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Soon. She's also I will admit everyone and uh all right, all all my best wishes, Professor Shri. All right. Thank you very much. Ok, thank you. Thank you. So, ok. Sure. Uh Hello, good evening. Was eager to start. Yes. Ok. So, uh who will start? Doctor Edward? Hi, Maceio. Hi, Coronus. Hello. Hello. So, uh we today I'm Doctor Sherin. So today we start about uh one of the common presentation in exam which is carinal nerve and examine the cerebellum. Uh This is very common in exam, uh also common in dental exam, common in the MRC S. Uh This is simply because our Mr S exam is including ent surgeon. Uh our FOSC topic in 10 minute examine the carinal nerve. Uh Is anyone uh uh ready to start? Just tell me what he will start. How, what is your ho how to present yourself in this situation? Anyone? Ok. Anyone just tell if you have a cranial nerve examination how he can start because we just need to know we show you that your mistake, what you make it wrong. So to avoid to do it in exam. Hello, sir. Hello. Ok. Hi Iman. Ok. So, Iman uh you have 10 minutes. I have a timer. So you need to examine uh carin nerve for this patient. Uh This is patient can be normal. So it is not necessary to have a finding. But uh uh uh just uh tell me how to examine the carina nerve. We can start. All right, I will start by introducing myself and get permission from the patient and the patient start. Hello, sir. Oh, uh This is Doctor Emma Mali, one of the surgical doctor working here. My name is uh yes, I am uh Mister Lim and I'm uh 65 years old and nice to meet you mister today. I've been asking you to examine the nerves that supply in your face and your neck. And this is called me doing some special tests. Is that OK with you? Yes. OK. OK. Uh In order to do that, II need you to uh expose your neck up to the upper chest. OK. I will do. All right. I will start to be with the factor nerve. Uh I will, I will ask the patient to close his eyes and um to close uh the left nostril and I will introduce him uh to certain know, to identify it. OK. After that, uh the neck is the the left. No, there also after after that, oh, you go for uh optic nerve. I will to examine optic nerve. Yes, I will start with visual acuity um with uh chart. OK. Uh Then after that, I will go for uh reflex uh uh OK. Uh Then I will go for a swinging light test for the uh say again, say again. Uh for what, uh it's a swinging lightest. What do you mean? Uh you swing the light between the two eyes to see uh uh to test uh if they're, uh they will restrict or not. You mean that you put the light in the right eye and sequel structure in the other eye? Yes. The uh the indirect, the indirect. OK. All right. It is including in B reflex. OK. All right. After that, uh after that, I will go for a visual field. OK. Can uh OK. After that, uh then for the uh confirmation test uh say again, confrontation what it mean uh we confrontation to test the um for uh uh the, the um temporal and the later side. You mean that you tested the visual field? Yes. After visual field, what is uh are you, are you saying or it, is it still in visual field? Uh Yes. Uh No. Uh Just II think now I'm finished with the optic nerve? OK. After that, then I will go for the OK. And Abducent. Yes. OK. Good. Is that what you said? All right. OK. After that, after that, I will go for the trigeminal nerve by testing the sensation, asking the patient to close and uh uh no, no, just a minute. Trigeminal, how to test trigeminal. Uh well, the sensation in the frontal, um a mandibular area and uh doing do, do reflex and to pt and palpate for the muscle. Ok. So you just is the motor by clench the teeth and just for medication and you do a sensation for the face. Ok. So it just a sensory and the motor. Ok. All right. Uh After that, I will go as a trigeminal nerve We there. OK. Uh After that, I will go for the facial nerve. OK. Uh I will ask the patient to um uh raise his eyebrows and uh close. Don't let me open it. OK. And uh OK. Yes. And 10 in his neck. Uh OK. 10 sui OK. And I will ask, I mean, um problem with uh destination. OK. All right. After that, I will go for the, uh I will start by uh marching is what test to it. Start my, what for balance the observation to march in his foot, close his eyes and march in his foot. OK. Uh After that, I will go for uh testing by uh whisper test and whipper and using the center for how to, how to do that. Yes. Um I will uh tell the patient to uh tell me when he feels a vibration is a mastoid bone and when it to stop after it stop, I will uh put it uh close to the ear and uh tell me what it mean. What does this mean? Uh we test the uh air conduction, air conduction is better than bone conduction. OK. Go on. Then I will do a test by uh put the turning fork in the forehead and ask the patient. It is uh no. Uh this is test. OK. After that, uh after that as the test really, you, you done first? Ok. After that, what else? Uh so we OK, after that, OK. After that, I will go for two things. The last, uh, for nerve by glossal as the patient to, uh, open his mouth and say, ah, I will be looking at ao, ok. Uh, for the vagus nerve, I will ask the patient to tell, he said, and cough and for the uh, asthma to do what to do what to cough. Ok. All right. Uh, after that, after, oh, this uh spinal nerve by, uh, er, to shrug his shoulder against resistance. Ok. And as the last one, a hyster nerve or to, uh, stick his tongue out and I will say the deviation to on his side and, uh, also to push against my hand when putting my hand in his skip. Ok. All right. Finish. Yes. Yes. It take