A Free Daily Dose of Medical Education for Medical Students and Junior Doctors <br/><br/><a href="https://yourdailymeds.substack.com?utm_medium=podcast">yourdailymeds.substack.com</a>
Podcast Overview
A Free Daily Dose of Medical Education for Medical Students and Junior Doctors <br/><br/><a href="https://yourdailymeds.substack.com?utm_medium=podcast">yourdailymeds.substack.com</a>
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Publishing Since
11/2/2021
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Recent Episodes
December 9, 2021
Your Daily Meds - 10 December, 2021
<p>Good morning and welcome to your Friday dose of Your Daily Meds.</p><p><strong>Bonus Review:</strong> What are the functions of the skin? </p><p><strong>Answer:</strong> The skin does a few things - </p><p>* Protection (barrier)</p><p>* Thermoregulation (both sensory and effector)</p><p>* Environmental monitoring (sensory)</p><p>* Role in Vitamin D metabolism</p><p>* Psychosocial functions</p><p>* Immune functions</p><p>* Site for drug administration (patches), elimination (volatile anaesthetic agents) or metabolism.</p><p><strong>Sweets:</strong></p><p>Which of the following test results is not diagnostic of Diabetes?</p><p>* Fasting venous blood glucose of 6.5 mmol/L</p><p>* Random venous blood glucose of 11.5 mmol/L</p><p>* Two-hours post oral glucose tolerance test venous blood glucose of 11.8 mmol/L</p><p>* HbA1c of 7.2%</p><p>* HbA1c of 55 mmol/mol</p><p>Have a think.</p><p>Scroll for the chat.</p><p><strong>Drugz:</strong></p><p>Which of the following substances is least likely to exhibit a specific withdrawal syndrome?</p><p>* LSD</p><p>* Alcohol</p><p>* Benzodiazepines</p><p>* MDMA</p><p>* Cocaine</p><p>Have a think.</p><p>More scroll for more chat.</p><p><strong>Diabeetus:</strong></p><p>Diabetes can be diagnosed from fasting (> 7 mmol/L) or random (> 11.1 mmol/L) venous blood glucose concentrations; by formal measurement of venous blood glucose concentration two hours post oral glucose tolerance test (> 11.1 mmol/L); or from measurement of glycated haemoglobin.</p><p>The upper limits of normal for glycated haemoglobin, 48 mmol/mol and 6.5%, are equivalent. </p><p>Of our options, a fasting venous blood glucose of 6.5 mmol/L is not indicative of Diabetes.</p><p><strong>WithDrawaLS:</strong></p><p>Substance-related and addictive disorders are characterised by compulsive drug-seeking and drug-taking, despite adverse consequences, with loss of control over the use of the drug. Dependence may take the form of behavioural use patterns, avoiding the physiological effects of withdrawal, or continued use of the substance to avoid dysphoria or attain the desired drug state. </p><p>Intoxication with depressants such as alcohol and benzodiazepines tend to manifest with euphoria, slurred speech, disinhibition, confusion and poor coordination. Their withdrawal is characterised by anxiety, anhedonia, tremor, seizures, insomnia, delirium, psychosis and death at worst. </p><p>Intoxication with stimulants such as MDMA and cocaine is characterised by euphoria, mania, psychosis with paranoia, insomnia and seizures. Their withdrawal may be manifested by a ‘crash’, cravings, dysphoria and suicidality. </p><p>Intoxication with hallucinogens such as LSD (Lysergic Acid Diethylamide), a 5-HT2A agonist, tends to manifest as distortions of sensory stimuli, enhancement of feelings, psychosis with visual hallucinations, delirium, anxiety and poor coordination. Other signs include tachycardia, hypertension, mydriasis and tremor. Tolerance develops rapidly to most hallucinogens, often within hours or days, making physical dependence unlikely. Hallucinogen withdrawal is usually absent of significant symptoms.</p><p>So of our options, LSD is least likely to exhibit a specific withdrawal syndrome.</p><p><strong>Bonus:</strong> How is the skin involved in Vitamin D metabolism?</p><p>Answer in Monday’s dose.</p><p><strong>Closing:</strong></p><p>Thank you for taking your Meds and we will see you Monday for your MANE dose. As always, please contact us with any questions, concerns, tips or suggestions. Have a great day!</p><p>Luke.</p><p>Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks. </p><p>Just credit us where credit is due.</p> <br/><br/>This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit <a href="https://yourdailymeds.substack.com?utm_medium=podcast&utm_campaign=CTA_1">yourdailymeds.substack.com</a>
December 8, 2021
