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so I'll give it to two minutes and then we'll stop the pole. Okay? 10 seconds, guys. And I saw you come back on the she weigh you. Okay? I will all go through the explanation. When? When it pulls up? Yes. So the poles up, even we could see you from two angles. Great. So sorry, everyone s So I'm gonna share the results of everyone. Consider results. Just copper. Yes. In the chat on, There you go. Even though yours so fantastic. Beyonce is d so But it was a job interview. Were correct. Could work and on. And if we just go through the answers. So the reasoning for this is that, uh, zone is the correct answer on the VNS dose. Saying is initially 5, 400 micrograms on, then 800 micrograms if needed at one minute intervals. If there's no response. So on we put for a man is older. First one is well, because actually best is the use of the antidote to a benzodiazepine overdose on D S O. No locks in 4 mg would also be the wrong dosage of being on 400 might rounds is, as we can see, here the correct dose for acute opioid overdose A Z. If you look, the cycle will be enough. This is what it comes under on. It needs to be given by an intravenous injection. As you can see that on, I think it does. The underneath that if intravenous administration is not possible, it can be given by I am route, but only if the IV route it's not feasible. Okay, so well, don't feel too full center. You got that right. Great when we want a question number two on So Ms Harrison is a 75 year old patient who is presented to you. Had GP for an annual review. She got background off high BP. Chronic kidney disease on type two diabetes. Um, so you do a set of bloods just to monitor kind of a routine set bloods, and you find the results as below which are normal sodium. It's slightly raised potassium at 5.8, a normal urea, a craft and 140 which is also slightly elevated. And I hate to be a one C of 54 ends in light of her electrolyte abnormality. Please select which of her medication should be stopped. We launched the polls that we got metformin Ramipril, amlodipine, bendroflumethiazide and Glipizide. Yeah, so that's really the pools. Everyone should be able to see them now. Yeah. Could you one time the same again? Guys. Two minutes. Try and use the be enough, right? Yeah. Here. 10 seconds, guys to try. And if you're not sure, try and make a guess to it. At least you tried it on to the question. Okay, Fantastic. So, guys lended Okay, great. So most of us this answer, right? The answer is ramipril and we'll just talk to you by the other. So you've got metformin, which doesn't have any impact on your, um, electrolytes, but it does impact you want you to would normally stop it. If, in the kind of instance of an a k I. So anyone a pic metformin with that kind of leading, but in this question was that was about the electrolyte abnormality know about her week renal function on. She also has known secret a CKD stage two s. So if it's if that is the same as her baseline creatinine, then it probably wouldn't need to be stopped. Um, unless that you do if I got below 30 which is the guidance for that, then ramipril where acts on the kidney. It affects the electrolytes regulation the same with bendroflumethiazide, except as we know Bendroflumethiazide isn't a potassium is very drastic. It's a loop diuretic, so they're likely effect that would have would be the opposite with me to make someone hypokalemia. And I'm not appealing because I don't have any bearing on people's electrolytes and to just kind of talk to on the courses of hyperkalemic questions. So I'm kind of drugs to watch out for are 80 or eight inhibitors, um, and your and your tensions and you tense in receptor blockers on. Like we said, that's due to their action on the kidney and the way that they regulate BP through retention of salt, um, and then decay, renal failure and Addison's disease. Okay, And then sometimes, if you have someone who's come back with a really high potassium like they come back with Testim of eight on. It's previously been completely in the normal range, and the patient looks fine and it seems like a strange change. It might just be because the blood samples humanized so often worth doing a quick blood gas and just checking that's the case and sending off another four more sample before you treat them with a load of aggressive treatment to bring their potassium down. Um, in case doesn't you know, just experience result with the heat? My sample Definitely something we see quite a lot in the woods. Yeah, great. So if you take it with case three, I think your muted and you're right from there. Sorry. So, Mrs um has a past medical history often end study. She has an echocardiogram of her heart, which shows that she has an ejection fraction of 35 to 45% reduced ejection fraction. She also has peripheral vascular