 I think you guys can just wrap up and send me what you have if you didn't get to the end of it. Just send it to me. I think it'll be more productive to also like discuss what we think. So um I guess you know we've been doing retina or doing mole for I don't know how many years now maybe five or so. I think it's a good time to kind of like assess like how effective the curriculum is in meeting your needs. You know that's the only point of like mostly the only point of the curriculum is to help you guys. So I think this is like uh maybe sometimes as faculty like we feel like we don't have that much like so now this is like a dedicated time for you guys to just you know discuss like what you would like to see differently like what would help you more. And I just say this is like my first time doing like the team-based learning thing and I've never actually experienced it in real life. I just went by what the med students told me and what I YouTubeed so definitely curious for feedback on that at the end too. So logistically it can be like a little challenging with all the different documents and things. So um so what I was envisioning was that we would split up into three groups and we would discuss um a couple different aspects of the retinal mole curriculum. So one could be discussing FA conference and other could be discussing the lecturers and then the other could be discussing you know learning on rotation. So I'm going to ask you guys for the case-based learning to like split up my year. One, two, three, four, five, six. So maybe like try to sort yourself into three groups where there's approximately like junior and senior people and the three different groups physically organize yourself together. So let's do three groups and there's going to be like some senior and junior people in each group so. All three groups. Not this one side of the room. We'll let you know but if you take them and all the you know the right side of the stuff, it's me, it's us three. All right, these three, these three, George. So you got us, you got two more of your people. So three more members? We're both good people. This is a problem. We can't help very hard. That's a problem. All right, so let's group over here. You can discuss FA conference. What are you, how do you like that to be different? Let's group over here. And then you can discuss like you know on rotation. And then nominate one of you guys to be the scribe to write down your comments. Okay. I'll look for that. I better put on that. Okay, so you need to look at the current curriculum. I posted it here. It's also in the box, in the peds written on 2023 under written a whole curriculum. In case you need to look at our current curriculum, it's on box in the peds written on 2023 folder called written a whole curriculum. I'm going to do it several times. Yeah, but I know what's interesting is going on. I was actually thinking it's really easy. It's like, you know, but more than once I wanted to do it, it's like I don't know what I was saying. So what was actually Well, so that's what I'm asking you. Yeah. So much. Like you're saying this is the area. Yeah. Yeah. Like my sounds like we're not all boys. You know, what is it? Yeah. Yeah. Yeah. Yeah. Nice. So so and then to so I mean, the Red Bulls are just like, yeah, they have that shirt, like I can't think of any better way to give it a more good gift than to give it to the Red Bulls. I've seen the pictures of the Red Bulls and I haven't recognized them in a while. I cut these three big dolls in a row. That's a Red Bull, right? Yeah, that was actually a bunch of things I had in mind. I've seen it a lot. Do you go to the Blue? I've been to the Blue so many years. Yeah, I've been to the Blue. Yeah, I've been to the Blue so many years. I've been to the Blue so many years. Do you guys feel like if we wrap up in like five more minutes of your time, are you ready now to discuss in a big group what your primary is? Okay. Like we're ready. You're on the ground. So it's almost like, it's getting like too creative. Yes. And you're like, just give me a lecture. I think it's on the ground. Yeah. It's basically just like that. You guys, do you have an anti-vegetarian lecture? No, wait, I don't. I was just curious because like I saw that on here. I was like, is there a specific anti-vegetarian lecture that's separate from diabetes and AMBs? No, that's true. You guys could also talk about like whether the topics of the didactic sessions are good. Like would you like different topics? Would you like to cut any of them out? Do you feel like there's something that's like really critical that's missing? Yes. Thanks for calling. Yeah, no problem. All right. So maybe we can just like, feel free to... Okay. Yes. Okay. So what do you guys, what is your, George, what did your group say about FAA conference? I can't go, I mean, should we go for it? Okay, we'll wait. Let's just get out. You're always... I guess since we showed up together, we've been together every