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Yeah, the structures. So the structure of this would be we'll go to, um, about, like, 30 14 s, B A s. Um, And at the end of the SBS, we just swiftly go through the conditions that we're covering. Um um and then we'll just have a chat about with the condition. Um, and then I just thought maybe at the end, we'll just talk to talk about the conditions that we haven't covered. Um, And then, you know, I can give you kind of links or resources that you guys can use to cover those conditions. Um okay, so just so we'll, um, we'll use the poll, um, to, um we either use the pool or you can use it. I mean, what do you mean? Should we use the pool or the chat whenever you prefer her? Yeah. Um I don't know how. What does the audience? What do you guys prefer? The chart, I guess. The pole that can give them the opportunity to kind of get give an answer. Should we use the let's use the pool? Let's use the poles because it allows everyone to sort of answer. And then yeah, exactly. Yeah. Let's Let's do that, then. Okay, good. Fine. Okay. All right. So let's start with the first question. So you get the pole, so I'll let you guys read the question, and I'll launch the pool. So what I'll do is should I give you I'll give you guys five. Let's give you two minutes. Two minutes, because that's the approximate time, you know, to, you know, you get in the exam, so just give you 222 minutes, and then I'll I want to stop the recording in progress. Yeah. Okay. That's been a minute. So yeah, I'm happy to do the pulse. Um, okay. Okay. So it's, um OK, guys. So it's been a minute, so if you guys need more, I don't know if it's for everyone, but hurry. You've cut out. Okay. A beer. Could you make? I've also got under the zoom link. Another zoom. What's it under? Is it the same signing? Okay, so the answer correct Answer is the Epstein anomaly. So can you guys tell me in the chat of why we think that this patient has Epstein anomaly? Guys, I used to Can you hear me? We can't Hurry up. Yeah, you hear me? People ask my thing. I think they were just thinking. Okay. Yeah. Good. So, um, like, low ebb Casco. Yeah, but anything from the history, um, anything from the history and the medications that you can think of. Lithium. Excellent. Good. So the bipolar and the use of lithium, it is the kind of, um so yeah, lithium nowadays? I mean, it wouldn't happen out if a woman has bipolar and the lithium, they will stop it before pregnancy. But if if I mistake, you know the mom, you know, continue to take the lithium during pregnancy that would result in something called Epstein anomaly. It's quite rare nowadays, but, you know, it used to happen in the past. Yeah. So it's a rare congenital heart disease happens in one in every 220,000 birds. Um, and it's mainly the malformation of the tricuspid valve. Okay, um, and then that causes poor flow between the atria and the ventricles, um, and causes the right to left. Shunt. Okay. So usually, um, and these kids usually present with signs of heart failure. So things like finish short of breath, difficulty feeding, and you might also hear a murmur as well when you examine them. Um, but the kind of the management wise, usually you just manage the symptoms, but definite of management. It would be surgery to fix the valves. Okay. Um, so, like I said, it's it's It's a rare one, basically, you know, for a common exam question, I'm associated with the drug like lithium. Okay, next question. Okay. So, again, I'll get the pull up if you guys can read the read the question. Sorry. You guys still see the screen? Yeah. Full screen. Okay, fine. Let's give you another minute to do that. Okay, Fine. Um, so now that more than 50% of you have already answered will end the pole and share results. Good. So most of you have answered the correct answers. Kawasaki disease. Um, so So can you guys tell me what from the question give you the clues about It's more likely to become a sake disease rather than something like measles or scarlet fever. Yeah. Good. The fever. More than five days. Yeah, things like, you know, especially if the it's not getting better with with all the medications that they're taking. Um And you know, with things like measles, you get maculopapular rash as well. Uh, but it's It's this. The spread distribution is different. Um, what is the distribution of that of? Of Kawasaki's different, um, and other other things from the history. Good, Michael. Popular Russia. Good. Other things for the history you could say is also the, um, the fact that, you know, the patient was given some antibiotics because that didn't help. Um, yeah. Good conjunctivitis as well is a good kind of sign. Yeah, so But the main thing is, the fever more than five days. Um, and some other signs that you can have is like strawberry tongue. Okay. And so you can see from the picture, Uh, the micro popular rash, Um, and, yeah, so they're they're They're the main kind of things that you see. So you got few. If you look at the images here now, the main thing that you remember about the management of Kawasaki disease is this This is the only time that you are allowed to give a patient a child aspirin. Okay. And I think