disease and hypercholesterolemia. She presents the hospital with bilateral putting a dina a raised a BB gun, shortness of breath. She has commenced on 80 mg off twice daily for his night. Which of the answers below best monitors the effective treatment. But Mondesi monitors how effective the treatment above It's s O. Is it a Denny's knees be Bianchi Sea food. No Kurt d daily weights or a lefty's. Okay. And if we can start it Yeah, so really itching cold. What? So you get one more minute? Yeah. And again, if you don't know, just give it a guess and educated guess and then you can try and then from land phone afterwards. Uh huh. Uh huh. Right. So five seconds guys were ending. Now, okay. Bending the cold results. Good work. So, yes, the answer is Deek on daily weights. So yes, Well, don't 61 center. You got that? It's erect. Correct. It was a bit of a difficult, actually, because I think daily using these could have been on appropriate answer to some extent. But actually, we want to be monitoring the level of fluid off loans that we've been able to do. So frozen mind is a loop diuretic on in the nose be NF If you look up its indication dose, it is correct. Eased. So for Dilma and on 80 mg is a ah high dose to be giving. But it's a very it's a good dose of resistant to Dina on a really good way of monitoring the effectiveness off. This is to be measuring their weights daily to see how much diuresis has occurred. So it's a good way of monitoring. If it's being effective, however, it is also really important to be doing daily use of needs. This is not necessarily the best way of seeing how effective the medication is, but that one of the side effects off a loop diuretic isn't it can cause some kidney impairment on lead to an A k I. So we really want to be monitoring the user knees. Um, daily. With this medication, BNP is not necessarily an accurate way of measuring day to day response to treatment. It's more indicative off on the severity on the heart failure for blood count in hospital. You'll probably be monitoring these regular anyway, but it's not necessarily going to show you how effective the medication is on again. A lefty's as well is not necessarily necessary. In this case, it's a well done to 61 sent to you about that, right? Yeah, great when you want a question for So Case full is about a Miss actual, an 18 year old girl who's being discharged from an impatient psych ward after her first presentation of psychosis during her mission. She's been started on clozapine 200 mg once a day and she doesn't have any past medical history. And her in the other medication she takes regularly is the contraceptive pill combined. Um, so you're completing her destroyed paperwork as the F one on the ward? What monitoring advice do you need to give the GP in the destroyed letter? That's if we nortriptyline, um It's basically about the regularity of the blood tests. Been probably your your head. You'll have to look this up on the piano. There is a question about the be enough, But we'll probably ask what we'll get to that. Maybe after the question is done best. Okay, another 40 seconds it is. Yeah. Okay. Okay. Five seconds, guys. If you don't manage to find the answer, just give it to stop. Okay? Great. So 84% of you got that right, which is really good. It shows that you've kind of figured out how to use to be enough because I wouldn't expect any ones have this kind of knowledge off the top of their head unless you regular working psych artery. Um, to the answer is a, um you need to do an F B C week leave the 1st 18 weeks and going forward from that, you send it monthly and then I think productive at six months and lipids three monthly. So this is what you can find on the B n f. When you look at clozapine as a drug monitoring section under on the clozapine as the drug, and this is where it tells you how we want it to those, uh, at just a flag up with the antipsychotic medications, they're often ones that have more complex drug monitoring. I think the closet peeing and lithium they've got a really narrow therapeutic window. So the monitoring is very tight because they have, ah, high chance of causing toxicity or someone being undertreated if they're not properly monitored on Guy Definitely seen. I had a psychiatrist or last year, and we definitely saw people who weren't being monitored correctly in the community. And both clozapine and lithium require normally in patient stays up titrate the medication so it could be quite an expensive mistake to make for any chest invasion beds. If you do need to re titrate someone on the clozapine on this, the narrow window therapeutic index means that there's, ah, high risk of quite high toxicity if people are taking higher doses and they need. So it's just something to be aware of when you see a question with, um, antipsychotic medications. And And what was the