CRF 09.05.23 Krok 2 Study Session, Dr Oruma Yaa Rhoda



This on-demand teaching session is relevant to medical professionals and is conducted by Doctor Rhoda. It aims to help medical professionals increase their understanding of how to make choices or choose best correct answers in examination scenarios to help them prepare for their exams under the Crop to Exam Initiative. The session focuses on scenario-based practice and Doctor Rhoda provides information about how to identify and use markers to narrow down the best choice of answer. Doctor Rhoda also provides advice on tackling tricky social medicine questions by frequently practicing them and keeping screenshots of questions they don't understand. By the end of the session, attendees will have further insight and tips for examining answers in medical scenarios.
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Learning objectives

Learning Objectives: 1. Understand the use of Crock Too Exam in medical practice 2. Identify markers that can be used to determine correct answers in medical exams 3. Utilize practice strategies to better approach social medicine related questions 4. Explain the difference between data obtained from many and data obtained from several 5. Describe resuscitation measures in cases of fetal distress
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The following transcript was generated automatically from the content and has not been checked or corrected manually.

Okay, got it. Alright. Hi everyone. So first of all, we want to say thank you to organization the Crisis Rescue Foundation for giving all of us all this opportunity. Uh despite the circumstances surrounding um the reasons for for the lecturers, I actually appreciate it personally. So this is for the purpose of crop to exam. And as we all know, there is no way we can actually, it's supposed to be a lecture for one hour, we can actually copy. Terrific. So what we are going to do now um using this normal popular um sites that most of us use for preparation, I will try to discuss how we can, you know, make choices or choose best correct answers um in examine exams condition because sometimes I'm talking from experience. Um we want to guess and all and exam tensions and all we don't know. So that's the people that's how the lecture is going to be like today. And if you have any questions you can indicate or probably drop it in the chat and I guess a moderator will help with that as well as we move on. I'm Doctor Rhoda. I'm sorry for not introducing myself. Okay. All right. So let's go ahead. So we will try to, I'll try to help you on how to narrow your way into choosing the correct answers without many confusions. Okay. How to identify the markers that we could use to probably pick are correct answers. Okay. So let's move on to this question. For example, we have the during winter. So I guess you all can see my screen. I guess you can see my screen. Yes, we can. OK. Thank you. So, all right. So during winter epidemic of influenza caused by the virus, the H ONE H one H one N one. All right. So it says on the second day after the disease onstage, the 30 year old man hospitalized presents with high fever cough and all. So what do you prescribe? So normally uh this H one N one is the uh Coumadin neuraminidase. So the inhibitor is going to be the the treatment for it. You understand? Now, uh you don't choose antibiotic festival because it's, it's a viral infection. So that's out. Interferon is most likely. Um there are drugs used to boost immune system, especially for um I am viral infections that don't have direct treatment as well as immu immuno globally. So se clover is used for viral infection treatment as well, but the disease H one N one Her Muhyiddin you are many days. So this is the inhibitor. So example of it is the ostomy vale Okay. So if this should be your correct answers, so that you're correct. Uh, so let's check. All right. So we'll try to go faster if you have any question, you can draw my attention, please. Okay. So, next question, um, it said the age of the person, 57 year old and they said the person occupation is a minor. All right. And now it went, I had to say that the patient, uh, complaint of chest pain, uh dyspnea on exertion, excessive sweating, you know, and, and the temperature not so, you know, bad. So when the patient cough, it has blood streak sputum and he smoked, he has been smoking for 40 years. So he frequently has pneumonia. And the survey shows triangle shadow. So this is where our answer should also come. They've given us the history now, they, they, they, they're telling us what we can find on S tary. So that will help us narrow down into choosing are correct answer. So it says that it shows a triangle shadow shape in the middle and one of the pieces of the shadow points to the long route. Now it says that the cardiac and Justina shadows are displaced towards the affected area. What do we think our answer should be? Now, when we come