a time. Uh, but, uh, I take about, uh, maybe 89 minutes. So it's ok. All right. I just, uh, go to with you one by one. All right. Ok. All right. So I'll just show you some slides. Uh, I think you can see the screen because I don't see it. You, you see a physical examination and cerebellum. You see that? Yes. Ok. So first, uh you start by olfactory actually, uh olfactory, you don't need to lose your time. Uh uh You mentioned that uh you, you, you put something to smell. Uh I, yes, I should ask the patient to uh tell what is the smell. Yeah. What you, what you gave him to Smidge. I will ask this examiner, I need something to uh test the test the patient. All right, actually want to give you something to ask the patient to smell. Just ask a patient if you have any problem of the smell, he say yes or no according to the scenario. But we don't to give you something like coffee or uh any spice spicy or something to, to, to smell. We don't do that even in practice. We don't do that. So just ask as a patient. OK. So this is fair after that you ask about optical uh uh vision. So no optic nerve we're looking for visual acuity, which is correct. Bilber reflects uh in one eye and looking to the other eye for the uh other constriction. And you, you mentioned the field of vision which is correct after that, uh you examine the oculomotor and the motor. So uh we started by, I used to start by visual vision by pupil. Uh you can test as a movement you can test the accommodation. We don't test as the color vision just to make it shape for eye movement. Ok, if you need to. Ok. Oh ok. Uh So after that, uh you just eye movement, both uh eyes are uh two eyes orbit or one eye after one eye. So it is not a problem. Uh We we ask you if we ask you what is the of course you take a time, longer time. So we don't have a time to ask you in 10 minutes. But what happened to the observation of oculomotor nerve in a kilometer? They, they will be uh the pupil will be dilated. Yes. Uh uh Yes, as um eye will be uh deviated laterally and downward. OK. What is the nervous supply of the muscle of the eye? Uh It is supplied by the uh oculomotor supplied by oculomotor and except for uh the lateral rectus supplied by the and the uh internal um later and so, OK. So just so four sever is supplied by four and the la rectus supply by six. OK. So you did it uh correct after that, you go to trigeminal. So when you examined trigeminal, you examined the sensation and the motor is just a muscle of mastication. So it is easy. So, trigeminal sensation like this by Coton, you see a picture and the muscle of mastication by killing is at or temporalis muscle. After that, uh your exam is official. Also this tral can o open the mouth. After that, you go to official official is easy. You see the branches official as sensory uh when you go to the motor, I don't under tell you what you test in the motor before that, why you, you ask you why you test that? You ask to test the taste sensation in the facial nerve. OK? You mean branches of that but uh coming through fa nerve. Yes. OK. But this is not uh OK. Can no problem. But you need to explain that. All right, after that, uh you, you ask the patient to elevate eyebrow, close, eye, blow his teeth. Uh Of course, uh you ask, you ask him to tense his uh neck. Why uh for blockage muscles, cervical branch of the nerve. OK. All I can, but it's not important, but OK, no problem. OK. So uh here I will ask you. So uh all muscle, uh uh what's your muscle supply by fai? Uh Yes. II, don't think that I can drive them. There is all, all uh of course, it is all muscle of the face and the blaster of digastric styloid and the ST OK. All right. It is important when you study, you know, what is the question can be asked? OK. So how to differentiate between fission nerve up and the lower motor uh in the upper motor neuron lesion. Uh there will be uh loss only in the lower half of the face. OK. And So you mean that is uh forehead wrinkling and all this. So for example, you, you mean that something like this in up face. So the patient can elevate the eyebrow, can close his eye and lower motor neurone lesion, he unable to do that. Yes. But in the lower motor neuro lesion, they will be the whole side. And if the whole side, what is the common cause of the lower motor neuro lesion for uh but uh tumor baroid, tumor barot carcinomas, OK? Or injury during surgery. OK. So it is important to differentiate between AIC a motor, a motor is not affected the forehead, not affected the eye because of the cross presentation. Uh you mentioned this is OK. After that, you go to vestibular and uh you make a lot. Uh OK. So vib or tunica, uh what you mentioned, uh it is important to know that air conduction is better than bone conduction. So what you make an exam, you just put that uni fork in the mastoid tell the patient say I don't feel after that, put in the ear. So the patient uh have a sensation of vibration. So this is after that you put in the forehead and it's any laterization. So it is a test. So just to say that just to do that quicker, don't waste time to do it many time. And just to give him the idea air conduction is better than bone conduction. After that, you go to uh I think you ask the patient to March. I don't know why uh for balance, why uh for the uh vestibular part of it is or cerebellum can cause imbalance is visible, can cause, can cause imbalance. It is can cause vertigo tinnitus, but it is not affecting the imbalance. A as, as, as much as I know uh how to differentiate. I don't quite know actually how to differentiate what, how to differentiate uh is the