Your Daily Meds

Good morning and welcome to your Friday dose of Your Daily Meds.Bonus Review: What are the functions of the skin? Answer: The skin does a few things - Protection (barrier)Thermoregulation (both sensory and effector)Environmental monitoring (sensory)Role in Vitamin D metabolismPsychosocial functionsImmune functionsSite for drug administration (patches), elimination (volatile anaesthetic agents) or metabolism.Sweets:Which of the following test results is not diagnostic of Diabetes?Fasting venous blood glucose of 6.5 mmol/LRandom venous blood glucose of 11.5 mmol/LTwo-hours post oral glucose tolerance test venous blood glucose of 11.8 mmol/LHbA1c of 7.2%HbA1c of 55 mmol/molHave a think.Scroll for the chat.Drugz:Which of the following substances is least likely to exhibit a specific withdrawal syndrome?LSDAlcoholBenzodiazepinesMDMACocaineHave a think.More scroll for more chat.Diabeetus: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.The upper limits of normal for glycated haemoglobin, 48 mmol/mol and 6.5%, are equivalent. Of our options, a fasting venous blood glucose of 6.5 mmol/L is not indicative of Diabetes.WithDrawaLS: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. 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. 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. 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.So of our options, LSD is least likely to exhibit a specific withdrawal syndrome.Bonus: How is the skin involved in Vitamin D metabolism?Answer in Monday’s dose.Closing: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!Luke.Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks. Just credit us where credit is due. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit yourdailymeds.substack.com

Good morning and welcome to your Thursday dose of Your Daily Meds.Bonus Review: With respect to the physiology of muscle contraction, what is a motor unit?Answer: 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. 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.Investigation:Alright. So a 36-year-old male comes to the Emergency Department complaining of generalised weakness. His ECG is shown below:Which of the following correctly describes the most likely diagnosis?Inferior infarctionHypokalaemiaHyperkalaemiaMobitz I heart blockAtrial flutterHave a think.Scroll for the chat.Quick Question:When considering ankylosing spondylitis, which of the following features is most suggestive of poor prognosis?Enthesitis on plain x-rayThoracic spine involvementAge 6mg/LLimitation of spinal movementDactylitisPeripheral oligoarthritis Inadequate symptom relief from NSAIDsSo of our options, hip involvement is most suggestive of poor prognosis when diagnosing ankylosing spondylitis.Bonus: What are the functions of the skin?Answer in tomorrow’s dose.Closing: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!Luke.Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks. Just credit us where credit is due. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit yourdailymeds.substack.com

Good morning and welcome to your Wednesday dose of Your Daily Meds.Bonus Review: Why is it that the posterior pituitary has neural connections with the hypothalamus, but the anterior pituitary has vascular connections with the hypothalamus?Answer: 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.Some Obstetrics:Which of the following is least likely to be responsible for uterine atony after birth?Chorioamnionitis Prolonged labourHigh parityMultiple pregnancyOligohydramniosHave a think.Scroll for the chat.Case: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?Serum Urea : Serum Creatinine ratio of 5:1Serum Urea : Serum Creatinine ratio of 1:20Serum Urea : Serum Creatinine ratio of 1:30Serum Urea : Serum Creatinine ratio of 30:1Serum Urea : Serum Creatinine ratio of 10:1Have a think.More scroll for more chat.“I Don’t Like Your Tone”: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. 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. 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 polyhydramnios.From the list, oligohydramnios is least likely to be responsible for uterine atony after birth.Those (A)KIdneys:Acute kidney injury (AKI) is defined as an abrupt (within 48 hours) decline in kidney function, as manifested by any of:Absolute increase in serum creatinine by 26.4 µmol/L or greaterAn increase in serum creatinine from baseline by 50% or greaterReduction in urine output, defined as less than 0.5 ml/kg/h for more than 6 hours.AKI is commonly classified as prerenal, intrarenal or posterenal as a descriptor of aetiology and differential diagnoses. 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.Bonus: With respect to the physiology of muscle contraction, what is a motor unit?Answer in tomorrow’s dose.Closing: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!Luke.Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks. Just credit us where credit is due. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit yourdailymeds.substack.com