Your Daily Meds - 9 December, 2021
<p>Good morning and welcome to your Thursday dose of Your Daily Meds.</p><p><strong>Bonus Review:</strong> With respect to the physiology of muscle contraction, what is a motor unit?</p><p><strong>Answer:</strong> So the unit consists of a single anterior horn alpha-motor neurone, its axon and all the muscle fibres it innervates. This is considered the functional unit of contraction, as the stimulation of that motor neurone results in the contraction of all those muscle fibres. </p><p>Then of course the number of fibres in a single motor unit varies. Muscles involved in small movements with fine control have few fibres per motor axon, while large muscles controlling gross movements may have 150 fibres per motor axon.</p><p><strong>Investigation:</strong></p><p>Alright. So a 36-year-old male comes to the Emergency Department complaining of generalised weakness. His ECG is shown below:</p><p>Which of the following correctly describes the most likely diagnosis?</p><p>* Inferior infarction</p><p>* Hypokalaemia</p><p>* Hyperkalaemia</p><p>* Mobitz I heart block</p><p>* Atrial flutter</p><p>Have a think.</p><p>Scroll for the chat.</p><p><strong>Quick Question:</strong></p><p>When considering ankylosing spondylitis, which of the following features is most suggestive of poor prognosis?</p><p>* Enthesitis on plain x-ray</p><p>* Thoracic spine involvement</p><p>* Age <25 at onset of symptoms</p><p>* Presence of night pain</p><p>* Hip involvement</p><p>Have a think.</p><p>Google enthesitis. Stupid word.</p><p>More scroll for more chat.</p><p><strong>The Squiggly Line Heart Thing:</strong></p><p>This ECG shows sinus bradycardia at a rate of approximately 70 bpm. There are widespread ST-segment abnormalities, such as ST-segment depression and T wave inversion. There is also a biphasic appearance to the ST-segments and T waves, with U waves present, that appear to be merging into one another such that it is difficult to tell where one wave ends and the next begins. </p><p>The combination of widespread ST-segment depression and T wave inversion, with prominent U waves and a long interval between the time of onset of the QRS complex to the end of the U wave, is suggestive of hypokalaemia. </p><p>An inferior infarction may be noticed on the ECG with ST-segment elevation in the inferior leads of II, III and aVF. </p><p>Hyperkalaemia is often characterised on ECG by a combination of bradycardia, flattening of P waves, QRS broadening and tenting of T waves. </p><p>A Mobitz I heart block, or Wenckebach rhythm, is characterised by the progressive elongation of the PR interval eventually resulting in a non-conducted P wave. These rhythms are usually benign and asymptomatic patients do not require treatment.</p><p>Atrial flutter is characterised by a narrow complex tachycardia with regular atrial activity at approximately 300 bpm, often described as ‘sawtooth’ waves.</p><p><strong>Spines and Stiffness:</strong></p><p>Ankylosing spondylitis (AS) is predominantly a disorder of men and affects up to 0.5% of the general population. The inflammation in AS is focussed, initially, at the sacroiliac joints before moving to the lumbar, thoracic and cervical spine. Enthesitis, inflammation at an insertion point of tendon or ligament to bone, is a common feature of the disease. </p><p>Ankylosing spondylitis is characterised by a gradual onset of symptoms before age 40, with a duration of symptoms longer than 3 months, prolonged morning stiffness and night pain. The symptom of pain tends to improve with physical activity and fails to improve with rest. Pain secondary to ankylosing spondylitis tends to respond to nonsteroidal anti-inflammatory drugs (NDAIDs). </p><p>The features predictive of poor prognosis in ankylosing spondylitis include:</p><p>* Hip involvement</p><p>* Age <16 years at onset of symptoms</p><p>* Presence of 3 of the following factors within 2 years of onset of symptoms</p><p>* ESR >30mm/h or CRP >6mg/L</p><p>* Limitation of spinal movement</p><p>* Dactylitis</p><p>* Peripheral oligoarthritis </p><p>* Inadequate symptom relief from NSAIDs</p><p>So of our options, hip involvement is most suggestive of poor prognosis when diagnosing ankylosing spondylitis.</p><p><strong>Bonus:</strong> What are the functions of the skin?</p><p>Answer in tomorrow’s dose.</p><p><strong>Closing:</strong></p><p>Thank you for taking your Meds and we will see you tomorrow for your MANE dose. As always, please contact us with any questions, concerns, tips or suggestions. Have a great day!</p><p>Luke.</p><p>Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks. </p><p>Just credit us where credit is due.</p> <br/><br/>This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit <a href="https://yourdailymeds.substack.com?utm_medium=podcast&utm_campaign=CTA_1">yourdailymeds.substack.com</a>
