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Thanks. Hi, everyone. I hope you can hear me. Ok. If somebody could just put in the chat, if they can hear me, that would be great. So today's topic that we're gonna be discussing is pulmonary embolism. So it's the final. Ok, thanks. It's the final part to the respiratory part of the series. Um Yep. And then we'll be moving on to Gastro. Um Yeah, let's just get straight into it. Thank you all for joining. Ok. So we're gonna obviously start off with the case as usual. Then we'll go in on the, what we'd ask in the clerking, what we look on, look for on the physical exam specifically with pe an important aspect in the UK is the different types of scoring systems. I know that in med school we might be familiar with wells score, but there's actually several that are used here and it's not just, oh yeah, they're used, they, they do have significance. So it's, it's good to be at least aware of them even if you, you don't necessarily need to know them off by heart, but it's good to be aware that they exist basically. Um Then we'll talk about diagnosis differentials will focus a lot on the management, which is kind of the main takeaway point. We want you guys to focus on as well because that's like bread and butter of what you'll be doing if you're working down in A&E and even on wards, if you come across those kind of patients, and then we'll go back to the case and hopefully we'll see an improvement in our management plans and how we can go about the case. Ok. So starting off with the case. So we have a 60 year old female. She was bebo she came in with sudden onset of shortness of breath and chest pain. So those are her two symptoms, the shortness of breath or dyspnea and chest pain. So first question to you guys is what are our possible differentials? Hopefully, if you've been tuning into the previous sessions, especially the respiratory ones, that's a hint. Um This should be very straightforward for you. Any ideas guys just pop whatever you're thinking in the chat. Um feel free to say whatever. I just wanna know what you're thinking differentials is very important in interviews. Like a lot of the times they'll give you vague symptoms and it's up to you to come up with possible differentials. More important than the diagnosis I would say is explaining your mindset and what your possible differentials are. Ok. Yeah. Thank you. So we have acute Coronary syndrome. Pe definitely. Yes. Thank you very good. What else guys? Shortness of breath, chest pain, aside from, um, pe what are the respiratory things? Could it be shortness of breath and chest pain? Yep. Absolutely. Pneumonia. Cap cap. Yep. Yep. Very good. Asthma, IEC O PD. So, if you were here in the last talk, we talked about cap, we talked about asthma, exacerbations, acute asthma attacks and also, um, exacerbations of CO PD. So all of those had in common that they could have the shortness of breath, the chest pain. So very good. Yeah, pneumothorax. Thank you. I think we've got the main one so we can move on also. Um Yeah, it's fine. We're gonna discuss differentials in a bit. So um I'm happy with that. So OK. So yeah, pleuritis with the, the chest pain. Yeah, absolutely. It's a possible differential. Yeah, they'd have like a what we call pleuritic type of chest pain. Yeah. Um So what kind of questions are we gonna ask in our history? Because obviously now if you, you guys can look through those differentials in the chat, how would you as a doctor if you were there? And you've got this patient at A&E how are you going to distinguish just based off your history or could this be more likely a cap or could this be a pe or could this be heart failure? What, what questions are high yield for you to be asking or even just like think of general history taking? Um what sort of things do we want to know about these symptoms and about this patient specifically, I'll give you guys a minute or two. Just whatever questions on history taking have a thing. You can refer back to our old ones if you want, but I wanna know like what kind of questions you'd ask to further narrow this down? Ok. Yeah, absolutely. Just so, um, guys, anytime you have a chest pain patient, Yeah. Thank you all good answers. Any time you have a chest pain patient, what's the acronym that we should be thinking about that? We should be working through in our history. Yeah. Thank you. Hi Socrates. Yeah. So anybody put any parts of Socrates in here cos all of them will be relevant um for this C Canula. Yeah. So I did turn my mic off for a bit but now I'm speaking. Can, can everybody else hear me? OK. Yeah. OK. Fine. Um And maybe just refresh it cause I wasn't um talking before. So maybe it's just glitching, just try and refresh and hopefully that should fix it. Um Yeah, guys. So Socrates, so what does it stand for? Just anything you don't have to say? All of it? Just give me some, somebody mentioned onset. That's one of them. We talked about radiation that's in there. What else? Yes. Very good. Nihil. Thank you. Yeah, sight onset character radiation. Um associated symptoms. Very good. Any others? Um And any of the questions we want to ask. What about the shortness of breath? How are we going to know if this shortness of breath? Could it be related to a cardiac thing or could it be respiratory? What, what do we wanna know there? What would we ask to narrow that down? Ok. I feel like it's ok. We, we're gonna discuss all of these anyway, so we can move on. So the final thing guys. So first thing, what is pain worse on inspiration? Yes, absolutely. That's an important question as well. Thank you. So, the next thing is what investigations are we gonna do? What's our like initial plan? So when I say plan, I don't just mean like, oh, start them on these meds, whatever. Um, investigations are also part of your plan, part of your work up, should we say? So tell me what investigations, um, what other things might you want to be thinking about starting the patient on? Um, yeah, give me like some rough ideas. What are you going to do to narrow down what's causing these symptoms in this 60 year old female? So somebody's having shortness of breath and chest pain. What, what scans should we do? What, what, what things should we be thinking about? What plans should we be thinking to do? What investigations are we gonna do? Uh, just scans? Is there other things we can do? Yes. X-ray. What kind of x-ray. Yup. Is it an abdominal X ray? CT.