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Uh Hi, I'm Isabel. I'm um one currently working in Liverpool and I went to Imperial and I'm gonna give the images and instruments um Pacer Station revision lecture. OK. Here it is. Um All right. So I'll just give a quick overview of the station and then we'll go over some images. We'll focus on the chest x rays, abdominal x rays, MSK and CT I highly, highly doubt you'll get any MRI S like close to 0% chance you get MRI because nobody apart from uh radiologists and neurologists know how to read MRI S. Um Then uh we'll go on to instruments. So I'm mainly gonna focus on the airways. Um And then some other random instruments and if we have more, we have time at the end. Um I've got some extra practice images. So this is one of your stations. Um It's half images, half instruments. It's quite a good station if you've done a little bit of prep for it because it can be quite chill a break. Um So the first part is you get three different images. Um The examiner will ask you to describe one image as if you were talking to a patient. So it would be sort of like a spot diagnosis image. Um And then you've gotta kind of explain what the diagnosis to the patient. Um And then the second or third is describing the image to a colleague. So that's your like um format that we will go over. Um And then instruments for the examiner will take you over to this table which has a lot of um different instruments laid out on the table. Um And they'll pick a few up and say um what's this? Was it useful? How is it used? And the complications? Um So if we go into images, first, most important thing is don't forget simple. This is quite a good time. Um When you're nervous to just be like, OK, what are we looking at? We got, this is a um chest X ray of X, date of birth, whatever it says on the X ray, um say when it was taken and say that you like to compare it with a previous image because that's ultimately the most important thing when you interpret images. So you have your right, which I'm sure you will know about. Um I'd say only comment on this. If there's something abnormal, don't waste time being like good rotation, good inspiration penetration. It's not that important unless you're like, OK, this is not normal. Um But I'll just go over it anyway. So your rotation, you're looking at the clavicles that the equal distance. I don't know if you see my mass, um equal distance away from the sternum and the trachea and inspiration you need um at least five anterior ribs, which is the ones coming down here. So this 34567, it's got eight. It's good inspiration. Penetration is um how well the x rays are penetrated through the body. Um You can have over and under penetrated um x rays and you want to see the spinus process fly behind the mediastinum. And then exposure is if there is any part of the body that is cut off, um that's gonna um mean that you can't get a full of the image. And then um the main structure of interpreting a chest X ray is your ABCDE. So your airway first look at the trachea. Is it central? Um then breathing, you wanna trace all the way around the edge and check the lung markings extend all the way to the edge. Um They don't wanna miss a small pneumothorax and then obviously see if there's any opacification. You wanna look at the heart size um and look around the heart borders. Um So you remember you can't, I might not size. It's a AP image and then diaphragm just to check that you got the costophrenic angles here, nice and sharp and then you have um appropriate rise of the right hemidiaphragm. So just a little bit higher because of the liver. But if it was a, um, really high, then you'd think there's a pathology. Uh, and then anything, everything else, external thing. So stoy wise you can see sometimes a, all the time. Um, X ray leads ecg wires, um, broken bones, things like that. Ok. Would anybody like to try and interpret this X ray with what I told you or time for the chat? Um, or I can just go and breath? Ok. So, um, I'll go over the first one and then hopefully someone else will do the next ones. Um So we're looking at the airways first or first of all. Um It looks like good quality X ray because you got it's not rotated. Um It's good penetration, inspiration is adequate and um you can see all of the borders. So in the exam, I'd say this is um a good quality x-ray radiograph. Um then airways to the trachea, central, the trachea is central. Then if you look around the lung uh borders, you can see that the lung markets extend all the way to the edge. Um But there's an area of a pacification here in the right upper zone. See it's in the um this uh lobe here. Um And then the heart doesn't look enlarged and you can see the defined borders, there's appropriate rise of the right hemidiaphragm and no blunting of the costophrenic angle. Um and there's no external um wires or anything like that. So, in summary, this is um in keeping with right upper zone consolidation. Um You could also um comment on the seeing uh bronchogram in the area of pacification which indicates that the, the density is outside of the airways, outside of the bronchioles and the um alveolar which is all the pus and the, the white blood cells fighting an infection. But if you didn't have the bronchogram, then um you think more like a growth within the airways like and that's obstructing the airways. Would anyone like to try