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Tinning crock. Anyways. Perfect. You can start doctor whenever you're ready. All right. Thank you very much. And hi, everyone. And first of all, let me see, we are thankful to cr for the opportunity given to us to study today. And today I, my name is Doctor Rhoda. Anyway, I graduated from Ukraine and a qualified doctor from Ukraine as well. So, um today I put up this file about infectious disease and it's supposed to be pertaining crock, but medicine is medicine and we can all benefit definitely from whatever we are studying. So, um the aim of my lecture was to or is to try to make us identify or help us identify why ancestors are that or diagnosis of that and how we can um limit options to help us narrow our way down to a particular question. So this file was, it's an infectious disease um file that I put together and try to highlight um what's and what were the markers that's um helped us to narrow to a single best correct answer. So, let's move on now to the first question we uh I um after eating shrimp, a 25 year old man suddenly developed skin itching and some areas of the skin became hyperemic and erupted um vesicle and um the answer was, oh, is urticaria? Now urticaria is um an allergic reaction? That's ok. I huh. Is somebody saying something? No apologies? Do you think it was just by mistake from someone we can continue? All right. Thank you. So, like I was saying urticaria normally because we have different types of urticaria, there are reactions to different kind of things, allergic reactions to different kind of things. It could be um contact to something that we are allergic to. It could be something that um the patient ate, but some are delayed and some are immediate acute. So, in this case, um we all know that the hemorrhagic vasculitis um or also known as um HSP is an autoimmune disorder that occurs after an infection, maybe a respiratory infection and usually affects um uh Children around the age of five or below or around that age. And it's characterized by um rash which starts on the extremities and then it moves to um the body. So this question doesn't give us, it's not, it's definitely not bee and it's definitely not urticaria pigmentosa. Like I said, urticaria is an allergic reaction of the skin or of the body uh like obviously on the body. But for pigmentosa, you see like the name implies like some patches like pigmentation on the body. That's not what um this question um described and we know psoriasis as well is an autoimmune disorder. It has nothing to do with um being allergic to any uh infection and scabies is a mite infection. And we know that the, we should know that scabies, the characteristics of scabies infection. We have increased area like the fingers in between the fingers, we have on the wrist, on the genital area. When you have questions that will boil down to scabies, then we'll see that um, those are the ca th those will be the characteristics of um, the rash that would be described in the question. So in this case, it is an acute urticaria based on the description that was given. So I highlighted first of all, the person ate something that the person became, the patient became allergic to. And definitely you see the itching all over the body before the reaction occurs. So it also, um it's same with the, the se the next question also talking about the person eating something that they are allergic to with the uh rash and blisters on the skin. Ok. So, um, here with the second question, you see, we have something like allergic dermatitis on the question. Ok. One would want to think that, ok, it might be an allergic dermatitis but the with the allergic dermatitis, the you will not have the rash in a form of blisters. Yy, you might have rash, but it's going to be like very tiny form, sort of you will not have blisters once you have this blister form of, um, um, rash followed by eating something or maybe using a particular product that you are allergic to based on your history taking. Then most likely is, um, acute, um, form of allergic reaction, which, which is called urticaria. It's also a form of rash as well. Now, uh, moving on to the next question, um, a young man has made an appointment with the dermatologist. He complains of painful rash at the beard mustache area and the condition persists for several weeks already after shaving, the patient's condition aggravated. And now they give us the diagnosis as psychosis or psychosis, whichever is correct it not. Uh II I have to use the psychosis because psychosis looks um sounds like the um how do you call it like psychiatric condition? Yes. Psychiatric condition, psychosis is a psychiatric condition. Like that's uh symptoms that you, you psychiatric like is a psychiatric disease. But this, in this case, no, the other word for um um for this psychosis is this bomb um, shave, is it, how do people call it? Shave, bomb? I believe, bomb shave like after shaving, you see those bump bu bump like rash form of pus and pales that comes, we know what I'm talking about on the