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I got one mentioned. You wait here. That's more. That's more related, Teo, Yet past. I get to increase the intestinal absorption. That's great. All right. Okay. Just small diagram. Demonstrate how path I'm tired. Woman will make it peptide works on in time. But, um uh, including calcium in the body in the blood. So it's just in quickly. It is the amount of parathyroid hormone related that side produced, Um, which five to the Brian, uh, binds to the hospital, um, receptors, which increases like rank ligand obstruction, which find the right Clyde and receptor from the sugar. Everything result. But then board was option. When that happened, the police teacher beater transformed. Um, and this increases gene transcription for pique. HRP, um, so basically, continue vicious cycle off increase piece in child production on this, some kind of produce. And so we've got detailed to see the x o. C. Extra one that I'll pick, um, which he eats the Christian. Pretty question. Kind of a vicious cycle of increased, um, Pete HLP production. So symptoms of hypocalcemia. Um, anyone know any good way of remembering? I usually have, like, a rhyme in my head, which I was showing a second. But anyone in the chat want to mention it Going Stand orange? Yep. Yeah, stuff like that. Um, goes don't burn during. Yeah, that's the best way for remembering symptoms of hypocalcemia. If you see, since since I've been on a question, start thinking about hypocalcemia. Um, in our one we had done no pain on the confusion. Um, so bone pains Also one on my algia also renal stone. Um, uh, in terms of, uh, um, the current we are talking about polyuria on constipation. So, um, for hypocalcemia on the main quite here is just elevated calcium off more than 2.62 point 65 minimal liter diagnosis. Using these pretty much the main diagnosis type of counting it. So but obviously, you will be doing other studies. Um, make sure you got the crime underlying cause The parathyroid hormones, buddies, um, albumin levels and without even level was quite controversial. Some some people do measure it once we're doing, but it's not studies. Then you don't really need to measure it. A long car. Calcium said the albumin does affect calcium levels. They're bound each other. Loss studies have said that Protonix. Um, captain level was just fine. What's the bone profile? Just checking the LP, um, checking for three levels. Get the bone performed fevers, Any other bank. Would you like that on? Also, a lefty's so commonly chronic liver to these forces sometimes causes hypocalcemia. Um, about another one. Just be aware of, um, it's quite poorly understood. Um, but it's just the length of been found. Um, so management, first line. Always IV should on a lot of the IV is this is quite bad. Usually give you a diuretic. The goal. Anyone know how the new tire it ticks would work? Teo, the quit caffeine get with the diuretic. It was just, um take the entry ct to transporter. Um, so obviously, blocks are usually casting transported into the cell. Um uh, but blocking that disrupts the potassium. Um, movement on it changed the grading within the triple. Lumen, Um, some more capsule excreted. Not really absorbed, um, with second line. But they make it so they just work. And did it show? What? What's your thought on talking tone in this? Well, any put a bad line on much action of catheter in and working with chemicals. Um, but they were so, um Oh, geez. Casting results in and kidneys all. All right, the question for one time. Next on political emergency. Um, and 83 old man presents the emergency department of this is a cough fever, fatigue. He has known to have a party, medical history, or COPD and lung cancer, for which he's undergoing chemotherapy patients. Basically privations. Cute. All right. Of 101 BP of 851 or spiritually of 27 any temperature 38.2 degrees and 94% on. So what is the next step in the management of this patient? Just a couple of questions. Couple of minutes, couple of secondary. Right? Okay. On so long. You going to be IV and perfect, I guess. Yeah, in a way, that's correct. Well, uh, but the question I was thinking, what? The next best step in the management IV Antibiotics would be part of a management, but that would not be the first step anyway, because of the patient's BP on the IV fluids actually would be the right answer. Um, because patients is very even on a stable. So the first thing you wanna get my view Should straight to it. Um, and I did ask about it would come after, um, after this, Um, so I'm getting a lot of you get that. Uh, this is a neutropenic sepsis. Um, so the patient has prevented the coffee and fatigue, science infections, the president, and you have off medical history off lung cancer. And he did after the therapy. Um, so anyone that has an infection and they just got chemo you was thinking about each accepts is and heart rate is high as well. 101. BP is very low. Argument on account stable were spiritually also very high on. We've got pretty high temperature. 