MY PACES

𝗦𝗽𝗮𝗰𝗲𝗱 𝗹𝗲𝗮𝗿𝗻𝗶𝗻𝗴| 𝑳𝒆𝒂𝒓𝒏𝒊𝒏𝒈 𝒕𝒉𝒂𝒕 𝒊𝒔 𝒔𝒑𝒓𝒆𝒂𝒅 𝒐𝒖𝒕 𝒂𝒏𝒅 𝒓𝒆𝒑𝒆𝒂𝒕𝒆𝒅 𝒐𝒗𝒆𝒓 𝒕𝒊𝒎𝒆 𝒊𝒔 𝒓𝒆𝒈𝒂𝒓𝒅𝒆𝒅 𝒂𝒔 𝒎𝒐𝒓𝒆 𝒆𝒇𝒇𝒆𝒄𝒕𝒊𝒗𝒆 𝒕𝒉𝒂𝒏 𝒊𝒏𝒕𝒆𝒏𝒔𝒆 𝒍𝒆𝒂𝒓𝒏𝒊𝒏𝒈 𝒐𝒗𝒆𝒓 𝒂 𝒔𝒉𝒐𝒓𝒕 𝒑𝒆𝒓𝒊𝒐𝒅 𝒐𝒇 𝒕𝒊𝒎𝒆.

𝗧𝗵𝗶𝘀 “𝘀𝗽𝗮𝗰𝗲𝗱 𝗹𝗲𝗮𝗿𝗻𝗶𝗻𝗴” 𝗶𝘀 𝗮𝗹𝘀𝗼 𝗯𝗲𝗹𝗶𝗲𝘃𝗲𝗱 𝘁𝗼 𝗯𝘂𝗶𝗹𝗱 𝗺𝗼𝗿𝗲 𝗲𝗻𝗱𝘂𝗿𝗶𝗻𝗴 𝗸𝗻𝗼𝘄𝗹𝗲𝗱𝗴𝗲 𝘁𝗵𝗮𝗻 𝗼𝗻𝗲-𝘁𝗶𝗺𝗲 𝗺𝗲𝗺𝗼𝗿𝗶𝘇𝗮𝘁𝗶𝗼𝗻.

𝐼𝑡 𝑖𝑠 𝑏𝑒𝑙𝑖𝑒𝑣𝑒𝑑 𝑡ℎ𝑎𝑡 𝑟𝑒𝑝𝑒𝑡𝑖𝑡𝑖𝑜𝑛 𝑟𝑒𝑖𝑛𝑓𝑜𝑟𝑐𝑒𝑠 𝑤ℎ𝑎𝑡 𝑎𝑙𝑟𝑒𝑎𝑑𝑦 𝑖𝑠 𝑘𝑛𝑜𝑤𝑛 𝑎𝑛𝑑 𝑐𝑜𝑛𝑠𝑜𝑙𝑖𝑑𝑎𝑡𝑒𝑠 𝑛𝑒𝑤 𝑘𝑛𝑜𝑤𝑙𝑒𝑑𝑔𝑒 𝑤𝑖𝑡ℎ 𝑒𝑥𝑖𝑠𝑡𝑖𝑛𝑔 𝑘𝑛𝑜𝑤𝑙𝑒𝑑𝑔𝑒!

Never underestimate the importance of 'Clinical Reasoning' in PACES.

Unlike medical licensing exams, in PACES, which essentially is a higher level exam, you are not expected to just present the findings and a default list of diagnosis/Ix. Moreover, your clinical judgement/decision making (Mx plan) also comes into play.

Tip: Practice simulated case scenarios to improve your clinical thinking.

A RENAL ABDOMEN IN PACES:

Commonly missed things:

1. Scars d/ previous central lines.

2. Scar of parathyroidectomy d/t secondary or tertiary hyperparathyroidism.

3. A scar in LIF with a mass underneath- d/t failure of a previous transplant (on the right side).

Complete your case presentation by mentioning that you would like to do a urine dipstick and check the blood pressure.

In general, your performance declines a few days before your actual exam, owing to anxiety.