day. I don't think she didn't realize that like a lot of siblings and like... I'm just going to get in. Now we'll hear what Abigail has to say about her group. FAA conference. Conferences tend to go over time. So having it less often or having only like a max of 2% each time. Okay, that would probably be great. Because I find myself, I couldn't focus in the first two presentations and then I just... And I think that's really good to think about because I think, I don't know if the... Like the, what is it called? The AUPO has some sort of requirement for how many like FAA conferences each fellow has to present at. So I don't know if that's like the driving factor. And then I don't know if residencies have a requirement for the number of FAA conferences you have to go to or present at. I think we should, maybe if you could make a note that we should look into that and I don't think we should be trying to go exceed the requirements. I've talked to Bernstein in the past about doing FAA conference and I asked him, what are the requirements? He's like, well, it's only required to have it once a month. So I was like, why are we having it twice a month? But he said it's because it often gets canceled. But I was like, I don't know. So it may be that if you guys unanimously would love to have it less often that we could, you know, bring that to the like PC and be like, hey, you know, we have a lot of burdens on our time already. Like we are not required to have this twice a month. Like, you know, I was not able to make a change, but I spilled that way. We can do it. Okay. So maybe the timing of it should be different too. Those are just ideas. I guess in terms of Tuesday and Wednesday, I assume Mondays are Orbit conference still. Is Tuesday or Wednesday preferred? Wednesday is also preferred. Yeah, definitely. I will be more strongly for the months of the month than the change day per day. But we can do both. That would be great. How they just like apply their words to just raise their solicits to see if they're going to have it easily preferred. Yeah. Do you guys have like a good resource that anyone found one that you like? There's a super basic one. I grew up in a medicine resource. I guess one thing I do, I personally as a resident looked back on is I got the slides from one of the fellows that they gave at the beginning of the year. So that could be something that we could share. Maybe that's the best resource to share. Like more systematic. Okay. And it is great to like be able to, if you're wondering, oh, what does this look like? Like be able to go back to that case. So it sounds good. And then the last thing is to focus more on book reps in the morning. And then at the end of the summer, I think that that sounds like a really good, like let's make that they like more resident focused. I do say that sometimes it going really long is like you're guys fault. So don't go crazy with your presentations. You know, you can also focus on what's necessary for. Okay. But the fellows are also too late. I don't really remember, but we did not have it as often. That's for sure. I barely remember it. Okay. So any other comments on FA take homes is having it less often and making sure the things get uploaded. And it's more like O caps resident focused. Okay. Thank you for not just trashing everything. Should we discuss the didactics first? I just want to point out that, you know, when I asked Elaine like, okay, how many hours of lecture are we required to have? It was substantially less than we were having. So just thought to keep in mind that apparently, although right in the lecture hours have been reduced, you know, whether you want to reduce that further or not. So yeah. Like there's not like a systematic framework for your brain to like stick the information in. That sounds really good. Yeah. So, and I guess maybe the, so I guess the pre-work is a very quality in terms of providing you that framework, maybe like some of us might have assumed that it like provides that. And that's why they're like jumping into the quiz. But maybe it's helpful to like, because people learn in different ways and develop that framework in different ways, that it is helpful for people to like share. Yeah, so I mean I think that the first thing to allow that to have been about two hours was having the fellow or the entire session of like first pass going through material, foundational knowledge. Wait, are you raising this in style? This is all just me. Since we're not really recording our lectures anymore, to update content and things like that, that's available. So if people did, are you recording? Yeah. She taught us lectures. So as you're making the chapter, you have like questions to answer or fill in the blank. I think we're just going through it. And then we're like, oh, I just come back to it. So it's rock, paper, scissors. Yeah. All right. So, and then I think you guys, if you have a specific, deep back for specific Brettnell lectures, if you, as long