this two? Uh I don't mind having you go for this. Great, right? Um So this x-ray, I'm more or less happy with the quality. It just seems a little bit rotated. But otherwise, uh I think exposure wise, I would uh I would like to see the closer for any angles as well, but otherwise, it's all right. Um Airway wise, I think uh the trachea is deviated towards the patient's right side and uh breathing wise, the lung markings are visible on the left hand side, but uh they are not visible on the right hand side. Uh throughout, there's a opacification throughout the entire right lung circulation. Um I do not think that the heart is enlarged, diaphragm wise, I cannot really see the right opic angle and uh everything else. Um I can't see below the diaphragm, I guess. All right. So in some ways, a right, complete lung opacification and my top differential uh if combining it with um um tra devi would be uh right left lung. Yeah, that was really good. Perfect. Um, so you got deviation of the trachea, complete white out the right lung. I'd say that the media is slightly shift with the, the whole, um, deviation. Um, but yeah, you can see the left heart border. You can't see the right hemidiaphragm, seek some cardiac monitor wires. So you're absolutely right. Complete lobar collapse, um, which could be caused by a bronchial obstruction. You want to try the next one. Ok. Go over this one. So this one airways, I'd say it's slightly deviated to the right but not a huge amount. Um There's lots of landmarking on the left side, but the right is normal. Uh The cardiac borders are normal and the heart is a normal size. No more diaphragm, maybe the tiniest bit of blunting um and potential second rib fracture here and maybe even these ribs down here are fractured hard to see. And so if um together with the deviation and the loss of lung markings, you think of the tension pneumothorax, which could be caused from the trauma and the rib breaking. Ok. So moving on to abdominal x rays, um I always think the main thing you comment on, first of all, just go straight into the, the bowels, then other organs you can't always see. But if you can see them, comment on it and look at the bone. So any vertebral fractures, any bony mets um calcification. So in particular, look at the aorta, um sometimes it can be quite obvious and calculi as well um in the kidneys or in the um uh ureter uh any artifacts. So, catheters nephrostomy, all that kind of thing. Anyone like to try and interpret this abdominal X ray. Yeah, I'll go over it. Um So in terms of the bowel, you can see um dilated loops of small bowel. Um because you can see the valvular convent, the continuous line to the bowel and it's very centrally located. Looking at the other organs. You can see the liver um, here and the, um, the rib cage, but it's not enlarged. Um You can, I can't see really see the kidneys, the bladder down here. This is uh the muscle down here. Um I can't see any obvious fractures or bony mets. There's no calcification and no artifact. So I just want to go over quickly. The small versus large obstruction. It's a very common one that, that might come up. Um So in terms of the location, the small bowel obstruction, you'd see it very much in the center as the bowel can, um, a lot wider spreading around the parameter with the small bowel. You can see the valvula conven, which are continuous lines that go through and it gives us spring like appearance, um where, how stre uh easily stretched out. And so usually you see very smooth, um, quarters of the V and then, um, small bowel uh dilation is more than three centimeters and large bowel dilation is more than six centimeters. And then your common cause is small bowel uh adhesion, abdominal hernia, malignancy, and large bowel. I think of constipation, ulus and malignancy. It's quite good just to have those three top um, causes he might ask you about that. Um All right. So M sk uh X rays, to be honest, I've always hated them. I don't know about you guys and I think I got, I got two or x rays in my Pacer station which was horrendous. Um But I think the most important thing I still did. OK? Because you just got it. Um Keep it very basic, I think um and basically just describe what's on the 10. Um So you wanna say what you're looking at and what kind of view it is, then just check, look around all the bones, see if there's any fractures or dislocation of the joints or subluxation. Um You might want to comment on the bone texture if you feel confident in that and then comment on any soft tissues or breaking in the skin, any soft tissue swelling, that sort of thing. Um And then with fractures, um we'll go into a bit more detail. So, fracture of which bone um and like whereabouts in the bone is it um distal portion? Uh the type of fractures, you got your um like a complete transverse um complete that uh communed fractures, whether it's open or closed. So can you see that the bone is coming out the skin and any displacement? So you're looking at the movement of the distal portion of the broken bone, is it anterior, posterior mediolateral and angulation? The varus vagus angulation. Um But if you're not confident, don't go into the detail because if you get it wrong, it's worse and just not saying anything. Um This is just going over different types of fractures. Um This is something you just, it's gonna remember, revise. Um Not really much. I can teach you about