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OK, so I've sent you live? Cool. Um And II think from now it's recorded it so that um I'm people with trickling. Cool. Go for it. Shows you what? Ok. Um So hi everyone. Uh I'm ZA. I'm currently an F one at UCL H in the Infectious Diseases Department which is why I was asked to give this talk. Um So what I will try and cover it's um high yield topics, give you some tips and tricks for exams and answer any questions that you have. So of course, feel free to either speak out or just type what you have to say in the chat. Uh And if there's anything that comes up and I can't answer it, I promise I will ask a senior colleague and I can give you guys an email, drop you the information some other way. Cool. So we'll get cracking. So I'll show you a little bit about what we'll go over. Um we'll go over TB um malaria. We'll just do a quick summary of pyrexia of unknown origin or fever of unknown origin. And then I have a pneumonic or not a pneumonic, but a memory aid to tell you about with hepatitis. Um Even though it's technically a gastrotopic, I just think it's a good thing to have in your back pocket. Um We'll do a quick summary of COVID because it still exists and is very examinable and then I'll put in the summary just some tips and tricks and I've got some, I've only got one reference, but I think it would be helpful to you and I've got some feedback request. So there will be a QR code twice in the talk. And if you guys could just let me know if there's anything you like didn't like or how we could modify this for the future. Cool. So we'll get started. So before we get going, I'll tell you that I always find it really easy to remember things if there is like a celebrity association or a film association that I remember. So I don't know if you guys have seen Moulin Rouge. Um But the character that Nicole Kidman plays a teen is always coughing up blood and she ends up having TB and a spoiler but tragically passes away from her TB. Um So in the stem of the question, so this is also something I think it's important. We'll obviously go through the theory. But I think there's so many places you can find really good um coverage of pathology and treatments. I just wanna make it as um memorable as possible for you so often in the stem of an M CQ. It's gonna say this person is of South Asian descent and then it builds up to this picture. So they have a cough, they're having, uh, the, there's hemoptysis or maybe not hemoptysis that they just don't feel themselves. They've been having night sweats, they're losing weight. And this is actually a good thing to ask in, um, history is generally always ask your bee symptoms. Have you lost weight? Are you having any fevers? Do you notice that you're waking up and your sheets are drenched? So, just to kind of summarize the pathophysiology. So it's an organism, there's lots of different types of TB, first of all, but primarily, I think in exam scenarios for medical school finals, it will be pulmonary TB. Um But you can get things like uh genitourinary TB and they have like a sterile py urea. Um You can get a spinal TB, which is called Pot syndrome. Uh and you have sort of uh your collapses of your vertebrae. Um But palmary TB is obviously like the number one for finals. So as I've said, they're in the slides, there's a primary, so the organism it multiplies um at your pleural surface, you get these gone focuses and then when you get these build up of macrophages, um they take TBT lymph nodes and you get a gone complex. I wonder if I'm pronouncing that, right? But very like if you see that word, sometimes, you know, when they try and put in a bit of pathophysiology in the question. So if you see the word gone, it's probably a mycobacterium like TB. Um, so in terms of investigations, you need them to give you uh, three acid phos bacilli positive sputum cultures. So that's what the patient needs to provide. Um, just for interest, if you ever need to have a patient, uh produce a sputum and they're not, they haven't got a productive cough. You know, you can give them hypertonic saline and that will help people produce a productive cough. But really, it's just such a hallmark for pulmonary TB, they should be coughing and they should be producing some sputum. OK. So you can also culture the sputum but it takes time to cook. So sometimes it can take about three plus weeks for it to cook and then there's the N A at tests, but they are not as sort of conclusive as your um acid phosphatide cultures and then finally on your chest X rays. So when you've asked for lots of different investigations, er, you say I also want a chest X ray is my imaging and you get that buzzword, which is the bilateral hilar lymphadenopathy. So, if you see that, er mentioned and you've got that clinical picture, then it's most likely to be. There is a helpful table that tells you about the man two test and screening for latent TB that you can find on lots