beard and uh behind the head, we have men suffering from such diseases a lot of times. So that's, that's the uh psychosis. Yes. And the characteristics of a those rash is they are pusto, the kind of rash are pus and pap, they are not. No do OK. Uh-huh. So that's why the answer is that it can be nodules and it's pustules, but it's not um bumps. So that makes the answer wrong. It's not nodes, they are not as large as nodes, they are not mules. So uh let's move the second question. The same, the same, the same you see the, you will always see in the history following the rash that the patient brings with a complaint that um they had shaved, they had shifts. So it's as a result of ingrowth hair, a hair, you understand? OK. So you see that in this question, for example, the man uh complains of the painful itchy rashes that appears on the skin under the beard and mustache one year ago. So, objectively, the facial hair growth area is bluish and with pustules. So, in other words, they are describing CSIS. But you see that now, in another way of asking these questions, they describe the rash and now we have to give the diagnosis. So let's move to the next question. And a 53 year old man complained of general weakness, loss of appetite and painful vesicles appearing on his skin, painful vesicles appearing on the skin. The disease onsets or occurs suddenly uh after an IPA insulation one week ago. All right, that's one cause of this aosis eps is an autoimmune uh disorder as well, but then it can be followed by uh an infection. So um now the characteristics, this Nikos Nikos sign is an autoimmune disease. But then the Nikos sign um shows that it has been infected. What this sign is. Niki's sign is um when we press on the skin to perform this um test, you press on the skin and try to slip it. You will see that um the skin is in a way like separating from the underlying um layer underneath the, the under lining layer, it is separating on its own. And then when you remove your hand, it goes back. But then in an abnormal way, not the full layer of your skin moving or stretching. No, you see it slipping off. That's how we know that it's a positive Nikos sign. It's all uh mostly common in um staphylococcus, aureus, um skin infections, staphylococcus or your skin infection. It's not dermatitis, Hepati form. We know uh dermatitis. Uh Hepati form is also seen in autoimmune diseases, but usually it is seen in celiac disease. Occasionally, sometimes in thyroid, autoimmune uh diseases. Most th some thyroid um th um autoimmune diseases you see, but it is typical of celiac disease and we know that um herpes is uh usually you would even see from the history um of maybe multiple partners or whatever. It's a sexually transmitted infection and the vesicles, the location of the vesicles they would state maybe the lips maybe the genital area and uh toxic like um it's a kind of a severe infection or? Hm, how do I put it a severe infection of the skin due to some toxins? Ok. And the history didn't give us into, um, choosing that. It didn't, it's not um herpes, it's not dermatitis, Hepati form. So most likely the answer is the um a tic and pes. So to the next question, the 33 year old man um who developed multiple rash on the skin of the torso, the body extensor surface of the upper and lower limb, all right, upper and lower limb and the uh uh um the body, the torso is the body. Now, for me, I would have already been thinking about HSV like I explained. OK, in the previous question, but let's go ahead and read um the rash is itchy occasionally fused together and forms the plaque. Now looks like eczema as well. Now looks like eczema as well. So as you read the question, sometimes you try to form your diagnosis in your head. OK. And then uh they went ahead to describe that the elements of the rash are covered with the silver white, fine scales, more like eczema um description or psoriasis description. So, oh, it's itchy uh greed tests. Uh grat sorry grat test results in three sequential phenomenal. OK. OK. So the Grah test, let's take note of that. The grat test is um used to look for the car, like to diagnose psoriasis and it's, is, um, it's characteristics. We have the tearing spots and the terminal film co um, and, um, the puc em, a pun hemorrhage, that's what we see in the guttate test once it's performed. And it's used to diagnose psoriasis. Ok. Now, psoriasis and, um, eczema, they are much more similar in characteristics. But eczema is usually, uh, uh, common, it's common in, um, um, kids because u usually it's um it's um believed that they are supposed to outgrow it around the age of five. Some, it's around the age of 12. But um it's in rare cases that they um carry it to adulthood. And if you see the question, like I said, it looks more like either eczema or psoriasis. Now you, there is no eczema in the option to even confuse you with and this is very typical of psoriasis as well looking at the age, looking at the age. So when you are looking out to diagnose a patient, we can take into consideration the age, the symptoms and then if