problem is in the balance uh in the vestibular uh vestibular or in the cerebellum. No, it is another station because in this, in exam, we have two station, one carinal nerve and one cerebellum examination. We, we, we, we take it after this but it is not in this station. You don't supposed to be neurology, it is not neurology exam. So don't be so sophisticated. OK. What else? Uh So this is not need to ask the patient to. All right. After that, uh you go to glossopharyngeal and vagus uh just to look into the uvula if something u what happened if the patient can have later? OK. Of course. Uh No need to ask to cough, which is not uh allergic test by the way. OK. After that. So don't ask that. After that, you spi uh spinal accessory uh supply to muscle trapezia and the mastoid. You make it after that, you ask the patient to protrude his tongue. OK. So uh uh so all uh this is OK. Now, uh, so I think your presentation is good. Excellent. Uh Of course, uh, this is, the station is critical because, you know, that you take about eight minutes. So it take a time, maybe sometimes you don't have a time to ask you a question. All right. Uh Of course, uh, you need to be, make it quick, you need to be trained on it because this station is difficult. Uh I happy that you don't uh uh put your uh uh yourself in the common mistake having an exam. What is the common mistake having the exam is that most of the student uh ask a patient about some called the mental uh many mental status. Uh This is we don't to do a surgical examination. We don't have to do any carinal examination. So don't do that. OK? You understand me? Yes. Yes. The Yeah. So we'd like to know as I see many students ask about this. No need. Of course. Uh We don't ask the examiner about something to smell by patient. Uh I think uh you did it good. Uh No need to ask as a patient to March. Don't beat yourself in differential diagnosis because if you do something unnecessary. So maybe the examiner ask you why you do that. And this is you lost some time and uh you lost the time. So you don't uh reach the final of uh nine minute or 10 minute. You speak faster. You speak good. You are well prepared. But uh actually you take eight minutes. Ok. Uh This station is a nice station very common. And we consider as one of the station in the exam because most of the student all over the world uh have bad performance, not bad performance. He don't reach the hypoglossus. Uh Last question if you reach hypoglossus, uh how to test the hypoglossia there. And I will ask the patient to stick his tongue out. There will be deviation uh in the tongue. What is a common operation? You can in surgery? You can have a hypoglycin nerve injury, uh submandibular gland, submandibular. If it is deep, it is difficult but can, but uh what operation in England can cause this? Yes. Uh the uh aortic uh not aortic. Uh I'm sorry, uh The carotid carotid carotid and the ar and carotid and the ar and carotid booty tumor, they can cause this and they usually defeated it to the site of the lesion. But observation have a stroke, sometimes they go to the other side but it is uh examines uh uh hypoglycemia uh well done. Uh how, how you feel gestation is ok or difficult or what is your opinion? Uh It is difficult and it is long. Yes, because you, you know that in the policy of exam, if you don't know the policy, we don't have all bar or failed, it is even if the exam is difficult to not all the student boss, it's easy. Not all the student boss, not all the student failed. So this is, you know, that uh the our exam is not a fair exam. It is uh somewhat uh like a competition exam. So just to choose someone to travel or to work in England, it is that the aim of exam. So uh usually you have some heart issues. This is one of the hardest issue. OK. So, but just the management of time, most of the season don't reach hypoglycin by the way. So the longest one is uh I just say, say again, the optic nerve has the longest examination. Uh No, no, it is just uh I think it is just of course, the visual field just to show him any circle in the snail sh and after that, just uh b reflex look into the second eye and uh uh feel the vision. And after that eye movement, it's not take a time. If you used to train it in your friend or any of your college, you can find it is easy. OK? Uh We know that, you know, this station is coming more than 10 years, maybe more, maybe 15 years. And still the student have bad, bad performance by the way. OK. So no problem. Uh Any question, anyone have any comment, anything to add. Uh After that, we have the second difficulty station which examines the cerebellum. Uh I have a question uh in this examination. Do we need to do uh the fine touch on the ping or only one enough? Uh say again, what mean by touch you for what uh fine touch using? A yes for cessation. After that, we need to do a pimping sensation or only one is off. No, only one is enough. Uh I tell you doctor a man, yes. Usually who fail an exam is uh uh what's called excellent studio. So we, we examine the stuff of the college, like the staff of the university, which is to student. Usually they are candidate for failure because they have a lot of knowledge and uh they need to be more clever. Uh uh uh You know that who pass the exam is a common is a student in house man or the youngest student because they have no much knowledge and uh they, they take the simple test. So if you are more clever in exam, the possibility of failure is very high because because not for mistake because you do a lot of unnecessary investigation or examination and you lost your time. So you don't