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Hello, everyone. I hope everyone is doing ok. We are gonna wait a few more minutes um just for people to continue to file in. Um, just cos I think that people like to join three minutes in just for the fun of it. Um I hope everyone's doing ok and the placement is treating you ok. If someone could just pop in the chat that you can hear me, that would be brilliant. Um um Just to double check that it's working, hopefully you can hear me if someone could maybe react to my message or something. Yeah, brilliant, cool. Thank you. Um Just wanted to double check. Um Excellent. Ok. Um So like I said, we're gonna wait for a few minutes, but just whilst we're doing that, I've actually um if I popped this on here. Um Yeah, I just wanted to say thank you to everyone um for attending last week and for filling out the the feedback. Um It was really useful to see what you guys thought about it. It seemed like a lot of you found it useful, which is good. I'm glad that you found it useful. Um I had a few bits of feedback about the sort of stuff that you want to cover going forwards, um, which is useful. A lot of people saying that you wanted to go through things like obs and Gynae pediatrics and the psych stuff, which don't worry, we will do all of those things. And we're also gonna have those all before the winter break as well, which means that they are before, I think one of them is actually after, but they are all before your mock because I think those are the ones that people really get, um, get nervous about because of the stuff that you've just not been covering. Really? Um So yeah, we'll definitely go through all of those, had some feedback about making the slides a little bit less distracting with less of these arrows. We've done that. So thank you for that as well. I appreciate it. Um Yeah. Um, and I did have a few, um, points about the C BDI. Don't know if I've put it first. Let me see. Uh, you know, here, uh Just whilst we're waiting for people to filter in, um, if people could answer and chat if you'd like to, I just want to know what your biggest concern or your biggest question is about the acute station. Um, and the SBAR ones as well. Um, don't be worried about putting it in chart. I think pretty much everyone has the same questions. It's always, which conditions should I know um but it's just useful to hear them from you if you do have anything um specific um that you wanted, just to make sure that I cover it. So it's most useful for you. So if you think I want to put that in chart, what's your biggest concern or question about the acute station and the SBAR station? It's ok. If no one wants to answer that question, it's fine, but I'll leave it up just whilst we wait for people to filter through. Yeah, very good question. Um And these two stations are different from the rest of them, but they are similar to each other, which is why we're doing them at once, but we'll cover them specifically. It's a good question. Yeah. The condition list is a really common one. It's the thing that I was sitting in your position doing the exact same thing. And the answer is is that like we can't actually give you a, a condition list of all the things that will definitely come up, but I've tried to make one and the reason that we can't do that is just purely because it will change year and year. And I also don't want me to suggest a list of conditions and you say, oh, this wasn't on it cos I certainly, from my experience in the EK last year, I certainly did not have ITP on any of my revision lists. It, I'll be honest, ITP is not on my revision list for progress test. So it coming up in the ICU really took me by surprise. Um So there's no onset list that we can definitely use that will always 100% be right. But it is a good starting point to have like a rough idea. So I have got a list of those. So hopefully that will be useful. Um Any other questions or things that people just wanna make sure that I definitely cover. Um There may be something that pops up later on. We can always talk about it then. Um I'm just gonna wait one more minute. A lot of times people worry about the four minute history. I think we had some feedback on it actually last week. Um So how, how are you meant to do a four minute history and cover all of the stuff which we'll try and talk about as much as we can? Um All right. OK. We've waited for five minutes. I'm gonna say that that's a decent chunk of people that we've got here and I don't wanna waste the rest of the union, especially because the majority have probably come back from placement at some point today. Um So we will move on. So um just wanted to remind everyone this is our timeline of the stuff that we're doing. Again. We've not got set dates for everything at the moment. Cos we're still trying to figure out one that Megan the doctor can come in and do, um, she's obviously done it two years ago now. Her is, but it is use forward to hear from a foundation new doctor and she helps on the slides as well just because she's got the practical experience. So the stuff that you actually end up using on place, uh, not on placement in your job, um, can come from her, which I can't, I can't tell you that I have not worked then yet. Um So yes, we did the introduction on how to do A CBD last week we did and we're gonna do the sbar in important conditions for the acute station today. And then we've got the Pharmacology, Peds, OB and G and the data stuff. Um Before your uh mock is I did just want, yeah, we had a lot of feedback that was asking about more clarity on the CBD. Um because it is a real challenge. I can't, I can't um give you the exact like list of conditions of things that are good to do a CBD on. However, just because we want to make sure that we're giving you