that. Does anyone want to go at interpreting this Ortho X ray? So I can give it a 10. Oh Great. Yeah. Um So this um radiograph of the left um upper limb shoulder and left upper limb of a mature patient. Um I can see the most obvious abnormality is um fracture of the left um humerous bone, the proximal end that is near the, the proximal upper third um that is near the joint. I think it is a closed fracture and I do not think it's displaced. Yeah. OK. That was really good. Um Did I put, so the ap radiograph of the left shoulder, you described it perfectly. Um The fracture is uh transverse and you could argue, I think um it's a complete transverse fracture that's immediately displaced. If you um imagine this line here, it's completely shifted medially. Um which also is quite difficult. It could, you might think that it's just a bit twisted. Um and it's still kind of connected, but um this one is immediately, immediately displaced. It's a transverse fracture and you're right, it's closed. That was a really good description. Um And I don't think you would have been penalized for saying it's not displaced and you wanna go at this one. And so um this one, the ap radiograph of both of the hands, you can see some subluxation of the joints, mainly the um the M CPS and some um erosion of the bone you can see on the deviation. So that's the hand spring that way. Um And some osteopenia. Um and then you can also comment on fingers, could potentially be some soft tissue swelling, which you would expect with um advanced features of rheumatoid arthritis. All right, I'm moving on to CTS. So um just to go on to the basics of the different um colors you see in the CT, the gray scale. So it's the same as an X ray. Um your least dense is black and the most stents is white, you have air at one and bone at the other end. Um So things that water and CSF and edema can appear quite dark um and also ischemia because when you have the dead cells, they're broken down into a water free adebit matter. So, um ischemia of the brain will appear um dark after some time not immediately need some time for it to be broken down and then white matter is very fatty, um which is less dense than um cellular gray matter. And then at the top end you got blood and to, to remember when you're describing it, something's black, it's hypodense and if it's white, it's hyperdense. Um and then just a little um of the bleeds. So with the epidural hematomas, you have that lemon shaped bleed because it's between the bone and the jura which the jura at touches to the bone at suture lines of the skull. So blood in the space can't extend further than the suture line. So it bulges inwards, um subdural hematoma um between the Jura and the um arachnoides which can spread all the way around. So you get the banana shaped, um look on the CT scan and then subarachnoid hemorrhages are under the arachnoid between the Arachnoid and the pia mater. And this follows the folds of the brain. So um you get a characteristic more, more of like a star like shape of the bleed. So how they sometimes describe it but pretty to see it moving in the, in between the folds of the brain. And then you got your intracerebral intracerebral hemorrhage, which is just right inside the brain. So, and you wanna go the CT scan. Um All right. So you describe it as a convex hyperdense area um that can be seen in the CT scan and in keeping with hematoma CTS describing CT S could be very um it's very basic. There's not too much you need to comment on because it's quite a, a specialized um image. Also, there is some um medial shift, midline shift. Um And here the suture lines of the skull too. So, and that's why it bulges inwards. OK. So if we have more time at the end, I have more images we can go over but now just going on to instruments. Um I'll start off with airways. So I'm gonna show an image if anyone wants to write in the chat, what they think it is um or on mute and say what they think it is. That'd be great. Um But if not, again, I can just go over it the first one. So um this is uh is it um or oropharyngeal airway? Um It's an a airway adjunct to help with obstruction. So say if um somebody's uh um got reduced G CS and their tongue is going back in their mouth. Um And how you use it. So it's from the hard to hard. So you um measure from the teeth to the angle of the mandible. Um And instead it upside down and twist it around. Um That's how you measure it. Um And the complications of this. So you might get some laryngospasm use too big a size or um it might not work as an airway adjunctive if it's too small um damage to the soft plates and it might not be tolerated, which is ultimately a good thing. Um If a patient can tolerate a, an airway, then um they're more unwell and then just to um for completion, anyone, I wanna shout out what this is. Um this is a nasopharyngeal airway which goes in through the nose. Um You measure it from soft to soft. Um So um the nose to the tip of the ear, um, and when you insert it, you just push it straight down. Um, and sometimes she needs to put a little bit of lubricant on the top. I think in the interest of time, I'll probably just go over it. But if anyone wants to ask any questions or, um, say what they think it is like, don't hesitate and um, to unmute. Um So, um, these are um supraotic airways. So you've got your eye gel and laryngeal mask, eye gel is used um, much more commonly. Um