that's already on there. But why wouldn't you give a child aspirin? Usually. Yeah. Races mainly race syndrome. But this is the only time that you're allowed to give the child rate. Um, aspirin. Um, and also, you can give them IV mean a globalist as well. Um, so yeah. Good. So that is kind of psyche disease. Good. One to remember. And an important thing to remember is also the fact that, you know, it's a, uh the risk of developing heart disease, Um, and also other different types of heart aneurysms and things like that. Because it's a vasculitis. To me, it's information of the vessels. These patient's are a risk of developing coronary artery disease. You know, vascular, other forms of vascular disease. So something to remember about these Children is to monitor them when they get older. Okay. Good question about differentiating between Kawasaki Disease and Scarlett will come to that. I'll come to that one. Okay, that's a good question. So stop sharing shared the salts off. Sheldon, no. Let's next question. Okay, so next question, uh, I'll give you one minute and I'll get Okay, Okay. So more than half of your answers. So let's send the poll share results. Okay. Good. So most of you answered it. Correct. purpose disease. Okay. Um, so it's, um So this is about this question. Is checking your understanding of limp in a child? Okay, so, um, so whenever I'm going through these questions, I'm kind of, um, covering kind of one disease within a spectrum of different diseases. So what I would kind of suggest you guys do is, um, to go through the rest of them in your own time, Because any any of them could actually come up, um, in the extra exams. Like, for example, the last question about the Russian Children. So there's things like me, those scarlet fever. Um, uh, chicken pox. Cava sake's, um So these are quite common things that come up in the exam. So in your own time, um, you know, make sure that you go through each of them and learn how to kind of differentiate between different types of them. Um, but going back to the question Sorry about the difference between Kawasaki and Scarlet fever. It's a good question. So if we go back to the question stem, uh, if the child was already given some antibiotics, that did not help, um, so with scarlet fever is infectious disease caused so that usual antibiotics will be helpful. Um, so, um and also, when you kind of the investigation, you do a throat swab, Um, and you'll be able to find the organism for scarlet fever. Where is Kawasaki? The vasculitis is not infectious infectious disease. You won't be able to see an organism, and usually antibiotics wouldn't help either. Okay. And so Yeah, that's the main difference. Um, so yeah, this disease. Good. So, um, so this disease is is something that causes limp in a child, and it's very important to differentiate it from things like septic arthritis, Um, you know, and other kind of more life threatening kind of causes. So it's a a vast kind of process of the femoral head. Um, usually affects boys. Um, gradual onset of pain. Um, and then usually, when you do the hip X ray, you, um, you do the normal hip AP view. You also do a frog lateral view. Um, and it might show them the combining joint spaces. Okay, um, and of the most important management would be to give them analgesia and rest. Um, that's if the if it's mild. However, if it's severe or more kind of more worrying. Then you can do surgery. Okay. So, yeah. So I think the most important investigation in this case we to do the x ray, because that would really show you, um, differentiate between a normal kind of hip and, uh, kind of, uh, you know, a septic, arthritic hip order. Uh, from, you know, the other Sufi. Um, other causes of limping a child, but with purposes, it's kind of a classical picture that you see on on the hip X ray. Okay, good. So most of you correct Answer the the other question. The other answer that was common. Oh, it's in a writer, so Yeah, I can see why. You know, some of you have thought of the, um uh I thought why it could be, um you know, sin writers. Um So can you guys give me a reason why he thought it was purpose and why you thought it was in writers? Can you tell me in the chat why you thought it was Perthes and why you thought it was Senna writers? Yeah. The age demographic good age demographic is you know, which one is more common in kind of which age group. Good. And also the onset as well. The gradual onset is important as well. And also the the bone scan with the bone scan. You should Yeah. Good. Synovitis usually has, like, a prodrome of an infection. Usually try to use it for some form infection, and then they get pain in the hip. Um, yeah, good. But it's here. There's no kind of infection. Good. Fine. Let's go to the next one. Okay. Again, You'll get one minute to answer this question. Does Can you still see the same scream? Full screen. Okay, good. It's good. Okay, fine. Uh huh. Okay, good. So, um yeah, and pole share results. Mhm. Good. So most of you have corrected this answer this correctly. Um, so yeah. So what do you think? What condition do you think the child has Christmas? Yeah. Okay. Is that the end of the name for the condition? Okay. Is it like a