of popular question banks. Um, but something that's often important to remember is that it can give you a false positive in patients with HIV. And sometimes that, that's where they're guiding you with the stent. So also if a patient comes in and you, you find that they're positive for TB, you must, must do a HIV test. Cool. So, the management of the active disease, um, I think the important thing here is that you keep a uh little mnemonic in your mind. So people often use ripe but before you even get going with the treatment, you have to check the renal and liver function because sometimes you have to reduce the dose of rifampicin if their renal function isn't great and they tend to kind of manage ethambutol in a different way as well if the renal function isn't great because of the effect of ethambutol on your vision. Um They ask people to have the Ishihara plate so as you know, or maybe don't know, the Ishihara plate is just for your color vision. Um So they'll ask you to test those before you start somebody on ethambutol. Er er because it can also cause optic neuritis and we'll get onto that shortly. So you give someone two months of the right and then four months of just the right. So, rifampicin key side effects to remember it can change the color of the urine, give you interstitial nephritis uh cause hepatitis, which I think a few of these can and is an enzyme inducer. So it can impact on the medication that patient is taking. So you'd have to co them on that Isoniazid. So I remember this cos Zid sounds a bit like zap and thinking about things like peripheral neuropathy is often the main side effect in final plan. And then pyrazinamide is the other part of the treatment. And this is a bit of a uh I want you to kind of really come with me on this journey. But I think of it as like a pyramid cos it's got the word Pyra at the beginning and Pyramid crystals gout. So you get this uh hyperuricemia that can cause gout and then finally, ethambutol or Ham Buttal for a memory aid, it can cause optic neuritis. And that's why it's so important for you to do the heart replace before you start somebody on treatment. There is uh if it again comes up as an OS station, it's really important to explain to patients about the importance of sticking with it because it is a really long treatment course. Like you're asking someone to stay on active treatment and take several tablets a day for six months. Um But you can involve TB nurses who are excellent and they can counsel the patient, they'll monitor them. Um And then also things like if somebody has Pulmonary TB and they live at home and they have other family members, it's important that you screen the family members for any signs of TB. So this is my, er, first feedback QR code that you will slowly get sick of. Um, but yeah, anything you want us to do differently or anything that you would find more helpful, just let us know, um, we can make the amendments. So this is a question. Um, and this isn't, I haven't written this question so it's not mine, but I'll give you guys a chance to read it and then I will do the poll and just let you choose whichever one you want. We'll just give it like 30 seconds and see what people say. I don't know if you guys can see it one sec. Sorry. Oh yeah, cool. OK. We won't get stuck on it for ages and ages cos you know, I know this is uh your evening as well. I don't want to take up too much of your time. So the answer when you guys get the slides, I have got the answers in the comments and like explanations and things like that. So I just didn't want to take up too much slide space um on the lecture, but this the answer to the question um essentially relies on you picking up that or recognizing interstitial nephritis. So it kind of is a um bit of a renal question as well. Um I think that they, there are a few red herrings so her work as a vet is a red herring. The polycystic kidney disease is a bit of a red herring and then the combined oral contraceptive pill. Um So when you see that, that answer, the answer is one or a and the fever and a rash is really classic for interstitial nephritis and rifampicin can cause it like they often would have called it like quite a dirty drug. It's got lots of side effects, but obviously, it's so integral in the treatment of some really important conditions that are still used. Um Animal exposure isn't really related to interstitial nephritis. Um The as you know, like sort of polycystic kidney disease, I think is this, would you expect to see a manifestation of it in like a 25 year old which says it says her mother was diagnosed at 45. So you have to kind of think like is this like the recessive part? Um the recessive er type of polycystic kidney disease and try and fill the picture in your head. Um There's no associated use with the combined or contraceptive pill for anything like interstitial nephritis and then renal TB is rare. So do you know when they always say common things are common? So