So these are used in emergency settings. Uh They're easier to insert than um, other, um, the et tubes. Um, it can then be, it can be inserted and attached to oxygen from mechanical ventilation and you still have quite a high risk of aspiration. Um So with the eye gel, it's inserted the right way around and it will, um, mold to the, um, the vocal cords area with the heat, the body. Um, and then with the laryngeal mask, you inflate the um the cough but your mold. Um and yeah, you connected to a ventilator or a bivalve mask and complications of this. Again, laryngospasm and damage to the soft plate. This is a endotracheal tube. Um It's a definitive airway. Um that's um allows for mechanical ventilation for a longer period of time and you reduce the risk of aspiration. Um So how it's used, you have the laryngoscope, which is used to visualize vocal cords and then you place the tube in between the vocal cords. So the um balloon cuff goes below. Um If you're struggling to do that, then you can use a bougie um which is a long um wire that is easier to insert through the vocal cords. Um And then you attach the, you put the et tube around the outside of the Bouie and pull the bougie out um to make sure that it's inserted correctly. You look for chest wall rising on ventilation um and look for NT or C two to show that um there's gas exchange. Um and you'd worry if there's any stomach ventilation. So, complications of an ET tube, um it's very um is associated with uh pseudomonas colonization. Um And then also any other kind of infection you might get by introducing an external um some external into the body, uh damage to the surrounding structures. So, uh the oropharynx um damaging the vocal cords um and also damage to the, the teeth and lips. But on insertion, actually seen that happen where um somebody chipped the tooth and cut the lip um with the laryngoscope. Um And then again, incorrect placement. This is a tracheostomy tube. Um It's a surgical airway. Um and it's, it can use for ventilation, mechanical ventilation, but the person can be, it's more tolerated so they can be conscious. Um and they might be able to talk if they have the, the valve on the top. Um So um it's done, it's inserted by specialists in theater. Um make an incision, 2nd and 3rd track your rings um and touch inside and inflate the cuff. A very common complication of this is obstruction. So, any secretions that get stuck in it or a hematoma um uh an infection and a fistula formation, uh it's important to know this is more for when you start working. Um But they might ask about it in the exam. Is any patient on the ward which who has a tracheostomy will have a, an emergency um uh flow chart above their beds. Um And if you ever called to see a patient who's desaturating, you gotta get that flow chart and go through step by step. Um Things so like suctioning and then um it's a in a tube that you can take out um because it's very, very easy to panic when you have someone with a trichotomy tube and you don't wanna touch it. But this um all patients will have this flow chart behind their bed, which I only learned about um a week ago. Um But that was useful. Um And then I just wanna go over um difference between adjuncts, nondefinitive airways and definitive airways. Um So your adjuncts, they assist the airway, they're not actually directly connected to any oxygen. Um A nondefinitive airway is one that um sits above the vocal cords and there's no cuff um inflated below. So it can be easily removed. Um But it is used for mechanical ventilation connected to oxygen and a definitive airway um is used for long term mechanical ventilation. Um And there's a cuff that sits below the vocal cords to prevent it from being pulled out and there's a much lower risk of aspiration. Um Just a few random um instruments that they might show. Um anyone wanna say what this is. So this was a um non rebreather mask. It's used in resuscitation emergency settings. Someone's dropping the saturations. Um You don't use it in the long term. Um And it delivers high flow oxygen at a high percentage. So it can deliver up to 50 L, technically 100% oxygen, but it's mo most of the time it's like um 80 to 85%. Um What you need to do is connect it to the oxygen, put your finger over the, the valve inside the mask, which then inflate a reservoir bag and then you can put it over the patient. Um And complications of this, you get um dry face and mouth and also oxygen toxicity um and CO2 retention. So it's very important that you do an ABG before and after. But one of these so on if um in patients where you think there might be a risk of being a retainer. So COPD patients. So this is a um an ABG needle. Um It's a really useful point of care diagnostic tool. Um What you do is um or it's used for taking a sample of the blood, the uh arterial blood um and you can get very useful things immediately. So the po two PCO two ph lactate glucose electrolytes and all that gives you quite a good picture of what's going on. Um And you need to feel for the strongest part of the, the radial pulse. Um And what I usually do is I'm feeling for it. I leave a little mark with my nail or something or a pen um clean it and then you insert your needle, it's quite useful to. Um yeah, but the the pump of the um the syringe bit because it could be a bit stiff. So just go like this. Um and then put it back in um and then when you insert the