Good morning and welcome to your Tuesday dose of Your Daily Meds.Bonus Review: What are some functions of the Hypothalamus.Answer: It does a few things -Control of water balanceTemperature regulationControl of anterior pituitary hormones (neuroendocrine function)Production of posterior pituitary hormones (more neuroendocrine function)Appetite and satietyRole in behaviour and emotionsQuick Question:In the physical examination of the neonate, which of the following describes a common newborn rash, manifesting as pustules with an erythematous base, often with a widespread distribution?Erythema toxicumMiliaPustulesLanugoNaevus simplexHave a think.Scroll for the chat.Ethics Case:You are a motivated little Emergency Department Doctor.You have just met a 15-year-old female who attempted suicide last night by swallowing button batteries.The girl was brought to the Emergency Department under the Mental Health Act’s Emergency Examination Authority, so if she had tried to leave during the morning, she would have been detained. But she had not tried to leave, she was calm and cooperative.Her parents are completely uncontactable.You know that these button batteries are very corrosive so you erect x-ray the abdomen.The batteries are still in the region of the stomach. They are potentially retrievable endoscopically before they can cause harm.You discuss all this with your ED Consultant, then you call the Gastroenterologist on call.“Sure!” she says, “If you could consent her for the Endoscopy, I’ll do it on my morning list within the next couple of hours.”You discuss the risks of Endoscopy and Sedation with the young girl versus the risks of leaving the batteries in situ and watching and waiting.The girl is receptive to your explanation, she seems to be able to understand, retain, consider, use and communicate her wishes and consents for Endoscopy.You take the signed consent forms to the Day Procedure Unit.“No”, says the Nurse in charge. “She is under sixteen - you will need to contact the Child Guardian.”Now, I ask you. What are your thoughts here?Do you punch on with this Nurse, or do you go and jump into the pre-recorded telephone cue of another government bureaucracy?Or do you do something else?Scroll for the chat.Bumpy Babies:Erythema toxicum is a common newborn rash manifesting with pustules with an erythematous base. The rash can have a widespread distribution that may change over a period of several hours. Differentiating infected lesions can be accomplished by microscopic examination of the vesicle contents which contain eosinophils in cases of erythema toxicum. Milia occur particularly over the neonatal nose and are small sebaceous cysts that disappear by several months of age.Pustules may be present from birth in congenital candida infection or may appear later with Staphylococcus aureus skin infections. Erythema toxicum is a more common differential diagnosis. Lanugo is the fine downy hair covering the skin of the shoulders, upper arms and thighs of the neonate. It may be more evident in premature babies.Naevus simplex, birth marks, are superficial vascular naevi commonly found on the occiput, over the eyelids or between the eyebrows of the neonate. They tend to fade over several months, often disappearing in the second year of life.What To Do…?:Well, you could calmly explain the concept of Gillick Competence to the Nurse.But that did not go down so well.You could tell on that Nurse to your boss.That works better.But the best result was to have the Gastroenterologist, the actual proceduralist doing the procedure, to consent the patient again in Endoscopy suite, just to be sure.Remember, just because you happen to be a medico-legal-ethics nerd, doesn’t mean that other people are. And when you are having a busy day in the ED, you can’t be having stand up arguments citing decisions from the House of Lords when you have other jobs piling up.Remember more that people who have tried to kill themselves can still have capacity to make the decision for life saving or condition-altering treatment. Like it or not.Because capacity is context-dependent. And someone with “…sufficient understanding and intelligence to understand fully what is proposed” has capacity to make their decision, wether you agree with that decision or not; regardless of arbitrary age cutoffs.(Also, just quietly, a 103-year old fellow with an acute delirium on top of his dementia very likely does not have capacity to consent for an Endoscopy……..even though he is over the age of sixteen…but I didn’t drop that bomb…)Anyway this was a real case. So there.Bottom line: People that have done silly things are still autonomous individuals (once particular conditions that would actively hinder their autonomy have been excluded) so are free to make their own decisions, in so far as they have the capacity to do so.Bonus: Why is it that the posterior pituitary has neural connections with the hypothalamus, but the anterior pituitary has vascular connections with the hypothalamus?Answer in tomorrow’s dose.Closing: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!Luke.Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks. Just credit us where credit is due. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit yourdailymeds.substack.com

Good morning and welcome to your Monday dose of Your Daily Meds.Bonus Review: What is the difference between the blood-CSF barrier and the blood-brain barrier?Answer: Whereas in the blood-CSF barrier, the barrier is due to the tight junctions between the epithelial cells (ependyma) of the choroid plexus; the blood-brain barrier involves a barrier of tight junctions between the capillary endothelial cells.= BBB - tight junctions between capillary endothelial cells= BCSFB - tight junctions between choroid plexus epithelial cellsPsych Question:Marked fear or anxiety about which of the following is NOT consistent with a diagnosis of agoraphobia?Using public transportationBeing in open spacesBeing in enclosed spacesStanding in line or being in a crowdAllowing others into one’s homeHave a think.Scroll for the chat.Somewhat Anatomical:The Eustachian tube is an osseocartilaginous passage connecting the nasopharynx and middle ear. Which of the following cranial nerves supplies general sensory innervation to the Eustachian tube?CN VIICN VIIICN IXCN XCN XIHave a think.Remember some rude mnemonics.Scroll for the chat.The Phobia:Agoraphobia is essentially a disorder of excessive anxiety about being unable to escape a particular situation or place. Anxiety is a fearful response in the absence of a specific danger or threat, or in their anticipation. Anxiety is distinct from fear, which is a response to a realistic and immediate danger. Fear is adaptive in situations of stress or danger with priming of the physiological ‘fight or flight’ mechanism.Agoraphobia is characterised by more than six months of excessive anxiety about being unable to escape a particular situation or place, in the context of at least two of the following:Using public transportationBeing in open spacesBeing in enclosed spacesStanding in line or being in a crowdBeing outside of the home aloneThe management of agoraphobia includes education around the symptoms of the patient’s anxiety and on how avoidance behaviours may be self-perpetuating. Relaxation techniques and graded exposure to a hierarchy of the patient’s feared situations may also be employed. So marked fear or anxiety about allowing others into one’s home is not consistent with a diagnosis of agoraphobia.Tubes and Supply:The Eustachian tube receives general sensory innervation from cranial nerve IX, the glossopharyngeal nerve. The glossopharyngeal nerve exits the skull through the jugular foramen and has motor innervation to the stylopharyngeus muscle and sensory innervation for taste and general sensation to the posterior 1/3 of the tongue.Cranial nerve VII, the facial nerve, supplies taste sensation to the anterior 2/3 of the tongue; supplies motor innervation to the muscles of facial expression and the stapedius muscle; and supplies parasympathetic innervation to the salivary and lacrimal glands.Cranial nerve VIII, the vestibulocochlear nerve, supplies sensory innervation to the cochlea and vestibular apparatus.Cranial nerve X, the vagus nerve, supplies sensory innervation to many structures including the pharynx and larynx; supplies motor function to the soft palate, larynx, pharynx and upper oesophagus; and parasympathetic innervation to the cardiovascular, respiratory and gastrointestinal symptoms.Cranial nerve XI, the accessory nerve, supplies motor innervation to the sternocleidomastoid and trapezius muscles.Bonus: Tell me some functions of the Hypothalamus.Answer in tomorrow’s dose.Closing: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!Luke.Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks. Just credit us where credit is due. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit yourdailymeds.substack.com

