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I wanted to show my face all, like, uh, probably up to you. I'll see, I'll see. I like a stage five B book. It's probably mainly by the slides. I recon common. Um, in it. Yeah. Just, just wait until six then and then. Mhm. I start to be. So, was it 40 minutes innit? It's supposed to crunch it all in, right. I have no idea about the timings. Oh, yeah. Um, yeah, actually because they do an hour and they do, like, an hour and a bit of osk stuff. So, probably say five minutes. Yeah. Yeah, because I remember seeing it on that, like, brief or whatever. I was like, please try and keep it within 45 minutes. That's all. Yeah. Ok. Ok. Give me a sec. Can you hear me? Yeah, I just checking if there's anything else I need to do before, uh, we get past. Yeah. Bone. Nothing's good. Yeah. My camera is gonna fry, bro. It's gonna, why? Because my laptop is so crap. Like, basically just once I turn on the camera it just bugs and then I'll just be frozen. That that's what happens on Zoom all the time. So I'm probably just noting to, yeah. Right. More blood o one more person. But, yeah. Do you know what the turnout is usually? No, this is not a, actually, I mean, for the, um, well, when you used to go, actually, no, I mean, I can see for the one that we've done already this year, er, 70 people signed up, 33 came 50%. That's pretty rubbish. Well, I don't know how many have signed up for this. Kind of see, we can like, are you a, so did you get hired? Not hired? But like, yeah, I just, like, applied for it. Uh, 55 people registered. Yeah. Ok. Probably like a five. So at 10. Yeah, so far, I mean, so far there's only a solid five. Yeah. Ok. Ok. Ok. When should we start at like, 705? Yeah, we'll give it a few minutes after seven. All right. And last minute, 23 of the other people as well. The, no, uh, I don't know where they are at all. I mean, they're probably gonna join out like a, isn't it or whatever. I didn't think, I thought they were meant to be in from the start. Oh, no, no, I think from that thing they come at 80 for the next hour so they'll probably join at 745 is what they expected. What if you finished your teaching? And they're not even here. I can still carry on with the, um, the sort of stuff because I've still not put a lot of stuff on my slides. If that makes sense, I can continue with the x rays and stuff like that because, um, I've only put, like, just how to go through an X ray. Not put any X rays. If that makes sense. I think I've only put a hip fracture. Well, just spoil it for 10 years. Yeah. If you see what I mean? So I can go through more, like, at the end of the day, um, I think the curriculum only puts on little amount of M sk if that makes sense. But obviously there's way more time scale. I'm only, I'm only covering arthritis for now. Do you get me? Yeah. Ok. So I could just go through a bit more and stuff like that. Well, I've just realized it's not me and you anymore? Is it? There's more people? Yeah. Well, starting, like, what, where you stay one minute, a bit more cos I don't think, um, II think I can run this pretty quickly. I can do it in probably, like, half an hour, 40 minutes, obviously without interaction. Probably 30 minutes. But, yeah, I'll leave that up to you then when you want, when you're ready to start it A and M at the moment. Yeah, I'll give it like, a minute or two. All right. Before I get stage 500. Panicking. Funny. Yeah, I think a bit more people join. I'll give it to all three and then I'll make a stop. All right, I'll, I'll just share my screen. Hold on and then yeah, it's really bad. So it, you get it started. OK. OK. It's probably gonna be better. I'm I'm gonna mute myself. Wait just before you meet just before you meet one minute, check it for me. Uh Is that fine? Yeah. Yeah. Yeah, that's proper full screen. Yeah. Ok, perfect. So you can go and meet. All right. So hi guys. Yep. Um I'm a staffer, I'm one of the fifth years and I'll be teaching the M SK um how I'm gonna do it is an style. Um and I've just realized that um I don't have the med sort of questions. So as Simon, if there's any questions and stuff or any answers, let me know. So I can just flip back. But um basically I'm gonna cover it as high yield as possible without this sort of gibberish. I'm gonna try and make it as little word as possible. Ok. So if you have any questions, drop them but down in the comments or whatever and then I'll have a look after to see answer them, right? So basically what most of this lecture is gonna be about is um arthritis. Um There's a lot of other things also um been covered in M SK but you might have to do that on your ones. I'm going to be covering mostly arthritis today. Um, as that's quite the biggest topic and usually your progress tests and your, uh, what's it called? Your osk? That's what's mostly covered, not really orthopedic sort of stuff. More arthritis room. So, yeah, beginning with it all. We're gonna talk about the spondyloarthropathies. So, there's four types of spondyloarthropathies that we need to know about. Right. So, it's psoriatic andys enteropathic and reactive arthritis. Yeah. So, these are the type of ar properties that we need to know about. And in terms of what do they mean? It's just that they don't have rheumatoid factor. And so that's what makes it known as sero negative. So in serology, they don't, they have a negative rheumatoid factor. Yeah. So that's all that it means. Ok, in terms of what it's associated, you'll probably see in textbooks. It's HLA B 27 associated. So this gene is usually affected in all of these um conditions. OK. So in terms of the first one, which we'll talk about is un closing spondylitis. Does anyone have an idea of how it sort of presents? Oh, I think my sorry, my screen has just broke. Um Has my screen just broke? Yeah, you've just gone. You stopped presenting? Oh, crap. Give me a moment. I will try my best to do this. There is OK. One