there are any elements of tests that were run and I have, like I said, the history history about the, the, the particular um complaint or symptoms. So that will help us to make a diagnosis and then further to, to treatment as well. Ok. So the next question is the uh huh. We discussed um the scabies before. So now I think we have a question. The dermatologist has an appointment with a 30 year old man that complains of severely itchy rash that especially disturbed at night. That's one characteristics of um most of this rash, most of this rash they usually disturbs at night. The rash developed two weeks ago after he had returned from travel, usually scabies, uh always given with a history of travel plaque, given with a history of travel plaque, bubonic plaque, malaria, usually given with a history of travel. What other disease? Ok. When I remember we'll keep on. So they said the passing traveled. So now the characteristics of the rash, I told you in between the finger, the wrist, the elbow, extensor areas, you see the rashes on the extensor areas, the genital area and the thigh and the characteristics of such rash is, is kind of vesicular, it's kind of vesicular. They said it came along with um scratch marks due to the severe itching. So the answer is scabies is scabies. It's not shingles because shingles, it's not dermatitis, shingles. Um I i it's the trigeminal nerve that is affected at one side. So we have the characteristics of the rash usually at one side, either one side of the face or one side of the chest based on the mm anatomical innervation of the trigeminal nerve because um so shingles um usually goes into is a form of um it's varicella Zuska. So it's a form of um chicken pox. Let me use that word. Yes, that goes into latent phase. So it can be in the body for years on the trigeminal name. So usually when the person um probably gets infected again or has um um a compromised immune system, then they can be infected again in the form of shingles. So the this answer scabies if it was to be shingles because I already explained dermatitis, uh eczema, pyoderma pus on the skin, pus on the skin. So this doesn't give it to that answer. And this is not shingles because you have rash on one side of the body, the face, usually the face or the chest, upper chest. Now let's move to the next question. A boy had a foreign body from under his nail plate. Three days later, he developed sharp throbbing um pain at the end of the distal phalanx which is intensifies when he, the phalanx is pressed hyperemia and the body temperature is high and there is discoloration on the um on the on the nail plate. So this is not a recipe. This is not erysipeloid inflammation on the skin inflammation on the skin caused by staph. Now, its characteristics is such that we have the um um erythema like erythema in a matte in a matte layer, usually affecting the fatty tissues under the skin to the skin. So you see it's raised and you see that um erythema layer that is infected, it's mapped out of the healthy skin and raised from the healthy skin. Now, Paronychia, the other name for Paronychia is um with lo so you see the pass accumulation under the nail bed. Now, this sublingual Panati is like an inflammation of the nail bed. All right. Now, the question said that some foreign bodies talked in. So it has not yet got into the stage of Paronychia. You understand, because it could be Paronychia. It's not yet abscess because there's nothing describing a yellowish form of whatever under the nail bed. Ok? And it's not paic it hasn't got into the pa it hasn't got into Paronychia stage yet from the description. So this is an inflammation of the nail bed under and affecting the tendon as well. So the patient was unable to raise their hand, oh stretch the hand, the finger, sorry, the fingernail. All right, let's move on to the next question. So mother of five years old noticed on the head that her child is about, sorry. Her child is bad about mhm spots of um three centimeter. Ok. Um They now went ahead to tell us the length of the the bow spots which looks like um a ring worm, but it's not a ringworm because now they now went ahead to say that the child was uh playing with a with a stray cat. So with a stray cat, such infections are the the micro which gives it straight to the microsporum. You get microsporum is an infection that uh one can get from is a zoonotic infection that you can get from um cats that are not um well treated or vaccinated. So that gives you to that answer. So we move on to the next questions which uh said that a 22 year old infant developed subcutaneous red nodes from the size of the node is 121.5 on the scalp on the scalp. So later on the note sud, the temperature is quite high. Uh intoxication appeared. The original lymph nodes also have appeared. All right. So when they did the full blood count, we found anemia. And uh what's interesting is the leukocytosis, the esr increased and all. So it gives it to the pseudo for co it's not epic because I said before Impey is somewhat like an autoimmune and this is an infant of a 22 