Your pre-exam mock PACES exams (no matter how well organized they are) do not truly reflect on your actual potential and the predictability of success,nevertheless, they are very much useful and are highly recommended.

Always remember that (despite having the same knowledge) you will be a totally different person on your exam day! The attitude on exam day is what matters the most!

It is usually the skills that decide a pass or fail (not the knowledge). You have to take this exam as your usual day in clinic in order to enhance your chances of success!
Just be logical and keep in mind the examiners' expectations!

You cannot simply be concerned about 100 things while performing a task; you have to be natural in order to set the flow of consultation.

Management plan to be given for a patient who presented with Syncope/collapse:

1. General:

Patient education : explain the condition and advise not to drive (until medically allowed to do so).

2. Specific for the condition:

(i) Cardiac arrhythmia:

a) May require a permanent pacemaker if it is a symptomatic heart block.

b) May require an implantable cardiac defibrillator if it is a malignant arrhythmia.

c) May require electrophysiological studies / accessory pathway ablation.

(ii) Seizure:

a) No need to start on anti-epileptics if this is the first episode and no underlying cause is found.

b) May recur in the future.

c) Pregnancy counselling in women of child-bearing age.

(iii) Vasovagal:

a) Stay well hydrated.

b) Avoid rapid changes in position/posture.

(iv) Endocrine:

a) Adjust medication to avoid hypoglycaemia.

b) Patient education on symptoms of hypoglycaemia and how to avoid it.

There are a no. of physical signs to be looked for in a case of Renal Transplant in PACES.

The commonly missed 2 signs are:

1. Pallor

2. Parathyroidectomy scar (tertiary hyperparathyroidism)

'The Mental Capacity Act' defines the capacity to make decisions as:

- The ability to understand information related to a decision.
- The ability to retain that information.
- The ability to use that information as part of the decision-making process.
- The ability to communicate the decision (by any interpretable means).

PACES TIP:

If a patient has a tracheal deviation, accompanied by a dull percussion note over the same side of chest (anteriorly) along with reduced breath sounds and vocal resonance over the same area, in the absence of a lateral thoracotomy scar, the most likely diagnosis should be a LOBAR COLLAPSE!

Possible D/Ds in such a case (dullness to percussion with a reduced air entry and tracheal deviation) include:

- Pleural plaques
- A loculated pleural effusion.

PACES TIP:

While presenting your findings and the most likely diagnosis, always keep in mind the clues given in the written case scenario outside the room!

For example, if a patient has Peripheral Neuropathy on physical examination and the information in the case scenario outside is that the patient either has:

DM/ is taking statin/ has a Hx/O R.A. (MTX) etc, your most likely diagnosis should be accordingly and this will give a good impression.

You will always get full marks in any case if your DDs include the most likely diagnosis.

In Station 5 (Brief Clinical Consultation/ Integrated Clinical Skills), the examiners will ask you to present the positive findings only and ask about only those things in viva which you haven't explained to the patient already because they have only 2 minutes for viva here unlike all other stations.

Keeping in view the above, when you are given a warning that only 2 minutes are remaining, please aim to mainly:
1. Explain the diagnosis (clinical communication skill) and give a very quick overview of the management plan to the patient.

2. Ask about and address the concerns (managing the patient's concerns skill)

Explain your better management plan to the examiner during viva (clinical judgement skill) rather than rushing it through during the very precious last 2 minutes with patient!

You will find it relatively easier to give a detailed management plan to the examiner rather than the patient because you need not to check the examiner's understanding/opinion in between, whereas, on the other hand, if you miss the opportunity to address the concerns of the patient, you will not be able to address them in viva!

PLAN YOU CONSULTATION WISELY!
PACES IS ALL ABOUT PRACTICE!