98.2. Um, right. So moving on shoppers and sorry. One. Just just to add on, um, in order to question IV fluids and antibiotics, uh, just that it's active, and you could do it simultaneously. Gal's. Yeah. You could just feel so well. Um, one question, so yeah. Exactly. So he's not for a bus on. Um, the patient is fine. Sent out of options. That would not getting better. Best that in this scenario. Right now. Um, yeah. Good. Good on picking. Eventually, redness give option, but most likely they would drop in that shot. Um, so that's fine cake and usually accepts is so definition plus criteria very common complication of cancer therapy as the neutral count is lowered. Um, because it's chemotherapy, Um, and this internal increased infection risk the criteria for you to be exceptions. Um, it's usually Steve Oh, 38.5 degrees, uh, one to contractive. Readings for over 30 degrees in a patient with mutual count of lessen their blood five times. That's not other common tactic. Symptoms are also usually president before the low BP. Try the confusion, the nausea and vomiting ago. The common causes of nutrition accepts is just listed, some of them to the grand. Negative on the ground is fungal as the colon connective be coli Ah, the other ones left over there, uh, fungal. Usually candid or pressure that specialist for gram positive from the staph stuff. Boy, um, some of the ones over that So, um, moving on to investigation remain medications to live here. Just identify the organism to provide the quite as far as the treatment, um, the blood cultures would be done. Blood test um, just always good to get the white cell count. Anyways, um, chest X ray, um, GI and PCR beat him and you and it's always pretty much identify the top bullnose. Um, Anyways, um, a CT scan Just judge, um, cancer itself is well on any other. Further testing comes in management. So management really depends on the patient on just the cast. Um, you know, risk for high risk. That's done using exploring assessment, which will come on two. Um, but for the lower one, um, it's usually all antibiotics, so crab and quinolone on eight million issue on these individuals are usually people have done that. Be stable, and they don't have any other complications as listed there. Usually COPD come as a complication is low in that scoring nothing, um, and high risk individuals would be you'd be giving understand? Basically, I mean, um, and really point of stuff on because it's in when the patient is a fibro scan. Blood tests and returns normal for for 40 hours. Any patient may be a risk off. Um, actually, except during the course of the chemotherapy. Um, when checking on putting on their results of your equipment that's usually given as perplexed. Yeah. Um, So this over here is the master Risk index. This's what is used individuals in the high risk for low risk. Um, for accepted. Um, if the school is above 21 that means patient. Okay, I think, uh, this one also is really important steps in sixes. Well, um, is anyone else you guys can put some of that sticks in the chart? That would be great, because it's a very, very high. Your question of finding Well, um, giving continuing blood cultures. I cleared. Good. And we go a, uh Yeah. Perfect. Yeah. Gets up the usual, Remember? Is, um get to take three of those other ones, someone on the chart just in Buffalo, which is great on diet member. Just give it to you. Yeah, that's about it on Get flu on. Take the recent take blood cultures measure. The lactase is kind of paper, like on, uh, measured urine output. Just get three. Take is coming the way I remember. All right. Good stuff. All right, so one for next question. Um, 29 year old man, as we should. I've been diagnosed with lymphoma around two days ago he started on his chemotherapy regime patients off a week and fatigue. There's noted. Decrease your output would find the fluid overload blood test a range which showed up following. So to prevent the prevent complication above which of the following perfect be given trouble. Seconds. Okay, so, um, good stuff. Must he did get the right answer. So olive Pernal on. So going through this question patient has been diagnosed with lymphoma. He started chemotherapy two days. Patients that feel weak and fatigued. Um, on we have decreased urine output afterward. Overload AKI over, um, on the blood. So we're looking at the blood test with the normal range is stated that we've got low calcium high crackling in and high potassium is we'll just try to deal with a tumor lysis syndrome picture, or, um, into molasses. The way I remember is everything is pretty