actual useful advice. W we're, we're happy to review any of your CBD S or ideas for CBD S. So if you want to know if you've picked the right topic or if you want to know that your series document is structured correctly or includes the correct details we're very happy to go through. Um And have a look at it. Um We can also, again, if you'd like um suggest the specific answers. Do you remember where we talked about? There are three questions that they will ask you in the CBD station and that one is to do with the investigation. One of them is to do with the management and one of them is to do with an ethical issue. We can pose what the questions are that we would ask about your specific CBD. If you want to engage with that process. Very welcome to at any point, just send it to my email there. I would take a picture of this slide but I will try and include this um on all of the powerpoints going forwards, just like with the summary slide to remind people. But yeah, just send it through the either your idea for what you might do a CBD on. So if you have a particular patient, just send through, I've got, I've got a patient with a migraine. Is that a good patient to do? Very happy to, to respond as best I can for that. Um or just the CBD itself. Um And then I can let you know if you're on the right track. Um And also um Meghan can get involved with that as well. Um So I just want to do that because I know there's some of the feed that we got last week. Is that, yeah, it's a, it's a real challenge um to answer what makes a good CBD choice because it is based on how you write the CBD. So we'll see so on to today's session. Um Again, as always, if you've got questions, just put them in the chat, um and I can see it at all points. So any questions just pop in there. But today, we are going to look at the overview of the acute station and the SBAR station, including the key information that you need to know and the conditions like I said, we're going through a list of common conditions that it's worth knowing about specifically for this station. Every time we cover a specialty or a topic, we will talk about the conditions that we think it's worth learning for that specific specialty they add up, right? So today I've included the things that I think it's worth doing on an acute station and there's quite a few. And then next week when we go through the next specialty, I'm gonna come up with a list for obs and Gynae and an obser list for Peds. It does add up and just remember just like with the rest of medicine, you, you're never really done. Um So it will seem like a long list, but starting early just making sure that you have the key information about a condition that you need to know. And before somebody asks what's the key information you need to know about the condition well enough about the signs and symptoms to know that it might be a differential, enough about how to diagnose it that you can list the investigations and enough about the management that you can suggest a topline for it. And I, when I say top line, I just mean, I don't, you don't need to go into loads and loads of detail about all of the different options. But as long as if I present to you itp, because husband came up in mind that you can have a rough idea of how would I manage that. And for me, I didn't know it, steroids, it steroids if IDP comes up. But I said, I'm not particularly sure, you know, refer to registrar, all that stuff. But then I said she's got low platelets, potentially replace the platelets, that sort of thing. Um So I gave her a rough overview of what do I think would happen here. That's what you want. Um So for me, with my revision notes and my flashcards that I made, um, it was like signs and symptoms, investigations management for each condition. And they were about six words after each of them, like really just really key points just narrow that down. Yes, we'll go through how to do SBAR. You've all seen sbar, we're gonna use some examples and then at the end we've got example stations that we're gonna work through, like I said, any questions in the shot. Um And hopefully this background is a bit less distracting. So the acute station then, so the acute station and the SBAR station very similar. There are two acute stations and there is one SBAR station in your mock there will be one acute station and one SBAR station, the way that they tend to line up the rotations, cos you remember you were in pairs. So you'll only do half is that one of you will do the acute one and one of you will do the sbar one because they are both four minute acute histories. For me, I did the acute station in the, in the mock EK sorry. Um And my partner did the S one. What are the components? Then the acute station is made up of your four minute history and then roughly two minute summary and suggesting your differential diagnoses, then you perform a four minute skill and then you've got four minute data interpretations and then they'll ask you questions, compare that to the SBAR four minute history, 1 to 2 minutes of writing it up. And what I mean is that they give you a sheet that says SBA R and you get to write down all the information four minutes to actually do the sbar. So they literally pretend that they're on the phone. Very embarrassing. And then your four minute data interpretation and any questions, sometimes the SBAR station structure differs a little bit. The data interpretation may become come before the sbar so that you can include it, sometimes it comes after, but generally, these are the components that are in both. So you can see that the majority of it is the same, the history and then the form it it skill. But with the sbar, the skill is being able to communicate. Um And then the data interpretation questions you've got at the end, it's literally just