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about house about how some diseases are managed clinically. So we learned about a lot of drugs in mode our and also a lot of cans and of action in minutes. And we don't really learn how they are flat in the clinical setting. So I'll just give you some insight about that. And usually if you talk about clinical things in that space, usually they will tend to get your fine marks. So hopefully that so this is just another line off. The conditions will be going through in the Selectra, so I'll see her start with us smoke. But I just give you some basic knowledge clinical knowledge of our pastoral that is required to basically enough strain order to diagnose asthma. You have to do a spirometry test and many matter of our force experience free for you, which is normally significantly reducing asthma. And the force, FDA say is normal. And then the ratio should be less than 70% and then, to make sure you also need you to the bronchodilator reversibility test, basically you keep the patient a bronchodilator, which is used as a treatment for last mark, and then if the spyrometry results I improved. That means they have a smell. And then there's also the fractional exhaled nitric oxide test was smasher. It's the amount of nitrous oxide that is Exelon aspirin. Usually there's a higher level of nitric oxide. And when you take a history from someone who's a smart say, you need to remember to ask about all the allergy mediated in to be conditions such as except my 80 va. Because usually they broke up, and it is also very important to ask what the person stop waste, because space occupational asthma, where by the patient will have asthmatic symptoms Onley while they are. We're probably due to some happens that and also report that little asthmatic patients you need to before prescribing them aspirin. Because aspirin is really to aspirin juice. Ask my insulin nations and worsening of their conditions. So this is how it's mixed managed. I know it's just a bunch off. Afternoon, Inspector. A ball. Throw it in a little moody. In motor wise, you've probably learned, or you will eventually think beat. Oh, calmness is one of the treatment for our snow. So, for example, salbutamol. These are the first line drug, so the patient comes to, um, basketball. Usually you just get them supportive law. And then if a couple of weeks they don't come back to us, it's not being working properly. So you have to go to Step two, which is giving them salbutamol, that also giving them because on inhaled cortical steroid, for example, your medicine or flea city cancelling, Oh, good examples and then usually slow dose. So basically, this is now Step two. And then, if a patient's still not improving you and on leucotriene receptor antagonist, I just want to know Cast, which is an oral medication. That's the third step. But then, if that's still not working, you can add a long acting, long acting albuterol calmness like salmeterol. So basically, however, whether the leucotriene receptor antagonists is still continued is dependent on whether they have bean. Some improvement in Step three. If there's been literally noticed improvement from step to to step three, then you can just discontinue the liquid tree and receptor antagonist. But if there's been a tiny bit of improvement, but it's not really that good, then you at the lab, but you also keep the leucotriene receptor antagonist, and then it's just still working. You upgrade the patient into a medium days? Uh huh. Get steroid and then level sex. If level fights not working you had a high does cause they're sterile. Or you could add some other drugs, like a miscarry *** tenderness or a PD saying, uh, fearful in. So basically, this is like the law step, and it's quite rare that this happens. And usually if the patient has been managed easily, except for, for example, in holding fairly well about every three months, you try to step down the treatments. If the one step, we try to give that to step three. So how are you able to see a B day which, because it's an obstructive disease based, um spell electorate, would show an effigy one of S E C off less than 70% similar to, uh uh, no. However, yeah, you should do the Bronco dilator. Reversibly Jesse will have no effect. So that's why I says post bronchodilator spirit tree is less than 70%. And on the checks X ray. Usually you'll see hyperinflation, some boo lays and also five mg diaphragm for COPD. And this is basically the different stages of COPD that you can have, and it's dependent on the 81. So COPD management is initially. If the patient is a smoker, you obviously ask them to stop smoking because it's quite high risk factor in COPD Thank you to happen. You could give them some nicotine replacement therapy such as clean, appropriate and that's first line. It's usually it's like and our first line usually use the sample was Summer Mr Miscarry Me next? Mm, they beat I'm on time. This and then further treatment is dependent on whether the patient has some athletic features or not. So, basically, um, if they're all suggestions of the patient is a smart say or the patient is can be responding to steroids by CS I become it hasn't. Uh, well, that has been a previous diagnosis off Asmara, and they have I phrase using it for level or high level of IgE in their blood's. Then you would give them a level in an R. C. S similar to what had happened with that and a a small. However, this is not the case. Then you would give them long team spirit thing and turn your list agonists and then, uh, long acting Peter Tightness, and then eventually you'll increase. Do if I. If it doesn't work, then you go to a summer and then you will also give them a cortical steroid respective. Or whether they have that's matting features or not, As the other drugs you can also use in, she'll be the management used all of theophylline, which to be the three inhibitor. You could also use a prophylactic antibiotic therapy, and sometimes you could also use her medical it, especially if the oh, if they are causing a lot of phlegm. And