moment. Sorry guys. Um OK. So does anyone know how it presents at all? No. Right. We'll go straight on with it. So, in terms of presentation wise, how it usually presents is sort of in the future. All right. Perfect. Can you see the challenge doctor? Um, yes. Yes. It's caught for me as well. Now, I think I, it's actually worked. This has been a blessing. But, yeah, inflammation of the joints and ligaments. Yes. Sweet, lower back pain and stiffness. Exactly. Right. So, it's an inflammatory response and usually in your sort of vignette, it's a young person and usually when you go to clinic you'll be a young person as well. So it's, it's the sort of likelihood and exactly as you mentioned, it's low back pain that's stiff and basically, it's worse in the morning and it eases throughout the day and the, basically the most relevant past medical conditions is sort of inflammation of other things. Usually anterior uveitis and achilles tendonitis. All right. So that's basically the presentation of an bond. Um, in terms of like, sort of investigations and management. Does anyone know what investigations you'd do? All right. Sweet. So we'll just go straight onto it. Yeah. So what you wanna be doing in the investigations is your shoulder test, you probably wanna get an initial X ray and it shows a bamboo spine or, yeah. Nice. A spinal x-ray and it shows either sacroilitis and bamboo spine and gold standard. What we actually wanna use is MRI that's gold standard. If you ever get any question of like PME and stuff like that. It shows bone marrow edema in early signs. So you won't actually see it like very clearly. Obviously, the radiologist will be able to identify that for you in terms of management. You'd give nsaids and physio and then if that doesn't work or if it's pretty bad, initially, you can go straight to anti TNF drugs. Now, anti TNF drugs. Me personally, I've never learned what they are. There's things like riTUXimab this, that the other personally, I've never learned it and I've done fine, but you can obviously learn it for the sort of extra points. So the icing on the cake and it will definitely help you out in your ay giving you that sort of distinction level there. Um On top of that um Before I move on, does anyone actually know what would come first? Would it be the bamboo spine or the sacroiliitis on your X ray? If anyone guesses this then that's pretty good or not? Guesses. It knows it. Oh, anyone or we got a lot of comments is no one gonna say bamboo swine. All right. All right, cool. So um yeah, it's sacroileitis. Yeah, exactly. So that actually comes first in your sort of um x-rays. So if you ever see a question where I've, I've seen on passed where it's like there's an X ray and it shows bamboo spine or sacroilitis, which one came first? And it was Sarro. So, yeah, that's your bundle. And can anyone tell me here. What's going on? What can you see from this little xray? Yep. Ok. Bamboo's fine. We'll take that and you can see the bamboo's fine. Ba basically, it looks like a bamboo. It's all fusing up from here. Does anyone else see fusion anywhere else? But I'm showing it along with you. So there's fusion here. Like these are started to, they've basically almost fused. There's basically supposed to be a space of the sacroiliac space here, but it's completely gone. And here, I mean, it's not really that visible, but there should be a space around here and that's completely gone as well. So this guy has had really, really bad um what's it called ankylosing spondylitis? So you just gotta make sure you'll be able to identify it. So looking usually at the sacro iliac joints first to see if there's any fusion of space or not or it'll be like inflammatory and really dense usually is what you can see and also here as well. And then a afterwards, obviously the pump be spine. So the next thing that we're gonna be talking about is reactive arthritis. What are the features that tends to be? Yeah, there's a bit of scoliosis. This is clearly like a crappy aligned um picture. So yeah, um moving on, we've got reactive arthritis. So what's the features of that? Does anyone know? Sweet. And so that's exactly what it is. Arthritis, urethritis or conjunctivitis. Now, it can be any of the sort of, um, conditions of the idea of can't see. So it can be conjunctivitis, uveitis, er, episcleritis can't pee being urethritis, balanitis and some form of arthritis can't climb a tree. So you've probably heard of it. Can't see, can't pee, can't climb a tree. I've also put here as well that basically you usually have a four week pro drawn period without, with the symptoms developing over time. So it's not instantly, it's more that the time course is around a month. So make sure you're aware of that as well because if it's really cute onset, you probably should be thinking more towards septic arthritis if you've had any of these sort of things. Ok. So what's the most common ST that causes it as well? Does anyone know if we don't know, we can just move on? So, all right. So in terms of the most common s ti it is um, chlamydia. Yes. And in terms of sort of the investigation we wanna do, there's not really a bond or? Oh, yeah. No, everyone's writing chlamydia now. Sweet. So in terms of, of investigations, you do wanna rule out sort of septic arthritis and other causes because it's not really a straightforward exam for er, investigation, sorry for reactive arthritis, if that makes sense. So, in management again, it's just nsaids, it will go away on its own and also treating the underlying condition as well. Yeah. And if it is recurrent, you do wanna perhaps start thinking about, um, referring on and probably even starting the d molds. Methotrexate. Ok. So psoriatic arthritis, I think it's gonna go through all as well. So we're gonna talk about features, investigations, management. So, in terms of features, what have we got that makes it different to arthritis, rheumatoid arthritis. Does anyone actually