Dear PACES aspirants as the results of diet 1 are releasing we want to thank to all our amazing course participants who made us proud all over the globe 🌏 .
We have candidates passed from Ireland 🇮🇪, UK 🇬🇧, Pakistan 🇵🇰, India 🇮🇳 and Oman 🇴🇲 . Apologies if we have missed to notify any country .
We will share the lists soon .
To book our upcoming course this weekend email now at [email protected]
Or visit our website mypaces.co.uk

Heartiest congratulations to Dr. Hissan Saqib (Post Graduate Resident in Neurology) on passing PACES with a very high score of 170/172 from Pakistan centre (Diet 2/2023)!
He took special guidance for Station 5 from team 'MY PACES'.

We are really glad to see your wonderful success and we wish you great luck ahead as well.

Congratulations to Dr. Umer who passed his MRCP(UK) PACES exam in his first attempt with such a high score after attending 'MY PACES' online courses.
He performed really well during the practice/mock sessions and got the very well-deserved success in actual exam (diet 2/2023) in Pakistan centre.

Congratulations to Dr. Sana on passing MRCP(UK) PACES exam in her first attempt with such a high score (from Pakistan centre, diet 2/2023).
She took our 'MY PACES' course and we congratulate her on her very well-deserved success!

Always remember:

🚨 'CONFUSION' can cause confusion in PACES!

🌀All PACES aspirants must prepare well: delirium/dementia/delirium on dementia/ transient global amnesia.

💊Oxford Handbook of Clinical Medicine is recommended for these topics at least, along with any other study material that you have chosen!

Our upcoming course will commence on 29/04/2023

Register now by sending an email at: [email protected]
OR
🌐Visit our website for details:
https://mypaces.co.uk/services
For any queries you can also whatsapp at:

00447432251025

'𝐓𝐎𝐍𝐄' 𝐈𝐍 𝐂𝐄𝐑𝐄𝐁𝐄𝐋𝐋𝐀𝐑 𝐒𝐘𝐍𝐃𝐑𝐎𝐌𝐄:

🌀𝑰𝒏𝒊𝒕𝒊𝒂𝒍𝒍𝒚, 𝒕𝒉𝒆𝒓𝒆 𝒊𝒔 𝑯𝒀𝑷𝑶𝒕𝒐𝒏𝒊𝒂.

🌀𝑰𝒏 𝒍𝒐𝒏𝒈 𝒔𝒕𝒂𝒏𝒅𝒊𝒏𝒈 𝒄𝒆𝒓𝒆𝒃𝒆𝒍𝒍𝒂𝒓 𝒅𝒊𝒔𝒆𝒂𝒔𝒆, 𝒄𝒐𝒓𝒕𝒊𝒄𝒐𝒔𝒑𝒊𝒏𝒂𝒍 𝒕𝒓𝒂𝒄𝒕𝒔 𝒄𝒐𝒎𝒑𝒆𝒏𝒔𝒂𝒕𝒆 𝒂𝒏𝒅 𝒕𝒉𝒆 𝒕𝒐𝒏𝒆 𝒃𝒆𝒄𝒐𝒎𝒆𝒔 𝒏𝒐𝒓𝒎𝒂𝒍.

🌀𝑰𝒇 𝒎𝒖𝒍𝒕𝒊𝒑𝒍𝒆 𝒔𝒄𝒍𝒆𝒓𝒐𝒔𝒊𝒔 𝒊𝒔 𝒕𝒉𝒆 𝒄𝒂𝒖𝒔𝒆, 𝒕𝒉𝒆 𝒕𝒐𝒏𝒆 𝒘𝒊𝒍𝒍 𝒃𝒆 𝒊𝒏𝒄𝒓𝒆𝒂𝒔𝒆𝒅!

Important to understand regarding Motor Neuron Disease:

In ALS (Amyotrophic Lateral Sclerosis), d/t LMN lesion, there is denervation of muscles and hence called AMYOTROPHIC!
Additionally, there is lesion in the lateral column of spinal cord as well; LATERAL SCLEROSIS (UMN lesion).

In PMA (Progressive Muscular Atrophy), there is a lesion in anterior horn cells (LMN Lesion)

In PLS (Primary Lateral Sclerosis), there is a lesion in Pyramidal Neurons (Corticospinal Neurons) (UMN Lesion)

ALS (Amyotrophic Lateral Sclerosis) is a combination of UMNL + LMNL (and more than 3 segments are usually involved).