Good morning and welcome to your Friday dose of Your Daily Meds.Bonus Review: Can substances pass freely from blood into the CSF?Answer: Nah. There is a barrier to diffusion of most polar molecules. Naturally, this is called the blood-CSF barrier. In this case, the barrier is due to the tight junctions between the epithelial cells (ependyma) of the choroid plexus. The endothelial cells in the capillaries of the choroid plexus have gaps allowing small molecules to pass between and cross the capillary wall.Paeds Question:Which of the following is NOT one of the primary mechanisms by which foetal lung fluid is cleared at the time of birth?Reduction of fluid secretion in the lungsExpulsion of lung fluid as the foetal chest is compressed during labourLymphatic resorption of lung fluid Resorption of lung fluid via capillariesReduced foetal urine output prior to labourHave a think.Scroll for the chat.Case:A 34-year-old woman, currently at 37 weeks’ gestation in her second pregnancy is reviewed in clinic.She reports headache, some visual disturbances and epigastric pain, although there has been no vomiting.On examination, she is hypertensive to 165/115 mmHg, has a tender abdomen worst over the right upper quadrant and is seen to have brisk reflexes.Which of the following is most suitable to administer given this woman’s clinical presentation?PhenytoinSodium valproateMagnesium sulphateCalcium gluconateCephazolinHave a think.Scroll for the chat.He’s Got Fluid:The foetal lung acts as a secretory organ prior to birth, with approximately 100-150 mL/kg body weight of fluid being produced in the lungs of the normal foetus. This foetal lung fluid, along with foetal urine, are the primary contributors to amniotic fluid volume. Lung fluid is cleared during the time of birth by several mechanisms, including:Reduction of fluid secretion in the lungsExpulsion of lung fluid as the foetal chest is compressed during labourResorption of lung fluid via lung interstitium into pulmonary lymphatics and capillariesOf these, resorption is the main mechanism by which lung fluid is cleared and a failure of this mechanism can lead to transient tachypnoea of the newborn. So a reduction of foetal urine output prior to labour is not one of the primary mechanisms by which foetal lung fluid is cleared at the time of birth.Pre-Nasty:Key to answering this question is recognising the pregnant woman with signs of preeclampsia with severe features.This is evidenced by headache and visual changes, symptoms of central nervous system dysfunction, epigastric pain and right upper quadrant tenderness, potential signs of hepatic abnormality of HELLP (Haemolysis, Elevated Liver enzymes, Low Platelets) syndrome of severe preeclampsia, and brisk reflexes, potentially foreshadowing the seizures of eclampsia. Nasty.Given the features of severe disease in this woman, delivery must occur to minimise the risks of maternal and foetal complications, such as cerebral haemorrhage, hepatic rupture, renal failure, pulmonary oedema, seizure, bleeding of thrombocytopaenia, placental abruption or intra-uterine growth restriction. Of the options listed, magnesium sulphate is the most appropriate medication to administer as it has been shown to reduce the risk of eclampsia, and may be administered intravenously.Phenytoin and sodium valproate are other medications used for seizure prophylaxis, but are inferior to magnesium sulphate in this particular obstetric context. Calcium gluconate may be used to treat magnesium toxicity in the context of seizure prophylaxis with magnesium sulphate. Cephazolin is used as intrapartum antibiotic therapy in those mothers positive for commensal group B streptococcus infection and hypersensitive to penicillins to prevent neonatal streptococcus disease.Bonus: What is the difference between the blood-CSF barrier and the blood-brain barrier?Answer in Monday’s dose.Closing: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!Luke.Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks. Just credit us where credit is due. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit yourdailymeds.substack.com