here, obviously, they did not just give you the occupation of the patient. Patient's who have been working as a minor are supposed to have um occupational lung diseases. We have different types, those who work in court. Uh mine ing you understand they have different kind of diseases that occupational lung diseases. So now when we come here, the um most likely answer should be either cancer of the lungs or pneumoconiosis. Do you understand? Now, the question says, triangle shape and, and the media Stina shadow is displaced towards the affected area. So I think the answer should be cancer or pneumoconiosis um uh narrowing down. So narrowing down, I haven't really solved these questions, but uh the right lung, how did I choose this answer? Carrot, in um lung cancer. That is where we find this uh shadow displacing towards the affected area. It's, it's, it's, it's it when it's the rest, you won't have any displaced um displaced part of the shadow to any affected area. I don't know if you, you understand what I mean? If it's too back Oculus iss, you will see um the shag it was like some parts of the shadows in the butt. When they tell you, they found a shadow that is displaced towards the affected area, then they are talking about the um lung cancer. If it was pneumoconiosis, there won't be used. Also, they will also tell you how they found some shadows, you understand some fibrosis in some specific area of the lungs. So that is the marker for which it narrowed me into helping me choose this particular answer. So I ruled out chronic bronchitis you understand because those are for chronic smokers alone. So probably it will not come with um how do you call it? The uh patient's being a minor, a minor good. So let's move on to the next question. So when planning treatment for a patient, it was decided to use a medicine with level a now I would like to say this, I would like to say this. Um when you are preparing for your crock too, questions like um hygiene, social medicine, we all know they are very, very difficult to um use your knowledge. Call me daddy. Sorry. There is, it's very, very difficult to use your knowledge to try to um excuse me. Uh All right. So I was trying to say that with questions like social medicine, you can't use your previous knowledge from the six year studies just like that to maybe like a case study. It's either you, you, you know a little bit about it or you don't know at all most times. That's how social medicine questions are. So what I would advise you to do when it comes to the social medicine questions, you have to keep on practicing. Most of their questions are repeated. So when you go to, for example, this in neutron like most of us, um most of the students used to practice, you go to the topic specific, choose um your social med or hygiene and ecology questions and practice. Then those questions that you keep failing you screenshot them. I always advise people have advised people previously before and it was very, very helpful to them. You screenshot them. So get was somebody trying to say something? Okay. So weeks, let's say one week before the exams, um you can now revise because social medicine questions are very, very challenging, for example, questions like this. Um It says that when planning planning treatment for a patient, it was decided to use a medicine with evidence level a what trial produce this evidence? So usually level where most of the trial that they do. I know we have different classifications for level ab and all. So most of the trials they do um uh the the randomize one you understand. Now, questions likely you see, I don't even know the difference between data obtained from many and data obtained from from several looks like it's the same but different English. So my advice for social medicine questions you need practicing to be familiar with most of the questions you need practicing a lot of practicing to be familiar with. Most of the questions, make screenshots, make screenshots of those questions that you keep failing and you don't get used to. So one week to the exams, two weeks to the exams, those are the questions that you're supposed to be revisiting to get used to it because most of the time um social medicine questions are repeated. Okay. So um usually it's randomized. First of all. So it cannot be one randomize. So uh it will be several. You can use just one random clinical trial as an evidence for a medication to be approved. So I would go for that. Okay. So let's move on to the next um after the pregnancy, after the pregnancy, pregnant woman, sorry, after the pregnant woman water broke, it was noted that they're significantly contaminated with meconium. So in your head, when a when you find me uh meconium in a broken water, you understand that the child had undergone uh fickle distress. Yes, the child had undergone thicker distress. So um they are asking upon bed, the baby was not breathing, remain in it. The skin was sanity covered with meconium and the heart