reach the the end of the hypoglycine death. So don't be so clever. Don't say I read in some books, something like this. I do that. I do that. I do balance. I do walking. If you do a lot of task, we don't stop you. But at the end the bell ring and you don't finish you. Maybe you reach the seven or nine gra nerve. So it is easy. I just comment professor. OK. Yeah. Uh the PP break test for the skin is not allowed because candidate yeah, becomes nervous and some of them cause injury to the skin. So we don't allow be breakfast. Even if you ask the examiner, can I do pain break? It's not allowed. So you only use cotton wool. Secondly, we prefer you not to touch the skin of the face if you can. It was during COVID era when we have the cranial exam, it was completely forbidden. But even now try not to touch the face of the, of the of the candidate as much as you can. And we don't use tongue depressor as well. You just mentioned I will do gagging reflex, but we don't allow it because this is an actor and he has to do 20 station. So at least you show me that you're capable of doing it, but you're not allowed to do it. The last point regarding field examination, some of the cases have ho ho ho um hemianopia, homonymous hemianopia. And we tell the actor that you don't see what is lateral to you. You only see what is in front of you. So some candidate when they do test, they don't come in front of him. So he said, I don't see, I don't see, I don't see, but he doesn't tell him that I can see with the finger in front of him in cases of hemo he anopia. So by temporal heman, it is ap adenoma. Yes. So it's important for you and I really some of the candidate I feel very bad because he done everything well. But when he was doing testing field of vision, he actually not taking the whole field, he stops maybe 10 or 20 degree in front of the patient. And the actors say I can't see if he continue, then he will see and he will lose the whole station. So these are some of the tips and tricks for this station as well. Thank you. OK, thank you. The second station is cerebellum. How to examine cerebellum, examine the patient cerebellum. So anyone volunteer or still doctor Iman up to you? Yeah, I can volunteer to care. All right, can so examine the patient cerebellum. Just tell me and after that, I'll show you the picture. So what you will do. Ok. Um Yeah, I just finished my exam in uh in March and they had the same station in my exam, uh which I, in which your center uh in my hospital, uh in Cairo, Egypt. Yes. OK. All right. Uh So, uh what do you feel this cessation? Easy or bad? Just tell me what you do. And I was, it was, it was a little bit uh hard. It wasn't easy. Uh You uh because of the time or because, uh you don't know the, because of the time there is a lot of things to do. Ok. You, you know the station before? Uh Yes, I know. Ok, so just tell me what you you do. We can count on the time now what you will do. Uh Firstly, I will uh uh I have the patient just to speak to me. Ok, good morning. Uh Good morning. My name is doctor. I, one of the surgical doctors today. I have been asked to examine your uh OK. I am mister uh Mister Adam. I am 25 years old. Ok. Go on and I uh so um I would start with the gait. Can you just please stand up with me? Ok, good. OK. Uh Comment on again. No, you comment or not. Comment uh while he's uh while he's working, uh the the patient gait is normal or abnormal or abnormal abnormal gait. Oh, so say abnormal gait. OK. What else? Yeah. And then I will uh do the uh room for him. OK. As I will ask him to close his eye and uh I will uh wait a little bit to see if he's steady or not. OK. Uh then I will start with the uh eye movement for the stigmus, eye movement for the S OK. Yes. Yes. All right. And I will ask him to uh say some words like which constitution uh say again, I will ask him for the speech. I will ask him to say words like British Constitution. Ok. Then I will, uh, examine the last 44 nerves, the ninth, 10th, 11th and 12th nerve, uh, say again, 9, 10, 9, 1011 and 12. Ok. Then I will start with the, uh, um, uh, down to the upper limb, I will start to, uh, feel the tone of the vision. Ok. The muscle tone, the coordination. Ok. Uh, so he can just reach my, uh, with his right hand to my finger and to uh like finger to finger and finger. You mean finger to finger? Yes. Finger to finger and finger to no. O OK. Uh Then I will uh start to uh examine the diskinesia. OK. What is this? Yeah, when he just uh you know, uh put his hand, the palm of his hand to his palm of the hand. Then to his, you tell the patient that or you show the patient that or what can you, if you need you, you tell the patient. Yeah, I tell the uh I can show him, I think you tell him or show him. I think it's Foster movie. Uh If I tell him, uh can you ju just copy me? And I will just try uh uh to you tell him. Yes. Yeah. So it makes the movement and the patient do it. Yes. OK. That's good. OK. After that, then I will do the perinatal cuff one. What's his per cough? Uh The drift? I mean, when he just uh, he, uh, he just, um, make his hand, uh, in front of him and close his eye and I will see if I will see if, uh, if his hand falls down or not. What is this? I don't understand it. It's called, I think the Peroneal Drift. Ok. The left. Ok. Uh, what else? Finish? And the, uh, I will, uh, just make him, uh, uh, put his hand again and see if there is any intentional tremors. Uh um OK. I will just give him an object in my hand and I will uh ask him to grasp that uh object. All right, I'll, I'll do the reflexes for the biceps, biceps and the