know? Oh, I've literally just gone and said it. I'm gonna wait like 20 seconds. Dactylitis. Yes. sweet. That's one. Anything else. So there's like usually four presentations or dactylitis as one sero negative. Yeah, true. That, that, that, that differentiates it. But features wise if you would say it skin condition. Yeah, that's, yeah, exactly. You're gonna have psoriasis 100%. Yep. Yeah, that's the one I'm looking for also P IP joints. Yeah. Uh, the, the tendon inflammation is one as well. Yes, someone's brought it there. So D I PS more than the P I PS. Exactly. So in rheumatoid, uh it's ok. It's ok. Um So in rheumatoid it is more, yeah, proximal inal joints. But in ps psoriatic arthritis most commonly is D I PS. So in terms of the four ways they present is usually something known as asymmetrical, which is common and there's symmetrical arthritis, which it presents literally is very similar to rheumatoid. But it's just that affects more of the distal interphalangeal joints than the proximal interphalangeal joints. And then that moves on to investigations. What are we gonna do for investigations and what is usually the diagnosis or clin in the clinical vignette that suggests it, psoriasis or psoriatic arthritis. I know. Mhm. Oh, we got the crowd stunned. Ok, let's move on. So, in terms of investigations you wanna be doing sort of, um, the X ray and the pencil in cup appearance is the biggest thing. So I'll show you that in a moment but in terms of management as well, it's an NSAID but methotrexate is usually the second line if it's severe or moderate. So, NSAID is always first line with psoriatic arthritis, you don't go on to the do. And so, yeah, we mentioned all of this before and there's also this thing known as the telescoping finger. Um and this is known as arthritis mutilans and that's pretty, it's pretty disgusting when you actually see it, but it's pretty scary. Um But yeah, who cares? That's not what we're here for. We're here for exam practice. So in terms of your x rays, this is what you can probably get in sort of a clinical vignette on your past med or your osk examination. And the idea is here, do you see this thing here? This is the idea of a pencil in cup appearance and I'm just trying to demonstrate how it looks more specifically. So if you look here, the idea is it's just like a bit more narrower. Yeah. And you can see it there. It's demonstrated here in these sort of patterns at the bottom, less sort of the top. But yeah, we did. So, enteropathic arthritis has not really mentioned that much, but in terms of that, it's basically any inflammatory joint pain and a change of bowel habits in keeping with IBD. You want to be thinking enteropathy and in terms of relevant past medical history, which is usually the giveaway sign, you probably have Cr Crohn's in your clinical vignette or they've had a history of pyoderma gangrenosum usually. And um in terms of investigations, you sort of investigate if they have the underlying IBD and then you sort of x ray for um axial disease, which is usually where it affects and that's basically on closing spondylitis. So, yeah, your treatment is again bond with the rest of rheumatological disease and conventional dos. So going on now to this sort of rheumatoid arthritis features. What is the bound or standard that you getting your ay station? Does anyone know? I'm sure you probably are aware now? Ok. So most commonly it affects the PS and it's known as symmetrical polyarthritic. So many, many joints and they usually the small joints as well. So some stiffness. Yeah. So female P IP joints symmetrical. Exactly. And um, yeah, it gets worse throughout the day and they have a positive squeeze test as well. That's one of the big things. And obviously you've got your late features as well, which you sort of have to memorize and you can see in your hand exam. So, make sure you know that for your hand exam, um, it puts you at like, the sort of distinction and, and stuff like that. Yeah. Bond or probably the most relevant one you'll probably get in your exams. Um, in terms of investigations, what is the cos we're all gonna say serology, but which is the more important slash specific serology in terms of immune testing, does anyone know? All right, the crowd goes silent again. Oh Rosewell Test you. I've never heard that. So yeah, I'm looking for the Yeah, that antibody there. Yeah. So what the hell's the Roswald test? Oops, I don't, I don't know what that is. Sorry, someone teach me. But yeah, you want to be doing rheumatoid factor and anti CCP. Yeah. So, and I mentioned before, the more important one or the specific one is known as anti CCP. So that's exactly what it is. And then you can also get it on an X ray right past me. So, um on an X ray, does anyone actually know what to identify? Now? I've not got a picture of an x-ray of rheumatoid arthritis. But does there, is there any specific signs that you will see? And if anyone knows it's fair play cos I didn't know it till I taught it. So not exactly loss of joint space, subluxation and sclerosis. OK. Periarticular erosions. All right, man. All right, man. OK. OK. We got, we got a lot of people we like to see this. Ok. Cool, cool, cool. So, yeah, now, lots of joint pains I think is the idea of subluxation. I'm not too sure. I won't lie. I just, I, I'm pretty, I knew about this just now. This is freshly learned from my own memory as well. So, yeah, you get that. The most important ones I think is, yeah, like I even wrote, I don't, I don't know what it means, but the easiest thing which no one has surprisingly said is that you get soft tissue swelling, cos remember it's an inflammatory response which gives a lot of um inflammation. So you'll usually see like fat fingers from the x-ray. Now, obviously, I don't have it. But if we were to go, let's say to the one before uh you see here. So these would be a bit fatter like around the soft tissues if that makes sense. So I think that's