fuck? Yeah. Hemophilia? Yeah. Good. The two types of hemophilias, um, hemophilia and be the A is factor eight deficiency and B is more factor nine, and they both x linked. Okay, so, um, it's called the Christmas disease. Okay. Interesting. Yeah. so it's a fact of mine deficiency. Um, so the, you know, Children can get bleeding into their kind of, um, bleeding into their joints, Um, and sometimes very smaller. You know, the trauma doesn't have to be that big. A small amount of trauma can actually cause bleeding in in, uh, in the in kind of the area of the injuries can be the brain. It can be in the joints anywhere. Any small amount of trauma can cause bleeding. Um, So I think the main thing is, if a patient comes in acutely with the bleed like, for example, like a swollen, joint, swollen knee, and that that basically that that patient has something called hemarthrosis of physical bleeding in the joint. So in that situation, you need to give them the acute in the acute situation. Give them the factor. Nine. And that that's missing. Okay, so that that would kind of stop that bleeding. Um, because the child is known to have the factor. Nine deficiency. We are. We just give them that kind of replace, um, praise back to nine. Okay. Um, so yeah, that is, uh, hemophilia. So the main thing to remember is there. Two different types of hemophilias Um, A and B. And the main thing is, also remember the signs and symptoms. Remember, small amount of trauma can cause bleeding and an acute phase. You just replace the clotting factors that are missing. What other things the French is. Do you need to always keep in mind in the child that comes in bruising slash bleeding? Um, uh, you know all around? Yeah. I tps another one and think of something a bit more Something that you know, Uh, not medical. It's a nonmedical. It's something that you always have the back of your mind if a child comes with bruising. Um, yeah, Good N a. I nonaccidental injury. So very kind of It's kind of hemophilia. Is hemophilia is A and B are not as common. Um, but it's obviously not accident injuries are so with this child already. We know this child has a him a failure, so we're not as kind of worried. But if if a child if if it was a new diagnosis, you didn't know that they had it. Always keep that kind of n a I at the back of your of your, um at the back of your mind, So yeah, good. So next question, I'll give you a minute. And also, guys, so far the things that we've done, please feel free to ask any questions If there's something that's not clear. Uh, fine. Okay. It's, uh okay, so it's a bit of a, you know, mixed answers there. So in the chat, tell me what the diagnosis here is. What was the child having? Like, what is this child you know, was Yeah, it's a nocturnal enuresis, which basically means bedwetting. That's another name for it. Um, so, yeah. So the child is having bedwetting here, and there is kind of a good through the different causes of bedwetting in Children. Yeah, So there's a term describes involuntary your generation. Bedwetting is called doctor. Do any recess and there's different. There's two different types. There's a primary and secondary one. Um, with the primary one, um, usually it's it's kind of presenting less than five year old Children, and these Children have never been dry. They've had this, um, you know, since they were babies, they just struggled with kind of keeping dry at night. Um, and these are the things that usually don't worry about too much, because that usually the challenges gets better by itself as they get older. So a lot of the management is just reassurance And, um, positive reinforcement enforcement, lifestyle changes and things like that. Okay, Um, also, sometimes any recent alarms and things that you can use all those kind of different, Like all the conservative management options. Um, so, you know, I was kind of worried about these kind of causes, but what is secondary is the child has been dry, so the child has become dry, but for more than six months, but now has started wetting again. And this is a bit more worrying, because then you're worried with what could a child have? You know, could it be Could they have diabetes? And one of the other things interest interesting. Again. Something to keep in the back of your mind is abuse. So kind of sexual abuse and things like that especially, um, so, yeah, the secondary causes a bit a bit more worried, and we usually you just treat the underlying cause. Um um so yeah, so I can see why a lot of you went. What was it was mixed answers. So I think this with this child. I mean, it's kind of him. I think we were gonna try the conservative trial of fluid restriction. First, I can see why a lot of you went for your, uh, your analysis about the possibility for UTI. Um, if, um you know, and I like I would not be, um I would not get that. I would not mark that as long. I would say that would be equally, you know, you know, correct answer. But I think the fact that it was a two week history of bedwetting has been going on for a while now. Um, and there's no and the patient's fitting. Well, there's no kind of fevers, usually with UTIs. Take it a bit irritable. Sometimes they have fevers, simply