Good morning and welcome to your Thursday dose of Your Daily Meds.Bonus Review: How is CSF different from Plasma?Answer: CSF is identical to brain ECF in composition. But the differences to plasma include - pCO2 is higher in CSF (about 50mmHg) resulting in lower pH (about 7.33)Very low protein content - so CSF has low acid-base buffering abilityLower glucose concentration[Cl-] is higher by about 10% and [K+] is lower by about 40%Very low cholesterol contentPsych Question:Which of the following does NOT contribute to the classification of anxiety as pathological?Fear greatly out of proportion to severity of risk or threatResponse continues until removal of the threatResponse becomes generalised to other similar or dissimilar situationsSocial or occupational function is impairedComorbid with substance use and depressionHave a think.Scroll for the chat.Surgery Question:A 49-year-old man underwent a complete thyroidectomy in the setting of papillary thyroid cancer. Which of the following would be the least likely complication of this surgery?Peri-oral paraesthesiaHoarsenessDysphagiaSeroma formationPtosisHave a think.Scroll for the chat.The Threat:Anxiety is a fearful response in the absence of a specific danger or threat, or in their anticipation. Anxiety is distinct from fear, which is a response to a realistic and immediate danger. Fear is adaptive in situations of stress or danger with priming of the physiological ‘fight or flight’ mechanism.Anxiety is more likely to diminish performance and is considered pathological when:Fear greatly out of proportion to severity of risk or threatResponse continues beyond existence of threatResponse becomes generalised to other similar or dissimilar situationsSocial or occupational function is impairedComorbid with substance use and depressionSo a response that continues until removal of the threat is least likely to contribute to the classification of anxiety as pathological, rather a response continuing beyond the existence of the threat would be indicative.Complications:Perioral paraesthesia is a symptom of hypocalcaemia. Hypocalcaemia as a result of hypoparathyroidism (parathyroid damage or removal in surgery) is the most common complication of thyroidectomy. This would be very bad.Hoarseness after thyroid surgery is common and can be due to a range of problems ranging from oedema to nerve injury, such as to the recurrent laryngeal nerve.Dysphagia, difficulty swallowing, post-thyroid surgery is common and may be due to adhesions, trauma, inflammation or nerve damage.Wound seromas post-operatively tend to resolve without intervention.Ptosis (as in part of Horner syndrome) is a very rare complication of thyroidectomy and results from disruption of the sympathetic supply to the head, eye and neck. Horner syndrome is most often associated with lateral neck dissection. (Or an apical lung cancer affecting the sympathetic trunk…)Bonus: Can substances pass freely from blood into the CSF?Answer in tomorrow’s dose.Closing: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!Luke.Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks. Just credit us where credit is due. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit yourdailymeds.substack.com

Good morning and welcome to your Wednesday dose of Your Daily Meds.Bonus Review: What are the functions of the CSF?Answer: Couple of roles - Protective role - water bath effectThe CSF is contained in the meninges - acts as a cushion to protect brain from injuryThe water bath effect gives a 1400g brain an effective mass of 50gBuffers rises in ICPCSF translocation to the extra cranial subarachnoid spaceAn acute space occupying lesion won’t cause a large rise in ICP until this buffer is exhaustedRemember, CSF is incompressible but mobileReturn of interstitial protein to the circulationBrain has no lymph vesselsInterstitial protein is absorbed with CSF across the arachnoid villiOther functionsProbably returns some waste from brain ECF to the circulationMay have a nutritive role (although is low glucose)Some suggestion that neuropeptides may be transported between brain regions via CSFQuick Question:Which of the following is a contraindication to induction of labour?Prolonged pregnancyPreeclampsiaPrelabour rupture of the membranesGestational diabetes mellitusPlacenta praeviaHave a think.Scroll for the chat.Case:An 80-year-old male comes to the Emergency Department.The problem: shortness of breath.He has a history of atrial fibrillation and has a permanent pacemaker in situ.On examination, he is afebrile and hypertensive to a systolic blood pressure of 200. He has a raised JVP and mild ankle swelling.A postero-anterior chest x-ray is taken and is shown below:Which of the following is least likely to be included in the emergency management of this man?Supplemental oxygenIntravenous frusemideIntravenous nitratesContinuous positive airway pressure (CPAP)Oral high-dose metoprololHave a think.More scroll for more chat.No Go:Induction of labour takes place in approximately 25% of pregnancies. The indications for induction of labour are any circumstances or conditions in which there is a likely benefit from delivery prior to spontaneous labour. These may include:Prolonged pregnancyHypertensive disorders (such as preeclampsia)Diabetes mellitusOther systemic medical conditionsLikely or suspected placental insufficiencyPrelabour rupture of the membranesMultiple pregnancyAntepartum haemorrhagePsychological or mental health conditionsSocial circumstancesSo placenta praevia is a contraindication to the induction of labour as it is a contraindication to vaginal birth. Placenta praevia describes an abnormal placentation near or covering the internal cervical os. It classically presents as painless, vaginal bleeding in the third trimester.A Wee Bit Wet:Key to answering this question is recognising the radiological signs of acute interstitial oedema in the setting of heart failure. The chest x-ray shows an enlarged heart with marked prominence of the interstitial markings. The prominent interstitial markings are called Kerley lines and represent expansion of the interstitial space by fluid.Beta-blocker initiation, such as metoprolol, is not recommended in the acute, decompensated phase of heart failure.It is used in the management of heart failure with reduced ejection fraction and is initiated slowly.If this man had already been taking a beta-blocker when he had presented with shortness of breath, there would likely be no benefit in ceasing it. The risk comes from initiating beta-blocker therapy while decompensated. The other options in this question all form the mainstay of acute decompensated heart failure management. Nitrates are especially useful when there is high systolic blood pressure.Bonus: How is CSF different from Plasma?Answer in tomorrow’s dose.Closing: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!Luke.Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks. Just credit us where credit is due. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit yourdailymeds.substack.com

