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Thank you, pee. All right. So, hi guys. Um, my name is Catherine and, um, I'm with Sophia and we're gonna be doing a tutorial today on M SK. So our learning outcomes are as below. So we're gonna cover kind of the main M SK presentations that includes osteoarthritis, rheumatoid arthritis, different fractures, back pain, soft tissue injuries and osteoporosis. So, trying to cover the different things that you'll see as an F one and an F two. But also the things that you'll see that comes up commonly in your finals as well. So this is just kind of a photograph of the MLA curriculum. Um, so we're just showing that we're trying to tie in with that as well. All right. So as usual, it will be 10 questions of, um, multiple choice answers. Um, so let's get started. So, question one, a 45 year old man presents to the emergency department with severe lower back pain that started 24 hours ago after living a lifting a heavy, heavy box. He also reports difficulty urinating and numbness in the perianal region. When you examine him, there is reduced anal tone and decreased sensation in the saddle area. What is the most appropriate next step in management? Cool. So we'll go ahead to the answer. So in this case, he needs an urgent MRI spine. So this question is trying to link into Corda Quina syndrome. So the patients presenting with red flags that are consistent with corner requi ca corda Quina syndrome. So those include severe back pain, uh urinary retention or incontinence, um saddle anesthesia, um and decreased anal tone or fecal incontinence. So, in short cadre syndrome is a neurosurgical emergency. So, it's caused by the compression of the cord quina nerve roots, usually due to disc prolapse, maybe after somebody who's been lifting something or it can be kind of out of the blue as well. Um The patients need an urgent MRI to try and confirm or rule out the diagnosis. Um and a delay in the diagnosis and decompression can lead to permanent neurological deficits. So things like paralysis or incontinence as well. Um So obviously the other things that were listed would be inappropriate because they wouldn't be the first line thing. So, pain relief is kind of one of the options that we would give as well whilst we're waiting for the MRI. Um but the MRI is the first line thing that we do. Cool. So moving on to question two, a 62 year old woman presents with gradually worsening pain and stiffness in her knees and hips