Registrations are now open for our April-May virtual PACES courses .
To book a slot please send an email at
📧[email protected]
Or directly enroll throughout our website
👩‍💻mypaces.co.uk
You can find all details of our courses on our website .
If you have any questions regarding our courses whatsapp now at 00447432251025

The top D/Ds whenever you come across a triad of:
weakness + wasting + fasciculations WITHOUT any sensory involvement include:

1. Spinal muscular atrophy(SMA)

2.Multifocal Motor Neuropathy (MMN)

3. Spinobulbar Muscular Atrophy (SBMA) aka Kennedy Disease

4. Post-polio syndrome (usually asymmetrical but can be symmetrical as well).

(Depending upon the presentation, you may choose the order from this given list).

We all know that one of the 07 core skills tested in PACES is 'D/Ds', which means that besides the most likely Dx, you must come up with a logical list of DDs.
What should be your 3 D/Ds if 'Motor Neuron Disease' is your most likely Dx?

Join our dedicated whatsapp group for 24/7 support in your PACES exam preparation.
We also take regular quizzes and test your knowledge and skills.

https://chat.whatsapp.com/C4guWXsbYkzLLmwFzxLe78

As the MRCP (UK) PACES Diet 2 candidates have received a confirmation of their acceptance for the exam ,we are here to ensure that you pass your PACES with good marks.

Our next full course will be on 29th April -7th May 2023.

Register now by sending an email at: [email protected]
OR
🌐Visit our website for details:
https://mypaces.co.uk/services
For any queries you can also whatsapp at 00447432251025

Note :You will also be able to find study partners during the course from different healthcare setups (especially NHS )to work on all of your skills tested in PACES.

A common mistake during preparation for MRCP(UK) PACES is that the candidates only prepare how to present a case and give viva after reaching a definitive diagnosis/DDs,whereas, the actual challenge in real exam is to proceed when you couldn't reach a definitive diagnosis/ you are not sure about the DDs!

You have to be smart enough to be able to manage things well, ensuring that you do not lose marks in the 'linked skills' under any circumstances.

This is the perfect answer to our previous image-based question.
Dr.Ayondyuti Bora explained this really well in our WhatsApp group!

We would like to congratulate Dr.Sonal on clearing her MRCP PACES exam in first attempt from the UK center .She attended our late February 2023 course.
We wish her best of luck for future endeavors.

https://mypaces.co.uk/f/dr-sonal-uk

What are the findings in this image?

If such a case is given in Station 3 (Neurology)/ Station 5 (BCC), what additional signs you will look for?

How will you manage such a case?

(Please comment your responses below this original post).

𝑰𝒏 𝒈𝒆𝒏𝒆𝒓𝒂𝒍, 𝒎𝒐𝒔𝒕 𝒐𝒇 𝒕𝒉𝒆 𝒖𝒏𝒔𝒖𝒄𝒄𝒆𝒔𝒔𝒇𝒖𝒍 𝑷𝑨𝑪𝑬𝑺 𝒄𝒂𝒏𝒅𝒊𝒅𝒂𝒕𝒆𝒔 𝒂𝒓𝒆 𝒕𝒉𝒐𝒔𝒆 𝒘𝒉𝒐 𝒔𝒄𝒐𝒓𝒆 𝒍𝒆𝒔𝒔 𝒊𝒏 𝑺𝑻𝑨𝑻𝑰𝑶𝑵 5 𝒂𝒏𝒅 𝒎𝒐𝒔𝒕 𝒐𝒇 𝑰𝑴𝑮𝒔 𝒈𝒆𝒏𝒆𝒓𝒂𝒍𝒍𝒚 𝒔𝒄𝒐𝒓𝒆 𝒍𝒆𝒔𝒔 𝒊𝒏 '𝑺𝒌𝒊𝒍𝒍 𝑪' (𝑪𝒍𝒊𝒏𝒊𝒄𝒂𝒍 𝑪𝒐𝒎𝒎𝒖𝒏𝒊𝒄𝒂𝒕𝒊𝒐𝒏).

