 What is up guys, Karma Medic here and welcome back to another dose. If you're new to the channel, hi my name is Nasser and I'm now a fourth year medical student studying at King's College London. In today's video, I want to go through a couple of questions live on camera in preparation for an upcoming medical school exam that I have. Quick disclaimer, I am by no means claiming that everything I say in this video is going to be correct. I just think that some people might find some value from watching somebody else go through questions and watching their thinking process, have the extractive piece of information and how they go about answering the question. Now a lot of people, when answering pass paper questions, they use them as a method of testing their knowledge and not really as an actual source of information or learning. Personally, I like using a question bank as a learning resource in itself. And so as I go through the questions, I'm going to be taking notes on why I got a question right and why I got a question wrong. And one information I think is going to be important in the future. And I'm going to be doing all of that over here on the right hand side using Notion. I've got an entire video on how I use Notion to take notes like this. You can check it out somewhere over here. Anyways, without further ado, let's get right into the questions. 76 world man. 76 world man. 76 world man. 76 world man. 76 world man. 76 world man. 76 world man. 76 world man. 76 world man. 76amoca. 72 world man. 74 world man. 74 world man. 74 world man. 75 world man. 75 world man. 72 world man. We should a think functions. We should a think function. Wi Wi Wi Type St А. 75 World mussae Law and Ethics, or did I have a MISC Death Certification? Okay, let me move that, draw X, copy that here. So as I've come to know from my friends who are currently doctors, writing death certificates is a important job of an F1. So I should know quite a lot about it. Yep, that was exactly my reasoning for why I didn't put aspiration in your mind. Let me make sure I write down the thing that made me answer this question correctly, the line of thinking that helped me ask this question, which is line 1A. Next question. I'm giving this answer by saying what's wrong with it. I don't understand what's wrong with it. General Higgs and his joints are going to be on top of each other condition. Okay. So immediately when I hear both his father and grandfather died of a liver condition, I'm thinking of some sort of hereditary condition involving the liver. And when I hear it's having problem achieving an erection, this immediately makes me think of hemochromatosis, which is answer C over here. So hemochromatosis, let's see if I got this right first. Okay, hemochromatosis, you have an overload of iron and the body doesn't know where to put it. So it gets stored in the liver, gets stored in the brain, and some doesn't get stored there. It gets pushed to deliver to the brain and it can go to the testicles as well, causing problems with erectile dysfunction. So now I want to find my hemochromatosis notes and add anything onto that that's missing. So under gastro hemochromatosis, hemochromatosis. All right, copy paste the notes and then write down sort of the most important thing. So So now I want to highlight and make bold important piece of information. So bronze skin pigmentation is usually a big clue but wasn't present in this question. Where's the side of action of fursomide? Wow, direct recall question. Fursomide is a loop diuretic. So it's in the loop of Henley. Now the ascending or the descending loop of Henley. So on the way down, you take out all of the, oh gosh, I should really know this off by heart. There's tons and tons of water. So the action of fursomide is going to be not there on the ascending loop. Thank God, I should really, really know that off my heart. Okay, so let's go to pharmacology and let's go to where we talk about diuretics. It should be pharmacology, not pharmacy, pharmacology. This brings me back to first year. Yep, seriously, I haven't studied this piece of information in so long. Nah, don't Google the questions, guys. Don't Google the questions. Take an educated guess. All right, next. What is the most likely diagnosis? Pete's seven-year-old won't have a sense for the three months. Otherwise, normal appearance. Fibromyalgia, unlikely. Lumbar nerve root compression, don't think presents like this. Osteoarthritis, very possible, especially with the narrowing of the joint space. Greater trochanteric pain syndrome. That sounds like it could be reasonable. Meralgia, pyroesthetica, literally never heard of before, but pyroesthetica, pyroesthesis, loss of sensory innervation, which doesn't sound like this, or sensory feeling, which is not what this person is describing, they're describing pain. So between osteoarthritis and greater trochanteric pain syndrome, what's gonna help us differentiate between these two? Three-month history of right side hip pain that came on spontaneously. That doesn't really sound like osteoarthritis. Osteoarthritis is quite progressive. It's gonna be worse on the outside, which is where the greater trochanter is, isn't it? On the hip bone, on the femur, it's gonna be worse on the outside of the hip, particularly bad at night, when she lies on that side. That's making me think it's not osteoarthritis. I'm gonna go with