just try and think like am I as a final year medical student gonna be tested on renal TB? Probably not. So that is our TB section done. If anyone has any questions, please let me know next one is malaria. So I don't know if you guys know that Cheryl Cole, if I don't know if she still goes by Cheryl Cole got malaria and was really, really unwell. Um And again, like I said, Celebrity Association really helps me to remember. Um So malaria it's spread by the mosquito that we know that anopheles mosquito and in and there's a few different types. So there's like avai and Vivax, but they're very rarely tested in finals. So FCI parum is the most common in real life and the most severe and the most likely that you'll be tested on. So, as we said, it's spread by a mosquito and the mosquito injects its plasmodium sporocyte which goes to the liver, migrate in your hepatocytes and they are released from the liver infect your blood cells and in the liver, they become something called erites and you get hepatosplenomegaly. Um because they multiply sorry, you get sperm megaly because of red blood cell sequestration. So you also see these things like hemolysis, cytokine release and that's what makes people feel really, really unwell. Um You then can see the patient come in and they're like, oh, I had a bit of a flu before and that, that word paroxysms is when people get a fever that like um ebbs and comes and goes. So they'll have a bit of a fever and then it'll go and they'll have another fever again. Um It's usually sort of on alternate days and then they find that they're shivering and then they're really hot and then they sweat as their temperature falls. So, really unpleasant symptoms. That program is just like usual malaise feeling like you've got a headache, muscle aches. Um, importantly, when you take a blood test for this patient, they'll have anemia and they'll have jaundice, but you won't see any rash on them, you won't see any, um, they won't have any palpable lymph nodes anywhere. So sometimes it's good to kind of be able to characterize the presentation from what they've given you in the stem. Um, then as you know, in terms of your investigations, they always say, you know, please say why you're asking for whatever investigation that you're asking for. So, the blood film and the parasite level is key because you need to see, er, the, how infected a person is essentially on your FBC. You'd expect to see like an anemia, a thrombocytopenia. And then on your user needs, you might see a renal failure. An ABG is a really useful thing to do because it can tell if there's any lactic acidosis, um, which tells you how unwell a patient is. So it's really important to try and do one and unrelated. But if you get a chance in final year or even f one try to learn how to do an ABG with local anesthetic, it makes all the difference to you actually succeeding with the procedure and the patient um, complying and being comfortable as well. So in terms of the management, it's riamet for your falciparum and everything else, you're giving Chloroquine and then primaquine. But again, I think it would be unusual to be tested on the management of malaria apart from this bar or stuff. Um So let's go on, I ask you guys the question. So 35 year old woman presents with a three day history of cyclical fever, myalgia and fatigue. One week after returning from Kenya where she was visiting relatives on examination, she had mild jaundice, jaundice, mild jaundice and spin oe of four centimeters. So hopefully this one should be a bit more straightforward. And I will get you guys just to tell me what you think the answer is. And the uh yeah, this one, this one is, well, you know, when they give you a gift of an easy question. Um This one is that cool. So with this one, the answer is obviously malaria. Um The important thing I think to pick out in the stem is that it says here she's returning from Kenya where she was visiting relatives. So that sometimes apart from the symptoms of the cyclical fever, that program that we talked about and the mild jaundice, there's a group of patients they often talk about in on the ID ward of, they say people who've gone to visit friends and family, they think they're now they think they're immune because they've grown up in the region. And they now think, well, I've always been around the high risk areas that they should be fine for me. So they don't take any prophylaxis. Um, so sometimes that can also help you with the question, especially if it's not as obvious as this. Um, all the others are red herrings and I think what's important, I think maybe I certainly didn't know this as a final year and have a very vague understanding of it now is just what uh you are likely to contract in certain parts of the world. So Japanese encephalitis were not in the right part of the world in hepatitis A. There's nothing in the stem to indicate there's any sort of hepatis A, they've not eaten anything that would make you