become clinic of pains. And, um, they might have other kind of symptoms as well. And they wouldn't last for that long is usually quite a kind of a two day history of three day history. So yeah, so I think with this situation, it seems like a more, uh um So you try with the trial of fluid restriction to see how the child goes. And if that doesn't work, then you go into a bit more kind of investigations. Okay? Um, yeah, but yeah, you thi I You know, I can see why, if you went for the, you know, Alice is to look for UTI because again that can, you know, that is a common cause of any resistant Children. Okay. Uh, okay. Next question. Yeah. Okay, good. So most of you answered this correctly? Um, yeah. Good. Yes. Input for attainment. So, again, it's not that common, but it's a congenital anomaly. Um, usually, it is, uh, the opening vagina you can see here. And if If if If this happens, usually when the woman gets period to the woman might be getting periods because of the kind of the because of this infant for retain mint, um, the blood will not be coming out, so the blood will be stuck there so that the patient would have pain in the abdomen. They, um but they would not be having periods, but that doesn't mean that they're not bleeding. They have. They are bleeding, but this is just They're not, um it's just the blood is just stuck in the vagina. strapped in the vagina. So yeah, so they feel fullness in the abdomen. They feel pelvic pain. Um, also, sometimes they can have painful urination. Oh, sorry. Um, so, yes, I think the main follow kind of management is is to is to kind of do a surgery and just open that Haman that area. Um, and, you know, sometimes it can It can be detected during, you know, natal examination on young girls. So, um, or we can be detected during the puberty during public examination. You can detect that in young girls. Uh, but again, something to have the back of your mind. The most common cause of obviously lack of periods in a young girl, 14 year old is normal. Physiological delay. Okay, that would be the most common cause. So you share yourself. Yeah, that would be the most common cause of if you're gonna have any young 14 year old. But something to keep the back of your mind is imperforate hymen because of the, you know, the pain and the abdominal fullness. Okay. Good. Uh, stop. Okay, so this, um So this this question The last question This is just testing about puberty and delayed puberty and things like that. So, um, when you guys have, you know, these are the questions that can come up quite a lot in the exam. Puberty and delayed puberty and things like that. And I'll just go through some of the common conditions that you could be tested on. Okay, Good. So I think most of you, you know, um, and polls show results. Good. So, yeah. Good. Split between A and B. So what condition is this? It's a good classic exam question, isn't it? A Web neck, Widely spaced nipples. Very kind of, um, classic exam. Question is, Turner's good. So it's a type of hypogonadism. Okay, um, there's different ones. Some effect, boys, some effect, girls. Turner's is the one that affects girls. Okay. And do you know what? That was? The one that affects boys. It's a and I can see that was a That was a a lot of you went for a Do you think whether it is that that's usually the effect boys more not Noonan's. I can see why you went for Noonan. Okay? Yeah, kind of. I can never pronounce properly. Klinefelter's good Klinefelter's is 47 x s y. Which is a which a lot of, um, some of you went for and that is the hypogonadism as well. But it's mostly employees. Uh, um, and they come in with small testes. Uh, you know, um, kind of last year and also problems with conceiving. Um, so but earn is usually more common in girls, and that is 45 X. So So one of the X chromosome is missing, and these girls can have different forms of kind of short stature. Web neck. Um, other things could be underdeveloped ovaries. Another class exam question is having a chaotic cooptation. Um, that can come up sometimes as well. The exam. Um, and obviously at these, these young girls are at risk of developing recurrent infections of the years like the tightest media. Um, and the way you kind of manage the is by replacing the hormones. So the growth hormones and the estrogen and also as they get older, if they want to conceive, they can get support with the fertility as well. Okay, so, um okay. Good. And then the next Let me get the pool. Okay. I'll just give you one minute. Can you not see the question. Oh, so what's the diagnosis? Sorry. My apologies. Questioning was the diagnosis. Sorry. Hurry. I missed it to answer. What does it mean by wide carrying angle? A white kind of angle. Yeah. Sorry. So white carrying angle is basically if you google it, I think it'd be easier to look at the image. So I think it's just like, um, anything in front of something called Cube Cubitus valgus. So it's like your hands are you carry your hands in a an anatomical position. So if you I don't have I make a good an image here, actually, let me just freeze the screen and I'll google an image. I've stopped the pole. Yeah, I just shared the results. Let me just get back on the screen. I