as Sean's written them down, I think we could maybe, anything else we should discuss. Yeah. I guess what kind of questions come up on about the empty, like the trials. Is there anything else? Okay. It's not so much about what we're trying to do. Right. Anything else? Do you guys feel like we have like the good topics? Like, I don't know. We have the intro to retina, which I don't know. I'm happy to ask any of my lectures. Pete's retina. I feel like Pete's retina, like, I don't understand. I still have been trying to find useful ways to occupy your time. Because I feel like you get a two hour Pete's retina thing from the theater service. And I'm happy to quit. So I don't know. I'm thinking of axing that. And then, but I do feel like the inherited retinal degenerations that are associated with systemic diseases are really critical for OCAPs and boards. And I know I've been to Bernstein's lecture about four times. So, but just, I don't know. And I created, you know, there's some videos out there from me on that, but I don't know. Just any thoughts about the overall topics? Yeah. But I think having your lectures that you gave last year that's pre-York, those are really good. And I believe like the way that you organized into a pre-York. So having that as pre-York and then focusing on that. Because those type of information, but those details are things that are constantly asked. So I think it's good to coach this. So if you want me to continue to occupy your time, I'm happy to. If you don't want me to. Like I'm happy. I, you know, can make horror videos for you or update them or whatever. Try to improve upon them. There's so many questions. Do you feel like the intro to retinal like scleral depression is okay or you want to have more like, this is basics you need to know what to call instead of like this and see it's on? Okay. Okay. Okay. All right. Yeah. Yeah. It's good. It's going to be relevant like how to see this and even down to specifics like that. Yeah. I'm going to get way faster. Right. Assuming that you see it. Yeah. And our, I don't understand. Yeah. Sounds good. Okay. So that's maybe enough discussion of the didactic sessions. Sounds like the anti-veget. Like Jeff lectures not happening. So I'll just remove that from the curriculum. Yes. Just one thought. Yeah. Yeah. There are so many times. Yeah. I have no good up much. Yeah. Yeah. Yeah. And I'm like, I've seen you and I don't know. I was like, don't look at this what's happening. I don't know is there a room for this. Yeah. And so that's been like a source of stress a lot of the balls. That's true. And I think that's really nice to go for like the really basic random moments. Yeah. I could. Yeah. Maybe I can incorporate that into the indirect. Yeah. Yeah. Yeah. Yeah. Do we have a copy of that? Yeah. Okay. No. It's also great. When you said that, I thought of that. It's also great. It's also great. Oh, really? You know me in the video. Yeah. Yeah. That's true. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Well, I said so much time. No, I mean, it goes through all different random pathologies. Yeah. Thank you. Thank you. Okay. All right, shot. You took good notes. You'll send that to me. Yeah. Okay, Ashley. Are you subscribed for your group? Yeah. Oh, shoot. Okay. We'll have Nicole. It's What I'm having to call is, are there multiple retina rotations? What is to this type of tissue, why is there retina rotation? Okay, so it's pre-charting. What other scutwork are you guys doing? I don't think it's like, I think it's a lot of scutwork compared to the rest of our rotations, but in general I don't think it's, like it's, you're seeing a lot of the patients, you see a lot of patients who are self-imaging. It does talk, when you're not used to it, like when you're coming off of a pee, it's in your eye. That's true. I feel pretty lost. Yeah, pretty used to it. So it helps, you know, the patient and thank you, when I do next, and then it's close and it protects really. I don't know what to do with you, but thank you. Other feedback on the retina rotation? Yeah, I don't think we're going to get, Tally has, we're not going to get away from taking, I think that I agree with you that it's not that educational, but there's, I can't change that. Okay, I have a question, so. Yes. I'm not sure, I'm not sure where this is, because it was definitely going to give you a certain direction when I was thinking about how I had to explain it, but what is happening to retina rotation? I don't know. I was just going to be my feedback. I think whatever happens in the future, that takes a change. There's so many OR days in my skin right now. So, what was bad about it? There's no direction. Yeah, there's no direction, so ORs, there's typically like, like it wasn't clear what you needed to be, or what. Yeah, but even if you were scheduled to hurt, like there'd be days where there's like zero cases. Can you write that down? Well anyway, there's not going to be a clinic with her. I see, it's