rate was 1988 which is quite um low and the resuscitation measures should be what resuscitation measures should be taken. Now see the child is not Britain, the child is in it. The skin is cyanosis, cyanosis. So what can we do? We can. All right, it says give adrenaline know tactile stimulation. It's beyond that tactile stimulation is for bet that is without any complication. So I wouldn't go for that. And we know what actor stimulation like between the baby when you have for the baby to cry. All right. And then um sir nation of the upper experience. So that's when we give just suction and that's when the delivery was normal. So this is beyond that, this baby is not responsive, not Britain and the cyanosis, we have to be very, very fast to deliver oxygen to the lungs and help circulation of oxygen to avoid brain damage, like cerebral passing and all. So I think the answer should be intubation and sanitation of the trachea, trachea to be able to deliver oxygen to the lungs. So that will help. Mhm. So let's move on to the next so far. I don't know if anyone has any question to say or maybe I'm going too fast or something. I don't know. Can you indicate if it's okay with the pace? We are going okay. Someone said it's okay. Someone said it's not okay. Mhm. Uh All right. Okay. Thank you. Thank you. Thank you for the feedback. Okay. So let's move on now. A multi gravity, multi gravity to labor to that's the second labor more than one pregnancy. The gas station is 36 37 weeks has gone into labor. Her water broke eight hours ago. The labour activity continues for the last four hours. It is regular. Mhm. With contractions that last 35 seconds. All right. And okay. Every 3 to 4 minutes the child is in the cephalic presentation. All right. With the head pressed at the entrance into the lesser pelvis. Now, the the woman complained of setting sharp pain, sardine champagne. Her pulse is 100 BP. It's 100 to 70. The U turn is tense and does not relax between the contraction. Feta heartbeat is small food. The amniotic fluid is blood colored and continues to leak. What is the diagnosis? I would think it is rupture. I would think it is rupture. The contraction is too much and that sudden sharp pain that the woman felt and right now, the heartbeat of the child is more food. So it's probably um enclosed with fluid. So that's why we can no longer hear the heartbeat of the, the chat. So let's choose our answer face and see premature detachment of normally positioned. No. Okay. So that's the answer, premature detachment of the normally position, placenta. Okay. Okay. So for me, I don't know what Markka. Um All right. So um sometimes when we, we see questions like um sudden sharp pain or knife, like sharp pain, we usually suspect the uterine rupture. Okay. It can also be the detached, premature detachment of the placenta also as well. Uh But I don't think there is any marker specifically for this may be the fluid is blood covered and it continues to leak. So, and we all know that the blood circulation and all has to a lot of connection to do with the, the placenta. So, uh actually, I don't see any marker for, for this particular question anyway, but it could be this and this. It is not definitely not surgical rupture, not um a rupture of the umbilical vein, you understand what I mean? Uh huh. So let's move on to the next question. So we witnessed the car accident when examining the place of the accident. You noticed a man of about 30 years who was hit by a car. All right, he is unconscious on his neck, on the left, there is profuse hemorrhage with bright red blood. So a terror bleeding, how do we stop this bleeding? Plaster cast cannot stop the bleeding. Definitely. So we put him in a stable position. Yes, but that will not be able to stop the hemorrhage because bright red tells us that it's a positing factory that is being injured on the neck. So maximal hyperextension. No, no, no, no digital. Okay. I would go for this applying neck brace. No. So um temporarily before we get a uh healthcare or a hospital to take the patient, I think they're talking about first aid. What we can do first to minimize the the bleeding or stop the bleeding temporarily. So using our hands is called the Michalic method. So I think that's the best option from this to be choosing. Okay. That's correct because putting brace will not, neither would any of these help with stopping the hemorrhage temporarily. So, okay, let's move on to the next. No. Um, a 72 year old man with pneumonias, complaints of marked dyspnea. All right, chest pain, severe cough with um sputum. That's the expectoration in then the temperature is high, no urination for the last 24 hours now that's an emergency. That's an emergency. There's urinary retention um for 24 hours. So, objectively moving on to the question, objectively, the patient is conscious. Okay. All right. Sorry. Objectively, the patient is conscious. Respiratory rate is 36. That's high. We should be around 20. The precaution sound