was just trying to google the image, so Okay, I'll show you I show the image in a bit. Okay. So basically, if if I don't get to show you, it's just Google White carrying anger or cubitus valgus, will you be able to see it? Okay. And it's common in people with them. Okay. Okay, fine. So yeah. So, um, let's see what a lot of your your I T p. Yeah. So it's, uh, idiopathic thrombocytopenic program. Okay, so I can see why a lot of you went for H S B. And I can see why you guys went for a as well. H us If you go to we go to I t p is. Okay, so it's a condition. Um, so as you can see, it impacts in India. Practically don't know what exactly the cause is. Um, it's due to a low platelet count. Okay? And it causes a purpuric rash. Classically, people present bleeding, bruising PT key. I okay. And, um, the management would be, um urgent fbc um, and platelets, you know, doing an urgent ABC. An appointment platelet count, um, and then giving them urgent steroids because it's a kind of an autoimmune condition. It's a type two hypersensitive sensitivity reaction. So you give them the, uh, steroids ASAP to stop that kind of, um, to stop the the reaction so I can see why. Um, you guys went for the HSP. So with the h S. B. If I go back to the rush, patient had okay to. So the rush is on the the, uh, on the extremity. So usually with HSV. Um, there's this medical rash on the buttocks and legs. So if you Google Hedges spin, you can see the rash there. It's very kind of plastic rush, usually buttocks and legs. Um, and they just they usually has. Um, sometimes they also have something like bloody diarrhea associated with it. Um, and and in in exams, sometimes it's like they had an infection like a viral infection. And after that, they developed this rash. And, um, now they have Sometimes they might have, like a bloody diarrhea as well. That's a classic question for H S B. Um, so that so whereas with this the rash because of the the way the rashes in the extreme it is. And also the arthrology as well. The pain in the knees, elbows and ankles. That's quite classic of HSB rather than, uh, sorry, I t p rather than HSB. Um, okay, so again, also with both I t P and H S B, you can get the glow marionette fighters like the hematuria and the proteinuria, so I can see why you you know, you could have confused. Um, and I can see they have the diarrhea here as well. But with them, Like I said, Ohh. Space, usually bloody diarrhea. So, um and, um, the ration HSP is more likely to be in the buttocks and legs rather than on the extremities. Um, okay. And then if, uh, tribute just and yeah, I would like both h h u s and H s B usually have an infection before usually have, like, an infection before. And then you get these, um, these kind of symptoms. Okay, so you have a previous infection, and then you develop. Okay, fine. Uh, so with a question. Okay, cool. I'll come. I'll come to the questions. I'll come to the questions. Okay, let me get the pole. So give a go to this question and I'll come back to the answer. The question. Okay, good. So I'll stop the and the pool and show results. Okay. Good. So a lot of you went for dominantly sound. Okay, So, um, what do you think is the diagnosis here? What do you think the change hurts? Oh, yeah. Sorry. I think instead of two year olds, just 32 month old, Um, the apologies for that, but what do you think is the diagnosis. Yeah. Hush. Frank's Yeah. Apologies. My, um Yeah, I want to confuse you guys. Yes, it's two month old Tyler hasn't opened his bowels. And, um, so it has a plan. Passed the meconium. And there's a Yeah, So it's, um it's her springs. And usually you directed biopsy to diagnose. Yes. So Hirschprung's disease is, you know, it's a congenital disease. Um, um, due to the the the nerve cells in the mind minded complexes, plexus is the is the muscles in the bowel. So there's the MS the nerves that are missing in the bowels so that that's why the child is not able to the bowels are not able to move. Um, um, do the Paris palaces that he needs to move that kind of bowel content around. And that's the reason why the child doesn't pass the meconium. Um, and they're not able to, and that causes obstruction. Okay, Um, so So usually the child develops chronic constipation, abdominal pain, vomiting, failure to thrive, and things like that, um kind of you can do abdominal X ray to look for obstruction, but the definitive kind of the kind of the most reliable investigation is to biopsy because they'll be able to tell you the lack of a nerve cells in the in the bowel. Okay, so, yeah. Apologies, guys. I know why I confused you guys because of that age, but yeah, when I was trying to get it was two Hirschprung's disease and the rectal biopsy is the definite tive. Um, um kind of investigation. That will definitely tell you whether it is his prints or not. Okay, The abdominal X ray will tell you and the ultrasound of things that will tell you the obstruction, but it wouldn't confirm the diagnosis. The biopsy will be able to give you that kind of confirmation that it is his Bronx. Okay, Yeah. Good. So most of you got this. Correct? Because it's where you what? So what does the child have? Spina bifida. Excellent. It's and it's common in