needle um quite a steep angle, um you can also see with your finger where the pulse is at the same time. Um It's a really painful thing to for patients. Um And if you get into the, the blood will fill the syringe on its own. Um And then you got to take it to the machine as quick as possible. So it doesn't regulate uh complications, hematoma if you don't press down hard enough, uh, after taking it out and painful. Um, and then this is a ABG reading. Um, so here you can see that there's um, what, so it's um acidic, uh there's normal C two. So if it's normal CO2 um not high, I think it's more of a uh um metabolic acidosis and there's not much um there are just some tips with the um instruments. Um Some of them are in packaging. So that will tell you what it is. Um If you can't remember what it is, describe what it does where you've seen it, just talk your thinking out loud. Um I think for mine, I got um surgical clips or whatever like I can't, I couldn't, I can't remember what they're called now. Um But the examiner was really helping me being like, so where have you seen this? Like um what does it do? Um And then eventually we got to the name of it and yeah, it was chill. Um If you're struggling just always think of um infection and damage to surrounding structures when they ask for complications. Um And yeah, the examiner usually um tries to help you. It's quite a nice po station. It's good if you get it about halfway. Um Yeah, so what have we got, we've got 20 minutes left. I have more images we could go over um Or we can use this time. You can ask me questions um about anything about applying for foundation year, about how F I One is about finals, any of the stations, how to revise um Or we can finish early. I don't know. Does anyone have any preferences to put in the chat? Ok. So you're a very quiet group. I can't even tell if they're still here, to be honest. Um So what we'll do go over a few more practices and then, um you people can leave if they wanna leave or someone can stay um and ask any questions. Yeah, I think maybe you could, you could go through the rest of them, please. Yeah. Um ok. So, yeah, I just had a little bit about um sigmoid and cecal vvs. Um These are kind of like spot diagnoses. Um The sigmoid volvulus is your classic coffee bee si coffee bean sign. Um And it usually starts more on the left lower quadrant and it goes up towards the right upper quadrant, um which is very textbook. It's not always like that in reality. Um And then the cecal volvulus, you got more of a, a fetus sign here. Um And it's kind of the opposite direction. So right, lower quadrant to epigastrium, left upper quadrant. Would anyone like to prescribe this X ray. No, I will go and describe it then. So um we have a central trachea. Um You can see that the long markings extend all the way to the edge borders. Uh the heart is not enlarged. Um There's very defined borders. Um The most obvious abnormality you can see is um uh underneath the diaphragm. Um This looks more like a stomach um bubble. So it's mainly here and the right hemi diaphragm. Uh So this is in keeping with a pneumoperitoneum. Um So we'd want to do an abdominal X ray um and call the surgeons. So this CT scan, um what you can see is um uh concave area of high hyperdensity. Um on the left side of the brain with some um midline shift, you can also see some um hypodensity surrounding the hyperdensity. Um So just a little bit to make it a bit confusing. Um high blood can sometimes look black because it hasn't had time to clot and get really thick yet. Um But it could also be surrounding edema. Um So yeah, this is your subdural hematoma, which is a classic banana shape. Um just to give some examples of some artifacts and abdominal x rays. So, um on the left, this is your um kg stent. Um So for someone who's had um stones, any sort of obstruction, um they have a stent put in and these are your uh nephrostomy wires, neostomy drains. So, this CT um you can see here there um um hyperdensity, which is if you extend your imagination, it's kind of star shaped and it's like following the folds of the brain. Um So if you remember where the um the bleeds on the different layers in between the arachnoid and the pia mater follows the brain shape. So this would be a subarachnoid hemorrhage. You've also got some um some swelling in the subcutaneous layer. And then this one, you have um a big area of hyper density on the left side of the brain and midline shift. There's also some surrounding hypodensity. Um This is in keeping with uh um intracerebral hemorrhage and which has some, some surrounding edema. Um And uh the midnight shift shows that this um increased intracranial pressure. So, uh this is one that needs to uh contact the surgeons. Um And then this chest X ray um is very characteristic of um congestive cardiac cardiac failure. Um The trachea is central, uh you got a fluffier past extensively and bilaterally the um the cardiac, the heart is enlarged um and you can see some uh curly, curly bee lines. Um And then the diaphragm is diaphragm is ok um in the snow um external um artifact. Yeah, this is very much in keeping with congestive cardiac failure. This one you can see some calcification, the area of the kidney, kidney, kidney. Um So that would be a um renal calculi. Uh This also shows um some fecal impaction and you can see here nicely the psoas muscle. Um and then this one, um you can