is though over the right lower pulmonary lobe on Oscar rotation, there is bronchia respiration and numerous crackles. Okay. So BP is low, the heart rate is 1 20. So the heart is sounds a muffled and there is the key cardia. What tactics should the family doctor used to manage this treatment with daycare? Know already said urinary retention for 20 for 24 hours is an emergency situation. Hospital hospitalization in the nephrologically unit, that's possible outpatient treatment know. So the hospital hospitalization in the preliminary um unit is also possible hospitalization in the intensive care unit. So I would go for the intensive care because the patient is deteriorating. His BP is really deteriorating. Look at the temperature is 40 already is 40 already. So this patient I think needs to be hospitalized in the emergency um in the intensive care units. Okay. Um These units for the nephrology, I think um for further management, specialist management. But for now, we have um conditions of the heart, more food heart stand, which might there might be possibility of maybe um cardiogenic shock if, if we're not careful. So we got we have to monitor this patient intensively and the urine output as well try to stabilize it. So for me, I think it's the okay hospitalization in the intensive care unit is the correct answer. So you understand how um you first of all limit yourself to maybe two answers. And then from that two answers that you manage to limit yourself, you can now try to choose, you know, now there is no, no, there's nothing like 100% because it's um an example. But at least when you are quite confused and you are able to analyze the uh the questions with the information's giving try to get because there are reasons for each particular information. The for example, the age of the patient, the the vital signs of the patient. If there were any imaging that was done, the results of the imaging, all these naps are supposed to narrow you down to choosing the particular answer. Okay. Uh Let me see. All right. I'm just checking if we have if I have any questions. So uh just uh feedback. I hope we all are following anyway, just a feedback so far. I hope we all are following. Mhm Now, um with this, it also boils down to micro two candidates. It also boils down to when you are to have your uh state exam because after this, you also um need to have your state exam. Okay. Uh Let me just still solve some more. Let's solve some more. Questions and then we can uh talk a little bit more about how to prepare for your, your state exam, how to answer your state exam and how it's probably going to be considering the conditions and situations that have happened so far. So, um moving on this question, a family doctor performed an external um obstetric examination of the pregnant woman and determined that her uterine funders is located at the naval. What is the most likely term of pregnancy in this woman? Now, a 32 weeks pregnant woman, the pregnancy is already um above the, it's already above the umbilical cost. Do you understand the U turn from doses already above the navel? Okay, that's the belly button. It's already in fact, occupying the whole abdomen. 40 weeks is already occupying the whole abdomen. Okay. Now 16 weeks is not really yet detected in the pregnancy. Like it's not obvious like coming out. So eight weeks, it's not, you don't even get to know that the person is pregnant. Now for the 34 weeks, if you measure from the 34 weeks, that's about seven months. If I'm correct, 67 months, now the pregnancy is already consult from the lying position. So how the examination is done from the lying position. They use the tape to measure it's going to be at the umbilical button region. So from the public safest is like just above the public safest to the uh belly button, that's how it's measured. And usually it's um at 34 weeks, it will be on that level just below the, the belly button. Now, the same way for the purpose of state exam, they can ask, you know, not even, only, sometimes you even find, find some questions that states that the woman has given. Beth. And let's say after one month after um two weeks, after um four weeks, after six weeks, that's how like with the finger like this, we measure by centimeters how the uterine is supposed to be reducing, gradually, gradually. So that's it for. So for this question, I think at the belly button position is supposed to be at the uh it's at 24 weeks, it's supposed to be at the level of the belly button. All right. Okay. So that's how I was able to narrow down to this. All right. Okay. So a pregnant woman at 32 weeks of gas station with the risk of preterm level undergoes a treatment to prevent fetal distress syndrome, risk of preterm 32 weeks. All right. So what medication should we prescribe? So usually when a woman that is pregnant and close to term starts to give risk of premature delivery or um preterm. For example, if we are assessing some complications that this child may be