much increased part from calcium, which is quickly get hypocalcemia in two molasses syndrome. Um, and that allopurinol is usually Publix. It's given before chemo. There, um, anyone know the mechanism of action of allopurinol she put in the trap? Yeah. Perfect. Um, so any of it, you know, rule common. How work in a second. Um, your tumor last in drugs, the biochemical change changes to add back taking three stages where members, everything increases. Um, apart from so the main thing. Yeah, we're looking out How you you're passing the urine hypokalemia hyper senior weight craftsman on hypocalcemia. Um, but the way to remember it also is that with chemo, last syndrome, everything interest in Italy is being released. Um, So, for example, potassium and on four stayed all interesting. That's where you're getting. Um Ah, hi. I clean and hyper between it is interesting. Components are being released. Uti destruction of the team. Um so criteria is usually in laboratory on clinical based criteria and space of Cairo. Bishop, I'm quite there. So laboratory, you're quite truth or more falling. Either increase your gas it or potassium or I phosphate. Why they lowered calcium. But obviously, in those values, you'd be looking at those values. Um, in terms of Pinnacle chemical, you need elaborate laboratory. Um, diagnosis is well, tough One or more. The following that over there, increase your, um, cracking in 1.5 or more. Oh, and a k. I said jack, time have particulates me a the okay to molasses syndrome. Uh, common symptoms. So, um, a little off a chi symptoms would be president. Of course. The the cereal or leg area of domino pain and weakness. Um, more the and vomiting and palpitations. But I think the key thing that would cause that is the hyperkalemia You're lucky to get ready and arrhythmias on palpitation of hyper hyper clena. Um, fluid overload again and achy. I, um, And on muscle cramps and spasms, anyone know why you might get muscle cramps? Um, completing the bike, a couple changes, but my calls up. Yeah, perfect. Well, I think all right, um, investigation. So use me. Um, just, uh, check the renal function. Um, blood, um, to get the phone again. Renal function as well on EKG. Just initial. There's no arrhythmia. Um, no. Going with time keeps the heart, pina. Okay, on, um, so treatment. So the key thing is aggressive IV fluids and corruption or electrolytes. Um, that's not the time. If you do get the tumor like a syndrome, I'm comfortable. Maybe temporary diet before, and I could give the profile axis for a patient that you may think might be higher risk. Um, again. So this was this is what we had in the questions are allopurinol was the one that we, uh, gave in our question as a prophylactic. Um, usually you can get ah, or are allopurinol for lowest individuals on doing chemo. And the usually that's what That I responded, IV, um, on you cannot rescue. Okay, um, with your case, Um, it's just enzyme. Basically. None of your case on it converts your cast it. Teo, I think Atlanta, which is more salable, they could be easy exploited. So all the buildup off your cast it is eventually, um, excreted in the urine. Because most valuable comment, um, something in your calf average anteon come from comes from the release of periods. So brakes on a, you know, gives you pure in from the team. Alexis, Human life itself, um, on Blandine is converted. Do it. Which is an American and 20 by your case. All right. Okay. On. So the question, uh, it's a trick. You in it as a 53 year old woman that was finished taking the therapy regime, but lung cancer. Um, yeah. She tended the oncology department for a routine blood check on explained it. Unusual tingling, feeling enough fingers. Blood. Russia by blood. Results should pulling. And we go, um, some results. That which chemotherapy drug most likely cause of the above. Okay, couple more seconds. Okay. All right. Okay. Well, there, then. So, um Right. So, yeah, most you've gone for the correct on the, um um if you have one full No, I don't. Which is I guess the lottery granted been Christine's all basically, um, hum, uh, for the answer over here is indeed, um so although vincristine doesn't cause perform, you're okie So this is, um, and hypermnesia is French is too. So we've got magnesium. Um, just a quick note in this question, you know, really at you're not really a quiet, you know, um, chemotherapy regime. Basically very special knowledge with the main thing is knowing the pharmacology behind these drugs on some comment like these drugs are very common. Uses this pattern so commonly used in place and Christine and just knowing common side effects. So just two quick know that you don't need to know what what would be given for lung cancer. The main thing of it is just picking out symptoms on what's been what's going wrong in the