there's also long term oxygen terribly, which can be used as well as long. You reduction surgery as a very last resort. So now we're going to move to be nonprostatic are playing so so usually a patient with the nine hyperplacia would present with some hesitancy. Basically, when they go to the loo, my pee would not be coming out and just plain, which is basically when they go to the loo. At the end, after finishing urinating, there would be some eye drop. It's going out, and not truly a year is. When they go to bed, they have to wake up several times to go to the loo and then urgencies like whenever they feel like they need to go to the loo. It feels like a big, urgent situation, and they have to do it. And they got by cold and frequency, which is basically they have to go to the liver the also and complications that can result combination prostatic hyperplasia or recurrent urinary tract infections. And you could also have doing three retention in the bladder, which is very, very painful, so to manage, be nonprostatic occupation. So the first line is an Article one antagonised, which is tamsulosin and how, as I does household side effects, notably like Vistaril hypertension, especially when patients stand up, they can feel a bit lightheaded. That's also dry mouth and and if the patient is not responding, probably do tamsulosin. Usually you'd add one more drug, which is finasteride, which is a five alpha reductase inhibitor, and five other reductase usually convert tester testicles from to the more active for so this is preventing that as a side effect. However, I will you tend to cause erectile dysfunction or gynecomastia, just basically breast to share in males, but this is because the active form off testosterone is important in these functions and the inhibit eyes, real big days receptor for and anticholinergics a doctor, if innocently, also be used. If stories and boarding symptoms possessed and it'll that conservative pharmacological management is not working, then you may move to surgical management. So basically, there's three main ways of doing so. Transmitral recession off the process is basically like cutting out the bulging part of the prostate, usually transitional zone. And then you could also use a laser, which is called whole lot to my delay, the obstructive bet. And then there's also your left, which is basically lifting the prostate and displacing it so that the patient can easily more easily go to the liver. So now we'll move to diabetes so that these are like several off the drugs that are usually used in diabetes. So just have like so I'm just going to you with the table, this one so basically the first line in diabetes in treatment of diabetes is metformin. We talked about Type two diabetes to basically metformin is taken orally, and it would increase the insulin sensitivity off the patient and also decrease hepatic gluconeogenesis. However, in some patients it is not tolerated and is contraindicated. And in such patients as First Line, you would use that insulin or we are all clear. Get it does. And so finally, it's basically a drop that stimulates the be to sell to secrete more insulin. And again it's taken. Or really, uh, it is important to know that with something over, you know, one of the side effects is weight gain, which is confident in Asia. There's also other side effects, such as I got a senior. I've been treating us and you could also sometimes I would be inappropriate secretion off antidiabetic Hold on and four pg design. Sorry. Yeah, basically, they activate. The GPA are gallon receptor, you know, leukocytes, and it will promote fatty acid uptake. And I did a genesis and again, unfortunately, it can cause some weight gain. Okay, classic leptin's that basically DP be four inhibitors and the increasing crediting level, which will inhibit good consensus, is and again there are taken or late. So you, the patient who's taking metformin has no responded, probably to the treatment on video on their glucose levels. Still quite high. Then you do it, you'll hear a big which is basically giving their metformin and one another drug, and I've gone through a gliptin signoria spent. You get to say so. Another drop that could be added on began his SGLT two inhibitors, which basically prevent the reabsorption off blue goes in the kidney, and again it's taken orally. When did you last year. So when advantage honest you know to give it is that they know course Weight Gain's. So that's good and again for people who do not tolerate metformin. The second line treatment is Joel therapy, with just adding two trucks. So it's the patient now still does not respond to treatment. Despite the second line therapy, you may keep them insulin, even the most of the time insurance is seems to use only for Type one diabetes management. And if the patient is responding to metformin, you could also, alternatively give them but trying terribly, which is basically just using three dogs, three drugs together. And if the trouble currently he's not interrogated, and the patient has a very high be in like more than 35 that you could use a jockey one agonist such as exam it Terry, which basically is an incredible mimic and inhibit fluke consecration and increases insulin secretion. These drops are usually introduced, some to get some continuously and or related. And basically, unfortunately, the king lead to pancreatitis, and nausea and vomiting are side effects and leads to weight loss. So now we'll move to call that fury Syria So blue downright X or using cardiac failure. However, they're only there to manage symptoms. They don't really tackle the fundamental problems and the root causes. And us First line. Usually it used 18 him bitter and be two blocker together and then a second line if he ate inhibitor each block on are working well, you could add on an older sister and antagonised No, basically, uh, the third line treatment you could use either Brandon Uh huh. Or digoxin sort of trouble Certain hydralazine in combination with nightly. And I was a final results, but also used called jak