delivered before 10, before 37 weeks, what they do is they try to give the dexamethasone to help the fetal lungs mature and help for just in case like two weeks, at least to, to help the fetal lungs mature enough to be able to um avoid feta respiratory distress syndrome if anything happens and the baby is delivered. So that's the reason why we give this is not easy to see. And also to see we all know is given at um after labor, the understand after the second stage of labor to um help with the uterine contraction and help deliver the placenta. We know that this, we give, we can give to help maintain the pregnancy dough and no, no, no, we don't, we can't give miss a pre so we know that this can even cause abortion. So let's go with, check on us. All right. So we, we, we, so that's how we, I narrowed my, my, my, my way into the exam. It er zone 32 weeks, it's close to 10, but we have not sure. So definitely we give the best emitters own to help the fetal lungs mature just in case the baby has to come out before the term. Uh we will not have to undergo the fatal respiratory, it helps the lungs. All right. Okay. So what should we prescribe as secondary prevention drug for a patient with arterial fibrillation after an ischemic stroke caused by amble is um all right. It's not going to be no trips. Okay. It's not going to be calcium um antagonist. So we have ruled out this it's not going to be bitter blocker because they said it's embolism. We all know that it's caused by ischemic stroke. So that's caused by blood clot. So what can we do? We can give the anticoagulants? Okay. Oral and KWA glands. Um we can, I know somebody might um want to choose the aspirin or the clopidogrel. Uh but that is for secondary treatment of, hmm. Am I, am I? Yes, when someone is like going through myocardial infection, okay. Uh on the spots like idiot treatments. But this they're saying we need to um prevent calculation from occurring because people who have undergone ischemic stroke approved to have this cardiac embolism. Okay. So I think we should go for this, not the aspirin or clopidogrel. Okay. All right. So moving on next. Mm. A 17 year old girl is suffering from hepatic cirrhosis for three years. Now, lately, her periods of excitation has been intermittent with depression. She does not sleep enough. Okay. Objectively, her condition is severe. The girl is sluggish gives one word response has tremor on her extremity. Her skin is eit eric with single hemorrhagic rash. What is the complications of her disease? All right. So she's having leave us um cirrhosis and now she's beginning to have some kind of psychological symptoms attached to it from the cirrhosis, uh we can, I can only, it's not kidney failure anyways, it's not kidney failure. So, um when we have liver failure or severe liver conditions, chronic liver conditions that are progressing have to check my answer would escalate or not, but when we have that. So uh we have a lot of complications that can come with that. Okay. Um uh The one we wonder why is the tremor of the extremities? Part of it? Okay. Now, the tremor, hmm, the tremor comes with its, its um ammonic. It's actually um ammonic that is part it comes with, it can come with different things. The cap put medusa, the tremor on the extremities. They hand the um conjunctivitis uh sorry, um yellowish discoloration of the conductive to join this. Sorry. So the joint is all right. Uh huh. And the hemorrhagic rash, those can give complications and then the encephalopathy can also come in. That's probably where the depressions and uh the one world response sometimes you feel so, so, so sick, dull, you know. So uh okay. So we are correct. Not, it's not bipolar a funny in the history that it's uh the person had or has uh liver cirrhosis, you understand? Uh huh. It's not Reyes Syndrome, it's not sepsis. There's, it's not kidney. No, they did not even give us any um in the history related to the, the kidney or infection or any psychiatric condition. So that should be the most correct answer in this case in my. So next, this is this is um one of the social medicine or hygiene and ecology question. I was telling you about uh some are pretty much straightforward. Some you have to think while some is either you know it or you don't. Okay. It's either you know it or you don't. So the the Children from setting township presents with brittle tips, melo occlusion, denta NML erosion. Uh okay. So the data pigmentation that looks like yellow, brown spots. What is the likely cause? Now with the dental um brittle in teeth and then uh dental NML erosion, it will tell you it has to do with floor in. First of all, it has to do with flooring. First of all, now, if they're, if they said dental pigmentation, it is only when something is excessive that will have maybe some pigments of it now depositing somewhere. So in that case, it will help me narrow down that it's probably high, high level of flooring in water. If that was not in the question, I would