heart disease. *Copied* . Good luck.

👉 *IMPORTANT 50* 👈 *Some info about GOUT, CKD N DIURETICS* Be careful while using diuretics in gout. If diuretics are being used to treat hypertension an alternative hypertensive should be considered, but they should not be stopped in the presence of CHF. They are not absolutely contraindicated in hyperurecemia in CKD but if possible other options should be used. Steroids can be used in case other medicines used for management of acute gout are not safe.But steroids have their own side effect profile. Good luck.

👉 *IMPORTANT 49* 👈 Please remember *PROGNOSIS* might be considered as a Jargon by some of the examiners so be careful while using it in exam and always say *OUTLOOK/ OUTCOME/ FINAL RESULT OF THE DISEASE* to your patient  Good luck.

✌️✌️ *HEARTIEST CONGRATULATIONS* ✌️✌️ To *Dr Berkas Khadidja* *Dr Kiran* For passing *MRCP UK PART 2 Written* They have been keen members of our part 2 group. We wish them the best for their future.

✌️✌️ *HEARTIEST CONGRATULATIONS* ✌️✌️ To *Dr Shiasta Qamar* For passing *MRCP UK PART 2 Written* She has been a keen member of our part 2 group. We wish her the best for her future.

✌️✌️ *HEARTIEST CONGRATULATIONS* ✌️✌️ To *Dr Nasir* *Dr Ahmed Sayed Hamada* *Dr Shafiq ul Islam* *Dr Jawaria Shuja* *Dr May* *Dr Aliyah Abdalla* *Dr Ashraf Jafrani* *Dr Muhammad Sher Ali* *Dr Mumtaz ahmad* *Dr Yousaf* *Dr Salman Afridi* *Dr Zaheer* *Dr Mohammad Sohail* For passing *MRCP UK PART 2 Written* They have been keen members of our part 2 group. We wish them the best for their future.

ANNOUNCEMENT Hello n salam everyone We are pleased to announce admissions for our *Oct 2022 online course ( 15 days ) for PACES MRCP (UK).* We will start from *14 October and finish on 31 October.* *Active slots available on first come--first served basis.* Listener slot available too. *Atleast 100 Important exam cases ( including recent diets cases ) will be practiced and discussed as we do in our weekly Sunday 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.

*Some info about heart sounds* *3rd heart sound (S3)* may occur just after S2. It is low pitched and best heard with the bell of the stethoscope. S3 is pathological over the age of 30yrs. A loud S3 occurs in a dilated left ventricle with rapid ventricular filling (mitral regurgitation, VSD) or poor LV function (post MI, dilated cardiomyopathy). In constrictive pericarditis or restrictive cardiomyopathy it occurs early and is more high pitched (‘pericardial knock’). *Copied* . Good luck.

*Some info about heart sounds* The 2nd heart sound ( S2) Represents aortic ( A2 )and pulmonary valve ( P2) closure. The most important abnormality of A2 is softening in aortic stenosis. • A2 is said to be loud in tachycardia, hypertension, and transposition, but this is probably not a useful clinical entity. • P2 is loud in pulmonary hypertension and soft in pulmonary stenosis. • Splitting of S2 in inspiration is normal and is mainly due to the variation of right heart venous return with respiration, delaying the pulmonary component. • Wide splitting occurs in right bundle branch block (BBB), pulmonary stenosis, deep inspiration, mitral regurgitation, and VSD. • Wide fixed splitting occurs in atrial septal defect (ASD). • Reversed splitting (ie A2 following P2, with splitting increasing on expiration) occurs in left bundle branch block, aortic stenosis, PDA (patent ductus arteriosus), and right ventricular pacing. • A single S2 occurs in Fallot’s tetralogy, severe aortic or pulmonary stenosis, pulmonary atresia, Eisenmenger’s syndrome, large VSD, or hypertension. NB: splitting and P2 are heard best in the pulmonary area. *Copied* . Good luck.