question about the be enough sugar? Yeah, sure. So, um, Darrin ask. Can anyone tell me how they found this on the B N? F? Uh, someone asked another question to go back. Can anyone tell me how they found this? Um, to be enough? I managed to get the answer by just knowing it couldn't locate it online. Um, I'm guessing they were referring to the question prior to this. So they won't be referring to the weight because then someone asked, Was the weight on the B n f? So was the waiting to be enough? But this was regarding daily weight for a deal. And let me just have, like, cry. You can you can do at the end. It's fine. Just don't know what? The questions at the end. Yeah. All right. Great. We'll move on to the next question if you already don't even. Yeah, I'm ready. So Okay. Sorry. Is Mr why he was 89 year old gentleman who was admitted for pain control are having a full without any fractures. He was struggling with his appetite. You to the terrible hospital food on his policy. Medical history includes hypertension type two diabetes, previous CD to PCI for stomach and on his drug. History is listed as follows, so he's on the linagliptin 5 mg once daily, the frozen 5 mg once daily metformin, 1 mg moderate release once daily aspirin at 75 mg would put a girl 75 mg once daily ramipril five on the grounds on by some low 5 mg. Once daily, your court see him in an emergency because his be ends our 2.8 on has he has a GCS of nine. What is the most appropriate management in this situation? So the A 100 mils of 5% dextrose IV, 20 miles like 10% Dexter's. I'd be 100 miles of 20% extra side. Be 10 mills of 20% extra side. Be 100 was a 5% extras. I be okay and we'll stop the fall closer up bridge. Yeah. Okay. Just under a minute. Yeah. Oh, okay. Happy with that? Yeah. All right. Well done, everyone So it was a bit neck. And I think actually, the correct answer is actually 100 mils off, 20% dexterous already on. But there is actually a good summary on the Vienna for hypoglycemia. They initially say that if our festival, if they're conscious and able to swallow, you should try and lose a fast acting carbohydrate by now and then repeat the treatment after 15 minutes. However, in an emergency and affairs, it would decrease level of consciousness has seen by this patient care who has a GCS of nine initially. Although we haven't set it here, you want to give intramascular Greek hum. However, if that's not effective, you want to get a glucose. Either you could give 10 or 20% on that. Just get out here on IV on D. Yeah, glucose, Something IV or attentive because 2070 and you want to get 100 mils about you do not want to give you quest. If tips and IV as this hypotonic so it can increase the extra visitation injury on, make it more viscous, make it more difficult to get following this. You also want to give a long act assume is they've recovered from this. You want to give a long acting carbohydrate as soon as possible. So once the blood sugars are above four millimoles. So there's a good guideline on that in the treatment of hypoglycemia on the VNF. Okay, great. You want a question? Six. And they're 10 Questions, by the way. Guys spending, you know, wondering. So Mrs Lynne, she's a 72 year old lady who's presented to you and me with a three day history of shortness of breath, a productive cough. And she's febrile. And she visited her GP and would started yesterday on Copaxone Club. So you examine her and you find that her spirit she rates raised. She's slightly tachycardic at 102 beats a minute. Her BP is 100 40/80. She's currently afebrile and has reduced Aaron Tree on the right side of her chest, and she scores seven out of 10 on a a M. T s. And in terms of past medical history, she has rheumatoid arthritis on high BP. She's allergic to penicillin on. Do you have her blood results back, which showed a raised white cell count at 14 slightly anemic with a hemoglobin, A 110 a CRP that's elevated at 89 on the area. That's in the normal range of 6.9. You're asked to write it up her drug chart. Which one of the below drugs would you discontinue A power set? Small. Be covered. Moxico. See, I'm not a pain d left flutamide on or a no 0.9% saline that you're going to give over eight hours. So if we start the whole pulls her up. Thank you. This one is quite nice. Yeah, he's got minute left, guys. Uh huh. Okay, five seconds. If you know, answer. Just give it a stop. Great. Right. Was in the poll less. I'm so majority of you got this question, right? And this didn't actually quite any look out for anything on the VNS. The answer was Elin, The question, um, it says that she's allergic to penicillin, and as you most of you know, come on club is competitive and containing so the amoxicillin in that means that she that should be contraindicated in her case, even though she was already starting yesterday by her GP, we don't know if