not like as clearly defined, like this is what you do, and if, like for example, if HeartNet has no cases, like can you just like relax? You know, that would be nice. I look at this good blood room. It's still awesome. Again, a lot of them are results from that. I think part of it is it seems like there's a lot of chaos among the fellows, like constantly they're like showing themselves around to make sure everyone's meeting the needy people's needs. Yeah. And I'm like, well, I'm happy to operate by myself, but I feel bad because you guys should be doing these things. That's why I'm like, yeah. I was thinking a bunch. There was often a day where I think Dr. Parks didn't have a fellow, and I was able to help in with you, which is BASCA. Yeah. Well, I think it would be really good when the Retina fellows remake their schedule for a resident representative to be like heavily involved with that. Any volunteers? Cole? Abigail? Okay, maybe I'll ask them to kind of schedule a meeting and maybe I'll attend the meeting too so I can help to advocate for you. And if you have another call. Yeah. She's been small converse personal fellows, so I'm not sure how I see it. It's helpful. All right. Other comments sounds good. I think hopefully we'll get some residents to attend the new schedule. I think that would be something. So, okay, so you might let that to me, Ashley. Let's see what time it is. It's eight o'clock. So we have until nine o'clock. Is that right? Yeah. So we might have to skip the Pete's Retina post year little chorea part, but I feel like that's the least important. That's just my... Okay, so next little mini lecture song, this Rob. So she requested it. So, by the way, I think I also probably have like a fakeomatosis lecture on their YouTube or the more I'm core somewhere. So, yeah, what does a fakeomatosis have in common? I try to, I'm not really good at memorizing things. So I try to like start from like a really basic level. Like what can I like find that's similar between like most of these things? And what can I find as like an explanation for why things are the way they are? I find that helps me memorize things more, but different people are different. So, but, so most of them are autosomal dominant, autosomal dominant inheritance. What's the reason for that? Why does that make sense? I try to, you know, like I think of, you know, like retinitis pigmentosa, like the ciliopathies. Those are autosomal recessive because like their mutations and enzymes. And if you have one bad copy of the enzyme gene and one good copy, you still probably have enough enzyme to do the job because like, you know, enzymes like catalyzed reactions, you know, we only need a few of them to catalyze a lot of reactions. So half is plain enough. So what's the explanation for fakeomatosis being dominant? The way I think of it is it's because many of them are mutations in tumor suppressor genes. So basically, if you have one bad copy of the tumor suppressor gene, you know, the other copy is still suppressive tumors everywhere in your body until something happens to that one copy. Then you start sprouting a tumor. So I don't know if that makes sense to you guys or questions, thoughts on that. So the lesions that people get are tumors. They tend to be hammertomas. They call them, you know, neurocutaneous syndromes because many of them affect the brain and skin. Not all of them have pain or skin findings. And then why are they called fakeomatosis? So fake, as you know, means lens. And the connection is not to like the lens of the eye and fake omulsification, but it's to the various, you know, birthmarks. They kind of look like lentils or lenses to the Greeks. So, and I tend to present in childhood or young adulthood, you know, if you think of it when you're born, you know, you haven't accumulated that many like random mutations in your body. So you're not likely to like have a tumor because your cells haven't grown that much, but it's more like as you go on in life and your cells die and replace themselves, that you will accumulate mutations. Some of those might knock out the good copy, the only good copy you have of the tumor suppressor gene. So a couple of definitions, hammeredoma, malformation, that's an excess of elements normally present at the site, chorostoma, it's a tumorous growth that has things that are not normally present there. Most of the neurofibromatosis or, sorry, fakeomatosis have hammeredomas, not chorostomas. And then some of the fakeomatosis, they're not really from tumorous growth, they're really some sort of malformation. So something didn't grow, right? Something wasn't developed correctly. So, you know, there's the mutations in tumor suppressor genes, which lead to tumors or hammeredomas, and then there's mutations in genes that affect development and that might lead to more like malformations, especially vascular malformations. So what's the angioma? There's a lot of words and then there's like variations on the words and