a pretty good giveaway as well. But yes, cos II won't lie. I don't know what the rest of these are. The periarticular osteopenia, the subluxation and the erosions. I don't actually know what they are. So for me personally, soft tissue swelling is you are, you're not gonna get an X ray anyways. But if you get it in like a clinical vignette, does that make sense? Most of the times in your sort of data interpretations, you will get sort of antibodies, not the X rays just to keep where it's for like the above and beyond students. And so in terms of management, does anyone know what it is? And if you want as well to talk about the specific dmards cos we all know it's probably gonna be dmards. So Dmards is first line. Does anyone know what specific B mods you'd use? Cos there's more preferred ones or not preferred ones? Yep. So methotrexate. Yeah. Anything else? Because there's more specifics in this one as well. And the crowd goes, oh, I was waiting for someone to say that hydroxychloroquine. I was waiting. OK. We'll put a hold on. Hydroxychloroquine. Anything else? Yep. SulfaSALAzine or whatever you say it and then there's one more. Uh but I'm not really too bothered, right. So hydroxychloroquine, we'll talk about that in a sec. But yeah, sulfaSALAzine, Leonide and methotrexate is the most common. Yeah. So someone just mentioned it nice. So I'd bloody just spoil this one as well, but it doesn't matter. So, biologics is usually used much later. So that's if they haven't really responded to the dmards in question. Um hydroxychloroquine is only used if like the disease is very mild or there's something known as Palindromic disease. II don't actually know what it is, but it's for initial therapy. You don't really use hydroxychloroquine. You use these three instead. OK. So yeah. Um in terms of sort of measuring sort of prognosis and measuring how well it's doing is DAS 28. And you kind of have to remember these scores as passed or quiz meed if you use any of them they tend to like talk about. So is DAS 28 score? Is this? How bad is the disease? And it's a pretty simple mark that you can get and it's also part of your MLA anyways. So, yeah, that's that management done. Moving on to the next form of arthritis. You've got septic. So what's the two big features in septic arthritis to make you worry or like other things that you should know? There's two big big features. Ok. So it's a swollen joint and systemic symptoms. They're the two big features, right? So it's a swollen joint and systemic features. It doesn't matter if it's red or not, it just has to be a systemic, a joint that's swollen and a systemic upset if you don't have systemic upset. Just you don't have to think septic arthritis. Does that make sense? So, yeah, as you all mentioned, that's correct in terms of investigations of it. Synovial fluid analysis. And I've wrote here, what's the most common organism versus most common in young patients? Does anyone know the difference? Again, this is more past me question and you can even get this actually in your um joint fluid analysis interpretation station where there could be a follow up of what is the most likely organism that's caused this. So, yeah, you know, stuff. Yeah, exactly. So stuff and um, gonorrhea. Exactly. So young patients have gonorrhea. So usually they'll be like sexually active and they got that. Now, I've seen a really, yo, um, a really important differential with gonorrhea and it's a complication of gonorrhea. So, if you done obs, you guys haven't done obs and gyna yet. So, so how do you differentiate the arthritis, symptoms in septic arthritis and symptoms in reactive arthritis? Great question. Um, as I mentioned to you before, so with, I'm not gonna go all the way back now, but we can talk about it later. So essentially with reactive arthritis, what happens is it has very similar features to septic arthritis. So the investigations of reactive arthritis is essentially to rule out other things because there's not really a gold standard investigation for um reactive arthritis. Now, in terms of clinical vignettes and your Aussies, you will be given the eyes and urethra symptoms. But in terms of in real life, when you go on the sort of the M SK orthopedic wards, um they don't actually know cos most of the time, they don't really have that much of a fever, that much of joint pain. So what they do, they'll always sign over your fluid and analyze them just to rule out septic arthritis. If it's not septic arthritis, then they can't, then they start thinking about the reactive arthritis route. And obviously, the clinical history being more the um looking for like they do sort of like n att swabs and stuff like that to rule out, um, sort of chlamydia versus, um, gonorrhea as well and stuff like that. But, yeah, hopefully that makes sense without too much of the waffle. Try to make it as least waffle as possible. So, management IV, antibiotics two weeks then switch to oral. What's the antibiotic of choice? Does anyone know? Cool. We'll just keep that till it comes around. Ok. So, next slide gout versus pseudo gout. This is just a whole big, yeah, nice flu clock. That's the one that's the one I was looking for. So in terms of gout versus pseudo gout, there's three things you gotta be aware of the location that differs, the sort of joint um food analysis that differs and also uh II think that's a big two actually. So. Oh and the X ray. That's the one. Yeah, x-ray. So in terms of pseudo gout location is usually big toe in gout, sorry. And in Pseudogout it's usually the shoulder and wrist in terms of the crystals. So in the sino of your food analysis, one's uric acid, one's calcium pyrophosphate and it's also one's positive Bering to light and is needle shaped. Oh bro what? So negative beringer to light and its needle shaped and it's positive beringer to light and rhomboid shaped x-ray punched out erosions PG er Pseudogout has chondrocalcinosis in terms of management