think of hepatitis A, they've not engaged in any activity that would make you think they might contract hepatitis A. Um in yellow fever, you see things like clots of bleeding. Uh and it's just not the right part of the world for typhoid. So we'll move on. Cool. So uh I was, let's talk about pyrexia of unknown origin. And what I'll say about that is it is more likely to be a, I think a history taking station in an AK than necessarily in a final year. You could try to delineate a diagnosis. Um because it really, it's very difficult to diagnose because it's quite a, a bit of a mysterious diagnosis. So the definition of pyy artery puo So they've got a fever of 38.3 for beyond three weeks. I've highlighted the threes just to help you guys remember. And they've had a week of inpatient investigations that have not kind of provided any sort of alternate cause of their fever. Um, there's three different types that we usually think about. So there's HIV, associated obviously patients with HIV, uh, neutropenic. So people with neutrophil of less than one by 10 to the nine and then nosocomial is when they inpatients or something. That's about while they've been in the hospital. Again. The key is obviously the history and there's something I'll say just quickly about taking a history in an osk is that it's really important not to get stuck in the presenting complaint part that eats up a lot of the time because you're trying to work out what's wrong and then you miss all the marks for like past medical history. Do you smoke any allergies? Social history, all those bits and pieces. So just try and remember when you do practice your history to like move on, even if you've know you're none the wiser about what the diagnosis is in that section. So you just, you adapt your Socrates that you come with so many of these uh histories that you want to ask them, you know, when did it start? Was it acute, gradual? Um Do you feel that the fever's there all the time? So what's the character or is it intermittent? Is it, what's the timing? Is it sort of night, day, is it there all the time? Anything? Make it better? Like paracetamol, anything make it worse? Um, are you finding any associated symptoms? So, and you're waking up at night sweating, you know, your sheets wet. Have you lost weight? Are you tired? So, just those b symptoms that we talked about and then I think what can work? Well, is just to do again if you're, if you've got a bit of time to play with like a systems approach. And I always think a good way to start a systems approach is to say to the patient, listen, I'm gonna want us to go from head to toe to make sure I don't miss anything and it will help keep me right, please feel free to interject if you feel like I've missed something because then it also shows the examiner that you're thinking systematically. Um So that's sort of system based approach and when you are talking about past medical history. So you want to ask if they're immunosuppressed. So that can be anything from, are they somebody with HIV or cancer or are they just somebody who receives like a Crohn's disease, like a monoclonal antibody for their Crohn's disease? Um In terms of the social history, we always ask, you know, do you inject drugs? But have you ever used drugs uh and injected them? Have you ever shared needles any other sort of like risky behavior. Um, sometimes it's also good to just find out if there's anybody else at home that's unwell as part of your family history. So, is this something that could have, is this an infectious disease that everybody could have? And then, then we say they're about sort of unusual jobs or hobbies. You know, sometimes you see in the stem they're like, I'm a, uh, I work in the sewage or I'm a coal miner and then it helps you understand the diagnoses but just asking people, is there anything that you do that's a bit different? Do you, is there anything in particular that you pass the time with? That's unusual. And then also asking them, which is key in any infectious history. Is there sexual history and the tribal history? And those can be a bit awkward to bring up. And I think sometimes it's just good to preface it and say, I'm really sorry, I just have to ask you a couple of personal questions. Um Just to understand a little bit better about what's going on with you. So that is pyrexia of unknown origin. I couldn't, to be honest, I was thinking about potential MC Qs, but I think it's quite difficult to test it in an M CQ um format because there's not any definitive answer. So we'll move on and just do a little bit about tropical infections. Um I think this is a really nice way to think of them. And again, this isn't something I think malaria seems like the most testable one to me. And in my experience of like finals and, you know, working through question banks, I didn't see a lot of these come up but it's not to say they can't come up. Um, and while it might be quite low yield, I think it's interesting, uh