she's actually taken any doses on. We don't know what the nature of the allergy is going to assume. It's probably no anaphylaxis, but you still normally wouldn't prescribe someone on medication they say they're allergic to on. There are alternative medications feel or pneumonia. You would start her on doxycycline rather than something penicillin based, so I'm probably close to my son as well. So in the context, off the other answers paracetamol. There's no contra indication to this. And she's got fevers that she does need paracetamol. Um, come on. Five. Right? Said she has the allergy to penicillin. So what shouldn't be prescribing that I'm not a P in her BP is okay at the moment. And then kind of if she was septic with a really low BP, you would hold that in terms of clinical and kind of indication so that not to damage her renal function, Delafield might what she's on for rheumatoid arthritis isn't currently indicated to be held. And the saline is just because if someone's febrile, they're gonna have more insensible loss is on. Um, a patient who isn't running a fever. Eso just don't want them to become even more on Well, when they have kind of tachycardia kind of having a fever. But there's nothing to indicate that fluid would be dangerous in this situation. So, yeah, make sure that you don't forget to look out for the allergies. And sometimes in the stress of the exam, you won't focus on the simple answer. The question is why in front of you and this really is like a drug safety, a recognition, it's really, really common. People prescribe things that actually allergic to um So it seems a bit silly to put this question in, but actually happens all the time. Yeah, so we were You want to question seven reformist HD who's presented with chest pain and his diagnosed with the end stemi. He was started on the A. C s medical treatment six days ago. You were the f one doctor asked to see him do two new chest his blood tests from today or as follows HB a 142 platelets and 43 Why it's still count of 5.5. I'm not 1.9 on often in the examine will be given a range. We haven't given you a range of the blood tests here. But I can tell you that the hemoglobin is not to, you know, within range. The cadence, however, does seem to be quite low. White cell count within range. And I and our eyes Well, depending on the target days. But I wouldn't be too worried about that. And current impatient medications include the ramipril 2.5 amlodipine, five aspirin, 75 uh, property uncle. 75 of the girls unfractionated have pepper and 15,000 units twice daily by suppertime. 5 mg. Okay, Like side you're 100 this PCG, and I'll leave you a little bit of time just to have a look at that and to interpret those CCG findings. Hey, on. But questions on the next slide. So given all of that history and his history is, Well, what medication do we think could be causing about the blood test results on the CT findings that you've seen is that aspirin, unfractionated, heparin clopidogrel myself, you know, or the wrong with grow, go back to the E C G for one second in case people wanted another look. Yeah, it's gonna say that I have opened the post guys, but we'll hold your horses for a second and, uh, get back to Is everyone happy with that? All right, good. Okay. Okay. Oh, yeah. Okay, Right Just under a minute, guys. No, No consecutive wins, right? We are about to end the polls or answer whatever you can. Okay, so the answer as 52% of people is correct. It's be It's the unfractionated tripping on. Actually, I said that the iron I was with a normal it's actually slightly below the normal range, a little bit low, which means, actually, the blood's clotting more quickly on the platelets are quite a warring level is Well, they're very low. So it's unfortunate tapering. That's I don't know if it's something that you may able heard of, but if you look up unfractionated separate on the B m f. One of the complications that can occur is happening. Do storm. Besides, opinion which is an immune mediated reaction on it can be complicated by storm basis. So a clot on that could result in what we saw on the easy G, a swell which showed that there was some definite ST elevation there that we can see throughout. So that could be indication off one basis. Where then? One of the arches. Hot on. Um, so when happening, just don't buy soda. Penia does occur. We should stop the heparin that they're on on. Consider an alternative anticoagulant on. This is something that you probably need Speech the hematology team in your local hospital and to decide what, um, watch to restart them on. But so HIV is a a complication to be aware of Unfractionated heparin. Yeah, Agree. Um, I'm currently on on collagen, which we cover hematology on calls. And if anyone platelets are below 50 it's normally pretty standard to stop the prophylactic doses. Well, so just be aware of when you're on the ward's. So it's also caused this presentation, but it's also you hold it If someone, if they got low platelets, um, that's just something to watch out for two patients on chemo. And keep that in mind. In or toe. Yeah. Great. We're going to question eight s. Oh, Mr Vaccinated for your gentlemen he presents to you have GP for a diabetic review. Um, he's got a background of COPD type two diabetes. He's had two previous t i A and he has atrial fibrilation. He is on metformin. 