resynchronization. Okay, Sorry. Obviously you also have some concern. Like when a patient comes to you, also need to get them lifestyle advice such as obviously increase exercises. So now we moved to atrial fibrilation, basically to the way you recognize in atrial circulation on an E. C. T. Is that you look at the CT. The top one is a normal CBC today, and then the bottom one is someone with atrial fibrilation. So as we all know, there's like the P Q R Rest way or ST Wave in a normal the city. But in someone with atrial fibrilation, you will not see the P wave like there's not really a P wave here, so that's one of the big sign. Also, there's also some sort of a tachycardia going on, So basically the part rate is a lot is quite a lot for seven normal in if trail super relation. Uh, you can also see that it's quite irregular, so we call it a irregularly regular rhythm. And for atrial fibrilation, you basically have to school two ways to control it, a basic, and you need to control the rate and all the real. The rate is basically trying to get the tachycardia back. Dilate that, and the rhythm is basically just trying to make it again. And for a control you could use be two blockers. Uh huh. And you could also using on dihydrofolate in see calcium channel blockers and also you can use two option B second potential blocker channel blocker and then for rhythm controlled. You can also use Peter blockers, so basically be two blockers. Happy it antigen do both great control and rhythm control, which is why it is usually first line and for rhythm conducted. You seen also use like until the next. So just a little drainage or flecainide. And then, as a rule, it's resort to use electrical cardioversion, which is basically trying. He's an external stuff actress, itty to get the heart rate rhythm back to normal, and usually when someone has it really population, you need to give them lots of anticoagulants, like heparin or new ones like the fact that any inhibit to fight with Iraq Suburban. Because if someone has atrial fibrilation, they're quite a high risk of stroke. Yeah, so basically males usually at a higher risk off a stroke if they have atrial fibrilation than women, so that the sex should be a factor in deciding whether to get all the anticoagulant not missing over here. So now we moved to high potential. So basically hypertension is defined. Yes, if the person is in the clinic, then having yeah, reading if they go to clinic several time to have the reading that is more than 140 over 90. It is important to note that this needs to be persistent because usually there's a white coat e fact, where someone goes cleaner, there will be a bit stress which would make their heart rate higher, that I need to be persistent. And also the definition, like um, use is that 24 hour BP average is 135 over 85 mold. So, basically, once you get the clinical reasoning, you need to check whether there are Stage 100 tension course Stage two. Hypertension will not really hypertensive, and that would determine how you managed. Um, so the patient is due to be on Stage one Hypertension, which is basically a reading horse 165 with the 85 mg hot mercury or more, and they are less than 80 on, and they have that organ damage. All they have called vascular disease or renal disease, or Time Uti's or they have a higher risk of cardiovascular disease is then you also that them treatment. However, if they are. They don't have any of these wrists. And there are, like, Young that you don't really offer them treatment. He fell on the stage one. How the patient is on Stage two. Hypertension, which is a BP off more than 150 of the night. If I've many grands off man three, then you offer them treatment regardless of age. So then the hypertension management. Basically, obviously you have to give them some lifestyle advice, and usually you'd have to tell them to have to lower their sort and tape. It also asked them to reduce their caffeine in today, and obviously your stem to you obviously asked them to drink less. Article. Stop smoking, Eating more balance Tired Britain Fruit and vegetable Texas I, small one. Try to lose weight. It's possible so no, it's going to move to the management off hypertension, sir. Basically, if someone is less than 55 years old, all the person has Type two diabetes. The first line treatment is an ACE inhibitor or an under tension to receptor blocker. However, if the patient is more than 55 year old and does not have time to diabetes, or if the patient is from the black, freckled or black African Caribbean ethnicity, Daniel would offer them a calcium channel blocker instead. This is bigger is 18 hypnotist and understanding two receptors have been. Should have in the way. Yeah, if you could see on black, African, African Caribbean people say these 39 treatments are not working, Then you offer them jeweled therapy, just basically combining the ace inhibitor people under tension to receptor blocker with a capsule channel blocker or you get them a tight sidelight. I wrecked it. Alternatively, if it's in the second category, you give them a channel blocker and you could add on. The ACE inhibitor will understand him to respect of blocker. Or you could just get them calcium channel blockers Court kind of direct this'll. One is usually favored the Capsule channel blocker and tires I'd like directed for the drug therapy in people off African African Claritin ethnicity because it's usually my wife at test. How about this? One is also a possibility, and then finally, if this is still not working, you need to get the triple therapy, which is just combining all three drugs together and hoping for the best, then step fall, which basically depends. All the potassium level of the patient is a patient house of relatively low potassium. Level off less than 415 million open letter. Then you add a low dose spirinolactone, which is basically a protection spare rain anti director. So you know, anti just protection, sparing diuretic. And then, if the patient has high, has the higher statin level off more than 44 4.5 million mold letter. Then you give them on our old beat up doctor instead. So if a patient's still is not manage on step for, they need escalate to consultant and someone who's more specialists. It's tough with me like a junior doctors level demolished this So So now I'm going to move to my coddling for shits to basically this roughly two top off my cardio infarction. They're divided into stem eyes. End on stem eyes to stand my sample. ST Elevation Myocardial infarction. 