especially if you're interested in anything like that. So just to kind of picture what, what is, what so like malaria is a protozoa. But then when we think about things like tapeworms and roundworms and more like helminths. Um So I thought I would first of all chat to you about the different kinds of conditions that we can see. Um And there are two. So if I sorry if I just show you this. So the try if I'm pronouncing it correctly, there are a couple that I think are worth knowing about. So again, like I said, I like to have a celebrity association. So there is an American type and an African type. So the American type, the bug is called T Cruzi. So like Tom Cruise, who is an American and it causes Chagas disease, which also starts with c So as I said, it's spread by bugs and you get the uh patient that is has this eyelid swelling that you see classically and they call that Romana sign. I think some people quite like that. I like to remember the eponymous name signs just because it helps me remember. But I know there's really a move to come away from that and we'll touch on that in a little bit. So, yeah, they'll have some fevers. You'll see, you'll be able to feel some um palpable lymph nodes. He pass megaly and cardiac disease as well as something, one of the manifestations that you can have with Chagas. Um And I think the thing here is in the stem will say, you know, a patient traveled to somewhere in Central America or just to kind of help you contextualize what might be going on. And then the African uh try or um it's called sleeping sickness. And there are two types. So there's the GBI GBI variation, which is the most common and then the Rhodesian variation. So I think Rhodesia was maybe previously Zimbabwe so colonial name, but I've highlighted it. Uh So it's East Africa and it's rarer. They are rare to help you. Remember, it's less likely to come up, it's spread by flight of a bug. And the um presentation is you get the tender nodule at the site that you've sort of been stung and you can get a hemolytic presentation. So you get a rash, like I said, fever, ry gauze uh swollen lymph nodes. So the cervical lymph nodes swell up and that's called winter bottom sign, which is, it's a um very depressing and horrible history. So winter bottom is winter, bottom sign is this sort of posterior er survival lymph node, swelling and winter bottom was a physician. And I think he was actually an abolitionist, but he reported this sign in er slaves because slave traders would feel for slaves next to see if they could feel the cervical lymph nodes and they wouldn't buy them if they could feel them because they knew that this person was unwell and then could, could develop this uh meningoencephalitic encephalitic manifestation where you're getting convulsions and it can develop into a coma. So again, yeah, it's lots of horrible parts of history are immortalized in medicine. But I think sometimes with these, I think he was an abolitionist actually. So we're not sort of Commemorating a horrible person. Um And then I also, if I show you again, we'll just go back a couple so I can show you where leishmaniasis. So it's also a protozoa. Um And I'll talk to you about leishmaniasis very briefly. So leishmaniasis, it is spread by sound fs. Um It is in South America, Central America, Asia, and Africa. So it knowing the region isn't as helpful on this occasion because it's so widely spread. But you get this cutaneous um manifestations, it kind of three types that you see. Um And I've said the kind of the sorry, I'm pointing at my screen which you, it's not helpful to you, but there are a couple of different interesting causes. So you can have you get a skin ulcer and I think you can see that there where your bite, where you get a bite and then it will develop into a scar. There's mucocutaneous and that is uh in the mouth and the nose where you'd get the ulcer and then you have the visceral one. So you get these dry water, skin lesions on the hands, prolonged fevers and massive splenomegaly. It's worth just googling images of a few of these things just so you can see it. Um And kind of have an idea. I don't know what all I think maybe for the licensing exams, there'll be most exams will be done online so they can include images and it's helpful to maybe be able to recognize a couple of these bits and pieces. Um So I am going to ask you the third question here. So it's not a problem. So which of the following is the most common pageant is the most common cause of African sleeping sickness so that you guys have. Think about it. See, cool. Give you a bit longer. Oh God, sorry, I see fab brilliant. So we'll wrap it up there. So the answer is actually e um and I'll just go through those with you for a second. Sorry. Give me a second. Uh If you just bear with me one second, I'd actually have these notes on my phone, but I think I missed this one really importantly. So just give me one moment and I wanna just talk through the