Children who are, well, you know who got a deficiency in women or we women who have deficiency and folic acid. Um, you know, it's kind of common to to I mean, know nowadays. It's not that common, but it can happen. Um, and it's also, um, women who've had previous Children with Spina bifida recommended to take folic acid. Okay, so, you know, it's it's not that common anymore, but it is if we do see it, and it does happen. Okay. So Okay. So, guys, um, I was just gonna go back to the other question about the i t p and H u s, um, and how to differentiate between them both. Um, so, um, I'm just going through this. So with the i t p, it's, um it's kind of it's a non specific. And, um, you can have, like, a usually a viral illness before that. What is with H u h u s is related to to a toxin called a Shiga toxin. Um, and you patients are more likely to present the bloody diarrhea with h us compared to I t. P. Um, so and it's, um yeah, so bloody diarrhea is more common with h us than I t. P. Um, and usually we need to do a stool culture. You you look for sugar toxin. Okay. Have you heard of what Shiga toxin is? So that's that was the smaller executive in th us. But with I I TPI tps associated with on the laboratory finding. I mean, it wasn't obviously that question, but it's something. It's a classic exam question with I t. P. Um, it's reduced activity of what? What do you What do you guys know? What reduce activity for what? And it's a common exam question. It comes up. Um, would you see on a lab test for I t P? Yeah. Yeah. Good. Low platelet. Yeah. Good. Um, but as with H u s, you wouldn't see that. Um, you know, um, with HGH, us is more likely to be associated with, like, a die bloody diarrhea. Um, And then when you do the stool culture, you'll see the Shiga toxin in the stools. What is with I t p? You'll see that low platelets on blood's okay. Um, fine. And then, yeah, Then we can. Okay, good folic acid. And then I just a little little bit. About what? Spina bifida, Um, or spina bifida is, um okay. And why it happens. Um, so again, lack of folic acid folic acid is important for the development of physical of the neural tube. And if the woman doesn't get in a folic acid, especially during the early phase of the pregnancy. The the spine of the the nearest tube is not, you know, the neural tube in not closed, it would remain open. And that that causes in this manner Biff to and the definitely management surgery. And some surgeries can happen prenatally so you can actually do the surgery whilst the baby is still in the room. So once the woman is still pregnant, and sometimes they do it after the baby is born. Okay, Um, so, yes, you can do the surgeries, even the prenatal postnatal. Okay, next question. Okay, Good. More than half a few months. It and yeah, if you answered it, correct. Yeah. It reflects anoxic seizure. So the child reengage consciousness very quickly, and it's usually after a trauma. Um, so there's two types of, um so there's a type of breath holding spell. Okay. Um, is it Do you know what the other type of breath holdings work? That was the other names. The other one. There's two types. Is it reflects anoxic seizure, which this girl had. There's another, um, as well. It's a type of breath holding spell. Okay, so yeah. So, um, it's an indirect anoxic seizure. Cyanotic, breath holding spell. So it's 222 different types. Okay, so, yeah. So this is how it usually happens when the child is like you had example of trauma, like they bump their head or they were startled or they, you know, they were shocked and things like that. So and it's kind of a Vegas related to the vagus nerve. Okay. The parasympathetic system, Um, the child comes and and stop breathing, and they might lose consciousness, and they might appear like a seizure. Activity was not actually a seizure. Um, it's just because the blood is not getting to the brain because of, you know, that kind of the because of the, um, the episode, Um, that causes, um smile. Twitching. Okay. Um, so sometimes you can, you know, if if you're worried, you can rule out at the pathologies, but most of the time, the management is just reassurance. Um, And if you know, if if you do a blood test, then you look, if the child is deficient in iron, you can do iron. You can iron replacement, But most of the time, you just need to reassure the parent, um, and try to avoid those kind of injuries or those kind of bumping heads or anything that caused that distress in that child. But it's it's something, but I nothing, you know, it's not. Not something to kind of be concerned about. Okay, so yeah. So it's two different types of breath holding spells, and, um, different reflects anoxic seizure is one of them. Okay. Okay. So why why do you guys Why have you chosen e? Why have you guys chosen? Um, e why not CPR? Yeah, my box is the commonest cause of of, um of, um, uh, arrest in a in a child, especially in the first bone. So what you do is you drive the baby and then you straight away. So this is the research council. So soon the child is born. You delay, um, called cramping, if possible. You dry wrap and stimulate the child. But you know what? When you're trying to dry it, you're trying to stimulate