say it's, it's decreased flooring in water that causes the um dental NML erosion and the dental um pigmentation, sorry, erosion and brittle ing of the teat. Okay. Uh So let's see high levels of flooring in water. All right. Okay. Uh So far does anyone has any question so far? Does you don't get it? Okay. So I was saying that's um in a geographical place or in a settlement, they are saying the brittle brittles, it's like there's erosion in the teeth, the teeth, the element of the enamel of the teeth days now when we have. So I was saying that has to do with Floren. First of all, that has to do with fluorine concentration in the water. You know, this water we drink and it contains some elements, contains some micro elements which they have been checked, treated and make sure they contain sift amount of those elements good. So when it's too low, we can have some setting conditions when it's high, we can have some setting conditions. Now, low levels of flooring in water can cause dental erosions on the teeth. Okay. But it didn't stop the high levels of it can also cause it. Now how do we know that it differentiates? Okay. It's high level is low level. They went ahead to say that there were some pigmentations that looks like yellow, each brand that had deposited on the teeth. Now, it's only high concentration of an element that can now even cause deposition of it. I don't know if you get me now, that's how I was able to choose high levels of it. Okay. Do you understand now? Thank you. So um let's still go ahead. I don't know if um how we've been able to help with the because for example, if you are in the exam hall tension is there, you're just reading uh erosion, erosion, flurry, flurry. Uh So which one do I choose? Now, which one do I choose? Lower level, higher level, low level it happens and then you just go to live billable, billable laba anyone I don't know if you understand. So this is to help you narrow your way down to because I know the crock candidates are already learning. They have solved a lot of questions already. There's no way I can come now and start teaching you topic by topic by topic, by topic. Okay. So this is to help, you know, how to find your marker in the question. Okay. You find your marker in the question. If it's a question that you are confused about, first of all, um, take out those ones that you don't even have to look at two times, take those ones out and then the ones that you are now able to find. Okay. It, maybe this, it may be this okay. Now, what does the question actually says about these two that I think is the answer? Where can I really find my, um, answer or my marker to narrow down to that particular question? Because it's all about differentials in your final, final year from your fifth year city. What we do is how to most, um, most diseases lookalike in setting with how to, you know, find that particular thing that makes me know that this is the answer if it's infective, if, if a question says, uh, if you think question answer is effective, for example, effective endocarditis okay infected, then look a, it has two most likely tell you how the person is a drug user by needle. You see such things in the question. Do you understand example, um if they are talking about abortion, how do we know it's straightened abortion? How do we know it's abortion in progress? Do you understand? Do we have, do we have the particles of pregnant or the components of the pregnancy in the, for example, there's bleeding in the blood, we have components of the pregnancy already in the blood. That's abortion in progress. Okay. We don't, they will also tell you, ok, the bleeding is coming out. What about the um the cervical dilation? How many centimeter is it? One centimeter? That's all it is. It allows just one finger. Do you, you find all those informations in the question? Okay. Okay. Strengthened abortion there spain there's mild pain, there's mild bleeding but the uh the office is just allowing may be inserting one finger threatening abortion. Do you understand? Uh you get those? So those are the ways in which you can narrow your ways into um choosing your particular answer. Now, I don't know if I'll be able to find way to maybe give additional lecture, but we don't have much time. So I would like to talk a little bit about your, your state exam. Now, your state exam is going to be such that um you have your pediatric examiner on the seat, you have your internal med social med. Now, uh your internal medicine and your gynecology. See today. Okay. Now when you are being asked a particular question, so you maybe be given a particular disease you have for surgery a as well. Now be smart enough to know how you are answering a particular examiner. If a surgeon is asking you about appendicitis, just no or college societies, you know, know that you have to mention. Okay, these are the signs uh I would see a pain in the right um Costa region and morphy sign will be positive. You get what I mean? Okay. Now