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Hi, how are you however you want? So do you want, do you want to go? No, no, no, go for it, Millie. Go for. Hi. Hi, everyone. Um Welcome back to the session. Um So I'm Millie. I'm one of the F one doctors um in London and, and we've got my colleague inducing herself as well. Yeah, so I'm on II one of the F ones in the East Midlands. Um and we're gonna have, so this morning, it's going to be a weekend session again. So some of you guys might have joined her last week in the first session to focus on this team is essentially surgery. I'm so going to run through all the surgical content that is, um, is present in the UK MLA essentially and it's going to be as same as last time in sort of three times one hour sessions um with slightly different focuses on each part. Um So we're going to have like pre surgical assessment, post surgical staff, et cetera. Um We're gonna have some polls questions. Um And yeah, I hope you guys enjoy it and find it useful. Amazing. So there's a QR code on the screen that you guys should be able to see. Um And that's just um a part of the research that we're working on and we would really appreciate it if you could scan that QR code and also put the link in the chat, um which you guys can also um just click on to respond to that um research whenever you get a chance there will be breaks at the point throughout this. So that might be a good time to try it out. And if you don't get to do it during the breaks, sometime later on and share it with any of your um colleagues slash friends who might be interested as well, that would be really helpful. So we won't waste your time because um you've obviously dedicated this time to come and learn and hopefully you'll find it a very useful session. So we'll be moving on to starting with the questions. And if you guys do have any questions at any point, then please feel free to put it in the chat as well and we'll try to answer it either as we go along or at the end. Um So yeah, let's get started. So in terms of the learning outcomes, again, it's mainly key surgical content, some stuff um in the curriculum that we will go over include things like preoperative assessment, acute surgical emergencies, POSTOP complications and other themes and elements around that. Really just so that you guys can think in a holistic way in terms of investigation management and what to do when I guess things go wrong unexpectedly in terms of acutely unwell POSTOP patients. So hopefully, we equip you guys with skills, not just for example, but actually real life scenarios for F one preparation. So we're keeping in line on the curriculum that you guys would be tested on. And so our cases are essentially drawn from these themes. So either the presentations or the conditions. So without further ado, we'll start with the first question, I'll let you guys read that um or I could just read it out and give you guys some thinking time. So it's a 45 year old man presented to S AU with chest pain and vomiting. He smells strongly of alcohol and on examination, you notice some copis as you palpate his chest, you request an ECG which shows widespread ST elevation and you also request bloods including troponin and a portable chest x-ray, which of these chest X ray findings would most likely be present for the suspected, most probable diagnosis. So I'll give you guys some time to think about that and then you can put your answers either in the pole or in the tract, but the poll would be preferable. So just going to give you guys some time to think about it, it is a bit of a complex question because you have to figure out the diagnosis and then don't worry about being wrong. It is a bit of a challenging one to start on. So honestly, whatever answers you guys think is right? Just be brave and go for it. Amazing. We've got very fast and going. You guys can either just pick the same one and hope you're all right or put what you genuinely think as well. Give you two more seconds to think about it and then we'll talk about it a bit more. Amazing, amazing. So we've all gone to see. So before we reveal the answer, um I just wanted to check. So what do you guys think is the actual diagnosis in this situation? So someone could pop this in the chat this time? What do you think is the actual diagnosis? Pericarditis? OK. II. Can I can see why that might be? Yeah, from, from some of the investigation findings, I can see why you think pericarditis. Um but it's not quite pericarditis. However, are there any other things that we might consider? So I think I'll kind of try and redirect you to the points that we need to focus on. So in terms of the fact that this person is presented with sudden onset chest pain and vomiting and smells strongly of alcohol. And you also feel some crepitations around his chest. What might you be thinking of? Ok, fine. I'll, I'll, I'll move on just so that you guys um know what the diagnosis is, but you guys are All right in terms of the actual answer. So you've all picked um spin in um but and someone has put in the right answer in the chat, which is and yes, we'll go into that as I get into the future slides. So well done guys. Good thinking. So pneumomediastinum. So the pneumomediastinum isn't necessarily from the Bohs itself. It's a multifaceted question. So you guys are right and that is Bohs um syndrome and that's esophageal rupture, which presents with subcutaneous emphysema, which is why you could feel these copis around the chest when you examine. But then he also presented with chest pain and vomiting with a history. He smells of alcohol with a history of, you know, quite a, a good amount of alcohol use. So that makes that diagnosis more likely. And in terms of the chest X ray findings, because one of the triad called micro triad is subcutaneous emphysema. Part of that is when you do request a chest X ray, you will see, you know, subcutaneous emphysema and part of that presentation would include a widened mediate. So pneumo. So that's what the, that's why that's the answer to that question. So hopefully, that will kind of makes sense, but it's kind of a multistep question because sometimes you think, oh, you know, you know, the triad and you're going to get a diagnosis, but it sometimes give you the diagnosis and expect you to kind of think a bit more laterally So I just wanted you guys to think more holistically in terms of um the question and obviously, the ST elevation, I see why you guys thought about pericarditis but widespread, the ST elevation is very nonspecific. So that can be related to pericarditis that can be related to other things as well. So we'll move on to the next question, guys. Um And this time it's a 50 year old lady that presents due to a groin lump, which she was unable to push back in. She's not in pain though and her observation aren't, are normal. Her past medical history include chronic constipation, type two diabetes, hypertension, three times, um, previous vaginal birth and on examinations, you palpate a lump that's inferolateral to the pubic tubercle. What is the best course of action in this situation? So this is thinking about your groin lumps. Um And what, where they're situated where they're located and what the best course of action would be. Well, then we've got some responses people can get in. We just give you about 10 more seconds and see there's a shift towards d. Ok. So for anyone who thinks it's an inguinal hernia, why? At least we, we figured out she's got a hernia. So that's good. Well done. So for anyone who thinks it's an inguinal hernia, why do you think it's an inguinal hernia? Right? Um ok. Fine. For anyone who thinks it's a femoral, why do you think it's femoral? So we've got people having thoughts but not quite sure why and that's why, because it can be very confusing and I think it's just one of these things where you just have to kind of let. Yeah. So, location. So, yeah. Exactly.