Good morning and welcome to your Tuesday dose of Your Daily Meds.Bonus Review: What is CSF?Answer: Cerebrospinal Fluid is the stuff that bathes the brain and spinal cord. It is contained in the ventricles and subarachnoid space and is part of the body’s trans cellular fluids.Babies and Stuff:Which of the following correctly describes the third stage of labour?From delivery of the baby until delivery of the placentaFrom full dilatation of the cervix until delivery of the babyFrom first ‘show’ of blood and mucous until delivery of the babyFrom rupture of membranes until delivery of the placentaFrom visualisation of the baby’s head until delivery of the babyHave a think.Scroll for the chat.A Relevant-To-Ward-Call Question:Which of the following medications, used in cases of hypertensive urgency, is most likely to cause a delayed precipitous fall in blood pressure?Nifedipine immediate-release 10 mg orallyCaptopril 12.5 mg orallyClonidine 100 micrograms orallyPrazosin 2 mg orallyAmlodipine 5 mg orallyHave a think.Have a guess.More scroll for more chat.The Labour Diaries:Traditionally, labour is described in three stages:First – from onset of regular contractions until full dilatation of the cervixSecond – from full dilatation of the cervix until delivery of the babyThird – from delivery of the baby until delivery of the placentaTreating the Numbers:Hypertensive urgency describes severely elevated blood pressure, with pressures at 180/110 mmHg or higher, with symptoms of moderate non-acute damage or dysfunction to end organs.The initial management goals of hypertensive urgency include relief of symptoms and reduction of BP to below 180 mmHg systolic over several hours. Amlodipine has a delayed onset of action compared to the other medications listed, and so is most likely to cause a delayed precipitous fall in blood pressure due to repeated doses over a short time (as a consequence of perceived lack of effect).PS. -Amlodipine and Nifedipine = Calcium Channel BlockersCaptopril = ACE-InhibitorPrazosin = Alpha-1 AntagonistClonidine = Central Alpha-2 AgonistBonus: What are the functions of the CSF?Answer in tomorrow’s dose.Closing: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!Luke.Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks. Just credit us where credit is due. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit yourdailymeds.substack.com

Good morning and welcome to your Monday dose of Your Daily Meds.Bonus Review: What happens during a cough? Answer: The cough reflex is a protective mechanism of the airway, used to expel irritating material with a high velocity turbulent gas stream.A rough guide would involve - InspirationEpiglottis and cords close very tightlyAbdominal muscles contract forcefullyPressure within the chest can rise to 100mmHgCords and epiglottis suddenly openRapid exit of high pressure gas from the lungs occursAnatomy-ish Case:A middle-aged fellow comes to the Emergency Department after being stabbed in the back during a mugging.On examination, there is upper motor neuron weakness, loss of vibration and proprioception sense in the left lower limb; and a loss of pain and temperature sensation in the right lower limb. Where is the most likely location of the pathology?Posterior spinal cordLeft spinal cordRight spinal cordAnterior spinal cordCentral canal of spinal cordHave a think.Remember all the silly multicoloured spinal cord tracts from the textbooks.Have a think.Scroll for the chat.Quick Question:In a community acquired pneumonia (CAP), which of the following patient characteristics is least suggestive of severe disease that will require inpatient management?Respiratory rate > 30 breaths per minuteSystolic blood pressure < 90 mmHgHeart rate > 100 beats per minuteSubjective dyspnoea at restMultilobar involvement on chest x-rayHave a think.More scroll for more chat.Stabbing Back Pain:This scenario describes Brown-Séquard syndrome, due to pathology to one half of the spinal cord; in this case, most likely a stab wound affecting the left half of the spinal cord.Pain and temperature sensation are carried in the spinothalamic tract, the fibres of which decussate at the level of the spinal cord. In this case, an injury to the left half of the spinal cord would explain the loss of these sensations on the right.Fibres carrying light touch, vibration and proprioception sense are carried in the dorsal column-medial lemniscus pathway, which decussates at the level of the medulla. In this case, an injury to the left half of the spinal cord would explain the loss of these sensations in the left lower limb.Furthermore, in Brown-Séquard syndrome, a region of complete sensory loss can be detected on the same side as the lesion at the level of the lesion.See the pretty pictures:A Bit Chesty:The features of community acquired pneumonia (CAP), that are viewed as ‘red flags’ and are suggestive of the need for inpatient management include:Respiratory rate > 30 breaths per minuteSystolic blood pressure < 90 mmHgOxygen saturation < 92%Acute onset confusionHeart rate > 100 beats per minuteMultilobar involvement on chest x-rayThese features are suggestive of more severe disease.Patients with these features, in the context of CAP, require close clinical review.Of the options listed, subjective dyspnoea at rest is least suggestive of severe CAP requiring inpatient management.Bonus: What is CSF?Answer in tomorrow’s dose.Closing: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!Luke.Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks. Just credit us where credit is due. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit yourdailymeds.substack.com