year old. Usually no, is not going to affect such um mm infants. And the vesicular pustulosis is not because vesicular pustulosis size is below one centimeter is below one pus, those are below one centimeter. Vesicles are below one centimeter in diameter. So the SCP leg mo we all know that leg mone are not some. What do I mean? What do I need to say? Um For uncles are like boils but not one. We know when we say bo bo for example, Lema where is the carbuncle? It's one like um form of a cavity that is separated, you get, this is not um it's not encapsulated. Let me use that word. Mons are not encapsulated. OK. So it's not, it doesn't give it out to it. You see the inflammation. Uh you can see um the infection on the whatever the location where of the skin, but it's not encapsulated that we could even measure the size. So which gives it to the Ronco Pseudo Ronco. All right. Uh Same with this, same with the next question. Same with the next question. So let's move on to the next mother. A new born from chronic suffers from chronic pyelonephritis. OK. And she had a case of um upper respiratory tract infection before delivery. Now, the delivery is term for a long period of what um is time for a long period of water were not broken. OK. OK. So now on the second day of life, the child developed an eryth rash. Later the rash developed into blisters. OK? Of one centimeter in diameter. And it is filled with sero subs uh ss purulent substance. Now they said Nikos is infected, then ss purulent is infected. Then now Nikolski sign is positive after the blisters had lance erosions developed in that place. OK. Mhm The child is in at the body temperature is sub feb what is the diagnosis? I have described the I've described the vesicular pus uh pustulosis is that usually is below one centimeter in diameter. Same with OK. It could be the pseudo furuncle but we did not see any question of OK. There's separation, there is su operation but the rash is Eric and blisters developed into blisters. That's not, that's not. I told you that pseudo is um pseudo furuncle is like a boil by multiple boils. Mhm Like, let me see if um a form of carbuncle but multiple more than one like together in one location. So, Rita's disease, it's a no go, go go. We know Ritas is an autoimmune uh disease that is car I know that it affects the kidney but it's characterized by, I have the mnemonic I use can't pee, can't, but here we talking about a baby anyway. So it doesn't go. But for it as I have a mic for can't pee can't see, can climb. So we have the conjunctivitis, we have the arthritis or atr and then, and then we have um the kidney infection also the triad for us to diagnose as Rita's disease. But it's not for neonates or infants. Ok. And it's not sepsis because we don't have um the symptoms though. They said the child is in it but not yet in a septic. Um the the not yet in a septic condition or septic states. So, impetigo neo Naum, it's a form of skin infection though it's quite um it can be from mild to severe. Ok. And is one of the form of um skin infection that neonates can um can be infected with. Ok. This is, is, uh, I'm going from the, the um, like form of vesicle, vesicular rash on the skin of the baby. Ok. That has this kind of yellowish form inside the vesicles or inside the rash. All right. It's usually affecting kids of early days of their life and for the mouth, you don't need any kind of antibiotics or anything to treat. Then if it goes to the uh moderate form of it, then we can now introduce some antibiotics to a severe form to treat it. So it's an infectious disease that affects um neon needs. Most likely these don't usually affect neon needs as well. Like I said, sepsis can affecting your needs but usually um not in the form of these descriptions. Ok. So with the new bone, we have different kind of diseases that can affect uh a new bone. Some are um new, we have something called neonatal acne. We have the uh is it the malaria or? Yeah, malaria. So there are different forms of disease that can affect the new bone within the early stage of life. Some are the physiological joins. Most likely don't require any treatment because they go on their own. They go on their own. All right. So are erma of the new bone? They go on their own. So now let's um right. Let's see for the next question during the new bone infants examination on the red skin was detected which occurred immediately after bed that is a normal phenomenon like changes from the intrauterine to the extrauterine. Ok. And became the most pronounced on the second day of um infants life. What's the provisional diagnosis? That's just an erma. That's just a normal erma, like transitioning from the entire uterine into the extra uterine. So it's just simply a ery, it's not toxic, has nothing to do with any um uh infection. Ok. Um This is car is characteristic of um the endemic um typhoid, right? So you have the circular erythema around and sometimes the center is uh what do you call it? The center is it should I call it normal or normal skin? And then the ring again, Eric ring