for both nsaids. Yeah. But gout specifically you need to know about um Allopurinol's sort of indication and usage, but always first line treatment is nsaids. Yeah. Or colchicine. Ok. Um I've put this question here. If anyone's able to answer it well done, when is allopurinol indicated? And when should you take it in terms of indications? There's quite a lot. But, um, so I'm more, I'm more worried about. When do you actually give Allopurinol? Cos you don't give it all the time? You see. So, after an acute attack, fine, but is that needed? So that's, that's when, that's the, when. So you've done the, when? All right, well done. You've done the when? So it's two weeks after, fine and I'll give a bonus question on top of that as well. But why would you give Allopurinol if it's someone's first attack? They usually say. So it's, as you mentioned after the first attack, there's also more indications I'm trying to get out. So, yeah, chronic gout 100% um, two attacks in a year. That's, that's the idea. 100%. Yeah. And then there's also a sign that you see on exam. That's my clue to you. What's the sign? Ok. So the big sign is that they have like sort of, um, to the gouty to. Yeah. Nice, nice, nice. So you get like in the sort of vignette, it'll be like big bulges around the elbows if that makes sense. So that's your indication to, to, and that's when you give allopurinol. Ok. So relevant past medical history. Yeah. Fine fat dos that have alcohol, sweet. Um, so osteoarthritis bond or just overuse of your cartilage. So, just walking a lot, running a lot. And you get this sort of picture on your x-ray, which is your investigation that you have to do. And this is what it will show the loss of joint space, osteophytes, subchondral cysts and sclerosis. Your consultant will ask you about this all the time. So make sure you remember it in terms of management, you do your nsaids with your physio. I don't know why they're separate. That's usually first line. Then if that fails, you can do intraarticular injections, then surgery is last line. Usually knee replacements and stuff. It's really, it's just a replacement this you will only see in surgery and when you go onto your M SK sort of wards, but you won't see it in clinical vignettes too much and it won't be in your osc at that point. They're more usually bothered about these before you here first. Perfect. Now, in terms of how it looks like, is this, this is your band or sort of assessment? So this is normal. This is very bad. So is osteoarthritis, there's super like the joint space is much smaller, there's also osteophytes which you can't see on here. I can't either. Yeah, sclerosis is just the idea. It's getting thicker, I think. And then the sort of how do you recognize subchondral cysts and subchondral. Well, so I've not got a really great one, but cysts are usually in the actual joint space. You'll see like a little like bubble sort of thing coming out of it and then sclerosis is just sort of thickening. So usually they're here and here and in the actual patella part here. But, um, that's how you'd identify. I don't actually have a picture for you. Unfortunately. I hope the, um uh, what's it called? The osk guys have it for you. I myself don't have it. I just literally got one from Google, but that's how you usually identify it. Cysts I think is at the bottom and then sclerosis on the side is usually thickening if I'm correct. I ain't sure though. II won't lie. I won't lie. But usually that's how I, if I remember it correctly from fourth years that I do need to revise myself 100%. So, fibromyalgia, next slide, actually, probably the worst condition to diagnose. Personally. I think it's fake, but obviously that's an opinion for later on in life. Um I think that was a very strong opinion as well. Of course, it's not fake. It usually these things are, are diagnosis of exclusion is what they call it. A lot of consultants will tell you it's fake, but it's actually not, it's, it's probably just more the idea that they couldn't find anything. So that's what they were calling it. But anyways point stands when you get in your clinical vignette, it's widespread pain that's not responded to much things. That's the idea, widespread pain that's not responded at night. They have sleep disturbance because of this pain and they're always tired and they usually have some form of sight condition as well. In the clinical vignettes. It's always like anxiety, depression or bipolar disorder that you'll always see. Investigation is clinical diagnosed. Um, it's usually a diagnosis of exclusion, as I mentioned and management is always neuropathic medications and CBT um both are hand in hand to help with sort of fibromyalgia as it's sort of a thing where your pain receptors are like ii igniting too much and they're always stimulated. So that's why you get this widespread pain. That's the theory behind it. So, fibromyalgia covered, I think that's all the sort of arthritis done. I have 10 more minutes to go through the OSC prep. So in terms of um osteo prep, right? So M SK history, most important thing is history presenting complaint and that's his Socrates, right? So as we mentioned from the histories prior that we mentioned, um that's what basically makes this outstanding. Now, if you wanna do it room focused, that's there's this thing on geek medics, it's called prism. I don't know, II don't really use it myself. Um But yeah, these are sort of things that you wanna be asking for as well in your sort of history presenting complaint or in just in terms of systems review as well. Ok. So the important ones when you do an M SK history is the stiffness, the swelling if you've had any recent infections and obviously back pain, talk about stiffness and back pain and stuff like that. And the other ones like rashes, mouth ulcers for SL E um, obviously, um, like ones that are exposed to the sun, this, that the other. So, yeah, and then obviously past medical