they're all like used, it's really drives me crazy. The way I kind of approach it is I just pick one that I like the best and then I try to like just use that one, but then, you know, once I feel like I have a better grasp on the whole overall situation, then I link those other words back to that same word. So otherwise, I find like I just get overwhelmed and can't like, you know, memorize things. So a capillary hemangioma is a proliferation of capillaries. There's not very much like cells in between and it's a hammeredoma. So that's like a lid capillary hemangioma versus a hemangioblastoma. The word blast sounds bad, right? Like those are, so that's when you have like more stromal cells and these stromal cells have a lot of like vacuoles in them and that tends, so you see it's not a lot of blood vessels like in the tumor. The tumor is actually mostly the stromal cells and it's got some blood vessels and that can be more aggressive. That's why the word blast is in there. So what condition gets retinal hemangioblastomas? VHL. So those tumors tend to be kind of more aggressive than a lot of the other hematomas that you get in the fecomatoses. And then unfortunately, like they came out with this word like racemos hemangioma, but it's not actually a hemangioma. It's actually an arteriovenous malformation. So I would try to like think of it as an arteriovenous malformation then later connect in the word racemos, you know, hemangioma there. So unfortunately, people came up with a lot of names and some of them make more sense than others. So I think of the, so most of them, you know, being autosomal dominant, a couple are sporadic. So that always like confused me, but they yet they have a gene associated with them. Do you guys know why that's the case? Like how can you be sporadic if it also be caused by mutations in a gene? Actually, I think usually it's when there's a sporadic or a new mutation. So it still kind of has some effects. So you can have like a de novo mutation that's everywhere in your body. And that's one way that I still would call that autosomal dominant, but you can also get a de novo mutation when you're like kind of like a blastocyst. And then that mutation will just be present in certain parts of your body. So for example, like in Sturgeweber, maybe the mutation is just present like here, like on one side, you know, because you're, I don't know, was it your poriola is like symmetric, but you know, this cell is not going to, mutation of this cell is not going to like affect the other side. So that's why, you know, they found that when they tested like the tissue of people that have like Sturgeweber, they have this GNAQ mutation, but the rest of their body doesn't have the GNAQ mutation. And so the Clipel, Trinae, I don't know how to pronounce that, it's also like that. Fiber basin, I don't think anyone's found if there's genetic thing, but it's also sporadic. So yeah, that's an overview of the genetics. What was over here? Oh, so I just wanted to say that in general, you can have a characteristic tumor that's a characteristic of this syndrome without having the syndrome. So for example, you could have like a retinal capillary hemangioblastoma, single isolated one, without having VHL. You could have like a retinal arterial venous malformation without having Fiber basin. So that's just something to, you know, keep in mind that although like maybe we most commonly see retinal capillary hemangioblastomas in the context of someone who has VHL at multiple tumors, both eyes and tumors also are in their body, that it can be by itself. Okay, questions? Thoughts? The ones with W's in them are sporadic. Oh, thank you. Sporadic. Sporadic. Okay, so next we'll go on to the quiz. So there's a, should be in the box a fecometosis quiz blank. So you can like download that to your device and start pulling it out. And then what you're going to do is you're going to like have a partner check your answers. Or maybe BK and Lydia could be partners. Abigail and George could be partners. Nana and Tony could be partners. Sean and Mubarak and Cole and Ashley. Just to kind of split up the seniority. Wait, you're silently working on this. This is not an open look test. And then you'll grade each other. Sean, could you send me your feedback on those? Is there still an intern reading list? The politics book is not here. Cause I feel like that could be a good place to put the like an MA, like imaging basics. He told me he has like five copies. Cause not everyone gives it back. Whenever you're done, you can speed up with your partner. Shhh. They will ask. Oh. They don't, they don't. Silas, you're right. Silas is in the eye. Wipe her nose. Oh. Did you do? I don't know if there's anything else. Is there another name for him? Oh, that's right. I think it is. Oh, yeah. Does it actually? I'll just like comment that I've definitely been gotten by this on OCAPS where they like used the first third lever and I guess they do like do it in real life like in