Good morning and welcome to your Friday dose of Your Daily Meds.Bonus Review: What is the chemoreceptor trigger zone (CTZ)?Answer: The CTZ is located in the area postrema - in the lateral walls of the 4th ventricle. It is outside the blood brain barrier. Various substances can stimulate the CTZ, which has inputs into the vomiting centre, resulting in vomiting.Public Healthiness:Which of the following is an example of primary prevention?Immunisation programBreast cancer screeningPerformance of a Papanicolau (Pap) smearRegular hearing tests for workers in high noise environments Pulmonary rehabilitation programHave a think.Scroll for the chat.Kiddies Case:A three-week-old infant comes to the Emergency Department with his parents.They report that their child has been vomiting and losing weight.They also think there has been a yellowing of their baby’s skin.The infant is afebrile and haemodynamically stable.Which of the following is the most likely diagnosis?GalactosaemiaHepatitisGilbert’s syndromeCholecystitisNeonatal haemochromatosisHave a think.More scroll for more chat.The Preventer:This question tests knowledge of primary, secondary and tertiary prevention methods.Primary prevention methods are those aiming to limit the incidence of disease and disability in the community. This is achieved by reducing or eliminating the factors that would impair health and function, and promoting factors that are protective. The objective of primary intervention is to prevent the occurrence of disease. Examples of primary prevention include immunisation programs, such as tetanus prophylaxis, and programs to discourage the uptake of smoking.Secondary prevention aims to prevent progression of disease, with examples including breast cancer screening, Pap smear tests, and screening for hearing loss in high-noise environments. Tertiary prevention aims to reduce the effects of established disease, with examples including pulmonary rehabilitation and self-management programs for those with chronic illness.Yellow Baby:Galactosaemia, or galactose-1-phosphate uridyltransferase (GALT) deficiency, is an autosomal recessive disorder characterised by impaired conversion of galactose-1-phosphate and uridine diphosphate (UDP) glucose to UDP galactose and glucose-1-phosphate. Almost all infants on lactose-containing diets, such as milk formulas, will manifest poor weight gain.Normally, galactosaemia is detected in new-born screening tests. It commonly presents with poor growth, jaundice, vomiting, lethargy and, in some cases, cataracts.Hepatitis and cholecystitis are unlikely given the infant is afebrile, and the young age.Gilbert’s syndrome is a mild disorder of bilirubin metabolism in which there is decreased activity of the glucuronosyltransferase enzyme. Jaundice often manifests in times of illness. Typically, no treatment is required for Gilbert’s syndrome, and it is unlikely to cause vomiting and poor weight gain.Neonatal haemochromatosis is a disorder characterised by severe liver disease and deposition of iron in extrahepatic sites. It is commonly associated with oligohydramnios, splenomegaly, oliguria and jaundice in the few days after birth.Bonus: What happens during a cough? Answer in Monday’s dose.Closing: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!Luke.Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks. Just credit us where credit is due. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit yourdailymeds.substack.com

Good morning and welcome to your Thursday dose of Your Daily Meds.Bonus Review: What are the functions of the liver? Is the liver essential for life? Answer: Heaps of functions - Role in lipid metabolismFatty acid oxidationSynthesises cholesterol and phospholipidsProduces ketoacidsRole in carbohydrate metabolismGlycogen metabolismGluconeogenesisGlucostat functionRole in protein metabolismAmino acid metabolismProtein turnoverProtein synthesis - albumin, coagulation proteins, carrier proteins, lipoproteinsUrea productionBile production - and secretion of bilirubin and bile acidsMetabolism of drugs and xenobiotics - like with the cytochrome p450 oxidase systemPlays a role in the reticuloendothelial system with Kupffer cellsEndocrine functions25 hydroxycholecalciferol synthesisInactivation of some hormonesHormone precursor synthesisSteroid hormone metabolismSomatomedin productionErythropoietin synthesis (mainly the forestall liver, still 10% of adult EPO is from the liver)Haematopoiesis in the foetal liverBlood reservoirStorage function - B12, iron ,glycogenPlays a role in acid-base balanceAlmost all plasma proteins are produced in the liver - except immunoglobulins.And yes, the liver is essential for life - a total hepatectomy results in death in less than 24 hours from profound hypoglycaemia.Something Anatomical:Which of the following anatomical structures joins the transverse process of a vertebra to its corresponding vertebral body?LaminaPedicleSuperior articular processLigamentum flavumInferior articular processHave a think.Scroll for the chat.Obstetrical:Which of the following correctly defines miscarriage?Presence of a non-viable intrauterine pregnancy before 20 weeks’ gestationEarly pregnancy bleeding with painPresence of a non-viable intrauterine pregnancy before 10 weeks’ gestationPresence of an extrauterine pregnancy with bleeding and painIntrauterine foetal death before 30 weeks’ gestationHave a think.More scroll for more chat.Bony Arches:The pedicles of a vertebra join the vertebral body to the transverse processes.The laminae joint the transverse processes to the spinous process. The ligamentum flavum connects paired laminae of adjacent vertebrae. The superior and inferior articular processes position the articular facets that form zygapophyseal joints with the adjacent superior and inferior vertebrae.See the images below for reference:Gs and Ps and the M:Miscarriage describes the presence of a non-viable intrauterine pregnancy before 20 weeks’ gestation. The definition does not require the presence of an embryo or foetus. Recognised miscarriages occur in approximately 15% of pregnancies.Viability can be confirmed by the presence of foetal heart activity. Failed pregnancy is indicated by any of the following criteria:Mean gestational sac diameter > 25 mm with no foetal poleFoetal pole > 7 mm and no foetal heart activityInadequate growth of gestational sac or foetal pole over course of one week (< 1 mm per day)Poor prognostic features include bradycardia (< 85 bpm) and large subchorionic haematoma formation.Bonus: What is the chemoreceptor trigger zone (CTZ)?Answer in tomorrow’s dose.Closing: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!Luke.Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks. Just credit us where credit is due. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit yourdailymeds.substack.com

