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Ok. Hello, good evening. Um Thank you so much for joining us on what is a pretty rainy Thursday evening here in North Yorkshire uh for meds respiratory session. Um I'm Doctor Aaron and with me, I've got hi everyone. I'm Doctor Chante and uh together over the next hour or so we'll be taking you through a couple of cases, but we'll give people a couple of minutes to join. Um As I know people are busy and people. Yeah, so we'll, we'll, we'll start uh say five past. Yeah, that's really cool actually. Um going on to itu as your first one. Yeah, it was um it wasn't as supernumerary as I thought it would be. Um I know. So my first weekend I was, I was on on call long days and at my trust, um it's pretty much kind of like the sho bleep and the bleep. Um You're part of like the crash team. So you go to like all the crash calls. Um And it was very long days. It was like 8 to 6 and then I think it's been like throughout the whole two years. Well, maybe not F two, but it's been like, my busiest job. But it's good though. They get you involved in, like, lines and central lines and ultrasounds. And so, yeah, I've, I've got, um, one month in it next year and, I don't know, it's just something about arterial lines that kind of gives me the creeps. It's weird. I always enjoy, like, doing ABG S over Cannula. So, II don't know. I just found them really fun. Yeah. I mean, I, II can never, I either a use for me either. Go straight in. I'm like, yeah, cool. I've got, I'm in the artery or I'm there going really sorry. I need to. I know what it is. Yeah. Um Yeah, next year though. Yes. Um, so II get a month in it and then three months on a medical education job. So it's, it's this for three months in, in real life. Yeah. So, um yeah, otherwise I would have gotten a full rotation in itu but I don't know, like I say, the environment kind of gives me the creeps. So like even a month though will benefit like you so much and you'll learn so much as well. Um I remember I was telling an IT UST eight about how I'm only getting a month and, and she looked so offended that I was happy. I was only there for a month. I was like, oh my God. But don't, don't you want to do a full rotation? I was like, Mm no, not sorry but no, you know, just I think a month's good because it can be really draining. I think there was, I remember like a six week period when there were a lot of like super critically ill patients and not many good outcomes. So it was very like draining and like emotionally taxing. So I think a month is sort of like a good medium to kind of like get that exposure but then like go away as well. Step away like cool. I'm done. Thank you for that. Yeah. Yeah. II feel that though with vascular um some of the outcomes aren't, aren't very, aren't very good as well. So I'm looking forward to going back to medicine and infectious disease and acute medicine. Oh. Mhm. Um You know like, OK, well, should we get started? Um Yeah, so this the session will be recorded just for anybody who wants to watch and go through the slides with us later. Yeah. OK. So um this is the agenda. I've got 10 MLA style multiple choice question questions for you and these 10 questions I've looked at the MLA contact map for respiratory and picked 10 conditions and presentations from there. So it's all directly. So I'm looking at things that might be tested on your exam um in terms of interaction, then if we, we're gonna put up a poll for all for each question. Um and then if people could answer and afterwards I'll go through what exactly I was trying to lead you down and if any considerations I might have, um, when I'm, when I'm seeing these patients on the wards, does that sound good? Ok. So I just thought I would, um, go through my, my personal experience of how I kind of go through MLA questions from what I remember. The MLA question stems themselves tend to be quite thick. So it's very easy to just read it and kind of get the wrong idea sometimes. So, what I used to do on the first reading is I always used to think what's the presentation or what's the issue that people are actually testing? Um And once we've identified, OK, this sounds like a pneumothorax. So this sounds like lung cancer. Um and then reread again and think about what, what is, what thing or what knowledge fact is the question testing on me because when you, when you design a question that there has to be a right answer. Um And oftentimes look at the clues and the information that you'll need will be in there. Um But it just helps when I was, I was feeling a bit lost sometimes. All right. Um OK. So first question. Um So got a 67 year old male who's a care home resident presents to the acute medicine unit with a history of two weeks of feeling a bit ill. So feeling not quite himself, cough and a fever during a consultation when you ask him where he is. Do you, do you know where you are? Yeah, he tells you. Yeah, I'm at home and that he, he keeps wanting to leave the bed and go upstairs to his bedroom. Um, on examination, he's got a fever and he, he's clearly confused. I've got the A two E assessment left and, um, he's already had bloods on admission, which is really good. And as they come through you, you know, that that's what they are on the right hand side. So based off of your examination findings and the blood results that you can see, um, what's the best treatment option for this patient? And I'll give you a couple of minutes, let's say three minutes to have a read. Yes. Yeah. Yeah.