real years. I don't know if this is going to happen. One is, and that IP is actually not in it right now. So if you just remember those three... It's a con. Oh. They have the refuse cruddle. I guess I'd be like... Yeah, what's the difference? So this one is just like... It's just like... You know, at the end of this beat, it's sort of like... It's like a sped-up moment, right? It's like a response. It's just like... It's a foul, a criminal, whatever. It's sort of like... Like that's a bad guy. That's a good syrup. I'd got a little bit of a triangle on it. What I was talking about was... What I was talking about was syrup. What I was talking about was still martial arts. What I thought was... What I thought of a HL on that. What I thought was like... Yeah, I don't know. I definitely had a u-world portion at some point that only showed this, and asked what it was, and it was, like, these are all heads of Thomas, and they're right next to him. It was, um, this was straight out of the house. Straight out of the house. Straight out of the house. Straight out of the house. And then you'd be able to tell. Yeah, that's right. That's a stick. We'll find out. Yeah. I feel like NF1 is the one that can do a bunch of random things. What are you guys about done going over your quizzes? Any questions that came up, or? I did have a question. Uh, is that supposed to be, those are supposed to be portable tumors. No, those are supposed to be subendymal nodules. The cortical tubers, I think, are just, like, triangular white things in the cortex. They don't really, like, I don't think they stick out. Maybe they, maybe when they get really big. Look like a potato, I don't know. Like they only call the potato because they're triangular. Oh, really? Yeah, that's two birds. Potatoes are triangular? I don't know. I don't know. In the description it was like, yeah, the two birds. Oh, maybe it's a bird. Oh, that makes so much more sense. Really bad character. Thank you. Two birds. Okay, so now we're going to do groups or two groups for our split it this way. And then this guy. Okay, so next we're going to give K-Space learning a try. So you can, each of you should have a scribe. Each group should have a scribe. Sir Bella. Oh my God, I don't know what this is. Sir Bella Pro. You can start going through this case together and come up with the answers together. And then we'll kind of, like, have periodic, which we, like, meet, discuss things. Yeah, you just come up with answers as a group. Like, so the first, you know, so you review this case. Then you come up with a differential. And then come up with, you know, what are the blood vessel abnormalities, names that go with those items on the differential. Just pick a couple of top items. Don't list every single fake hypothesis. Is this something you, is that a crap? Just be a non-spiric. So act like this vessel's a little dilated and tortuous compared to a dilated and tortuous. It's hard to examine so you can't see it. He's on the left. Wait, are you two on the left or are you two on the right? Are we on the right? It's a lot of follow. How is it? I'm trying to look at everything. Hey, Chow, how are you? I'm on the right. I'm supposed to do this one, see how I'm going to do it. You're supposed to do this one. You're supposed to do this one, see how I'm going to do it. You're supposed to do this one. He'll probably do it. And he'll have to do it. I didn't realize, I forget, it was like really small, it was like what color did you see? Yeah, what's your favorite color? I always guess the birthday, I'm looking at the chart and I'm like, oh, it's your birthday and I'm like, do you know what it is? Oh, I guess it's my mom. And then like the brother's like, I want you to look at my eye. I don't know, you gotta be really good. Now listen to what your mom says. I guess that's one of the favorite colors. It's always green. And I'm like, you know what you're gonna see green? And they see green. Is it blue? More questions. Go to the next slide. I can bring it up. Yeah, you're gonna break it up and drive yourself. Oh, this is a self-driving exercise. Yes. That's what my question is. That's what my question is. That's what my question is. You're gonna break it up. Yeah, we only came up with that. You put like IVT. Oh, sorry. Coherence. I can't hear you. Doesn't he have a skill or what? IVT does. I'm just like IVT up. Okay, so you put it in? Oh, that is something. It's like an other, yeah. And I put also, uh, make a mitosis treatment for vascularis. Yeah? I don't care about that. What do you guys do to work together on this? Okay. We're key questions asked in parents. Family issues. Family history. I was like, you're expecting this? I don't think it's necessary. Oh, what? I know it. Yeah, that's like what they'll ask of you. Check their blood pressure. They have feel, I think. See if they have curative or anti-aging. It's rare though. Okay, do we do the break? Are you guys up to the break for group discussion? Okay. So