Good morning and welcome to your Wednesday dose of Your Daily Meds.Bonus Review: What is bile? Answer: It is the stuff that is secreted by the liver into the hepatic ducts and then subsequently undergoes further changes in the gallbladder.Bile contains:Water (the main constituent)Bile saltsBile pigmentsElectrolytesSomewhat Anatomical:Which of the following correctly describes the layers of the heart wall from outermost to innermost?Fibrous pericardium; parietal layer of serous pericardium; myocardium; epicardium; endocardiumParietal layer of serous pericardium; fibrous pericardium; epicardium; myocardium; endocardiumFibrous pericardium; epicardium; parietal layer of serous pericardium; endocardium; myocardium Parietal layer of serous pericardium; fibrous pericardium; myocardium; epicardium; endocardiumFibrous pericardium; parietal layer of serous pericardium; epicardium; myocardium; endocardiumHave a think.Scroll for the chat.The PPH:Which of the following is consistent with primary postpartum haemorrhage?Bleeding of 500 mL or more from the birth canal in the first 24 hours after delivery of the babyBleeding of 1000 mL or more from the birth canal in the first 24 hours after delivery of the babyBleeding of 500 mL or more from the birth canal in the first 7 days after delivery of the babyBleeding of 1000 mL or more from the birth canal in the first 6 weeks after delivery of the babyIntra-abdominal bleeding of 500 mL or more from uterine incision after caesarean sectionHave a think.More scroll for more chat.Layers, Like Onions:The layers of the heart wall from outermost to innermost are as follows: Fibrous pericardiumParietal layer of serous pericardiumVisceral layer of serous pericardium, also known as the epicardiumMyocardium EndocardiumThe endocardium is loose connective tissue and simple squamous epithelium.The subendocardial layer joins the endocardium to the myocardium and contains the Purkinje fibres.The myocardium comprises cardiac muscle and is involuntary striated muscle.The epicardium is composed of connective tissue and fat. The connective tissue secretes a small amount of lubricating fluid into the pericardial space, between the parietal and visceral layers of the serous pericardium.See the pretty picture:TTTThe Bleed:Postpartum haemorrhage occurs in approximately 4% of pregnancies and accounts for approximately 10% of maternal deaths. Primary postpartum haemorrhage is defined as bleeding of 500 mL or more from the birth canal in the first 24 hours after delivery of the baby.Postpartum haemorrhage occurring from 24 hours to 6 weeks after delivery is known as secondary, delayed or late postpartum haemorrhage. The common causes of postpartum haemorrhage are categorised by those involving ‘tone’ (such as uterine atony), ‘tissue’ (as in retained placental tissue), ‘trauma’ (such as birth canal laceration) and ‘thrombin’ (to signify coagulopathy).Active management of the third stage of labour with oxytocics reduces the risk of uterine atony as a cause of postpartum haemorrhage.Bonus: Alrighty then, here’s a big one. What are the functions of the liver? Is the liver essential for life?Answer in tomorrow’s dose.Closing: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!Luke.Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks. Just credit us where credit is due. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit yourdailymeds.substack.com