answers in text. Yeah. So uh eight is leishmaniasis. So we are thinking about ruling that one out because it's not the cause of African sleeping sickness. B uh the try Cruzi. So like we said, Tom Cruise, that's the American one. So no good to us. Uh c so the er Brucei Rhodesiense, like as we said, rare in Rhodesia. So it's not that one. Ascaris is actually a parasitic one. So it wouldn't be that one. So the answer is e the most common one, the East African one. And that's the answer. So, uh like I said, I just wanted to touch on hepatitis B because hepatitis B serology comes up all the time in final questions and it's really, really hard to figure out. Um, and this is not my uh memory aid. A good friend of mine made this up and it has always served me really, really well. And ever since I memorized it, I've been able to answer the questions correctly. So I just wanted you guys to have a look at that so you could see it and see if it would be of any benefit to you. Um I know there's a swear word there which I'm not sure is allowed, but it just is a way to kind of try and get in your mind what the serology actually um means. And in practice, we do have to interpret the hepatitis B serology. So I think it's worth having a tool to keep it in your mind. Um And I'm just gonna hold it, leave it on the screen for a little bit, but then I'm going to ask you guys a question about it. So I don't know if you wanna like screenshot it or what we wanna do, but I'm gonna move on to the question and then I can flip back to let you have a look at the serology to help you answer it. So I'm gonna skip to the question and I'm gonna start the pole. So sorry. And then we will go back and I'll show you the topology. I'll let you guys just have a look at the question and see what you think. And then we'll go and to have a look at what we saw before. So let me flip back briefly to show you my little memory aid and then we'll come back to the question. So we'll have another look at the memory age. I see it cool. And then we'll have a look back at the question. See what you think so. Yeah, great. I'll put everybody out of their misery. And this is actually the question we have the most sort of answer distribution. The answer is actually d and I don't think this one needs an explanation as much because it sort of, it either is, it's much more black and white sort of it is or it isn't. I'd really encourage you to use my friend's memory aid. It's really helpful and it served me really well. Um Since third year I learned it. So I will credit her Rachel mcveigh and uh make sure that she gets the credit if you guys find this useful. So last bit I want to talk to you about was COVID. So COVID is very much still around. Uh obviously very grateful that it's much less um fatal and less severe now because of vaccines. Uh But it's very much something that could come up, especially in an oscopy station. They say, you know, you've taken a history from the patient, they show you an X ray. And I think the kind of the next thing is that what would you do next? You know, so first interpret the X ray. I don't want to teach you how to suck eggs. I think you'll have gone through X ray interpretation many, many times. So just doing your usual Dr ABCD E. Um And I think what I was once taught was if you're looking at a chest X ray in an oscopy situation and you can't ascertain what's wrong with the patient and they're just sort of generally unwell. It's probably COVID and this is quite like a classic called COVID x-ray, COVID pneumonitis. Um I've shared the link from where I pulled this from. It's a website called Radiology Masterclass that it's free to sign up to really good for revision of radiology stuff because it's one, you know, where you hover your mouse over it and it will tell you like what you, what thing you should have picked up on the image and they have it for everything. So like trauma stuff, hands, legs, everything. So really, really worth looking and practicing. And that's one of those things that you can practice on your own if you don't have anyone to practice with that day for your ay prep, it's a good one to think about. So they say, you know, what would you do next for this patient? You think they've got COVID? So you've obviously tested them. So you send away the what we call it a copa or whatever swab you want to send away. So a viral swab comes up positive, you then want to isolate them. So really important they're in a side room. Um And then when you think about your investigations just from a, when you're presenting, um this is just from osk stop where they talk about having a system. So they think they use boxes. So things like Beth bedside investigations. So essentially like a set of obs um O is for orifices. So like, do you wanna send a urine sample? Do you wanna do APR what do you wanna do XS for imaging? So your X ray that you would do. So I'd wanna give this person a chest X ray and then s is for any special tests. E sorry