see some hypodensity in the um right side of the brain. Um and also some uh hyperdensity in the um ventricles. So, this is in keeping with an ischemic stroke and calcification, the fourth ventricles. Um So yeah, when you have ischemia of the cells after time, it's broken down into um a watery a substance. Um and this will take some time. So when you do the CT scan in stroke patients, it's to rule out a bleed rather than um, brother diagnosed an ischemic stroke. And then this one in the bowels, you can see uh dilated loops of large bowel, um and a typical lead pipe, um descending bowel. Um You can, you can see potentially this is some um small bowel dilation, maybe not big enough to be dilated, but you can see the spiral um sort of character. Um in terms of the other organs, you can't um really comment on the other organs. Um The bones look, ok. And there's no external artifact. So this is in keeping with the toxic mega coon, ulcerative colitis. Um ok. So some more instruments, um this is a laparoscopic port. Um It's used for minimally evasive laparoscopic. So, what they do is the first one you put in, um they make a little incision um and then push the port inside, you pump the abdomen full of C two. So it's inflated and then you put other ports in and you have, um, camera in one and, um, two other. Thanks for the surgery, hippy things. I can't remember the name of them. Um, and complications. So, quite obviously, if you're pushing something into the stomach and you can't see where you're going, damage to internal organs and bowel perforation. Um, and you can get some herniation through the port site. Um, this is a chest drain bottle. See it along, uh, intensive care after, um, open heart surgery. Um, because it's very edematous. You, they want to put the drains, um, they put the drains in the, the medias DYN and also in the pleural space. Um, so you don't get, uh, massive rise of pressure after surgery. Um, and yeah, for chest drains. Um, um, so the, um, insert it into the, um, for chest change, it's in the triangle of safety, um, or it could be under here after surgery. Um, and it's to closely monitor the, the volume output in infections, the complications and, uh, leaking. Uh, these, this is a, a blood glucose monitor. Um, what you do that it's used to detect blood glucose levels. So, very important part of the a work up in the, um, for anyone who's and well, but, but in particular, reduce G CS, um, you gotta to calibrate it first. Um, prick the side of the finger, get a, um, drop of blood onto the strip put it into the machine. I got this in my pa station. Um complications, not really that much but pain and some sclerosis with repeated use. Um That's also in other paces stations. Um Quite a, a smart looking thing to look out for, to comment on. If you see, if you see um scars that tips of people's fingers, you can comment on um potentially repeated use of um a blood glucose monitor um for someone with diabetes or it could also be um for monitoring inr levels because they um are the same little machines for ketones and inr apples. Um And then this one is a ap uh peripherally inserted, central catheter. Um It's used for long term IV access. So you can administrate um due to parenteral nutrition, uh give fluids, especially if you need um high potassium concentration and giving medications. You can also use it to take blood from. Um So if you ever do that as an F one, you got to remember to take a new cap um and clean. So you take the cap off, you clean it really well and let that air out. Then you take a 10 or 20 mil syringe and you um draw out 10 mils of blood and discard it because that's gonna contain the last bits of medication that you gave the patient gonna mess up the results. Then you can attach um, a little vacutainer thing to the Picc line and take your blood as normal. Uh And once you finish taking the blood, you need to flush it with quite a decent amount of saline um, to stop it from fogging up because you definitely do not want to be cool IV access again because you block the picc line. Um Yeah, so it's used inserting into the skin. Um, and you follow up into the superior vena cava uh and it can stay for a long time. Complications are infection thrombosis phlebitis. All right. I think that's, yeah, that is everything. Um So good luck everyone. This is a good station. I would highly recommend just reading over um and practicing the images uh because once you've seen them, then um you have something to go on. Um uh it's a really easy station to gain marks and then with the images, just try and practice with your friends and on placement. Um describe them because if, when you're on placement, you describe an X ray, um the, it would be very similar to uh the examiner. Um And the examiner will get quite like irritated if you go into too much detail and say things that aren't that um important. Um The same as like your consultant or reg on the ward who have don't have that much time. So it's a good way of just like refining your description um and saying it nice and quick because you don't have that much time in the station. Thank you. For um coming to watch if you could scan the QR code and um give me some feedback. That would be great. Um And also there's my email address there, uh feel free to email me with any questions. Um If you wanna have a chat about finals and how to revise um and yeah about applying or anything.