this little bit in the middle, That's the main change. So family history, this is the thing that everyone is very worried about. Um Yeah, it's not a lot of time. We all know that this is not a lot of time. Um Remember it that in this form and history, the most important thing is that you remember those safety alerts and we went through the common ones last week one specifically here. Don't be rude. Don't forget allergies and don't forget your psychiatric risk factors. My sbar station was a patient with mania. Um that is a very challenging four minute history because you have a patient who um is a talks a lot. Um And is excited and wants to answer your question with a lot of different, a lot of unrelated content, very difficult to narrow down. Um And in that station, the difficulty is being able to take a patient who presenting in front of you is very upbeat. They're, they're not, they're generally euthymic. They're not, they're not down or low in mood at all. And somehow change that upbeat consultation and be able to ask. Have you had any thoughts of harming yourself? Have you ever any thoughts of harming anybody else? Have you read any plots very challenging to do. But it's important that you leave enough time to do that because that's a partial fail. For that section of the station, not the whole station, but for that section, it's the difference between fail and satisfactory or concerns. Yeah. Um Oh II forgot the, the order of my animations on this slide. It's just a little bit wonky. So I'll just put them all up. Um So number one, in terms of this acute history, they are often acute and simple presentations. They tend not to be, I've got a chronic condition. I've had it for 20 years and therefore you need to take 20 years of what's the course of my history. Where did I have any surgery in that time? Furthermore, the histories will be limited. And what I mean by that is that they likely will have one or two presenting symptoms and they will be big ones that will be red flags pointing towards the diagnosis. Um and are less likely to actually have a family history, past medical history or an important social history. You should still ask. But the reason that this history is shorter is you a patient presents to you and you're thinking that they have a lung cancer and you will ask them do you have any family history of lung cancer? No. Do you take any, do you have any other medical conditions? No. Do you have any drug history? No. Um Are you a smoker? Yes. Oh, that's an important one. Do you drink any alcohol? No. Um So the, the reason that it's shorter is that those answers are quicker because less detail is provided to the actors. Um, as a result, put their family history and the systems review are therefore the least important you smush them right to the end because the answer is likely no to the majority of them. So you really want to streamline the questions that you're asking to make sure that you're focusing on the really important stuff. So if you've got somebody who's presenting with a cough, think in your head, well, what are the two like or three, I suppose, likely causes of cough? They might ask me about, it might be a cancer, it might be AC O PD and it might be a pneumonia. That's my, my things. I'm, I'm thinking it might be those two things. Um So what do I wanna make sure that I'm asking about? I wanna make sure I do my weight loss, fatigue questions. Nine night sweats ones. Um I wanna make sure that I've asked about coughing up blood. I want to ask about smoking and occupational exposure and then for the pneumonia I wanna ask about, is anybody else unwell? Um, and general viral symptoms, like uh viral, sorry, infectious symptoms. Do you feel like you have a fever? That's for me, enough of assistance. Review for that. And I wouldn't then be like, oh, do you, are you feeling dizzy or do you have any changes to your vision? Any headaches, that sort of stuff? Because it's very unlikely to be. Yes. And it takes you a while to ask those questions. So push that to the end. Family history is a one sentence question. Do you have any family history of the differential diagnosis you are considering? And if you don't know what your differential diagnosis is, use a generic statement, do you have any family history of problems with your lungs? Like you don't need to say CO PD lung cancer or any of that stuff, just be really general with it. Don't forget to introduce yourself. Um, I'll show you the Mark Scheme in a second. It, it, that huge thing in a four minute history. You feel very stressed. Introduce yourself in the correct way in the EQ. Remember they will never make you act to be things that you aren't. So just so you, you're usually a medical student. That's what they say anyway. I feel like it was, I was at F one in one of my ski stations but they say that they weren't but whatever it says on the door. You are that thing. So you introduce yourself. Hi, when I'm seven I'm 1/5 year medical student. Try to make them feel like you have lots of time even though you don't. Um this is especially important for if it's a specialty acute history. So for example, acute history that I had was a pediatric acute history. Um So you just want to make sure that the child feels like they have enough um that, that you have enough time for them. So try and leave what I would, what I would aim for like one, one gap at the beginning we go. Oh really? Um And you like pause and you like that? OK. And it, it's made them feel like that you have time. Um You can also do the like the big, big broad introductory statement like the, so tell me what's brought you in today. It's a very conversational starter that makes it feel like a friendly chat that you have lots of time. Don't forget to put in those, those sentences like, oh, that must be