I guess, oh wait, you guys are past that. Okay. Okay. Where are you guys at? The first break. Okay, they kept charging on, but I accidentally left the answers in the next question. Anyway. All right. So, what did your group advocate want to do for examining the kid? Take a clinic in a U.A. Consider fluorescent mu-teography and examine the periphery. Awesome, that sounds pretty good. My soul throw PMA on there. He left us for PMA. Okay. So, the one thing that might not have come up when you guys were discussing the differential is a congenital retinal macro vessel. You were going to tell. I did overhear something. That's good. Actually, when you have a congenital retinal macro vessel, you can get a brain rupture. What's a congenital macro vessel? It'll be pictured if we ever get to the end of this. Which we probably won't. All right. Let's just discuss. I'll just tell you that it's really awkward sometimes telling the parents talking to them about the U.A. when you have not that good of a clue what's going on. If I have a really good clue, I try to get as best of a clue as I can before I schedule the U.A. First, I can be prepared in a second so I can talk to the parents about giving them some idea. Because if it is like VHL and the tumor is pretty small, we should just cry over it while we're there. They'll come out and tell the parents that they've got a tumor in their eye and then you're trying to set them in five minutes so you can rub back to the OR and laser them. That's not good. I think if I saw something like that I would tell them that maybe VHL is on the differential and that we have tumors but they're not like cancers, they don't spread elsewhere in the body but just tell them we're going to take a really good look and that's going to help give us something generic like that. This is VHL. There's some subretinal fluid leaking from that tumor that's affecting the vision. Did I leave the answers on the next question or today? Maybe we could just discuss this one as a group. No, you can discuss them in small groups. Okay. You can enter small groups and start going over that. Is that an OCTO subretinal fluid? I can see it right now. Can you adjust a little subretinal fluid in that? So what kind of treatments do you recommend? I'll just see it about myself. What are the risks of treatments? What are the risks of treatments? What are the risks of treatments? What are the risks of treatments? These are... This one is you can't always ask them what happens if you get a treatment for as far as... If we can take the... Yeah. So these tumors can be really, really bad. If you let them go to the forearm that's like a total endometrial retinal deterachment in that way. doesn't that happen? So yeah, and they probably, it's exadata, but they're just scars together. As long as it's not like, they're growing for 10 colleges. Okay, say that you want to do genetic testing. So I think genetic testing is good. Like, it's really sensitive. So, you know, you could consider whether you want to get all the other tests, or if you want to get the genetic testing first, and then if that's positive, then do all the other tests. So, because it's a single isolated Cavalier-Humangeoblastoma, it could have just been a random occurrence and not associated with BHL. So, then you can go on to the next question. Discuss in your groups. A test back. Oh, like, let's say you have a variant in BHL. How do they quarter the classifications? There's like a variant of uncertain significance, of the nine variant. Likely pathogenic and pathogenic. Pathogenic means like, probably, there's better evidence that it causes the disease, but nine means like, lots of people, you don't. Okay, let's have her. So, I think, let's, any questions, you guys on like, the treatment and like, effects and stuff? Or you don't feel like you have a reasonable understanding of that? It should. I saw some, a lot of us preparing for the lecture, I didn't see some people ejected anti-vegeta, as well. Like, I don't think it was like, you know, if you crowd lesion and like, it stops growing and stops exuding, that's the end of the summer. I don't think it'll be gone forever, but. So, yeah, what tests? I guess I have the answers somewhere here. What do you think? So, I thought, you know, if someone had like a VHL, so, okay, so you would expect it to be a pathogenic variant. So, variants, when you get a clinical genetic test back, if someone has a variant, it means like, you know, 99% of people have this and I don't have this, this, you know, variant in the gene. And they don't call them mutations anymore, they call them variants. Then, you know, these are classified as benign variant of uncertain significance, likely pathogenic or pathogenic, based on the existing evidence in the literature. Like, for example, if someone did a pedigree, you know, another family has this exact variant that everyone who hasn't had a VHL in their room doesn't have that, that's probably gonna be a pathogenic