𝘾. 𝘾𝙡𝙞𝙣𝙞𝙘𝙖𝙡 𝙘𝙤𝙢𝙢𝙪𝙣𝙞𝙘𝙖𝙩𝙞𝙤𝙣:

𝑬𝒍𝒊𝒄𝒊𝒕 𝒂 𝒔𝒚𝒔𝒕𝒆𝒎𝒂𝒕𝒊𝒄, 𝒕𝒉𝒐𝒓𝒐𝒖𝒈𝒉 𝒂𝒏𝒅 𝒇𝒍𝒖𝒆𝒏𝒕 𝒉𝒊𝒔𝒕𝒐𝒓𝒚 𝒓𝒆𝒍𝒆𝒗𝒂𝒏𝒕 𝒕𝒐 𝒕𝒉𝒆 𝒑𝒂𝒕𝒊𝒆𝒏𝒕’𝒔 𝒄𝒐𝒎𝒑𝒍𝒂𝒊𝒏𝒕(𝒔).

𝑬𝒍𝒊𝒄𝒊𝒕 𝒑𝒓𝒆𝒔𝒆𝒏𝒕𝒊𝒏𝒈 𝒄𝒐𝒎𝒑𝒍𝒂𝒊𝒏𝒕, 𝒔𝒚𝒔𝒕𝒆𝒎𝒊𝒄 𝒓𝒆𝒗𝒊𝒆𝒘, 𝒑𝒂𝒔𝒕 𝒂𝒏𝒅 𝒇𝒂𝒎𝒊𝒍𝒚 𝒉𝒊𝒔𝒕𝒐𝒓𝒚; 𝒂𝒍𝒍 𝒊𝒏 𝒂 𝒔𝒚𝒔𝒕𝒆𝒎𝒂𝒕𝒊𝒄, 𝒇𝒍𝒖𝒆𝒏𝒕 𝒂𝒏𝒅 𝒑𝒓𝒐𝒇𝒆𝒔𝒔𝒊𝒐𝒏𝒂𝒍 𝒎𝒂𝒏𝒏𝒆𝒓.

𝑨𝒔𝒔𝒆𝒔𝒔𝒆𝒔 𝒕𝒉𝒆 𝒊𝒎𝒑𝒂𝒄𝒕 𝒐𝒇 𝒔𝒚𝒎𝒑𝒕𝒐𝒎𝒔 𝒐𝒏 𝒑𝒂𝒕𝒊𝒆𝒏𝒕’𝒔 𝒐𝒄𝒄𝒖𝒑𝒂𝒕𝒊𝒐𝒏, 𝒍𝒊𝒇𝒆𝒔𝒕𝒚𝒍𝒆 𝒂𝒏𝒅 𝒂𝒄𝒕𝒊𝒗𝒊𝒕𝒊𝒆𝒔 𝒐𝒇 𝒅𝒂𝒊𝒍𝒚 𝒍𝒊𝒗𝒊𝒏𝒈.

𝑬𝒙𝒑𝒍𝒂𝒊𝒏 𝒓𝒆𝒍𝒆𝒗𝒂𝒏𝒕 𝒄𝒍𝒊𝒏𝒊𝒄𝒂𝒍 𝒊𝒏𝒇𝒐𝒓𝒎𝒂𝒕𝒊𝒐𝒏 𝒊𝒏 𝒂𝒏 𝒂𝒄𝒄𝒖𝒓𝒂𝒕𝒆, 𝒄𝒍𝒆𝒂𝒓, 𝒔𝒕𝒓𝒖𝒄𝒕𝒖𝒓𝒆𝒅, 𝒄𝒐𝒎𝒑𝒓𝒆𝒉𝒆𝒏𝒔𝒊𝒗𝒆, 𝒇𝒍𝒖𝒆𝒏𝒕 𝒂𝒏𝒅 𝒑𝒓𝒐𝒇𝒆𝒔𝒔𝒊𝒐𝒏𝒂𝒍 𝒎𝒂𝒏𝒏𝒆𝒓.