really hard for you. A that must be really hard for you is worth just as many marks as do you have a family history of depression? Right. So make sure that you put in a sentence like that, try and figure out which sort of empathetic statement rolls off of the tongue for you and employ it liberal sleep throughout your stations. Um Just to make sure that you're getting those marks for empathy. Um You're in a high stress scenario, even if you are the kindest person in the world, you will not feel your most empathetic on very few hours of sleep and a lot of caffeine. So just make sure that you do at one point in all of your histories, appreciate that these, these patients have come in, they're unwell the majority of the time. And for me it's that God, that must, that must be really hard for you And then just pause and let them respond to that as they will if they are like, yeah. Right. You gotta get on, uh, or if they're like, no, and you're like, oh, ok. This is something I need to explore a little bit more. It just sort of allows you to demonstrate. Look, II appreciate that you are not just a symptom who has walked in, in front of me, you're not a problem to solve. You're a person who's experiencing the symptoms. And this symptom sucks, ask allergies early because if you're early, uh, allergies and also the second one harming self harming others. If these are things big safety red flags, you've got to make sure that therefore you get them in and you don't forget about them and push them to the end. Um, what I did in this scenario, um, is I pushed it after the presenting complaint. Usually the way I go through my histories is I think Pip dfs presenting complaint, ice past medical history, drug history, family social history, I wouldn't recommend I'll put it in chat but like, er, because I imagine that somebody will want it. I'm the kind of person who would have wanted it. Er, pip. Um, the second is system review. Um, I do that in my head because I'm, I'll forget bits if I don't, but you'll have your own way of taking a history. But when it came to four minute histories it was presenting complaint, allergies, risk factors immediately. So anything that I think is a big risk factor for it? So am I asking about harming yourself in a lung cancer history? No, but I am gonna ask about those bee symptoms if I haven't already. So, um, figuring out what my differential diagnosis is and then I say, ok, so do you have any allergies? And do you have any of these other symptoms? Make sure I've got it and then I continue with the rest of it. So then I would do my past medical history, drug phone, please. Social et cetera. Lastly, always thank your patient for your time. This is advice that I would give for all stations, not just your four minute ones, but again, you want to make them feel like they had this all the time in the world at the end. And II always did this after the person told me to stop. Like, so if you, if you finish before the time, that's great. But in a form of history, you're unlikely to. So the the examiner would be like, OK, I'm gonna stop you there and I would turn to the patient like thank you for your time and then I would turn and I would turn to the, the examiner to ask if you do have time to summarize and, and end obviously say, thank you for having taken, letting me take this history from you today. Do you have any other questions? Answer? No, say brilliant. In that case, I'm just gonna present to the examiner. But yeah, just talk over the examiner to say thank you cos it's important. The way that the p the patient perceives you is a large part of your mug. OK. That's my general advice for a four minute history. OK. Moina, look at this snazzy animation that I came up with. You'll, you'll appreciate it in a second. So communication skills. Um this bit here, the main things that we're we're taking away that you can read the paragraph at the top if you want. But the main things we're taking away signpost, the patient really clearly to demonstrate your structure. So what I like to say is just like, give a really clear introduction to my different sentences. Like when you're doing ice, I'm not gonna be like, I will ask like, do you have any ideas about what you think this is uh do you have any concerns in an ideal world? What would you get out from this station. Is it from this consultation is how I ask expectations, but I've, I've signposted to ideas and concerns. So they, they know, oh, we're doing the ice bit, ask the patients for their thoughts. So that's in, in the relation to the appropriate mental health examination. Like I said, ask the patient for their thoughts. Do your ice also just use those sentences that must be really hard for you. Is this affecting your day to day work? Would I ask all of these questions? Like, would I ask like, is this affecting your work or this affecting your normal day to day life? Is this affecting your relationships? I wouldn't ask those in every history, but I would try to ask one and answer their questions in my, I always end my histories and my examinations with thank you for your time. Do you have any questions? And in my thyroid examination, I said thank you for your time. Do you have any questions? And they went? Yeah. Why did you look at my hands? And I was like, cool and I was like, ok, so I'm looking at it cos there's a, there's a thing that's called thyroid acropa you and that's when your fingers can get quite swollen and they cut up quite vein. Well. So I'm looking at your nails, I'm looking at your hands just to check to see if you have it and you don't. So I've explained what it is. I've used the fancy word for the examiner. I've explained it in patient terms and then I have reassured them you do not have this, the person that I had was a patient. They did have a palpable