blood. Um, it's just the pressure from European hard. My meat doesn't make this. You want this back in, um, moving on. Next question. So fortunate, Shoulder man, uh, presents the emotional department with increasing fatigue and shortness of breath. There's a past medical history of lymphoma and COPD. Lymphoma has been treated previously previously with chemo and see if he's well controlled with salbutamol. Once a week on examination, a hot mama which is falling most course of this presentation again. Um, just quit. Know that you don't need to know again then from the treatment or anything. It's just based on from college in common type check books on the occasion to give it a couple of seconds to this question. Okay. Okay. All right. So and it done so mostly again. I had gone to my aunt's A Yeah, the split between doctor for my quite down to he doctor. Um, so it's a pretty common drug, um, useful in plumber on. But again, you didn't know that. I mean, being over here is quite mild. Fetal heart murmur. Heart murmur has been heard, and it's very common doctor movies, and it's one of the main side effect is cardiomyopathy. So, um, have you tell her the question? This is all that type of toxic agent. I think the main thing about these are just little memory work with. There's quite a few agents I need to know. Quite a few different classes off that stopped occasions as well. Main thing is, just learning the key one, um, learning the key side effect. So I've got some of them listed here. So without client alkylating agents, um, maximum off action is, um, an additional reputation. And then the key side effects off taking agent is hemorrhagic cystitis, mild suppression, infertility, and your happens to talk about for my age, not got it alkylating agents. And that's what you would kind of see. And that one they would not be. Um, any card. Um, i'll be fine. Um, agent, um, pattern, we just came across. Um, so the common side effects and it works also by an addition off the air. If occassion, um, also keep that is on 50 is well, that's also important to bear in mind. Public antibiotics for something works very differently. So that's about 22 types of over here, you might. It works by the gradation of being a, um on side effect. Main side effects are lung fibrosis. Carried, um, and poor circulation on, um, anthracycline such a dark room. It in one of the key side effects are cardiomyopathy on. They were quite inhibition of RNA. And, um, and was anti metabolite, antimicrobial tubules. Kind of some others that are listed. Um, so again, couple more as the flight five or so, um, main side effects are mild suppression dermatitis. And be precise. Is, um, meter Track stays well, very commonly used, uh, drugs. A very common side effect. Oxidation key key side effects are liver, fibrosis, lung, fibrosis, a modest impression. And me close because I it is. Well, um, was last tired. Be I'm securing Larson. I dropped compromises row. Um, but maybe you don't need You don't need a lot of them. I think most common ones that they're beating me to track safe for your entire beating. Well, um, and the time sexually keep, uh, antimicrobials that came in Christine already on intestinal. I did with the other thing you would be expecting with something like, uh, vincristine. And we got some other such a pack change on Tobi ovaries, too. Um, the taxanes inhibiting my nurses, um, and call me again. Each cleaner with him on, um, provides almost inhibitors, uh, effect wise some reason, um, on, um, breaks in the in the front. Um And he, um it does have some key drugs over that. All right, so, uh, moving on the lung cancer now, the next topic, um, long cancer, there would be an X ray. Don't need to pull. All right. So for lung cancer on you just picked up in small, so I'm nonsmall long time. Um, and it's quite a few different custom on small cell lung cancer. Still got a question for women. So large, so and obviously the constant on from two adenomas bronchial adenoma. It's not really a passing over, but most of them eventually progress on to becoming a cough now. But I did that anyway. Eso talking about non small cell lung cancer birth called different ones. And they're very I'm quiet it. So it's good to know the individual presenting teachers on the fire in your plastic syndrome. They can be common. Find out the damn questions. So, um, with a d a carcinoma, it is one of the most is the most common lung cancer. And it's combination and non smoking. Usually the peripheral in the lung, It least the diner Comast your, um, on hypertrophic pulmonary off your neuropathy. Can't anyone explain what, uh, HBO I perfect policy. Osteo is in the shop. The common trials with annual nose. So usually this tried off bishop having pain for the authority of the joint on various side. Think as informational pairs