500 mg glipizide. 10 mg report ago. 75 mg and he's on Apixaban. And for his f He's also once a beautiful inhalers. And Symbicort inhaler is for COPD. I hate a one. C comes back at 53 minimal police and which is how you're monitoring his glycemia control. So what would you do with his medications? Based on this result, would you a increase his metformin to 1 g? Would you not change the medications at all? Which increases glipizide to 50 mg stop the glipizide and increase the metformin or add sitting Lipton. And so we will launch the pole was up there some questions by that. You guys go through this case first. Okay, great. Great guys. Got another minute. So keep looking. There's on stuff on the be enough. Yeah, Yeah, No. 10 seconds. Have a guess if you don't get the onset, Yeah, we'll go through where to get the answer from. All right, So we're going to end the pole. Guys, everyone just give it a shot. Okay. Ending the pole. Sharing the results. Fabs said majority people Forceps. And if you got this right So I think people get more difficult than previous questions. So just the answer is be. There is no change in medications on this. Is can be found on the be enough but the neck below. Basically, it's the like diabetic. You could be enough, I think again, if this is going to release some people's questions, they have it split into different sections. You can look up the specific drug, and then it will have things about the drug, like the dose that you give the drug monitor during the unity of that drug. It will talk about hepatic and renal impairment and what you do in those cases. And then there's a bit more on kind of products that are available. So if it's something that's given IV, it'll tell you what kind of vials will come in and have to mix it and and then side effects. There's another side to be enough, which is drug treatment summaries, and some of the questions you have today will be much easier to find the answer on the treatment summary of a condition. So this will be under the drug treatment of diabetes, and it says that for any patient who's prescribed and a drug that's associated with hypoglycemia. Such a sulfonylurea or two or more anti diabetic drugs in combination to this patient as well. Remember, was on metformin on glipizide that we should aim for HBA one c of 53 so it's more of a conservative target on. That's because when you're on multi agents or on a drug that has a risk of hypoglycemia, that risk of the hypos, it's something that you need to bear in mind with maintaining their treatment target. If someone's been hypoglycemic, hypoglycemic three years, trying to bring that blood glucose down is likely to have an effect on them as well, in just lowering the blood sugar. And also, if the drug has a risk risk of them being hypoglycemic, that adds another risk on top. So it's kind of more about adjusting your targets when someone's on just one agent, and it's normally metformin. If it's well tolerated that we would aim for more strict Target 48. Um, so great place. We got that and hopefully it's a bit clear. Let's find the answer. I was on the treatment. Some resection. Okay. Um, what would that be to be Have any questions? I'll be helpful is run through now? Sure. Uh, yeah, there is. Ah, there's a couple that me go through here. Um, so someone asked about, you know, the chest thing questioned the c G. Um, how does hit cost pericarditis? Uh, confused. I don't know if you remember the context of this question, I think, Yeah, I was going to say the EKG was meant to show a stemi. I'm sorry. That didn't look very clear on the CGM. It was a study that we were looking at. There's ST Elevation on. So I'm from the increased risk of from both sis on in hit, you can increase your increased risk of forming a clot, which can occur. Are you seeing one? The arteries of the heart and ankles on a scheme of events is what we were trying to get out with that question. Okay, so next one is confused. Why? It couldn't be ramipril chest pain and term beside the Penis Side effects. Um, can't quite make out that question, Karen or sorry, Darren, Every day do you understand what they meant by that? Um, no, specifically, I think we were kind of looking more there tried of those effects that would cause by Yeah, by unfortunately happen rather than ramipril other would know where the chest pain. And but it's