10 10 Semis. No ST elevation myocardial infarction. So basically the way we divide into the streets by looking at the E. C. T. So this is the ST segment in a normal person, like there's like a control a straight line. You can see my cancer. Yeah. Nope. Sorry, right? Yeah. So you can draw a straight line here like the ST segment is at the same level as the baseline. However, in an ST elevation, my cardio infarction like it's not at the baseline. The ST is elevated and no, no See elevation. Myocardial infarction. Destinations are depressed or just the same with the TV on, but it will. Usually the stem eyes are a lot more serious. Standee Aniston rice. So I'm just going to move to the how best advice on managed in the clinical setting. So you give a patient aspiraion you also give them the pew to 12. Was that done? Tightness, which would be probably to grill, trick a glow and prescribe. And you can also give them unfractionated heparin or low molecular weight. Basically, these all the first week are anticoagulate. And then I used to be in the past that the main treatment or stem eyes was from pharmacist. So basically, you often you also them tenecteplase. That's what for them to like lies the trombone trump list of allowed. But again, with now, we prefer to do primary Burton this career. Really? Intervention basically is just like prostate is just getting a bill laying and then putting a stand. And usually you'd prefer to use a drug eluting stent, which is basically just relating plants and preventing the formation off new, uh, close. So this is just, like, passed way off how to manage a stem, I So if a patient comes to you with a stent, my first to see you give him aspirin and then you see if this situation permits you to do the operation that happen. This Uh huh, That's great. Yeah. Policy with the dye alluding stent within 100 and 12 within two hours. If it is indeed possible, then you go and proceed with the operation. However, if it is not possible, then you have to do five. Problem from probably will assess, and you also do. You usually need to give them an answer from it at the same time. And basically he's obviously photo. Some assumptions back for the patient has come to your office in African within 24 to 12 hours of symptoms, and the patient is not at a high risk what they say in which case, you wouldn't really be able to get that anticoagulants, and you'd have to respect to someone high up. So also, the patient has been managed, like in the immediate time for stem like you need to look at that, the longer term, basically any patient without that high bleeding rest who's come to you for? For my cardio infarction, the past needs to be on to antiplatelet therapy, aspirin and a second translate agent, which could be, like happen. Rain over, have low molecular weight, heparin or rivaroxaban and then you get should also get them in a sink. Better be two blocker, usually they Are you sure? So put that one nastier started I that'll last that said, we'd also put them on and off the steroid and tightness. But this is usually only if they had an acute um I and symptoms or signs of coffee earlier and left ventricular systolic dysfunction. So examples of the out just really in time, this could be a hemorrhoid. So if someone comes to you with an instant my, which is less serious than the stuff my basically again you put them on last era and then you see even within six months us to make, like how likely they are to die within six months. And to do so. That's grace, which is like a which factors in many different factors. It's just like an algorithm that factors in many different factors. You see, what's the more time to wait going to be like and then conservative? They didn't give them typical. But if you if the patient is believed to be the higher dose of mortality in the 16 months not six also monster, then you offer them the Androgel see with a drug eluting stent. So thank you so much for your attention. I mean, this is the first time I get elected, so I know wasn't too bad. So if you have any question that wasn't good, So if you have any question, please send it to my email, my mail. And also it would be great if you could fill in this war like you can set. You can send some questions to the chapped. Now what you want also for awesome. Ah, so hopefully everybody joint Tanzas lecture like pencils. Sedentary, helpful. First, get some feedback both in terms of his like journals about to improve are so few free? Definitely in either form that that's 32 different forms. But if you could fill in at least one of them, that would be fantastic. If you do have any questions for you, if you just take them in the chat now, tonsil will answer any questions that you have. Obviously, this is very critical, and this is the bread and butter off kind of contractors. And you'll come across that when? When you start fourth year. Um, so if you have any questions, please do send them in tens. And I think there's a question here. So how does GLP one mimetic cause weight loss? Compliment that my mood I look into, you know, like send it to your to you by email. Sorry about that. So I think it's It's if I can answer this question, it's slightly. Yeah, it's Amanda said it increases in credited, and so it goes through that sort of pathway. Um, again, it might be quite useful in terms of ah, moder. Um, sort of s a question. Uh, but I go through that bathroom. Yep. Is among the sides. So, Terry, that they're either chapped, but Does anybody else have any questions? Know if you don't have any questions, feel free to just complete either the forms. Um, Andi, Hopefully, we'll see you again next week.