greater trochanteric pain syndrome. Let's see. Correct. It's another preferred term for trochanteric birthitis. Okay, so what made me know this was greater trochanteric pain syndrome? That's what I want to write down and focus on here. Osteoarthritis is less likely given the palpable nature. Good. And the short duration of symptoms. Good, good. Both things that I thought about. Yeah, the comments are a laugh. They definitely make studying a lot easier. The problem with checking the comments is sometimes you can spend longer getting involved in the comments and reading people's beef and funny things instead of actually answering questions. What action would you take? 33-year-old woman. What's important for this question? Woman who is pregnant and has had exposure to varicella zoster virus. So the cut-off is at 20 weeks gestation. Before 20 weeks gestation, we want to give immediate immunoglobulin, okay? Which is this, varicella zoster immunoglobulin because the risk of congenital varicella zoster virus syndrome is very high and that can have really poor effects on the child once they get born. If it's after 20 weeks, then we want to wait, I think, seven days before commencing either this immunoglobulin or an antiviral, so like a cycle of your comments. Chickenpox exposure in pregnancy under 20 weeks. If not immune, give the immunoglobulin. That's it. What is the most likely diagnosis? All right, so a lot of information here. So P and C antibodies are associated with rheumatoid arthritis, ulcerative colitis and... Wec... Neurons, granulomatosis? No, that's C-anca. Wecner's granulomatosis is C-anca. P-anca is chirgstrouse. Oh, great, they haven't used the epitomes. I think that's Wecner's. I think this one is Wecner's. Wecner's, which I remember as Wecner's for the C-anca, but so that means it's not this. So I think it's this one. Granulomatosis with polyangiitis. Chirgstrouse is P-anca associated. And the way I remember chirgstrouse is PAPS, PAPS blue ribbon beer. And I remember eosinophilic beer or something like that. So I'm gonna go with the eosinophilic. Yes, okay. Let me show you guys that real quick. So if I go to my USM at least step one notes and I search for dirty medicine, and then I go to C-anca. One, two, three, four, five, six, six, seven, eight. Vascularities, here they are. All right, so chirgstrouse syndrome. Eosinophilic, granulomatosis with polyangiitis, which I remember as PAPS, PAPS blue ribbon beer. Chugstrouse syndrome, chug an eosinophilic beer. What a memory association. Anyways, so that's why it was this. I need a better way of remembering this without the actual names, so let's focus on that now. So Wecner's, the normal name, has a big G in the middle, Wecner's. So immediately it's gonna start with granulomatosis. I'm not sure how to get your G in the right direction. So I do have a G in the middle. Here's my G in the right direction. Very strange associations, but sometimes you need those in medicine. Diagnosis of Lycan planus is suspected. Very big, remember that. What is the word? Lycan planus. Yeah, I definitely don't know this. Honestly, I just don't know. So I need to answer the question, get it wrong, and then learn from there. So, topical quabetosone butyrate. So let's learn about Lycan planus. There we go, in the term question. Of course, the answer is steroids. Would have probably been a better guess. What's the most appropriate next step? You're reviewing a patient with COB. So, if I remember correctly. Are there asthmatic features or features suggestive of steroid responsiveness? So Saba and then Laba plus Lama, which is here. Laba plus Lama, okay. So if there is steroid responsiveness, then it's inhaled corticosteroids, ECG. Business. ECG shows the following. What do we see here? Very, very high R-waves. Probably indicating it's a hypertrophic obstructive cardiomyopathy, H-O-C-M, there we go. Yeah, it's a classic presentation. Young, healthy fit person who has these really big R-waves on the ECG, I'm just gonna show you. That's always the next question. Which one symptoms is least consistent with the diagnosis of irritable bowel syndrome? Didn't know about mucus in the stool though. Passage of mucus, okay. Let's highlight that and make sure I remember it for next time. Make it red. Passage of mucus is normally, I guess. Which one happened regarding anticoag? I want to say it's six months. Orphan should be continued indefinitely as this is his second episode of AF. And yes, risk factors for stroke, age and hypertension. Next. Which of the following is the biggest risk factor for malignant otitis external? ENT, man. ENT, honestly, no, sure. I'm gonna guess and try and learn diabetes and malitis. Malignant otitis external. It's most common in patients with type. All right, Lee, very common. All right. Been on a bit of a rough stretch here. Three wrong in a row. All right, let's get that percentage up. Urine dipstick shows both blood and white blood cells. What's the best treatment? A 20-year-old woman who is 16 weeks pregnant presents with pain, passing urine and an irritating rash. Okay, so we're thinking urine and tract infection. So hematuria, okay. Is telling me that this infection has reached further up into the body than just the vulva, okay. Clotrimazole is for fungal infection. Cephalexin, this is Cephtriaxone. Is a cephalosporin, viral, viral fungal. Cicular rash actually sounds