a good point. Maybe no such recognized side effects as it is for unfractionated heparin and yeah, fantastic. Um, fine, I think that's fine. Someone Oh, but would you not want to stop self on the urea? According to you, stop! Start noticing the an increased metformin. That's a reasonable question. What do you think of that current? So I say that Repeat that one again for me. So it's in the chat. It says, Would you not want to stop so funny? Urea According to the stop start and elderly and increased metformin Onda, someone also Austrian. See she be on the higher dose of metformin first when I increased metformin, yes, there were valid points. I think at the point that you see a patient hospitalists what you find often as a doctor, you want the person that started the medications. So unless something's going wrong with those medications, I wouldn't be changing something that's already working. So they're meeting their conservative HBA one C target of 53 millimeters per mole so I wouldn't go in and change the anti diabetic medications, even though I do agree it would make more sense to have them on 1 g on up. Titrate it for the purpose of kind of reviewing the medications and the drug monitoring. If they're already on that form of kind of hype, anti hypoglycemic so on isn't managing their target to the level that they should be aiming for? I wouldn't be changing it around at that point unless the patient was coming in and saying All this like the burden of the, um, burden of the tablets is too high because you don't know the patient may have actually gone on to 1 g metformin. Initially, some patients really don't tolerate the higher dose metformin. They get nasty GI I side effects. So it might be that they initially tied to try to up titrate the metformin and brought it back down. But off to be only have the vin yet that's in front of us. We don't have the whole background, so I would take it what it is you're not being asked to change the medicine. Well, you're being asked to take in what hate being one C is and whether that means you need to adjust anything. Sometimes you'll see people's medications. And then, well, this isn't really a sensible kind of set of medications to be on, but we don't You don't necessarily know the whole background to it. So I would say the aim of the question was to look at the target his fianc? And see whether that meant you have to talk up titrate down territory, any medications. Like I said, you don't actually know why they're on the dose that they're on and why they're starting that they may have tried other medications, not tolerated it. And the questions can't go through all of that. So you just kind of have to take them a bit more of a face value, but good that you're thinking about more laterally about what's sensible. Yeah, fantastic. Uh, okay, so let's go to the next question. That so the next question Mr. N. Is 92 year old gentleman who was admitted with acute cholecystitis treated with also talks, and he has been in patient for five days, and it's now well on awaiting discharge. You're also see and do. Two profusely sweating. Diarrhea is hard. What medication is likely to treat the course of this? Diarrhea on And the lancets are a in the paramount. 4 mg the metronidazole six month, 600 mg or really see vancomycin 125 minutes. Lasts 40 de Arixtra mycin. 500 mg formally or he metronidazole 500 mg IV earned free stuff. Okay, so the same again, guys, right? Yeah, yeah, yeah. Great. Guys. 30 seconds trying that you're off of them. Nice work. Well, John. Okay, right. So 52% of you got the correct answer. Just seen vancomycin 125 mg or really? So the symptoms and the history that we're being told from Mr and here is in keeping in keeping with the c diff infection. So we would obviously need to take a stool sample, too. Make sure that this is the correct diagnosis, But all of this is pointing to see additions, infection. He's got quite a few risk factors such as his age. His hospital stay, son Trilipix he's had so separate flocks is in along with Linda Myson on some other capsule Is sports is a swell. Have been frequently associated with cheat if infection, which is why there's a big push towards and microbial stewardship and trying not to prescribe some antibiotics unnecessarily. So it sounds like from these infections he have a seat. It hurts from from the symptoms he's got. He does sound like it's got a CT infection, and there's a good if you try concede if to the banana in the search bar that comes up with gastrointestinal system infections. And actually, if you scroll down towards the C diff infection, it gives you a good kind of performer of what to do and how to treat it on the number one and back to choice for treating mild, moderate or severe C diff infection is first line is done for my sin on in modern model moderate infection. It's to be given all