December 8, 2021
Your Daily Meds - 8 December, 2021
<p>Good morning and welcome to your Wednesday dose of Your Daily Meds.</p><p><strong>Bonus Review:</strong> Why is it that the posterior pituitary has neural connections with the hypothalamus, but the anterior pituitary has vascular connections with the hypothalamus?</p><p><strong>Answer:</strong> Well the posterior pituitary is part of the brain, so develops with the expected neural connections. The anterior pituitary develops from Rathke’s Pouch, an ectodermal outpouching from the roof of the oral cavity, and so develops vascular connections with the hypothalamus.</p><p><strong>Some Obstetrics:</strong></p><p>Which of the following is least likely to be responsible for uterine atony after birth?</p><p>* Chorioamnionitis </p><p>* Prolonged labour</p><p>* High parity</p><p>* Multiple pregnancy</p><p>* Oligohydramnios</p><p>Have a think.</p><p>Scroll for the chat.</p><p><strong>Case:</strong></p><p>A 61-year-old male is seen on the wards 2-days after abdominal aortic aneurysm repair. He was noted to have an increase in serum creatinine by 55 µmol/L over the two days since surgery, and has been passing urine at a rate of 0.4 mL/kg/h for the last 8 hours up until the time of review. Which of the following investigation results is most strongly supportive of a diagnosis of prerenal acute kidney injury?</p><p>* Serum Urea : Serum Creatinine ratio of 5:1</p><p>* Serum Urea : Serum Creatinine ratio of 1:20</p><p>* Serum Urea : Serum Creatinine ratio of 1:30</p><p>* Serum Urea : Serum Creatinine ratio of 30:1</p><p>* Serum Urea : Serum Creatinine ratio of 10:1</p><p>Have a think.</p><p>More scroll for more chat.</p><p><strong>“I Don’t Like Your Tone”:</strong></p><p>Uterine atony is the most common cause of postpartum haemorrhage due to failure of the contracting uterus to occlude the vessels supplying the placental bed. </p><p>Uterine atony is less common with ‘active management’ of the third stage of labour, that stage between delivery of the baby and delivery of the placenta. The administration of oxytocic drugs and assisted delivery of the placenta halves the risk of postpartum haemorrhage due to uterine atony compared to those women choosing a ‘natural’ third stage of labour. </p><p>Other causes of impaired uterine retraction after birth include chorioamnionitis, uterine ‘exhaustion’ after prolonged labour, high parity, and overdistension of the uterus during pregnancy. Overdistension of the uterus may be caused by a large baby, multiple pregnancy or <strong>poly</strong>hydramnios.</p><p>From the list, <strong>oligo</strong>hydramnios is least likely to be responsible for uterine atony after birth.</p><p><strong>Those (A)KIdneys:</strong></p><p>Acute kidney injury (AKI) is defined as an abrupt (within 48 hours) decline in kidney function, as manifested by any of:</p><p>* Absolute increase in serum creatinine by 26.4 µmol/L or greater</p><p>* An increase in serum creatinine from baseline by 50% or greater</p><p>* Reduction in urine output, defined as less than 0.5 ml/kg/h for more than 6 hours.</p><p>AKI is commonly classified as prerenal, intrarenal or posterenal as a descriptor of aetiology and differential diagnoses. </p><p>The ratio of Serum Urea : Serum Creatinine is an important finding and, when exceeds 20:1, suggests conditions of increased reabsorption of urea as in a prerenal AKI.</p><p><strong>Bonus:</strong> With respect to the physiology of muscle contraction, what is a motor unit?</p><p>Answer in tomorrow’s dose.</p><p><strong>Closing:</strong></p><p>Thank you for taking your Meds and we will see you tomorrow for your MANE dose. As always, please contact us with any questions, concerns, tips or suggestions. Have a great day!</p><p>Luke.</p><p>Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks. </p><p>Just credit us where credit is due.</p> <br/><br/>This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit <a href="https://yourdailymeds.substack.com?utm_medium=podcast&utm_campaign=CTA_1">yourdailymeds.substack.com</a>
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