goiter. I was this patient did have high thyroid. Um So the important thing for me though is that like, take me out of this exam, I've just pointed out a sign that I'm looking for in a patient and she doesn't understand what it is for a condition that she legitimately has. So that's why I thought it was important to then say which you don't have. I've demonstrated to the examiner. I know that this patient doesn't have this and I've demonstrated to the person. Don't worry, you don't need to worry about this. So if they have questions, answer them also, obviously, same advice from before. If you don't know the answer, just say, oh, I'm not actually sure if, if you say like, why is it important about that? You ask about my family history? And I'm like, you know what, I'm not sure, but I'll, I'll, I'll work it out and I'll get back to you on it, you know, just give us something like I'll come back. Look at that, see that slide. Yeah, everyone's really impressed technical skills. So this is for the acute station. He says, did the student explain and perform the procedure appropriately and safely be, be familiar with your skills? Um this, I'll be honest is, tends not to be the thing that people are worried about when it comes to the is because it is basically the same, your skills basically the same regardless. Like you can learn how to take a four minute history. But if I present you with a condition that you've never heard of before, you're gonna struggle to take that history in four minutes, you're gonna struggle to take that history full stop, right? The skills are the same every time. Like if you struggle taking venipuncture in the clinical skills, you're gonna struggle taking venipuncture in the yy because it's the same arms with the same kit, right? So do just make sure that these skills are, you are happy with, you have four minutes for it. So remember watch those videos that the clinical skills gives you, they show you how to do the skills in four minutes. If the video is not four minutes or sometimes it will be like four minutes 16. If the video is not four minutes from clinical skills, they can't give it to you in this part. Bearing that in mind. It doesn't mean that they can't give you an abridged version of it. For example, wound healing. Clinical skills video is seven minutes as is catheterization. It wasn't for my year a couple of years ago, they had wound healing where they were just told to do the wash and swab part of it and catheterization like just the putting in part of it in the sense that the patient had already been cleaned and everything. Now, I've only heard of that happening once. That is a very challenging skill to do. Not because the skill itself is hard, but because you will have a process of how to do a skill. And so the really key thing there is, have you got yourself in the right mindset to know, do I have gloves on at this point? Do I need to change gloves at this point? Um and all of that sort of stuff? Right? So for those longer skills, like I said, watch the clinical skills video, see which ones aren't for minutes, watch those and in your head have a really clear like I would try and come up with like a mnemonic, for example, really clear step by step. When is my gloves go? When are my gloves going on? Uh when do I need to redo something? And what are the actual processes? The clinical skills also has nice step by steps up in the department. Remember that those are the things you're being marked against in terms of proper technique thing being like this a lot of you are on the wards, on the wards. We don't use the black and green needles to take blood, right? We use butterfly needles. They are well within your rights to not give you a butterfly needle in your exam because we don't get taught how to take blood, using a blood, a butterfly needle. And technically, we shouldn't take it with a butterfly needle. Um So you need to make sure that you are most comfortable doing it the way that clinical skills will tell you to do. OK, I hope that is all clear on clinical skills. Um Really, I think I said this before, the clinical skills will book up and it will book up quickly and it will book up all of the time, book in your clinical skills. You can book it in a couple of weeks in advance. Do that, make sure that you try and have one a week where you're definitely going in and practicing it. If you can, if you're not on GP placement, you can book ones at your uni hospital as well. So for example, at the moment, I'm in Ro Glamorgan, there's a clinical skills lab that I can book to go in and either do myself or be taught a skill. If you're not aware of where it is in a hospital, chances are they do have one, just email the med department and be like, oh where's the clinical skills lab? And if they don't have one, they'll be at a point towards somewhere else. The reason I'm saying that is that you're maximizing your ability to practice your clinical skills because it's not dependent on other people. The clinical skills lab in uhw the Cochrane one, that one will be booked up cos all year fours are trying to practice their skills but not all year fours are in Roy Glamorgan, not all of them are actually in uhw which has a separate clinical skills lab. So just maximize your ability to do these sessions. Yeah. OK. Hello. It's again, amazing. Um diagnostic and clinical reasoning. This bit here says logical interpretation of the clinical and preliminary investigation findings. This means that you need to have a structure for your data interpretation. We will go through data interpretation. We have two sessions booked in one for basically interpreting bloods ABG S similar and one for imaging, make sure that you have a structure that works for you. We will give you a structure that we think is worth learning but work