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Mhm. Oh, hey, hey, how can you, can you hear me? Can you hear me? Yes, I can hear you. Can you hear me? Yeah. No, you're fine, man. Wonderful. All righty. And I'll just do a test on the slides. Are the slides changing. Yeah, I do. Yeah, everything's going all right on my side as well. Um, yeah, I'll get started if you wouldn't mind. Um, just, uh, curing some of the polls for the questions. Yeah. Yeah, absolutely. I can do some right now. Thank you so much. Um, hello, good evening. Um, thank you for waiting. Uh, welcome to Meds Weekly Road to Final Series. Uh, this week we've got a bit of a mix of rheumatology and dermatology by myself, Doctor Erin and, er, Doctor Yi. Er, we'll be taking you through 10 high yield questions. Um, each with a key learning point as well. Just a little bit of teaching about each of the, the conditions that we cover. Yeah. All right. Um, if there's any questions or any queries, just put them on the chats and, uh, we'll, we'll endeavor to answer them. Should take about an hour. Um, yeah, after which we'll we'll stay on for a couple of minutes for any further questions, right. Let's get started. So when we have a look at the MLA content map, um I think we just wanted to combine rheumatology and um um and so we extracted these are the conditions that we're going to hopefully try and cover. And uh at the end of these slides, there's a big list by you in terms of what things came up or particularly high yield in last year's MLA. So that's right at the end, right? So let's get started. So, question one, I'll read them out and I'll give you a couple of notes to um put them on the pulp, 45 year old male presents to AM U with a unilateral painful knee on examination. It's red hot and swollen and the pain is worse on movement. He denies any fevers or systemic symptoms like general malaise. Uh he's tried paracetamol and Ibuprofen to no effect. So the pain is still there. A joint aspiration is performed. And when you look at it on a microscope, you can see no organisms or blood cells, white cells on the sample. Uh It's the picture of what you see is on the bottom right hand corner, given your findings and the likely diagnosis. What's the most appropriate treatment for this patient? Yeah. When uh when anyone is ready, the pool is just up right now. Yeah. Ok. Um So in this patient, uh they're likely having an acute gout flare. And the most appropriate management is to start uh some colchicine. And uh we will go into why in the next slide. But in terms of the features of this patient, so it's a unilateral painful knee which could kind of lead you down to thinking of is a gout or pseudo gout. However, but you also need to consider whether this is septic arthritis um or an infection in that joint. Um If when, when I was on the acute medical unit, a a unilaterally painful, swollen knee, we usually get a joint aspiration because then you can do the caution sensitivity and as well as look at what it looks like on the microscope. Um on the bottom right hand side, you can see your classic negatively bent needle shape. Um And I've got an example slide that will go through the differences. So the definition of the gout um I'll just ii won't read it out. But um the key learning point for this one is uh you use colchicine in your acute flare. Um Allopurinol does have a place in gout. However, you use it more for longer term management and prophylaxis. Um it's conventionally not started d during an acute flare. So we normally treat with nsaids and colchicine if the nsaids aren't working for the pain. And after a couple of weeks, once the acute gout flare has calmed down, you can re you can start the allopurinol for longer term uh protection note that um just as a, as a practical note as an fy one, you can prescribe nsaids both orally for the systemic benefit and also topically. Um just so you can get some more specific local anti-inflammatory and pain relieve effect on the joints. Now, as I mentioned, uh your diagnosis is based on joint aspiration and uh you got classically needle shaped, negatively bent crystals uh which we'll get through. No. So this is, this will most likely be done in the lab and you will just get a report that says negative or positive by fence and the appearance of, but it could come up as a pathology slide. So, gout is your needle shape and your pseudo gout is your rhomboid shaped. And that's I think that's about the level that you need for your finals. All righty question number two. Thank you for the measurement of the U urate levels. Yeah, that um I think normally when we see them on the acute medical unit, when we discharge them, we just ask the GP to check the urate levels and we can restart that, that um allopurinol. Yes, question two. So a five year old male presents the attack from GP with new rash and painful joints. This has been recent uh rapidly progressing over the past week. Uh When you asked the parents, she's recently recovered from a viral respiratory illness. So just like a viral cough, uh the rash is purple, pink. It's palpable to the touch, uh, predominantly across the lower limbs and buttock region. What's the most appropriate initial management of this condition? Ok. Yeah, we've got a good, good number of answers there, so I'll move on. Uh, yes, that's correct. It's, uh, a supportive management of the symptoms. Um, one thing to note is, uh, I've, I've left it out of the question, but on a practical note, you'd probably want to do a blanching test on this rash. Uh just because of where it is and what it looks like. Given that it, it's um yeah, it's a palpable purpuric rash. Um We go into why. So this is likely um a vasculitic uh hemlocks line purpura. It's the most common benign vasculitis presentation in Children with a peak incidence in the 4 to 6 year old age group. Um The exact mechanistic cause is largely unknown. However, on exams or classically, it's been tested following a viral uh um The pathophysiology is there with an, with immune complex deposition in the small blood vessels causing that leak of the blood vessels which causes that pru rash that you can see. Um you'll often find a triad of symptoms um great for the MRA like uh arthralgia or painful joints, abdominal pain and the palpable purpura. So that's like raised little bumps that are purple and they might have signs and symptoms of renal disease such as a derangement and their kidney function. However, you, they, they won't come with that if, if you know, if you, you only find out when you start your investigations. Thank you for the ITP. Um Now I know that um most of my teaching resources in med school were on lighter skin. So um in the, on the next slide, I've got some images of what HSB looks like on darker skin tones. However, NHS England recommends that you look at the pa areas, areas of the skin.