again. So let's move to the next question. I think I, I explained the physiologic eryth already. So with the question, just one question in the chart. OK. And as I said, why not a transitional erma erythema? Yes, transitional erythema is, that's not transition, it's transient. So, yes. So the transient is after we have moved from the um how do you call it? We have moved from the simple um normal uh every time I that um uh the neonate is supposed to experience, do you understand? Now, transient means it has stayed longer? Ok. And usually is due to uh different defects, either um some sort of infection or it could be that there is some blood disorders or hemorrhagic disorders that is causing the erythema on the skin. So we further have to now check. Ok. That's the meaning of the transient. It's no longer normal. It could be due to an infection, bacterial infection or hemolytic disease or blood disorder that's causing the, the, the ery. Now it's no longer simple. It's no longer true ery or normal erma. I hope I have explained. So, it, it has become transient. Erythema is a pathological erythema, not the normal um, one that you see from the uh on the skin of the baby or the units. Uh So I hope we can move ahead. Uh mm I think we stopped here. Uh because you all know that aga scope the pinkish kind of look on the skin is also important when we are having our AGA co OK. Uh But that should be physiologic when it has persisted for more than, let's say two days. Then we know that um it's moving on to transient. So we have to monitor the child, the vitals, you know, vitals and other things, the temperature check the activeness or innateness of the newborn. So a child two days old, um the weight is normal. So from 2.5 it's normal uh to four, you been mhm to 3.5. But we can still take four as normal. Uh we or less than four downwards to 2.5. Now, the body length is 50 centimeter which is still normal. The exa examination intensely red elastic with preserved to goal. Now, there is uh no more respiration. The respiratory rates is 14, which is ok. And the cardiac sounds a rhythmic, the abdomen is so basically everything is normal. So and they are saying that there is redness is intensely red, but the baby is just two days old. But every other thing is normal. Like I said, if we check, if we, if the redness persists, then we begin to check the vital signs of the baby and monitor. But for now, um uh though the stool still has meconium, which is normal because the child will still be um excreting meconium, we know there's a dark form of stool. That's the new bone or neon, it passes out. Ok? So everything here is still physiologic and that's why we will choose the physiologic erma physiological ery of the newborn. Ok. It still answers the question that the, the lady asked. Uh huh. So, mm, we've answered so much dermatological. The, the questions are so many. I don't know if we can move to maybe other, but she is. So let's do this. A 27 year old sexually active woman complains of numerous um, vesicles on the right lips, itching and burning sensation. Like I said before. Now, they have indicated in the history that she's sexually active and the vesicles on the sex lips is itching and is burning the sex sleeps. They mean the, the Libyan Majora. Ok. So it is the herpes. Now, it is not syphilis. Note that syphilitic rash, it's painless once it is painful and burning, that means it is herpes. Ok. Let's take note of that. Let's take note of that. The rest options are wrong. It's not Bati Baris is like an infla inflammation of saying the Libya, the Bali gland and the on the mid uh Libya um Majora region. And you see it kind of, I don't know if I should call it a node or like a, just like a spot that you see it come out a little together with other symptoms like redness and maybe itchy. But here they have said that uh she's sexually active with a numerous vesicles. So it gives it soon hape instead of syphilis. All right. So a 26 year old woman, a 26 year old male patient complains of rash on the upper lip skin. Ok. So we know that uh herpes simplex uh one and hers two herpes one HEPA iss two HEPA. One affects uh to help you um re remember or remember that one to the mouth area. Two down. So one comes before two. So up and down the genital area for two. All right. So the male 26 year old male patient complain of rash on the upper li and the skin uh arose on the background of influenza with high grade fever pain and burning sensation. Ok. So the skin of the upper lip is hemorrhagic flips, fill, filled with ses vesicles and, ok, so it gives it off again to herpes. Now, that's the form of so on one side of the herpes on for the herpes, one that I said on the upper area, that's the uh mouth aa epi mucous membranes affected. So the lips under the lips, you see numerous vesicles. I know most times we have seen maybe uh normal, healthy people move around with such this thing, such symptoms with the vesicles and some kind of ulcers followed on the mouth area. Ok. Usually it's he herpes on the skin, the mouth form. All right. So, Erma already