history, I talk about psoriasis, any STIs, anything like that. What is immune imprison? So immune imprison is, is more the what's it called? It's like the immune condition. So it's more like talking a whole lot of waffle. Basically the rashes, the mouth ulcers, the dry eyes, Raynaud's phenomenon, systemic sclerosis, that sort of stuff. So it's just immune based things. So it's basically this left point hit. Um Yeah. Drug history. Diazide also like diet history. If they have a lot of red meat, have a lot of alcohol, that sort of stuff. Cool. Next M SK x-rays approaches, I don't actually know how to approach an X ray just like I just want just a yes or no just I didn't know how to approach x-rays until my osk in June. So literally like three days before. OK, the card goes silent. Yeah. Yeah. Right. Sweet. Anyways, it's pretty simple. Um If you ever get told by a consultant, basically the best way to go about it is you view it. What view is it of the X ray? Is it ap or lateral? After that? What you wanna do is you check your alignment. So for example, if you're looking at a hip X ray is the coccyx aligned with the um pubic synthesis here. Um After that, you want to check the bones itself. Is it fractured? What type of fracture? Where is the fracture? Yeah. And obviously what bone is, is the left or the right? Um Then after that, you want to talk about the cartilage and joint space if that's applicable and soft tissues as well. Yeah, so that's bond or we can do the hip x-ray. Does anyone have a go at it? No, actually, I don't think so. But yeah, the most important thing anyways is that the history. So when you go into your dating inter and you get an X ray, just know that the history is what's gonna save you realistically when you look at x-ray, I promise you, I promise you, I don't know what I'm looking at. I'm sure a lot of you also don't know what you're looking at. Well, I don't know, maybe I'm just uh I'm just dumb put like um yeah, just the history when in doubt if you don't know it, just base it off the history that will help you out. Yeah. So hopefully when you do your osteopro in a bit, this is gonna be your lifesaver if you don't know. So I've got a hip X ray here. Anyone we wanna talk about um what we're looking at is this gonna be uh I'm gonna try and cover that up. Is this a ap lateral? Yeah. Sweet. OK, cool. Yeah. So it's ap yeah, nice guys. It's all done. And then um do you want to talk about alignment after? So in this case, this is not aligned because this is the middle, it's got the coccus bit misaligned here. Does anyone tell me just a bond or diagnosis here of what's going on? Just without me having to do the waffle, how do you know it's ap right? So it's all there, right? But that's, that's the big thing. But also when you look at a hip, imagine this to the side and it, it look like more like a that's what it looks like. It's like just this, I can obviously show you without having it but imagine it flip to the side that that's all I can say. So does anyone have a guess at what this is? Bonus points if you do, if you get it right, right off. OK. We got a writing off. We got, we got that. Um anyone else wanna give it a shot until three people do it, then I will move on. If you don't know, then please say you don't know. So we can actually go through it cos you're probably gonna get this in like 20 minutes. Obviously, I don't know but I'm just like come on please guys, this is the last slide man. This is the last slide, please, please. Both begging fraction off. OK. Which one left or right? And if it's not specify, you've got to specify cos you don't specify uh we're getting not specific guys, you're not gonna get the marks, you're gonna, you, you're not gonna be passing that station. So come on, you need specifics, you need specifics, right? OK. We've got right hip dislocation a bit different. OK. I like that. Anyone got anything else right? And off we go right and off again. Yes. II feel like I'm bitting, bro. Go right off. Go right off. Any left off, any left, any left dislocations. Oh Nothing. All right, fine. We'll just take it as it is. We, we got enough, we got enough um participations. But yeah, basically um drum roll P is most, basically this is a right neck or femur fracture. Now bonus question. Is it extracapsular or intracapsular or even bigger question? All right, man. OK. OK. Fine. Fine, fine, fine, fine. All right. Yeah. So it's intra yeah, 100% 100% right. So um yeah, so it's intracapsular. It's above the chalk and teller line. Yeah, blah, blah, blah, blah, blah. So you guys know how to analyze that x-ray but to get the marks, make sure you just go through it in our systematic order. It makes you look nicer. But yeah, to pass it all you have to say is the diagnosis. So if you just get it straight up, you'll pass. Don't, don't say I said that disclaimer. Er, actually before I move on, disclaimer this entire thing, please do your own um your own one med, you know, this is a supplementary sort of um you know, learning. So please do do that in your own time, right? So food analysis summary last slide. This is it. Yeah. So I don't know why it's just been completely cut out but basically normal, colorless, translucent, no white cell count. Yeah, non inflammatory. So things like osteoarthritis, it'll be like straw like yellow and it'll have like quite a bit of high um white cells but not too much and everything else is negative. Ok. Inflammatory which could be reactive arthritis. Um Just anything really you can have like even sep septic arthri no septic, we'll get on top of sex, sorry, sorry, sorry, like reactive arthritis, psoriasis, everything else like I don't know, rheumatoid, these sort of things here. Septic is like bajillion and it's like opaque. That's usually the question and your grand stain is positive. However, trick question, which I'm gonna get up now if I have time. Um Actually one sec. Yeah, that's your bond or standard. How much time