subordinated. OK. Good. Yes. And I will do the coordination for uh the lower limb. What is he? OK. Good. All right. All right. So uh finish. You take uh five minutes. Good. Uh doctor uh You take the report. Why you fell or not? Uh No, I think England uh didn't review it for uh our exam or the exam before we don't ask. I tell you, uh uh for example, I think you failed it because you do unnecessary uh test and you do something is not uh done in the practice. OK. OK. So we start one by one. OK. OK. So first when you start to introduce yourself, you need to ask is a bishop name. No problem. OK. After that, you ask about Gate, you need to come maintain the gate. So the gate is abnormal gate or what type of abnormal gate. Uh So I uh you know, I um I will comment it while he's getting or after, after I feel like he walk. After what? After I finish the examination, he will. No, no, actually, actually it is important. It is first time you enter the exam doctor. Uh Yes, it's my first time. We have a policy in exam. We don't have a presentation in the traditional way of history taking or examination. We don't have a presentation at the end because we see you. So what you need to do it, do it, what you need to tell us, tell us at the same time. So this patient walking is abnormal gait. Like for example, he walk in his to two limbing, whatever the gate, usually he's actor. So whatever he make you need to comment in the gate, you're going to comment in the gate. First mark, second your test uh for 9, 1011 12. Why? I think it's a little bit connected to the cerebellum. How do you feel? Uh Not sure. OK. So this is uh wrong. Yeah, this is uh if you make it in exam, you're going to take a mark and you don't take minus it is zero. So no mark. So it it just my OK. Second you test for nystagmus. Why? Um I think uh some cerebellar tumors might call it is not cerebellar tumor, you mean cerebral Bonine tumor, cerebro bonti tumor is not the cerebellum, cerebro bon angle is not in the cerebellum. So the test of SAGM is is also not in the scoresheet. I tell you what we have in the score sheet. So 9, 1011 is not in the score sheet. The stags is not in the in the skin sheet. You asked about the species. Why um uh about speech? Yeah or I think that uh yes, I asked about speech. Why I think some cerebellum problems might have problem with speech. So they can, you know, actually I can it is it is just is not for cerebellum, maybe basal ganglia or something like that, but it's not direct. So cerebellum is mainly for coordination. So this is also is not in the ulcer sheet. I just tell you what we have in ulcer sheet, I tell you. Yes, II can understand. And that's honestly, I think you, it's choking for me and for all candidates. I think watching us because you know, we have uh um no, no, if you are, I don't know what, what, what is your background, but if you go to any surgical book, just examine the cerebellum. The life is easy. OK. OK. Or if you go to any book, what is the function of cerebellum is easy. I tell you at the end after that, what is, I don't understand what it is. Uh When the patient, I think when the patient just, uh, uh, moving his hands uh in front of him. And if he close his hand and, uh, uh, the affected side of the cerebellum, if it's right or the left side, it will just, uh, drift down. Actually, we don't hear. You found it in book. Uh, I found it here in books, in book. It takes like any traditional. No, no. II. Uh, this is, this is, uh, I, it is the first time I hear about it. I am examiner for 16 years. II. Take this station more than 100 time. OK. First time to see from a student. OK. After that uh Uhle is OK. Coordinator. Why you just reflex? Yeah, I think uh doesn't affect cerebellum, doesn't affect some reflexes. I think so not OK. I just show my presentation after that we can speak again. All right. Uh So you see, you see the tongue, this, you see this, you see the slide or I share again. Uh Yes, I can see it. OK. So in cerebellum function with just 12345 tests in five minute gate of the patient. Comment on the gate ring test which is ask the patient to stand. I close arm out stretch, support the patient if it is positive ring test after that finger nose or finger to finger test. After that, the movement of this Kinesia after that here to shin 12345. OK? In, in in detail, cerebellum function, gait, ring, test finger, nose or finger, finger, finger nose. This diazo kinesis help to this is the first test ask to close his eye, uh stretch his hand or hand beside him, support him. Do not fall, he fall in one side. So it is possible if he fall second it finger to finger with this nice actors who can do finger to finger. This is found in medics. I tell you about medics just remind me after that here to sh OK. After that, the, the uh the kinesis or kinesia OK. 1234. After that, thank you. This is a picture of Maia when we run the exam. So again, it's 123455 minute, very easy station. You, you are so clever doctor. I think you are neurosurgeon or something like that. So it is easy to fail. What are your neurosurgeon? Uh no muscular surgeon? OK. So vascular is easy. So I uh first this is picture is from Jackie Medics. So back again. So this is picture. So Medics, Jackie Medic is official for student for our student in England. So if you found, if you need to, to see something like uh something like this, you can just uh Google in the youtube Medic or can Google in the site of the Royal College, you can find as you see, the test is easy just to get ro science. And for God knows this year this year do kinesis. I may be drunk and the health machine ask the patient