really, if it gets more severe, a click on to a good underbite microbial and that does. Gardening is well, if it doesn't most that you can add an IV metronidazole, but for this infection would just probably give a low income, I said. Obviously, you want to be assessing him on his symptoms on considering escalating. If you think this is more of a severe infection if he's dehydrated or if they're at other abdominals abdominal signs. One thing that we want to look out for is something called toxic megacolon on. That is why the answer? A repair? Um, I would actually be incorrect and actually quite dangerous in this situation. You want to avoid any anti parasitic agents because they can precipitate development off toxic megacolon, which could be a life threatening complication off this so vancomycin. Urgent Range. 5 mg only. It's the answer to this one. It's okay. One thing to say about bank license. This is the only time you've given. Can I send all released Normally given IV except has really poor absorption from the gut, which is why it's great and c diff because the infections in the guts and so all the vancomycin stays that went there where it needs the treatment. But in any other story wouldn't be giving vancomycin already, so it makes it really easy. Sorry to remember that you give bank because you've never give tablets otherwise, and and there's a little summary off just what you've given when so I saw in the chat, someone said when would you give IV lectures up? Metronidazole? So if you think is more disability life threatening infection, you would give added metronidazole 500 mg IV three times a day. Yeah, this would be assessing things like how how septic they are all clinically on. Well, see, like, even was saying about whether they need fluids. If they're dehydrated, that's when you'll be worried that was more severe. But in those cases you start someone on antibiotics for one or two days, and if things start resolving with that, then you don't need to escalate the antibiotics unless they're kind of really, really on well, on on that observations, it would be guided by that. But in this in or you've just been called because of his diarrhea, you have no escalated any of the observations. So that's why it's considered more moderate to mild and great guys. Thanks for being with us. So it's well over one site. Is this to the last case? Um, Mr I, whose gentlemen has come to see you about skin rash on his GP practice. It's itchy, and it came up recently. It's not had any bleeding and and there's a picture of the rash below. It's quite pathognomonic this picture on. So I'm next to ask you what you treat the rash with. So hopefully you guys looking this thinking I know exactly what this is. Dermatology wise. Um, So what would you do for the rash? Give him dermal. Give him fluconazole. Refer him to dermatology. Give him clotrimazole. Could try. Not so good. You could read it. I'm a hydrocortisone. Right. Okay. Is this the last one? Guy's? Yeah, this is the question. And on the on the presentation tomorrow and for the rest of week 12 questions Because we don't have one of this. Start a bit about how the PSE works. But you had 10 for today? Yeah. No. Oh, so opposed to the feedback as well, guys. So as soon as you've done this character, I she can You can fill that in. It's a super important feedback for, um, I've changed up form out a little bit. We're gonna add a lot more questions in the feedback for him to gauge a couple of different things. Uh, of say something on the end about that that you're on to the question. Great as the 30 seconds left. If you're not sure, try and narrow it down to one or two and then just give it a guess and we'll go through the answer. Okay. Sorry. That's basis a D. So majority of you got this one, right? With the one that I can't say the name off. I'm not gonna try again because I just didn't think I had the cream. So correctly notice that this rash is a kind of ringworm. Bring one. That's I've lost my words. Um, is a kind of localized fungal infection. Um, we'll go together, answer safer, dermal. You be thinking if it was something more like psoriasis, Celexa, which would be a widespread rush in the kind of specific areas. So for extra in the kind of Flexer areas and for psoriasis and more the extensor areas. This is really localized. You'll be referring some to dermatology. If you were concerned about their this being something cancerous, like a squamous cell cost, name or basis, so carcinoma it hasn't bled or change dramatically inside. So it's not good. That pearly ring that we see in the basal cell cost name is or the kind of character like carrot in coating that you get in your schoolbooks cell carcinoma. So we're not concerned that it's a, um, some kind of cancer and fluconazole or a We don't normally give people or anti fungals unless it's a really systemic