said, OK, it's not eczema. We already talked about eczema, contact dermatitis. You will see in the question that they talked about having contact with some sort of chemicals or maybe something that you are reacting to that is causing inflammation of your dermis. That's your skin. And I already said the dermatitis hepatis form seen a celiac disease um is, is uh usually accompanied with celiac disease and some uh few form of autoimmune infection. All right. So, OK, so same with the Erma HEPA uh Multiform. Erma multiform is almost like um the dermatitis, uh Hepati form. They come in different, like you see the patches on the skin, different um shapes, different sizes and all. So, a 23 we've talked about genital herpes, so painful blisters, itchy, burning sensation. Now, this is syphilis. I was talking about syphilis is painless, painless in the genital area. Ok. It can be in around the anus or around the penis or the vagina around those area, but it's usually painless. So just know again another question about syphilis, painless. Uh See I want, I, I thought maybe, huh. So, um this is a question about plague. I talked about plagues when we were starting earlier that you will usually see in the history of the question that the person traveled. It could be to Africa. It could be to India, usually endemic area and one characteristics of um plague is not even plague. Even if malaria, you will see my headache. Those are some of the symptoms and then usually um um lymph node, lymphadenopathy like enlargement of the lymph lymph nodes that are painful and or you also see malaria, but you see they will not confuse you, plaque will not go together with malaria. In the question, if it was Amtrak, you will see that the person had a contact with cattle. You will see in the question, the person had a contact with cattle. Now, when we're talking about sepsis, they will tell you about the symptoms of sepsis. You see hypotension together with severe like hyperten um hy hypothermia like a high temperature around the 40 degrees census as well. But you see collapse of the volume. You see colase, that's hypotension. You see collapse of volume as well with plaque. You also have severe high temperature. You see uh-huh but the, you, you always have a history, a travel history together with the lymphadenopathy. You see it in malaria as well. All right, let's move on to the next question. Herpes Zoster, I said this question before. Herpes um Zoster is um shingles. I said it affects uh that's it along the 4th, 5th intercostal neve, it affects the tri gemina a nerve which travels um also around the, the fourth feet intercostal space. So that's why you have it around the chest. But usually it's one side. Usually it's one side. Usually it's one side and it's a latent form of uh chicken pox. All right. So I said about Amtrak, you have a dead calf patient had examined, you have contact with uh for Amtrak diseases. You see questions like the patient, you see always that my must be dead. That history of being ha uh must have had contact with a, a cattle. Uh huh. A calf is a cattle, all right. A meat of a cattle or cow. Uh Time is fast gone. Lepto sclerosis. Um symptoms. It's almost like you have your muscle ache. It's also an infectious disease that has to do with aud in contact with a rodent urine, usually with a rodent urine uh or of stool, stool of a like infecting the food of the patient. Sort of what's usually the dum symptoms are also more like plaque or malaria. Now, with this pa patients, there is no travel history. You see there is uh malaria in the options of the question. There is muscle ache, there is uh Teric like conjunctive um oh jaundice, sorry, jaundice, trying to wrap up jaundice. Muscle ache, chills, high fever. But there is no travel history and the urine has dark color. We can also see it in malaria but then they didn't give us any if it was uh hepatitis. We know it's transmitted by also um it can be transmitted through um contaminated water or some food. Uh If it was in the history, we'll see. And then if it was infectious mocs, we'll see something like generalized lymphadenopathy, generalized lymphadenopathy. Usually maybe they might give you other marker in the question. Ok. So let's let me just talk about other infectious disease which you commonly see. And um example is um Shigella Dyer um which uh we can get from maybe the food, the water contaminated as oral route of transmission, raph route of transmission. We have the salmonella or salmonellosis route of transmission cholera. Now, rice waters two for cholera, usually the patients don't have high temperature for cholera. But you see really um severe running stomach with rice, rice waters too. But for salmonella and um shigellosis or shigella dysentery, you will see they both have green stool, they both have greenish too. But the difference in them for salmonella, they will tell you the patient had eaten maybe fresh vegetable or egg. Ok. So based on the history, you know that that's um gives it up for and then the greenish um stool or diarrhea. Now um with um for