to stay in court and do that. So from your point of view, if I have examined you, I think you are in will be in critical situation because you mentioned 12345 item. You take it zero, you maybe you, you, you do it good but it's unnecessary. What is the response of the examiner, by the way? Doctor? What is the examiner response? He stopped you or leave it, leave it to do that. Uh He, he left me to do uh he didn't interrupt me. Uh Well, II was examining the patient and when I finished, he just tell me, uh told me uh what was you doing? Ok. Uh I think uh usually, usually I have a habit that I redirect the student but I found the student as the end for a B because for example, if you make sagm or carinal nerve examination in this station, so some students say he interrupt us and he interrupt our sequel. So sometimes in some country like India, I stop to redirect the student. But uh you know, most of the Children do like like you by the way, OK? You are the the only one but don't do something unnecessary if you do something unnecessary in easy station. So you mean that so don't be so clever if you are so clever, it is easy to fail. If you are seeing your doctor more expert, it is easy to fail if you need to find any way of clinical examination. Just to go to s you can find what is the United Kingdom student do? II have experience I was examining Cairo many years ago and found one of the student and she is girl, she smells the patient now is in abdominal examination and she was the exam. But after that, I asked why you do that. She said I looking for feet are hepatica. So I tell her you expected to have patient with liver cell failure and come to the exam to be candid or simulated patient for exam. So it is important, don't pursue something unnecessary until it is found in book or found in doctor. She knows or Doctor Mohammad notes uh whatever, maybe I wrong. But if you, if you need, if you are in the level of the Royal College of England and you have some misunderstanding, we have only one choice which is uh normal brown stick to book or any official site for that. Uh Of course, uh I don't know why you bring all these topics. It is from uh the of neurology or something like that. Maybe bigger. No, it's from, you know, uh some doctor's notes, it's not from uh OK. You know, you know that it is uh you know that it is important to know the college. Of course, we have most of the idea of other doctors. They are either our student or our friend. But uh you know, why is the college leave? This is book to be published. What is your opinion? Yes. Uh I don't know, honestly. No, because we don't, uh we don't need the result to be 100. So this is a book is the easy way to make. The result is not 100 because you have a lot of experience, a lot of uh seniority because most of these doctor Google it. So they have a lot of thing. But have you see what is the decision now? Is easy or difficult? Yeah, it's uh and it, it's a way easy like uh I was doing uh for more than 50% of it, unnecessary tests. And it was your time. Actually, you do most of it except uh I think you do all. But I think the examiner become angry because you lost the time because uh you do gate, you do ring test, you do finger nose, you do this uh this hand, the movement head to sh I think you did all but because you had uh five other item. So make him maybe in a stress or he don't notice that you make the original one. Ok. OK. So just to take it easy, if you have any problem, go to, don't see any other tickets. OK. II have any questions regarding to this station. Can I just ask you OK. So about, about the comments. So uh if I do any of the five items, should I comment during doing that item? Like of course, of course, because usually what we teach is a studio. If I hold this area and they don't tell me what you hold can be lymph node can be submandibular, can be carotid. Uh OK. I don't know what you are doing. So in some situation, you need to comment. This is patient is walking. So his gait is abnormal gait. But don't say because in other exams, especially in India, I found the student come to the back of the patient to examine his neck, lymph node. He said I go to back to the patient. I see him. He, he come in the back. OK, I introduce myself to the patient. We just introduced. So if you don't to comment, suppose you put your hand here and don't tell me I feel carotid for example, or I feel this lymph node. So which marker? I put it, I put it in the lymph node or carotid. Uh In the steroid, we have two mark, one for lymph node, one for carotid. So if you put your hand, you examine the lymph node and tell submental submalar per you need to, to ener. So I know that you examine the lymph node in some country. I found the student. I examined the patient gland, I tell him which gland. So it is lymph node. OK. So it is important to just to don't uh uh to become easy. Of course, you need to ask a patient about his name. It's more. OK, thank you. Is any one of the student have experience in cerebellum? Yeah. And the doctor, she, I have another question, please. OK, good. OK. Uh uh we had, I had uh like uh uh after we finish, he asked me like a, a hard question. I didn uh what is this called? Yeah, the question was, uh what is the new type of surgeries that we do for cerebellum? New type of surgery? Yes. Uh Maybe he asked about Gamma knife or uh something, what is called the s static uh surgery? What's called the gamma knife? But it is not in the answer sheet. Oh, ok. I just found, I think is uh uh usually in the na National Institute in Cairo. Yeah. Oh, ok. Uh Mao, what, what, what is