Clinical Skills Pro @pass_paces

We know there is a lot of confusion about the MRCP PACES. Well currently, the UK exam centre application window is open: To apply to do your PACES this autumn, visit buff.ly/3hoSmLM

1/ We know there is some confusion about the MRCP PACES. We have had a number of questions about the the September exam diet as well as whether the new format will be introduced this year, or delayed until next year.

3/ It doesn't matter the method of testing, you still need to demonstrate you are clinically safe and can communicate effectively. Therefore, if you are revising, we suggest, you continue to do so, as the curriculum hasn't changed.

2/ The MRCP PACES website is a little confusing, and we have contacted them for clarification. Once we know the situation, we will let you know. What is important to remember is that the PACES examinations, no matter the format tests your clinical and communication skills.

The MRCP are yet to release the actual September dates for PACES, but keep an eye: buff.ly/3df6yod As soon as the MRCP release the dates, we will let you know #PACES

2/ ...We have been working closely with our third party providers to find new dates for the SCE's and European specialty examinations that were cancelled early in the pandemic and are pleased to confirm these have now been rearranged. From MRCP - subject to change

1/ Restarting MRCP(UK) assessments and training progression 3 Jun 2020 The Federation of the Royal Colleges of Physicians of the UK is focussed on restarting all assessments; MRCP(UK) Parts 1 & 2, PACES and Specialty Certificate Examinations, in September as currently scheduled

Serum natriuretic peptide Be aware that: high levels of serum natriuretic peptides can have causes other than heart failure (for example, age over 70 years, left ventricular hypertrophy, ischaemia, tachycardia, right ventricular overload, hypoxaemia

The decision about whether to start treatment with dabigatran for AF should be made after an informed discussion between the clinician and the person about the risks and benefits of dabigatran etexilate compared with warfarin. #PACES

Serum natriuretic peptide an NT-proBNP level less than 400 ng/litre (47 pmol/litre) in an untreated person makes a diagnosis of heart failure less likely level of serum natriuretic peptide does not differentiate heart failure with reduced EF and heart failure with preserved EF

Also prescribe NSAIDs with caution in: Women trying to conceive — NSAIDs may impair female fertility. The elderly — increased risk of cardiovascular, renal, and serious GI adverse effects (including GI bleeding and perforation, which may be fatal). #paces

Bleeding risk in AF: concurrent medication, for example concomitant use of aspirin or a non‑steroidal anti‑inflammatory drug (NSAID) harmful alcohol consumption #PACES

Lifestyle advice in chronic heart failure 1/ Salt and fluid restriction Do not routinely advise people with heart failure to restrict their sodium or fluid consumption. #paces

Deep vein thrombosis Consider catheter-directed thrombolytic therapy for patients with symptomatic iliofemoral DVT who have: symptoms of less than 14 days' duration and good functional status and a life expectancy of 1 year or more and a low risk of bleeding #PACES

VTE: immediate interim parenteral anticoagulant therapy followed by a CTPA, if a CTPA cannot be carried out immediately. Consider a proximal leg vein ultrasound scan if the CTPA is negative and DVT is suspected. #PACES

Dabigatran etexilate is recommended as an option for the prevention of stroke and systemic embolism within its licensed indication, that is, in people with nonvalvular atrial fibrillation with one or more of the following risk factors: left ventricular ejection fraction below 40%

Dabigatran etexilate is recommended as an option for the prevention of stroke and systemic embolism within its licensed indication, that is, in people with nonvalvular atrial fibrillation with one or more of the following risk factors: symptomatic heart failure of >NYHA class 2

Patients with signs or symptoms of both deep vein thrombosis and pulmonary embolism. If a patient presents with signs or symptoms of both DVT (for example a swollen and/or painful leg) and PE (for example chest pain, shortness of breath or haemoptysis) #PACES

VTE: For patients who have an allergy to contrast media, or who have renal impairment, or whose risk from irradiation is high: Assess the suitability of a ventilation/perfusion single photon emission computed tomography (V/Q) scan or, if a V/Q #PACES

VTE Rx: Start the LMWH, fondaparinux or UFH as soon as possible and continue it for at least 5 days or until the international normalised ratio (INR) (adjusted by a vitamin K antagonist [VKA]) is 2 or above for at least 24 hours, whichever is longer #PACES