do I have left as Simon? Do you know? And is there any is I'm not sure there's time but only one of the facilities, only one facility Thanks guys. Um That's it. It's final start. You don't need anything more. Uh Simon. Uh Can you hear me? Yeah. Yeah. Only one facilitator here so far. So just so should I just like Q and A? Just keep going? Yeah. Yeah. All right guys. Um So we're gonna do a bit more now. Um I will, I'm gonna do this the last one I think on joint fluid analysis. Let me just uh one sec. Although if you have any questions, put them down below now, so I can answer them if I can answer them. Well. OK. And top and joint in uh adil. Do you know what time they, all the facilitators are meant to have joined at um 745. Uh No, wait, what time? 45. Yeah. All right. So I've got five minutes, any questions or anything like that because I think there's, there's not much time really. So I don't know. Um Obviously I'm not gonna do any practice OSC cos that's with the other people, but it seems that there is no questions. Will we have access to the slides non M SQ er with hindsight. Would you do anything different to prepare for final, final Osk? What prep would be best would that for you? Um Me personally um obviously how I did it was more start early for finals. You gotta start early, full stop. OSK, have a friend, do it with a friend, exam wise. Do your an, or do your, um, pass med do that every day. Now, go and if you're doing it early stages, I think, go through, do, er, go through it by system, so do cardiology, do respiratory, do orthopedics, do it by specialty first and then when you start getting to your exam, do it all, that's how I see it because you should have revised it all by then and then make sure you write down your errors. Cos I didn't do that. And yeah, I kind of got kind of got shafted. How long would you prefer for, for oy final dates? Um Me personally, I'm doing it at least a month and a half, especially for fourth year. Third year, you could have, you got away with it, right? Cos it's not that much, but fourth year, there's quite a lot like even me now in fifth year, I'm like, yo I need to start soon because there's fourth year and third year I have to cover. So, yeah, and I've still not started. So don't take it from me. I'm not, I'm not really a great candidate. So, yeah. Mhm. I'm not really selling myself. Yeah, please do your own revision guys. Please don't just use this. Thanks. Will we have access to slides? I think you will. Um I think there's gonna be a feedback form that uh moderator will put in. I think some will put it in and then um what happens is you fill it out and do that. Yeah. Well, so how I've learned, I've only learned it this year really. Which is so stupid of me. But basically every time I get a question wrong on pass Metal or quiz me, I write down the ki and then I do those Anki later on so that I remember it and then obviously just with an, you just go through it as you would isn'tt it and then obviously you can have the Yank. This is how I do it. So I've, I've named this the Yani sort of style thing. Um So basically how I write it is and for example, well, let's just do psoriasis in this case, ankylosing spondylitis. What's the features, back pain, stiffness in the morning that ease throughout the day? That's one card if that makes sense. And then relevant past medical history of an anterior uveitis, achilles tendonitis, that's how I tend to do the Yankees if that makes sense. And obviously, if I get anything wrong, I'll put it in any other cues. I'm also trying to get this FNC one. Basically what I'm trying to um for that sort of joint fluid analysis, I've seen one where it was more, it won't be on the Aussies, but more the past med like a h higher harder question a person comes in with. Um, he's got like, um he's sexually active young lad, he's got joint pain, right? But on his synovial food analysis he has a gram negative um thing. So most likely anyways, it should be septic, right? Um But obviously in septic, it's staph aureus, which is a positive gram stain, but sometimes it can still be negative around 30 to 50%. It's negative. However, what the answer was, it had basically all of this, but this was negative and it was um it was disseminated gonococcal infection. So when you do your obs and gynae, you can probably see that but disseminated gonococcal infection was because he also had like a skin rash as well. So be wary again as of the um what's it called? It's actually on geeky medics. I'm gonna try and find it as well cos I was on a geeky medics. I have a minute. Hold on, let me see if I can just Yeah. Yeah, I find it funny, funny, funny, funny. So obviously don't tell anyone but you see this basically he has a fever and skin rash. Everything else is the same except this was negative. So you should think Gonococcal disseminate gonococcal infection. That was a question that I saw on past me and then I saw it later on in um geeky metics. Don't worry about it. Now, just think just use this table, please. Screenshot this table. This is fantastic. Ok. So this is the one that you really wanna be after. But obviously it's for those above and beyond ones that I wanna think outside the box Yeah, it was crazy. Yeah, I think that's my time over. So leave me a feedback. It would be great or whatever. Um, yeah, Simon, what do I do now? II don't know. Oh, still waiting on some, I'll, I'll just wait around anyways if anyone's got any more, if not, I'm just gonna, I know I'll, I'll wait for about 55, 10 minutes. Uh Yeah. Well, yeah, thank you for that. That was good. Um Yeah, just still waiting for in terms of feet or any tips for you maybe asking the wrong fellow. I won't lie. Um Is there practice later today? Yes, there's going to be osk practice right now in about like 5, 10 minutes. So that's why I'm gonna leave in a bit. Um, any tips before you. Ah, fourth year mate. Fantastic. Fourth year for debilitating, make fancy