one. But, this is a variant that's present in like, in one in 1,000 of the general population and that is considered healthy, then it's gonna be probably a benign variant. So, you know, the genetic testing of the tumor, they would likely be compound heterosigus or homozygus or pathogenic variants. And if someone had, were homozygous and they had basically, they'd have no tumor suppressor in their whole body and it has to be one big cancer, so that's why people aren't born with that. What's compound, what's compound heterosigus? Well compound heterosigus, sorry, compound heterosigus means like you have like one variant that's bad and another variant that's bad, but they're different. It's like, it's on the same gene. Different, like the locations on the same gene? Yeah, like different locations or one could be dilation, the other one could be like a, a sense mutation, you know, those are the same gene, Okay, so you can move on to the alternate reality slide. For a hundred steps in the race, we'll look at it. So, what's that mean? It's called fixed, what's it called? Toid. Toid. Toid, toid. Toid. Toid. Toid. Toid. Toid. Toid. Toid. Toid. Toid. Toid. Toid. Toid. Toid. Toid. Toid. Toid. Toid. Toid. Toid. Toid. Toid. Toid. Toid. Toid. Toid. Toid. Toid. Toid. Toid. Toid. Toid. A lot less, or was probably more. So the next vertex, ok. I know what happens. You tell a joke. And they can have like a brain, I think brain vascular abnormalities too, so it's a scan of time for you to change. Is there like fat problems with that or? I don't think so, but I'd have to google it. It's general problems. So you think of almost like, you know, like, transplants, weird vessels, and other miscellaneous. It's a dying brain. Yeah, I know, I missed it last year. I won't just see her. I'm lucky no one's there. It's the 13th of June. I put 11. Yeah, that's cool. Yeah, I love it now. They moved much more, so I won't miss it again. There's an extra survey. Ask, they're just like right now. Is it asking for a survey of toasties or something? I've never made red-hot cameras. You know, it's a great deal of clifferative tumors. Or too often, maybe. It's like the elevated risk of mutation associated with a cause of reaction. It's 70 years old. It's like, well, you're a zombie. Especially with a cause of reaction. Yeah, I did almost disease. It's a cause of reaction. It doesn't matter. You get cause of reactions and not cause of disease. It's like R.P. I thought something that was interesting was why they're releasing it is like they can have like skin things. I heard someone mention orbit, or whatever, vascular malformations. That was really good. Yeah. That's what I heard. Oh, gosh, that's the term. That's the term. The thing with a macro vessel is that there's like a blood vessel going through the central macula where there normally is one. It might not necessarily be bigger than normal, or that it's just out of place. Do I see your approach? No. I don't see it. I never thought to ask. I have seen people's visual acuity be decreased from there to normal, but without any fluid or anything like that. Okay, so retinal blastomas is what I wanted you guys to think of. Maybe that was a leading question. I came up with carotidol hemangiomas, retinal cavernous hemangiomas and basal proliferative tumors. Do you guys come up with anything else? Yes. And the basal proliferative tumors, apparently the most common causes are retinas, pigmentosa, and coaxies. So... All right. So I think, you know, it's 850. I have a lot more stuff, but I don't think we should necessarily go through it all. Well, I don't have any more science. We can keep going. Or we can just call it quits. You can work on your own and let me know if you have any questions. Let's call it quits. Thank you. So if you guys could, you know, I guess let me know, tell me more about this format thing, with the case space and how that's going. What are your thoughts on that? I'm looking for your feedback now on the case-based format and talking and discussing. I do like the little pre-lectures. That was nice. You read our minds. I think, Ashley, we can talk to Strav and then Strav now. Any other feedback on how this thing is today? Wow. Thank you. Thank you guys for participating and for doing your pre-work. Yeah. Comment, Janssen syndrome. Okay. So speaking of off-the-questions, does Janssen syndrome affect the eyes? Wow. No. He has told me that it did and the off-the-questions is like it's not the correct answer, but it is the answer. So I think it does not affect the eyes. I've searched the literature as thoroughly as possible. Don't think about it. But if I'm wrong, let me know. Is that a different Wagner syndrome? Yeah. It does affect the eyes with high myopia of right-wing attachment and it's a mutation in versicam. That's like a skeletal dysplasia. Yeah. It's a metacondro dysplasia, but I don't think it affects the eyes. I just want to clarify that. Yeah. This thing, I don't know. I just want to clarify that.