that usually in March stop early. My Christmas. Okay, then across. Name is you should get glandular squamous cell carcinoma strongly associated with smoking on usually central in the lung. Um, uh, yeah. And then across them is more common in women. Um, pastime, uh, common symptom or common syndrome in school himself. Cost them is is the t. J choppy, uh, leading to have a cafeteria? Uh, you also get that topic TSH. Release on. That leaves the heart if I order them. And this kind of cutting his own going to cost them is, um And again, you also get hypertrophic pulmonary off shore on. Um, it's, uh, swim. So, um question I have in it. Um, and it's microscopic, large cell carcinomas. Um, you see, quite undifferentiated, but it does have a record prognosis. It wasn't strong, efficient, that smoking, but can be purple or central. Um, and infusion last, you know, with the attack. That's why it from a poor prognosis that you should pick up late stages well, are the oldest cough moment I know the one that no very related to smoking can be peripheral or central, um, another one poorly diagnosed on common symptom off. This is large amount of seats in speech and produce, and you get this is a long term symptoms without any infections or anything. There's just a lot of eating production on our last one bronc, you know, move on. Originating the kids, um, usually, uh, can lead to cost know it syndrome. Um, but very rare, um, cost down syndrome and the carcinoid tumor can usually be 80. Um, it's fast growing. Tried that what could be slow growing. Those are all a non small cell lung cancers and teaches of them small cell lung cancer on some common feature and fax here, the strongly associated with smoking, usually centrally located another one that's undifferentiated with very aggressive and very early, um, passages of the very poor prognosis and picked up late stages. Well, um arrived from the cold chipsies cells on both of the end of clientele. That's why you get a topic ACTH release, which may lead to Christian windrem. Um, so it's a very common paraneoplastic syndrome or small cell lung cancer, um, SIADH as well, so which will lead to you believe that hyponatremia and also lumber Ekins injuring. So usually it's muscle weakness and muscle pain. Um, but it's basically where I'm 20 produced toward your, uh, trouble skates is a calcium channel, and you'll, um yeah, the overall can call feature must have very similar clinical features of cough. Chest pain. This is near, um, and weight loss. Um, in terms of diagnosis, chest X ray is usually first line. Um, but contrast CT scan is the one the confinement days. Usually. Oh, speech and psychology is done. Bronco stop. He's on histology, and pet scans usually show good metastases. Management, um, the first line always go back to me, but it's usually contra indicated and doesn't situations. So it's stage three, stage four usually love it to me on translocated. If the TV one is below 1.5 m, it's superior vena cave obstruction, as you mentioned earlier on parole effusion. Um, with the tumor is near the hilum, or vocal cord is affected. Um, second line G rated therapy. Um, with small cell like that, it's usually diagnosed late stage as impact in metastatic disease. Um, if you know, you would respect that, but usually politicking done for that common complications. So, uh, uh, CEOs final started Superior vena cava obstruction. Um, Horner's syndrome. Um, so does anyone know Want a syndrome is on what you get in 100? Yes. Perfect. I first my assistant. Ah, that's great. So, um yeah, yeah, that's usually occurs because the pancreas schumer and what happened is the back of humor. Well, basically compressed the lateral cervical perfect. Someone's put in, the child's up. Um, and you may get voice hoarseness or so. And, um, that happens if the pancreas tumor will compressed the required laryngeal, um, pack of peanut use a tumor in the apex of lung on Usually is dana carcinoma or swim. Yeah, but the other, some of the other ones can also, uh, a, uh, type of humor is Well, um, and of course, the other paraneoplastic syndrome doesn't mention. So the idea is, uh, on the topic. ACTH really, truly in the individual comes right. So over here left. Of course C p scam on that shows the lung cancer over there. Um, anyone know what the chest X ray shows from the chest X ray. Anything wrong with anything wrong with it? Not really a cure shit to keep in the middle there. Yeah, there is a bit darker area. That's fine. Yeah, no renewal for X. Amazing is actually the pancreas tumor. So there's a pancreas tumor on the back on the upper right lobe. So we've got back of him over here. Um, it may seem like the may See, like, a moment. Go back to the pancreas is just causing the compression of it. But it's no, a little right. Um, you can see that there's a