the child and the child to kind of start crying. Um um And then you assess the color turn breathing heart rate and you do a little app. Gas school, and then yeah. So, most of the times, the child as you try to stimulate them, they will start crying. Um, but if the child doesn't, you know, you need to that you're worried, and then you you go straight to put them into the neonatal life support. And then they they usually have. You put the mask on to the face and give them five breaths. So most of the times after the five breath, the child starts, Um, you stimulate them again, the child starts crying, and that basically means the Airways open and the child is healthy. Um, so, yeah, it's good. It's the most common cause of that kind of cardiac arrest. Or, you know, or delayed or not No, not able to kind of, um uh Or not crying after Chinese born most common cause is a lack of oxygenation. Okay, so that's why in Children or spending not Children, units, units. Um, you always do the breaths first, and then you do other things. Okay. Gets that neonatal life support. Have you guys done Pete's placement yet? Have you guys been on your piece placement? Um, so if you if you've been in peace placement if you And if you've spent or knobs and Gilenya And if you've seen how when the C section happens on when the, um when the delivery happens, how the kind of the mid wife stayed with the baby So they that's how they do the a gospel they rub the baby, dry it, and then the baby starts crying. And that basically means that it's healthy, baby. Okay, so, last block. Yeah. Good. So you'll you'll see it. Um, so we'll watch some deliveries. Um, c sections normal. You know, normal vaginal deliveries from my experience the most, most, most of the times when I've seen this done. Um, child given breath is you have to c sections because usually normal jello deliveries. Um, the child the Children usually start crying, and the airways are fine, but usually didn't. C section is when the child can get some respiratory distress, because the child is not having that kind of a normal kind of delivery where the, you know, the baby goes through the vagina. Um, and, um, you know, all the kind of the lungs are squeezed, so all the fluid can kind of come out of the lungs and that, you know, the baby was able to breathe when they're born. But using C section that kind of normal delivery doesn't happen. So the child is more more likely to kind of develop that respiratory distress syndrome. Um, and more likely to require neonatal life support, So yeah. So, Yeah. So if you get a chance, watch some c sections. Um, so let me start the pool. Sorry. Good. Most of you have asked it correctly. So ultimate under peace and single dose of decks. Because, um, can you tell me why you chose and under piece other than just give single dose and, uh, this and discharge? Yeah. Good. Because of the distress and the intercourse, the recessions and things like that. Okay. And raised respiratory count. Okay. So I wouldn't be comfortable sending the child home, Um, and wait for the try to start breathing, you know, you know, to start, um, if if the child is working really hard to breathe, I'd be more concerned. I like to observe maybe 24 48 hours, and if they you know, if they settled down, I can send them home. But with this situation, usually, you know, when When I said mate, I mean, like, observe admitted for observations. Okay. I don't mean like, you know, we'll be, you know, giving them anything, like IV IV fluids or taking beds and things like that. No, it'll be mainly for just observations, because you're just worried. Okay, Um but yeah, but but all the other things, like nebulas additionally in and oxygen and things. So you only give that if it's if it doesn't get better. Just very dexamethasone. Okay? I think initially, you just give, like, some of his own and observe, And if it doesn't get better, then you escalate. Escalate the treatment. Um, but yeah, it's common. It's common in young Children. It's caused by something corporate influence, the virus. Um, and Charlie usually comes with a barking cough and a horse voice. Um, and we talked about the management already. Okay, good. Okay, good. So most of you wanted to the ship suit. Good. Okay. So I can see. So what do you think this lady has or this young adolescent has? That's okay. Okay, So she's got something called Osgood shuttler. Um, and it's common in, um, young athletic Children. Okay. Um, have you heard of Oscar Schuttler? Um, yeah. So Oscar shuttler is information. Um, who read the patella inserts? Um, and then, you know, you can get if you wanna examine them, you feel tender lump. Um, things like physical activity makes it worse. Um, so you know, the advice you would give the child is to reduce in the amount of physical activity rest? Um, because you know that that that is the only kind of best treatment because it's caused by increased activity. Um, so things people who are runners who run a lot or empathetic you Children adolescent, especially, is common in this age group. Um, yeah, but it's it's, you know, it's one of the common exam questions. Okay, Good. And a final question. Yeah. Okay. Good. Since most of you can