Mate. Just, just, just know. Um Yeah, I think, um, he's gonna, they're gonna put in after the, the next session they'll put in the feedback form. I think, I don't know how the feedback form thing works. It is my first time teaching. I won't lie. I'm also, yo, Simon. Can I, can I shout myself out? Yeah, why not? Go for it. Um, cos basically guys, I'll probably be doing a, so I made a society. I've not actually finished it. It's called Edged on Instagram. Yeah. Go follow it if you want. I, I'm the owner of that society. So, um, yeah. That's all I got. It's currently got no profile picture or anything. It's got like three followers on it. Write down the name of it again in the chat. Hold on, let me just um, Adil. Do you know, is there a chat with the volunteers or anything? Do you know if you can see where they are? I've got no idea, bro. Just got an email. So, all right there is. Yeah, I'll try and chase him. Go me. Yeah. For real. Go me. Well, I'll, I'll share, I'll share it in the chart and see if I got it. So I should probably pull. So it's, it's literally Ed Ed underscore underscore something, right? I think that's, that's it guys gonna make, I've made a society. I wanna try and teach even though there's like a billion teaching societies, but I wanna try and do Anky style, oy or not ak Anky style very, very high yield and less waffling. That's what I'm trying to do. So, yeah, I don't know. Trust some support maybe or something like that. I don't know. Um I'm gonna start, I don't know when, but yeah, hopefully soon I think that's it from me. Um I'll start presenting the Yeah. Yeah. So. All right. Well, um I'll start, um, is there anyone else gonna join or is it gonna be a deal? Are you gonna do it yourself? I hope not. I don't have a clue where all the other people are though. I think there's three of us doing it. But yeah. Um so apparently leaders are joining at eight. He just got a hope so, bro. I don't mind taking a group now because I've got to leave at around 840 anyway. Uh Yeah, I'll, I'll give you, I'll allocate um some people to your breakout room. So, um do you know how many people you were, how many people you were you expecting in a, a breakout room? Not a clue, bro. I mean, a few people have left now as well. So, uh I'll just keep it like, um, I think it probably 55 each. So, um, I think the way you join the break rooms is you actually click them. Um, someone said usually two or three, I don't think we have enough, um, volunteers for two, for two or three per room. Um, also there is supposed to be two others. Yeah. Yeah. Even with two others, we don't have enough. Um, apparently the others are joining at eight, but for now I do, um, just head into my breakout room and then, yeah, just come into your breakout room and I'll, I'll send some people in but I should, I just do a bit. I don't have anything though on the things. That's the thing. I don't, um, I don't think you, I'm not even allocated towards it or no, no, I wouldn't worry about that. You've done your part. So we'll just wait for the other. They were told to join at eight. So we'll see if they do. Um Yo, if the team wants me, I'm here, bro. Don't worry, man, I appreciate it. But yeah, there's not, you've not really got anything prepared, have you? Um I mean, I could, I could if no one actually joins, do you have a number for you? Of the guys? Can you see the breakout rooms like on your screen? Can you see them like available to join? If somebody just said that on the left? Yeah, that's for the, that question for the viewers. So can you see, like if there's a breakout room for you to join, if you have the option to join breakout rooms? Yes. Ok. Ok. Um, I can't allocate you. So I'll just, mm, we'll just say the first, um, five people who say me in the chat, feel free to join, um, Adel's cos I don't know who's active as well. And once you've said me just go and join that, then the rest, everyone else can wait until, um, if you're willing to, the, the facilities are joining at eight o'clock, um, in terms of feedback. Do you get it? Do you send it out on this thing? Right. Yeah. Yeah, I send out at the end. I'm pretty sure. And then does it come to me afterwards or? Yeah. Yeah. And do they get these slides as well? Uh, I don't know how the slides work especially cos it usually it goes through metal. But yeah, that's what I mean cos mine's a can of slide show like I don't know if they Yeah, I'm not sorry you guys might have be you there. Um Yeah. Um uh Did you guys hear what I said? So just in terms of allocating breakout rooms, just the first few people who say type me in the chat and then go ahead and join Adel's room um because I can't allocate you. So OK. Right. So U 23. So Sarah Janelle and Gift Conjoin A and then two more Laser and Eliza. OK. Well, you guys join anyway and then we'll see when the other facilitators come. So we'll come in the chart, I think. Yeah, the at the end of the session we send out the feedback forms. I mean, I actually maybe I can send it now or I'll send it. It shouldn't, it's like, yeah, that's the first part is, that's my bad. Um So yeah, it's in the chart. OK. Right. Yeah. And Puga go ahead. So then everyone else just a couple of minutes and hopefully the other facilitators will join. Uh Yeah, you can go if you want, you've been here like an extra hour as well because you joined at six. So, no, no, I didn't. Yeah, I did. I obviously if this doesn't get so thank you will do in a bit. OK. So um Amira three Janet, um, why don't you guys join Danny's breakout room? So, Amira Far and Janette see if you can join Danny's room and then uh everyone else join somebody's room. So everyone should have a room that they can join so far. And Janette, you're in Danny's room, Lisa, I believe from before you were meant to be in a deal's room. But at this point I'd say join, er, Samir's room. So freeze and Jeanette's join Danny's, then Lisa Sadat and Tusa join Samir's room if you are still there.