massive the upper, right? Uh, all right, I think. All right. Um, and she's a quick word about my feet now, as lung cancer has no quickly touch up on this is Well, um, so you can either have local, uh, or distant metastasis. Local. If you should just cut yourself writing to surrounding healthy tissues on the lung cancer, you just around spread to the of the load. Um, with distant, it's spread off cancer cells throughout transport systems, so either through blood vessels along packet with Cassidy's really depends on where it's spread. So whichever almost affected you would get the top. Um So, for example, and if the liver spec did, you would get you on this theme a fever, liver failure. Um, if the bone is like they depends where, um, where it's being metastasized and the vitamin d quite common. Um, spinal cord compression. Uh, you don't get bone paid. Weaker bones need infections. Well, as what you make a hyper county man raised GLP due to the, uh um, and it's called the person has to be 10 because our many canisters as a big mentioned previously the prostate on breast cancer, the most common. But there's also the cancer lung cancer. All right, Okay. And on the chest, X ray. What we got here on the chest. Sleeping on a child? Yes. Cannonballs. Yes. That kind of the lung cannonball community and commonly caused by good guys. Okay. All right, Uh, on our last question, uh, so 60 old woman presents the emergency department with the yellowing off her in, um, yelling off the skin fatigue. And tomorrow is castrate pain. On examination, there's no tenderness. Aside from a powerful mass in the right upper quadrant, she also has some weight weight loss. In the past two months, laboratory tests show and weight lp been a ruby in CRP, you know, most likely other night underlying diagnosis for investigational bickered out. Which sign? Okay, just a couple of seconds. Okay. Right. March. Chemo, Akins. More chance. All right, guys. So if it so, um, quite mixed. But the majority of you did take a, uh, which is quite doctor. Uh, he's got, um, so looking at the history with jaundice tightknit gastric pin, um, palpable mass, Um, in the right upper quadrant. That is no tenderness on. There's been some weight loss in the past two months. Um, so most likely going to be some sort of counter. A swell cause. Weight loss on We've got common presenting symptoms off pain issue on this weight loss on the gastric pain, which are all symptoms off the cancer? Um, one of the investigations. This is a CT scan in which you would see a double duct. Okay. And quest it. Cancer, most smoking. Very big risk factor Age. Uh, chronic pancreatitis is being overweight. Um, diabetes inherited inherited syndrome. Agent C, which is average treated non polyposis colon rectal cancer on an interesting from is actually on Pete Shaking Syndrome. The birth committee course. Correct terms of the also linked at the counter. Um, Bracco. One in to think on a very encounter that I get another one. Linked in graphic on multiple endocrine year. Um, men usually causes, um um yeah, men. One roughly. You guys, um n one. The pain this joint about cold. Last year's time. We've got a weight loss there. Um, dark urine stools. Anyone know why would get dark urine and peel stools? Yeah, it's a truck. Have joined this for. Why are we getting the pill schools as well? What would be instructive? Um perfect. So, yeah, that would be instruction of the common bile duck. So your bowel can get into the stomach circulation and get the, um, we know that you know, uh, so it can be excreted in the urine, but it won't be treated into the intestine because I'm about as being blocked. Don't get diabetes. Um, because pancreatic dysfunction. Yeah, to re again, you know, getting the bile and the fatty stools and try to sign off lignin. See, anyone know what trust this kind of malignancy is, but I get my greatly from lumber phlebitis. Mostly. The CT scan is the key. Ultrasound done commonly. Easel. And it's what sensitivity quit. But CT scan is the gold standard. Usually to diagnose by 10. You get a crack, it doubled up trying candy, MRI we can use well, pets, guys, um also may do I may check their bilirubin LPN common tumor markets. See a 19 year on, um, in terms of treatment, uh, tumor section it curative. Uh, you can only do it if it doesn't involve the periods that without you any distance. Uh, usually it's neat presentation. There's no easy respectful. Be usually, when receptive. The whipple procedure. Done. Um, Pellet, If treatment from testies by chemo, radiotherapy, and stop it, then maybe future start. You just need a, um any other button man Also pain management All right. Go. Um, thank you for listening. Um, that concludes our on college lecture today. Please allow feedback form on. 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