answer it correctly, I'll just share the results. And so Yeah, good. So, uh, calorie stone is a classic projectile vomiting a little olive mass in the the epigastrium and examine Mhm. Um, so yeah, common first few weeks of life. Um and yeah. So usually do you can use ultrasound to diagnose, or you can just diagnose the examination. Another other important differences to think about now I remember from my P displacement a few years ago when I did it. Um uh, I think for differences. Think about common, you know, is in Children, especially 23 weeks is over feeding. So, um, a lot of babies when they first bought especially it respect the first child of the Manchester new mom, Um, and they kind of not really kind of educated in terms of how much is normal for the try to be to feed, especially that bottle fed. So when you take the history, I always ask them, Have the child is fed breast fed, bottle fed and usually when they're bottle fed, Um, it's very difficult to know what's too much and what's not. You know, it was too little. So sometimes the checking before fed it's very common for Children were all fed when they're first born. Uh, is to get this kind of and the, um, it can be quite projectile, so it can be mistaken with pyloric stenosis, but and a common, more common differential for for the kind of vomiting milk out in young babies is kind of overfeeding. So I had this story who came in with very similar symptoms of paradox, stenosis and I just thought, Oh, is it product students is, But it's actually, well, actually all feeding, and we kind of advise them on to kind of calculate how much the child should be having and just give that man and, um so, yeah, it's kind of common kind of thing to think about. Okay. I think that is it not matter for Yeah. Yeah. Good. Okay, so, um, So I just wanted to talk about I didn't really cover all of the conditions that could possibly come up. Um, I just covered kind of the basic ones, but the other important pediatric things to to learn about. So I talked about pediotic rashes. Um, the answer to the last question was pyloric stenosis. Um and, um, yeah, the answer to that question is pyloric stenosis. And it was projectile vomiting. Okay, so yeah. So things like if pediotic so empathetic rushes the cover like the different types of rashes peripatetic M s k. Which is we cover the specificities. But there's quite a few things like septic arthritis, um, and Sufi, um, common come off and other things to think about is, uh, faints and funny. 10. So we we we went through the reflex anoxic seizures. Um, but this kind of other things as well. Um, like, you know, federal convulsions, epilepsy to kind of go through, You know, those kind of conditions, Um, and yes. And then physiatrics surgery, which we didn't recover that much of, um, so things like appendicitis. We could covered his prints, which is kind of one of the pediotic kind of acute abdomen in in Children. Um, but other things could be like mesenteric adenitis. Um, you know, I'm pen appendicitis. Um, things like IBD like Crohn's. Um, and as the colitis. You know, again, that's pediatric kind of. Well, it can be pediatric or adult, but, you know, it's one of those things to kind of think about. Um So what was the question before? The last, uh, it was pylori X two nurses And the other question before that, let me check. Was it the ours got shirtless syndrome? So the answer was analgesia and, um, just analgesia physiotherapy. Okay, Alright. Someone had a question on the Q and A as well. They said, Can you explain why there is arthritis? Uh, yeah. It's a good question. Um, I'm trying to see. So I mean, I thought, it's it's an autoimmune. So it's, um, uh, the patient gets a viral illness, and then they get this autoimmune reaction where they produce antibodies in case the platelets, um, and that causes a little bit of bleeding everywhere, sometimes cause bleeding in the joints. Sometimes they can cause bleeding in the skin and get rash. So, uh, so I was looking into it as to why that it could be, um so this could be a couple of reasons. It could be the bleeding, the lack of places located, count, causing a bit of bleeding and that causing pain. Or it could just be the fact that it's, you know, two means in a cell. Autoimmune condition. Um, it's just attacking pictures, but could also be attacking the the joints, um, joints as well. So yeah, so that could possibly two possible explanations. But there's nothing. There's nothing on the From what I could could see. There's nothing obvious that know kind of obvious path of physiology of why the person is having pain in the in the joints from specifically related to I t. P. Okay, um and yeah. Yeah. So So I guess that was quite, you know, quite quick and brief. Um, but like I said, you know, it's with Pedes. It's just knowing, um, kind of having those categories, like an M s k rash, fibroid illnesses, you know, and then just learning 2 to 3 common conditions. That's how to go with Pedes. Um, yeah. So thank you before bearing with me. And Yeah, and good luck with progress test. Thank you, Maria. That was Bob. Thank you. Good morning, guys. Remember to fill out the feet, but phone, please. It's a cream. Uh huh.