your opinion? What else you need to add from the Asian culture? Uh II think when he mentioned the speech, I think those are part of the cerebellar as well and also to test the tone muscles and also the reflexes. OK. I check it but I don't find in the answer sheet. So this is why II don't ask. But OK, we can check for it, no problem. But in the check list, I don't found it. Ok. Uh uh What is the relation between cerebellum and nystagmus. II think. No, you need something for coordination maybe. Uh Yeah, because uh it's uh you get nystagmus as well when it involves the, yeah, that's involvement. It, it was part of the ki medicine, the ki examination as well for cerebellum. Yes, I check it again. But uh in, in the answer she is a college. I don't found it. I only found this five. So this is why I uh I attend this station many, many times is one of the difficulty station because the student usually become in be OK. But uh in the answer sheet, we don't have it by the way, maybe with the, the who designs the question don't know that because usually this question is done by general surgeon, not neurosurgeon. So it's not much expert. And uh usually we, we take it simple, more simple. OK. Uh uh I tell you, I tell you in from the college. The Candid. Oh yeah. The, the college say some candidates perform the eye movement testing for the Stigmus. OK. They noted that the student do it by the way. Yes, but we don't know why. But if, if OK, if the student didn't do it, we can check maybe something. We don't know it. And also, yes. II, is it it uh you, you told us after communication skills, we have to make a summary. So after we finish the examination, should we make a, a summary of what we have done or we have just uh communication scale is different. OK? You know, a communication skill is like you, we make order in KFC Kentucky Fried Chicken. So before he say thank you, we summarize the order. This is true. So what we do in the history, taking order of communication skills, but in a clinical examination is a clinical examination. You don't tell the patient in real life, summarize the case. OK? Or even present the case. So uh we don't have presented the case in the regulation of the Royal College or the we don't present the case. The examiner observe you even uh Matthew your your exam in nine you present at the end or the examiner watch you. Uh generally, I'll comment during the examination but at the end I will summarize the positive findings and also the relevant negative findings. OK? To support the diagnosis. Ok? You you can do that, you can summarize at the end but don't present to the whole because simply you forget to, to what happened. OK? OK. Uh Usually the examiner is observe you even he's not observe you. He ask after you, you leave the room, he ask the actor what happened? Did he say? He forgets to do that? He forget to do that. Ok. Sometime professor some abdominal examination, he tell you examine the patient for six minutes and after the be ring summarize your positive findings. Sometimes this happen in the news station can, can be done done in the city. And what I advise candidate to do is to say what he is doing while he is doing it. So for example, in EPE to abdomen, if you just look at the abdomen, but don't say anything, you don't score point. But if you look to the abdomen and say uh no scar, no apparent deformities, no ascitis, then you are scoring points. But some candidates will say the examiner, do you like me to speak as I go along with the exam or just summarize at the end, we usually say you can speak. We usually as an example. Uh and I think this is a advice for candidate if you are trained. Well, give me the information as you go along. Otherwise uh as Professor She Hariri, if you put your hand on carotid or gland or lymph node or submandibular, how I and as an examiner assist you, but you tell me what is going on into your mind, I think is a safe scenario. Uh Thank you, Professor Shein. OK. Thank you. So again, it is important when you examine, especially in the neck, you tell what you examine, examine the lymph node, examine the thyroid, examine the carotid exa because you, we have we have a lot of structure in this area. So it is just to avoid misunder standing between you and the examiner. OK. And of course, if you ask as a patient like in cerebellum as a gate so you can comment on the game. You must to comment if you don't to comment. So it means that you don't, do you don't notice? I don't know, you notice it or not? Ok. All right. Uh Any question, anyone have the cerebellum station again or anyone enters the exam have cerebellum, we still have 10 minutes. So anyone have bad experience in exam, just tell us we can, we can evaluate uh both and I have a question. Ok. Uh Is, uh, do we do a tandem get cerebellar examination? Do what tandem get? What do you mean uh to ask the patient to walk with a foot in front of another? Like he's walking in a line. No, no, no need. Of course. No, no, no need. Don't, don't to be, it is running the police station but it is, I think there's no need to do that if you need to do it, do it. No problem. Ok. Just don't waste some time in something funny but it can no problem. U usually the, our checklist is easy because this is exam is exam of general surgery for a general surgeon. So we don't even the question and the examiner is, is not neurology. So it's not much experience as, as, as you expected just in simple way. Any, any question you have the, you entered the exam before doctor Emma. No. Uh my exam in uh the next month. Ok. All right. In which country? Uh in Abu Dhabi. Abu