the shigellosis, they will tell you how the patient has the greenish stool and is stained with blood. Usually the location of the pain is at the sigmoid area. Location of the abdominal pain usually is at the sigmoid area. Ok. So each other. Yeah. So for the other one is rice water for cholera. Yeah, cholera, you usually see white. The stool is whitish in color or in the form of description. Rice water. All right. Now, tri trichinella is an infection that is got from, it's a form of tapeworm disease or infection. It's gotten from eating, not well cooked um pock not well cooked pork. So each time um someone comes with um an infectious disease of abdominal symptoms and the history was done, they had um pop and then you do blood tests. We found uh increased level of eosinophils in the blood. And then we go to the Trica uh Ella these Echo Cocci. They tell you about contact with dog ascaris is also a form of uh put to well infection, raph mote of transmission as well. Uh but it has its own manifestations. That's it's a form of diarrhea. You found, you find the characters of the diarrhea. You find some sort of mm you actually find the is it, should I say the egg form inside the stool stool analysis. Stool analysis. Yes, that's the word. Yeah. So good. God, we have three minutes. OK. Do we have any question so far? And we've got one question regarding the PDF. Was this the exam that was on the 23rd of May as I asked? No, this was personal, an infectious disease file. I put together. I also have that for, um, th myology because I realize a lot of students struggle. But unfortunately, I haven't gotten time to be able to, to also lecture that as well. I have, it's, it's, it's come, it's, it's a combination of different form of questions that usually uh or form of diseases that usually they ask. Usually they ask about infectious diseases. It's a large, is a large file. I think by the time you go through all these, you should be able to take the exam confidently there are different, different um um discipline I have for the pharmacology I have for the, the um other, other discipline. So uh this usually comes, you know, it's a question of an infectious disease that comes, it's called a defib Tiia. When you see it don't even, you don't even just look for something that has to do with fish. Salted fish is an infection gotten from salted fish. Ok. Usually they ask about it. Ok. So I think um unfortunately, so uh so it's um infectious disease like measles, we could see measles, we could see rubella. Now, measles and rubella, they are almost looking alike with symptoms. Ok. Uh measles, we you look out for the triads. The three CS, the uh Corisa conjunctivitis and the coupling spots, coupling spots is co spots is actually a case spelling. But you know you can just use the C and the coupling spot then together with the rash and the high temperature. OK. So the coupling spot can help differentiate from the and mac. If you want to look for rubella infection, check for occipital lymph node enlargement, occipital lymph node enlargement. The axillary is also there. But you see the oci um occipital lymph node enlargement and the characteristics of the rash usually looks or the um the other symptoms looks usually like um measles. OK? It looks like measles, but that's how to differentiate it with the mumps. You see they're telling you about um swelling in the parotid glands, OK. Swelling in the Perin gland and usually it's in kids, it's in Children. And uh you know, it causes infertility as well with male uh male Children. OK. Dial meningitis is a serious severe form of infection is very intoxicating. You see the rash all over. All right. Uh-huh, you see the rash all over the skin, non meted rash as well, all over the skin. Mm A non me rash all over the skin. You know that and severely high temperature. The kid is in it, you know that it is um Yeah. Yeah. So I think we'll have to so measles high temperature runny nose, that's the con Corina conjunctivitis. Uh the coupling spots, you see whitish deposits on the cheek mucous membrane. That's the meaning of coupling spots. It's inside the mucous layer in the mouth. It's just like a one rash red on whitish in the mouth. So that's the triad. But you see they did not specifically state that coupling spots they did not. So what's your provisional diagnosis? So I think that would be it for today. And I want to thank you for having me, let me come to the meeting now and see your faces and see, you know, nobody. I can't see anybody's faces. So, all right. Thank you very much for your lecture. If no one else has questions for the doctor, um Thank you very much for the lecture again. Can I just please have everyone to fill out the feedback form? It is very crucial for us to continue what we're doing right now and it will be really appreciated. And um no one has any more questions for the doctor. I can thank the doctor personally and everyone else and I hope you have an amazing evening doctor. Thank you too. Thank you for having me. Lovely. Have a lovely evening, everyone and goodbye. Bye bye.