they'll ask you signs, symptoms, treatment. Ok. Science symptoms, treatment. If it is internal medicine, you can now start talking. Okay. Uh So your okay, let's talk about um tactic ulcer. For example, if it's a surgical examiner is asking you about peptic ulcer, the way you should answer. It is different from the way you answer when your internal man, when an internal man is asking okay. Um uh peptic ulcer or gastritis is a gastrointestinal um disease, you understand and the science include pain uh before eating and then uh science, you get what I mean, the treatment you can use. Your, your PPI you understand. But if it's surgery, yes, depends on the complication. Now, complications can be preparations and can lead to diseases like peritonitis. You have to be mentioning those things for them to know. Sometimes they want to specifically here surgical, want to hear those peritonitis e signs that you if it's peritonitis. They're asking you for your blue. Um Yeah, Bloomberg signs you understand must be elicited. You see it if it's gynecology, your stages of labor, for example, if you get questions like that already mentioned about abortions. So those are asked for your, your, your your social medicine have always said the only way you can prepare for for that is mastered the questions even the once the MCQ as you get, you can use it as well to prepare for your state exam. Because that will be very, very challenging. Social med, I will know lie. You will be very, very challenging because as doctors, I understand that we have read through the city here, we understand that. Okay. Um At least there is no particular disease they will bring for me that I will not know um what you see. Okay. So you must have something to say. It's just that they might ask you a particular question that you might not be able to answer, which might reduce your skull. Okay. So for the surgical exam, know your surgical diseases, ulcerative colitis to ulcerative colitis Crohn's disease. I just wish we could get another section Crohn's disease or ulcerative, all your acute abdomen. You must know it for your surgery. You must know it authoritative colitis, peptic ulcer, um Jordana ulcer, uh which one colecystitis? Mhm gallstone all the acute abdomen, okay, peptic ulcer. You need to know those for your surgical, all the acute abdomen you need to know those uh they are so much. There are just a lot you still have time. So let's continue to solve these questions that we're solving. Mhm. Um All right. So a pregnant woman of 32 weeks of gas station underwent to parametric of. Mhm. I guess that's doper, they're trying to say good of um the umbilicus circulation which revealed uh reverse diastolic component. Objectively, the height of the uterus is above the pubic. This pubic bone head is uh of the total is mobile located above the entrance of okay and the heartbeat is it's OK. Vagina examination shows that the uterus cervix is still closed. It's less than three centimeters. What taxes should the ob substitution news? All right. So um what do you guys think I've been talking? It's time to get a little bit interactive. Someone said number uh C three. Mhm. So the first of all, the, the child is not yet term the feta had beets is okay. Uh The cervix is closed. So three centimeter. Mhm. Oh goodness. Yeah. So we have to to, oh, we have a lot of too. All right. So I think the tools that we need, you know, the tools so many to someone said five. Okay. All right. So let's narrow down and see. Even me, I don't know. So we have to narrow down. So, but then I examination shows that this meter is closed, neighbor should not be induced. I don't think labour should be induced. Repeat the ultrasound the next day. Fetal. Mhm. Fit about, fit about uh should be fatal profile. Okay. Mm. I'm really sorry doctor. But we need to finish in two minutes because we've got another lecture following this. Oh, okay. Okay. Okay. Okay. Okay. Okay. So let's just choose, um, repeat Doppler the next day. Well, I don't think so. Uh Cesarean section. Okay. Mhm. All right. So uh, so tired. Okay. All right. So like we said, um, let's just run the lecture up um croc to it's all about confidence, it's all about knowing your thing, not getting confused. Okay. And um if you follow the rules that I, I have showed you and thought you, you'll be able to score nothing less than 70%. The people have tutored before showed them how to do it. That's how they did it. Any question that is confusing you because nobody can be perfect. Nobody can score 100% screenshot those ones, especially your social medicine. Pay attention and always, always, you know, revise those ones that you find difficult. Okay, I wish you the best and if we have time, I guess we'll maybe have another lecture somewhere in the future. And uh I want to say thank you for everyone who um were able to participate in my lecture today. And thank you to uh Crisis Rescue Foundation for the opportunity. All right. Thank you very much doctor