Dhabi. Ok. All right. So it is. Uh England. Yes. All right. Ok. Uh, anyone have experienced in exam in Cerebellum Carina before? Uh, yes, doctor, I have uh, the experience I was uh in the same day of uh doctor um Mohammad. But I was, I was a clinical uh board but I fell in the knowledge board. Uh, although, although I did very well in, uh, in knowledge, um and I did very bad in uh in clinics. Uh but uh II was a clinical but I fail in the knowledge. Oh, you know why II don't know because we usually we don't have in this exam. We don't have pass mark, we have pass rate, you understand like it is in comparison to your to other students. Suppose I have a question when we put this car examination many years ago for first time, all the students fail it but we have a bus, this is out of 20 at this time, the bus market become a wet. So this is why you pass in the station when you are doing bad. You understand me? Yes, yes, because the other student do it bad. So the curve is within the curve because we have something called of standard sitting in each question, each station, we make a curve. 100 student. So the student between 15 and 17. So the bus mark is 15 or 14, the student old performance they take from 7 to 9. So the bus mark will become nine. So you can fill the, you can buzz the station also, you have bad performance and you can fill in the station although you have good performance. OK. So you feel in, in theory you, in theory that is there is there is a common feeling, Hariri if you go to the exam in Egypt, your chance to pass is better than if you go to exam in London. Because in London you're competing with British graduate who will have this curve very, very high. And I think I agree with this point. If you come into an exam with, let us say more Egyptian colleague, your chance to pass is higher than if you go to England. What do you think? Professors? OK. No problem. Uh I can go to any place but uh you know that your theory party, you did it good. Yes, I did that. I did well in, in, in, in Syria but, but II don't know uh uh what is your mark? For example, you have the mark with you or not? Yes, I have you can, you can send it to us in whatsapp. For example, if you don't have it now it is what uh 11 2nd. OK. So whatever you can send it to me but is the idea is whatever your performance it is in comparison to other performance. So sometimes you have very, very bad. II see in one stage one exam, one of the students, she is a girl and she's young and she's crying at the middle of exam. But at the end she was yeah, ok because it is, yeah, I would like just to mention thing I have prepared the checklist for clinical examination. So for example, in the abdomen, you need to do 15 steps and this is a checklist and this is the steps that you are required to do because there are things that you can do but you don't score marks, same with same with cerebellum. And I hope with the next session, we can share the checklist and we share with Professor Jean. And if you train yourself on this checklist, you can do it blindfolded. It makes things so much easier for you because a lot of time candidate stops doesn't know what to do next because he doesn't have a checklist throughout the uh what you need is the next gestation. Anyone is what you need to in the next gestation. It difficult. Anyone have an idea you do. You mean in, in uh in examination or any any anyone examination uh history taking communication skills up to you what you need for for next decision. I uh if we can just cover, you know, uh one station from every part, so we can know as uh today we have examination and I think um it's shocking for all of us as a lot of things that we uh have done, I think we have done it a wrong way. A spine examination advised to get to have a spine examination next time. It's why don't take a time so it can make a spine and for example, uh some neck or something like that. Ok. So uh don't worry, what is your performance is not means that if you make a good performance, don't mean you pass the exam. If you make bad performance, don't mean that you fail the exam pass rate. And usually in the college we say when your day come, you pass. So the pass is depend on the curve and the disease is curve is depend from different from question to question. And uh sometimes we suppose this is easy station and found the the student fail, all the students fail in it. So uh of course, we must have a bus market. So the bus part to become low, this is uh a standard setting is a common for uh for college but not in Middle East in the far east Southeast Asia they use this is under sitting for a station. So we don't have a bus mark like in in Egyptian College, we say 60% after 60 bus below 60 you fail. We don't have that in the Royal College. Sometimes the bus mark become 70. I see one time in the pediatric, the bus mark is 45% which is very, very low. OK. So it is like uh when Allah wish you to pass, you will pass. So it is not a, not your performance is what happened in the station. Yeah, but, but performance is definitely uh definitely an advantage for. I don't want them to think that just uh it's a toss of going to pass or not. No, if you study hard, if you study well, yes, you take all the advice of Professor Sinha, you will pass whatever the girl will say. So I want to confirm this study hard. It is the problem. Uh, is that, is it especially doctor from Egypt or Middle East? Does he have the main source and have the same mistake and the same way of presentation? Ok. Uh So this is why, uh, all I think all will be the same. This is, uh, very strange by the way, but it