infection. That's more like to be given for, like a fungal nail infection, which tends to need a long course of treatment. Just given the you think how long it takes for you to grow and a little you need that length of time to grow the infection out of your nail so you don't really give tablets or e with the cream, which is the correct answer, and then your steroids, which you would again be using. In a scenario that was describing kind of explore all psoriasis and so kind of by process of elimination, you can figure that one out if you weren't exactly sure what was going on, and you probably could all look at this and realize it wasn't expired or psoriasis, Um, and hopefully realize it didn't have any of the rectal axe eines over cancer and great. Any more questions booking up in the chart? You, uh, no. Nothing. Oh, there's one. Could you please go through the hydro guy Senior question again. So that's from the on. Yeah. So I've actually it just been looking back at the at the b n f on that on. But I saw that there are few questions about the actual volume that you get and sorry that you're correct because actually, it doesn't give the specific volume of the VNF. It just says 10 to 20% but 10 to 20 g in from practice. It is 100 mils of 20% given, So I'm sorry if that was a little bit complex. Um, I made I think, having a bit of a red herring with the B being a little bit less. But you want to aim for 10 to 20% dextrous IV. You don't want to be giving any higher. Onda, although to be enough, doesn't say the volume. It does tend to be 100 but that probably won't come up as a question because they wouldn't give you the volume. If it isn't states, that would be enough. So I'm sorry. That was a little bit tricky, but it's useful. Want to know for when you are practicing as F ones as it is, a really a common scenario that you'll probably have to encounter. Yeah, if you'd remember that your 20% meant 20 g and 100 mils, then that would have correlated. But you might not have had that knowledge off the top of your head, those kind of conversions of good things to have in your head for the calculations. We haven't had one of those questions. Day will have one tomorrow on, but that might have helped you had that knowledge on top of your head to answer that question. And I've just seen that any resource recommendations. I don't know if any of you got it yet, but there's a really good PDS, um, cools policy BSA, which I think I was turned it out by some one of the clinical findings in there, um, at my med school, and it seems to be going around. I think you should be up to Google. It sells. It's called past Guess A, and it's a pdf that comes and it's got quite a few mark exams. It's free on. It's really, really useful resource to be using. It also gives good explanations off different questions on common kind of prescribing issues that might face. I'd really recommend It's downloading that. It looks it looks like this. Can you see my screen? Oh, yeah. No, If no, I can put the pdf in there. I'll see if I can share the pdf from the lake. It was like a tall again on the water. Um, but what if we can't get this time? If everyone's gone, will put a link to it in the next week. You put a link to in the next. Okay, in the next session, Yeah. I found that this was also why you serve eyes. And it was really good here. There's ah, if there's a way to pop it in the chart. Oh, so that again. Thank you. Remission your hair. Any more questions lugging up? No. Nothing that I can find. Ah, so So guys do do do please fill in the feedback form. It is super important. I tweet the feedback form from are very generic form that we usually do, Which is like, um, pretty similar for each electrics. I really want to collect a few data points and how things are going on. How people find the PSSA Siris. Um, so do you Check it out. If you have any friends that are going to be doing the PS a soon or they have a prescribing examined your international, uh, coming up in your in your final year. Please do tell them about the lecture series. It's going to run all week. There's going to be lots of lots of amazing contact on Karen. Uh, obvious. Put in a lot of effort into it. So Ah, we did appreciate Ah, your attendance in the next one and the guys. Is there anything that you want to mention about the next sector here? It would be similar. Former will see you tomorrow. And yeah, I would appreciate if you if you used to be an African tomorrow, like we discussed today, hopefully will reinforce those same principles of kind of getting on with the exam. Um, and he's got a TV know again. Same. We'll go through a number of questions that we great to get some interaction. And again, even if you don't know the answer, just just take uneducated. Guess it's a good money experience. Right? So you guys tomorrow? Yeah. So you guys two more, but bye.