for things like E CG and then the S is for a special test. So I think it's good to always keep your diagnostic kind of window wide. So even though you think, oh, this might be B or COVID or whatever, a pneumonia like if they're tachycardic on the OBS, you still wanna do an E CG just in case. Um And then as we said, when you are requesting something like a set of bloods, you just want to say why you're requesting it. So why am I requesting a full blood count? Oh, I want to see a white cell count or I wanna see ACR P, you know, and then I also want to do an A BGI want to see if they are acidotic. I wanna see what the story is, uh imaging wise, what sort of imaging. So we've done a chest X ray, we might want to do a C TPA as well. Um If you're particularly concerned and then we talk about management. Now it's things like oxygen, you're giving people steroids like dexamethasone if you think they need it. Um There's also the antivirals. So, you know, things like Paxlovid and Rem desvi that's I think what would be good to say at this point is, well, this is very much local policy specific. So whatever the my local department is or whatever the local guidance is, I'd follow that, I think it varies, not just trust to trust but hospital to hospital. Um and then always it's an opportunity to do some public health engagement with patients and say, oh, look, if you haven't had your vaccine, this is a really good time, maybe in a couple of months to consider getting vaccinated and you know, talk to them about the importance of vaccination, counseling them. Um And so in summary, just even if you don't know what's going on in the Osk station, so like a fever of unknown origin, which I think would be a really nasty Osk station to give people just try to approach it systematically and go through whether it be your imaging interpretation, your history taking as systematically as you can with lots of patients that have an infectious disease, you should always do an HIV test. So whatever it might be TB leash, if they, if they've just got a presentation where you think this is quite unusual for this person to become so unwell, do a HIV test, um It's really important. So I said they're about memory aids like ripe or that he hepatitis B1 just to help you remember stuff. Um And I think what I'd say is lots of your other modules are gonna include some section on infection. So in your obs and Gynae, there's gonna be stuff on sexual health, pneumonias in rest in gi or your hepatitis is like it's gonna come up time and time again. And what's important in finals is that you're able to recognize the patterns from the stem, you're able to recognize like they've chosen this demographic of people that is very like to have XYZ. Um And it's, it's not always, you know, it's not brilliant because you're stereotyping people. But for the sake of finals, it's really important to kind of try and keep that in mind because it will help you. Um And I think this is, yeah, I said the, the one reference I'd really, really recommend is Radiology Masterclass. It's free and just really excellent for practicing all your radiology, especially if you're not confident presenting them, which I never really was. And it was just a good thing to go through. So just so that you are code again for any feedback that you have. Um the next talk is going to be on the 23rd, which I think is Thursday and they're gonna be talking about upper gi there is a um email address if you guys want to raise any questions or you have any comments. Um And yeah, I'm happy to hang around cos that's the end of my slide and answer any questions that you have. I know this is just a short and sweet 40 minutes. So any questions you have, you want to type in the chat or anything you wanna email me with? I think I've put my email, I will put my email in the chat and even if you're just like ammonium F one, but if you're interested in infectious diseases or you want to know what it's like as a job, please feel free to drop me an email. Um But yeah, I'll hang about for about 5, 10 minutes. And anyone, anything you wanna ask? Feel free? Sorry. I've just seen one of the questions. Do I mind explaining the memory aid and the answer following the HEP B questionnaire? Of course, let's pull back. Sorry. Hepatitis. What was the answer for? Hepatitis? Question four. Let me show you that. Let's go back. Hepatitis. Question four. So the answer is D right? So let's look at that together. Sorry, when you see me, look down, I just have all of my notes written on my phone which is why um I'm looking down, I'm not just sort of checking my phone when we are doing our talk. So with the er HEP B question. So this person is the antigen negative. So they haven't caught the disease, right? So they're not actively currently now, either an acute or chronic have the disease in the sense that like they're actively H BB positive. Um And then uh they're HB S ab positive. So HB SAB, so that's the antibody, right? So