quite viral to me. Even though I'm not sure what this is specifically referring to. I'm gonna go with oral, because it sounds quite serious. Okay, the way I deduce the answer to that question is that this rash didn't sound very fungal and these are both treatments for fungus. They're both ketoconazoles. And then cephalexin is a cephtriaxone which you would give for a bacterial infection. It didn't really sound very bacterial because of the vesicular rash. That's what made me think either human papillomavirus or herpes oblique virus. And then oral is used when you have a more serious infection as opposed to topical. So that's why I wanted the oral. Next. First of all, medications could be a cause of her pulmonary fibrosis. You're viewing the 40-year-old female genart practice as a new diagnosis of pulmonary fibrosis, okay. Medication history. Nitro furan toin. Disoprolol, warfarin, salbutamol, and halar. And calcium with coleg calciferol. This is a beta blocker which I do not recall causes pulmonary fibrosis, warfarin. I also don't recall. That's salbutamol, no. Calcium with vitamin D. So I'm gonna cause pulmonary fibrosis. I don't think so. Nitro furan toin is a treatment for a urinary tract infection. Let's find out. Nitro furan toin. Somehow I knew this piece of information. Nitro furan toin, drugs causing lung fibrosis. I was thinking along the lines of chemotherapeutic drugs like bleomycin and buesulfan. But yeah, nitro furan toin. Did not know that. Don't think so. Don't think so. All right. What's the most like diagnosis? 26 year old. Pelvic pain and smelly discharge. Why don't you tell me? Describe the discharge to me. Since she has had the HPV vaccine, I'm gonna go with this is not cervical cancer. She's also quite young. So I'm gonna eliminate that. Cotopic pregnancy, worsening dull pelvic pain. That is not how a cotopic pregnancy presents. It's much more acute and much more severe pain. Pelvic inflammatory disease is definitely possible. Dull pelvic pain, smelly discharge. Definitely possible endometriosis. Doesn't really present like this. Increased pain during menstruation. Doesn't present like this. Inflammatory bowel disease. No. That would not cause the smelly discharge. Yeah. Gonna go with PID. She's young, probably sexually active. Nice. Pelvic family disease most likely was vision. Pelvic duration. Planetary GPA. Pains not severe. Smelly discharge. STI. Next question. Tonero loan, who is an intervener's heroin user. Contribute, which one of them complains? Both names are as a result of her drug use. Teasures. No. Osteoporosis. Peptic ulcer disease. No. Schizophrenia. Venous thrombol embolism. Intervenous heroin user. This is not so. Yeah. I'm gonna go with VT. Upward misuse. Schizophrenia is not going to be caused by that. There is such a thing as drug induced psychosis, but that's not the same schizophrenia. What's more important advice to give? You receive a letter from the endocrinologist on our website. Yes, that rings a very strong bell. This is for the risk of neutropenia. I believe that can come with taking carbimazole. That rings a very strong bell. So I'm gonna go with that. Any granulocytosis. Yes, okay. So carbimazole. That's a long one. What's the most important symptom evaluating this patient? 24-year-old man. So weight loss, fatigue, and a lump in the testicle. Not good. No pathological history, no regular medication. It's actually active. It's not drink alcohol or smoke, okay. No other symptoms other than large, non-tender, left testicle. I'm gonna start with that right. There's no palpable lymphatic alchemy and no gynecomastia. Okay. So this definitely sounds like a testicular tumor. It's called lymphatic alchemy as a marker. First line investigation of a testicular mass is an ultrasound reproduction. Reproductive. I'm really annoyed I got that wrong. I should definitely have gotten that right. It's got oncology, testicular cancer. Ultrasound is first line. I've written it down before. It's getting close to two, which is what I mean, nor usually have lunch, and I'm quite hungry. So how many questions do we have here, 18? I'll do 19 and 20, and then we'll stop. What is this? 34-year-old man. This rash definitely rings a bell. It was something like a yellow waxy rash on the soles of the feet. That rings a bell. Karate derma. What a random, random thing. Reactive arthritis features. Karate derma, blenoragica. I know I've written this down before. I remember it. Karate derma. There it is. Karate derma, blenoragica. Waxy yellow soles. I remember that. Final question. What treatment should be initiated? Five-year-old boy. The panic membrane's not visible due to debris. What's the debris? Why have there been so many E&T questions during this session? I'm gonna go with that. Great. Childless classic symptoms of a tyrosis. They're not like cause after swimming on holiday. Okay guys, I think I'm gonna end this here. I'm really hungry, and I can hear Nor preparing lunch in the kitchen. So we got a score of 70%, which isn't great. It's not too bad either. It's just fine. I've definitely learned quite a few things when answering the questions today, and I hope you have as well. If you did enjoy this video, don't forget to leave a like on it, and also subscribe to my channel to see more content from me in the future, and I'll catch you guys in the next one. Peace. But to start, touch the lens too much there.