out one for yourself. Um For example, for chest X rays, um the one that I work through is like airways, um uh airways, bones, circulation, diaphragm, ABCD, airways, bones, circulation, diaphragm. So when I look at a chest X ray, that's what I'm thinking. Um But that might not be the way that you go through it. So whatever the one is that you use, whether it's one from one of the textbooks that I recommended where it's one from geeky medics or something else, just make sure that you are um happy with that. It says here, did the student formulate an appropriate prioritized list of problems and differential diagnoses now, compared to other medical schools, schools at medical schools. And oy, we are not told that we need to give three. I would recommend to think. Can I think of two? Can I think of the thing? I think it is and the thing that's similar, but I don't think that it is. If you can push for one more, that's great. At the end of your history in an ideal world, you have a main differential. And remember these are quote unquote simple histories. So they tend to be the one, the bond or ones that you're expecting. So if it's a pe they will come in with a swollen cough and coughing up blood, like it will be, it will be an obvious pe sort of history. It won't be a subtle pe with just tachycardia. Um but you still want to come up with another one. So when you present them, if you've got your main differential, like I would say, my main differential diagnosis is, I think this is like pulmonary embolism because they are presenting with hemoptysis as well as clinical signs of a DVT. However, I would also like to rule out a lung cancer, um because I'm concerned about the, the coughing up blood and the age, however, they don't have weight loss, night sweats, something like that doesn't mean that like it doesn't mean that lung cancer never presents in the absence of those symptoms. But you've told me why you think that one is more likely than the other. And I said here, be honest, if I'm sure if they say, tell us, tell us what your differential diagnoses are, I would say, I don't know, I'll be honest. So what the way that I would phrase it would be something like in this specific case, I'm a bit unsure about the diagnosis. Um However, I would be considering something along the lines of and I would give some things. So if you've got someone with a cough, I'm thinking lung things when it comes to lung things. Um, in my brain anyway, I'm thinking uh pneumonia co PD uh asthma cancer. Those are like my main like top ones, there are other lung conditions, don't get me wrong. That's what I'm thinking. So I could just rattle off a few of them if I'm not, if I'm thinking like there's a reason I didn't say pe was my number one diagnosis. II would probably say that. So in this case, let's say this random example that I've come up with. Um I'm not actually sure about the diagnosis. In this case, I would think something along the lines of a pulmonary embolism. However, I'm, I'm surprised that they've not got hemoptysis, something like that. Um Now how do you wrap that up? Remember you then say because you are unsure, you say because I am unsure. I would like to check this with an immediate senior. If they ask you to elaborate, you need to understand what the team structure is in reality. What that is is you're, you're a med student. So you check with the F one, if you're F one, you check with the F two and if they're not sure you're gonna check with the reg and if they're not sure you're checking with the consultant. So just rough awareness of that structure there. Um Yeah, hopefully that makes sense. Like you should just have these like sort of scripts, make your own scripts but have your own scripts of what I would say if I had no bloody clue what was going on. Yeah. And if I didn't know, I would say in this situation, I'm unsure of the diagnosis but and then I'd give an example. Yeah. So try and come up with your own version of that cos it will be what rolls off the tongue for you, clinical care and patient safety. Um This one here, the main thing here is um did the student interpret results and sure they acted upon appropriately and voided over investigation? So like I said, again, we will go through data interpretation which will talk about investigation structure but have a structure for how you will suggest investigations for me. II told you before I do bedside bloods, imaging, special tests, but just cos I'm thinking bedside bloods, imaging, etcetera test, I don't have to do something in the bedside. If I've got someone that's coming with a pe I'm not definitely gonna do a blood glucose just because I can. Um and is it super important uh when you're doing bloods, a lot of people will rattle off FBC S using these LFT ST FT S because it covers the whole body basically. Is it super important to do liver function tests on someone with a pe I imagine there's somebody probably somebody in there talking about thinking about a rare liver function derangement that occurs in pulmonary embolism. I don't know. No. The main thing is like we do like superficially, this is an acute station, what are the most important things to do? And if the examiner were to call you out on it and say, why are you doing LFT S in a pe? Could you justify it? And for me, no, I couldn't. Um and also consider the long term and the holistic implications. So that's this last paragraph here. And this is more when it comes to the management of a patient, there's a few different ways that you can structure your management answers. Again, we'll talk about this when we talk specifically about conditions um in the specialty ones. Um but I would be, they often say in the acute scenario, what would you do to manage a condition? And I would say in the acute scenario, I would do this