they're positive for I GG. So going further back and negative for I GM, which is in this moment, more recent. So we know that there is potentially an element of past infection here. Right. And then the anti, sorry, they're HB C antibody positive. So uh anti HBC antibody positive. So that means that they've caught the disease. So they actually have the infection, they're not vaccinated against it from the memory aid if that makes sense. And then HB E antigens undetectable. E is the, when they are ill, so acutely infectious. Um So when we put that picture together, the answer is d because they've had this past infection. So going further back, they've not been, um, they have actually caught the do not stop from vaccination. Um And I think that's why that answer is D so they've, they've cleared the virus because it's not their, their H BS antigen negative. Does that make sense? Sorry. I think maybe I've not talked through that in the most logical way, but I can go through it again if that's helpful. Ok. Um If I can think of any other, like I used a lot of memory aids to help me with my revision. Um And I just found that when you sort of tailor them, it's really much easier to remember. Um But yeah, I'm happy to, obviously they're not all ID ones and I think the thing about ID for finals, it's gonna differ from place to place, but it's just, it's not like I think apart from the big hitters, it's often not a huge amount of the questions people tend to have like malaria or something. Uh easier to distinguish straight away. So somebody's asked here, what would a patient's HEP B so look like if they'd been vaccinated. So, the vaccination, they'd always be, they'd be anti HB S positive. So, again, Auntie sorted me out. So I've had the vaccine and that usually when you put that, when I show you that it's much more easy to identify. So it often doesn't come up as someone that's had past infection. It's usually that they've actually been vaccinated. Um So that's the one to look out for the anti H BS. Uh Someone also asked about helpful tips and memory aids for antibiotic coverage. This one is a real corer. Um And I think it's actually, I haven't got them, I don't have any er, helpful memory aids. If I'm honest for that, I, um, before I did my medical degree, I studied to be a pharmacist. I worked as a pharmacist for three years. So I always kind of, some of that is just from my previous pharmacy knowledge. It's in the, in the brain. Um So that's not a very helpful answer. I'm really sorry. I don't really have any good memory aids. I think definitely what I would say though is if in an ak scenario as someone and they say, what would you treat this patient with? I would always, always say I would refer to the local guidelines and I would check their allergy status. So I God almost got burned by this in my final session. So it was neutropenic sepsis and the patient had a penicillin allergy. And I like at the last second, did I ask otherwise? I'd have given them a penicillin and they would have been fatal. So, just say I just wanna check the allergy status and I'd refer to micro guide or something like that. Um How do you differentiate between typhoid and yellow fever? I'm really sorry. I don't think I'd be able to answer that off the bat without looking in into it. I think with yellow fever, they always have like bleeding from like in the stem, they'd have bleeding from the back of an eye or something quite um dramatic like that. But I would definitely look into that and just make sure that you, you know the difference, but it feels quite low stakes for a final question, but I'm happy to look at it for you and also just drop you an email if you'd like me to. That's no problem. Um Any other bits that anybody wants to know about or anything that you feel like infection wise that um has come up for you and wasn't clear or you would want us to chat about a bit more in future things. I'm happy to like put something together even like a brief PDF just with a few bits of information about other infections that you guys want covered. Yes, cool. I think we're probably coming to the end. The one thing I would say also is obviously best of luck for everyone who has finals pending. And the other thing I'd say is make sure you have a break over Christmas. Don't just do loads of revision, like you need to have time off and relax and stuff and spend time with friends and family. Um But yeah, I think that's us, isn't it? So, thank you everyone. Thank you for your attention and engaging with the poll. I really appreciate it. Yeah, yeah, sorry I was gonna say I'll turn off my camera but I'll still be in the background for a little bit longer if you guys have anything you wanna ask. Cool, everyone. I'm gonna step out now but I have put my email on the chat genuinely. Anything that comes up, please feel free to drop me an email, anything that you need. Um Yeah, you can drop me an email. Thank you all so much for your attention. Bye.