Good morning and welcome to your Tuesday dose of Your Daily Meds.Bonus Review: What are some of the actions of gastric acid?Answer: A few main ones - Activation of pepsinogens to produce pepsinsAssists protein digestion (pepsins require low pH for activity)Kills ingested bacteria - helps prevent infectionInhibited gastrin secretion from antral G-cells (negative feedback loop)Increases secretion of bile and pancreatic juicesFacilitates iron absorption in duodenumPaeds:A 4-year-old boy complains to his mother of acutely painful defaecation. The mother reports that there is spotting of blood on the toilet paper. Whish of the following is the most likely diagnosis?Meckel diverticulumIntussusceptionAnal fissureHenoch-Schönlein purpuraAppendicitisHave a think.More scroll for more chat.A Query:Which of the following biochemical abnormalities is most likely in Cushing’s syndrome due to ectopic ACTH secretion?Elevated ACTH, elevated cortisol, reduced serum potassiumElevated ACTH, elevated cortisol, elevated serum potassiumElevated ACTH, reduced cortisol, reduced serum potassiumReduced ACTH, markedly elevated cortisol, reduced serum potassiumMarkedly elevated ACTH, reduced serum cortisol, reduced serum potassium(Where ACTH = adrenocorticotrophic hormone)Have a think.More scroll for more chat.Spots and Pain:Anal fissure is the most common cause of painful rectal bleeding in this age group. It is often due to passage of a hard constipated stool. Intussusception can occur acutely, it is more likely to be reported as colicky pain and the stool classically has the appearance of red currant jelly. Meckel diverticula, when acute, are associated with central abdominal pain and can cause sufficient blood loss and result in haemodynamic instability, as opposed to spotting on the toilet paper. Henoch-Schönlein purpura is also associated with intussusception and bloody stools (as opposed to spotting) and often presents with abdominal pain, vasculitic rash and joint pain and swelling. Appendicitis classically presents as a central abdominal pain that localises to the right iliac fossa. It is associated with fever, nausea and vomiting and diarrhoea but is less likely to cause spotting.Cushingoid:Key to answering this question is understanding that Cushing’s syndrome is caused by excess activation of glucocorticoid receptors.Most commonly, Cushing’s syndrome is iatrogenic due to exogenous administration of glucocorticoids.Endogenous forms of Cushing’s syndrome are due to over-production of cortisol by the adrenal glands as a result of adrenal tumour, excess adrenocorticotrophic hormone (ACTH) secretion by a pituitary tumour (Cushing’s disease), or ectopic ACTH production by some other tumour. In ACTH-secreting tumours, there is likely to be impaired negative feedback sensitivity to cortisol, unlike in ACTH-secreting pituitary tumours, which retain this sensitivity.So patients would most likely exhibit elevated ACTH, elevated cortisol, reduced serum potassium.This inappropriately elevated ACTH is associated with pigmentation changes, as it binds to melanocortin-1 receptors in skin melanocytes. The elevated cortisol can overcome the kidney’s capacity to inactivate cortisol, resulting in Hypokalaemic alkalosis, contributing to the myopathy and hyperglycaemia typical of Cushing’s syndrome.Cast your mind back to awful feedback loops like this one:Bonus: What is bile?Answer in tomorrow’s dose.Closing: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!Luke.Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks. Just credit us where credit is due. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit yourdailymeds.substack.com

Good morning and welcome to your Monday dose of Your Daily Meds.Bonus Review: What humoral factors stimulate parietal cell gastric acid production?Answer: A few important ones include:Histamine (H2 receptors)Acetylcholine (M1 muscarinic receptors)Gastrin (gastrin receptors)- these receptors are on the basolateral membrane.Query:Which of the following is not among the extrapyramidal side effects of antipsychotic use?AkathisiaRigidityTremorBradykinesiaOdynophagiaHave a think.Remember some Latin (or Greek?).And scroll for the chat.Query:In the case of community acquired pneumonia (CAP), which of the following organisms is more likely to affect the elderly patient with pre-existing lung disease?Mycoplasma pneumoniaeHaemophilus influenzaeLegionella pneumophilaBurkholderia pseudomalleiStaphylococcus aureusHave a think.More scroll for more chat.The Pyramids:Extrapyramidal symptoms are common side effects associated with antipsychotic usage. The incidence of these effects is reduced with the use of second generation antipsychotics. The symptoms are due to their effect as Dopamine D2 antagonists or partial agonists which can interfere with the dopamine transmission in the nigrostriatal tract.The symptoms produced by interference in this system are similar to those seen in Parkinson’s disease and include akathisa, rigidity, tremor, bradykinesia and acute dystonic reactions. So, odynophagia, painful swallowing, is not among the extrapyramidal side effects of antipsychotic use. Lung Bugs:Streptococcus pneumoniae is the most common causative agent of community acquired pneumonia (CAP).The likelihood that other organisms are involved or responsible for a clinical picture of pneumonia is based on patient age and clinical context.The age and context of the patient with CAP may suggest a causative agent, unlike radiological findings, which are often unhelpful when distinguishing organisms. Mycoplasma pneumoniae is more common in young people and rare in the elderly; unlike Haemophilus influenzae, which is more common in the elderly, especially when there is an underlying lung disease. Legionella pneumophila occurs in outbreaks and is often linked to contaminated cooling towers in hospitals and hotels. Staphylococcus aureus tends to be more common following a bout of influenza. Furthermore, foreign travel may raise the risk of less likely organisms such as Burkholderia pseudomallei in those travelling from south-east Asia.Bonus: What are some of the actions of gastric acid?Answer in tomorrow’s dose.Closing: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!Luke.Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks. Just credit us where credit is due. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit yourdailymeds.substack.com

Good morning and welcome to your Friday dose of Your Daily Meds.Bonus Review: How is H+ produced in the stomach and secreted into the gastric lumen?Answer: So CO2 reacts with water under the influence of carbonic anhydrase. This produces the H+, which is then actively transported into the gastric lumen by H+K+-ATPase. The HCO3- in the reaction passes across the basolateral membrane in exchange for Cl- via an antiport.Question:With regard to episodes of delirium, which of the following is not a feature of extrinsic and environmental management?Well-lit room or patient cubicleRemove seeing glasses to reduce risk of injuryRoom or patient cubicle near nursing stationFamily member present Frequent orientation with calendars and clocksHave a think.Scroll for the chat.Quick Investigation:Consider the following ECG:What is the correct rate, rhythm, axis and interpretation, respectively?Ventricular rate 40/min; atrial fibrillation; left axis deviation; rapid ventricular responseVentricular rate 60/min; atrial flutter; normal axis; 3:1 blockVentricular rate 40/min; sinus rhythm; normal axis; complete heart blockVentricular rate 40/min; sinus rhythm; normal axis; left bundle branch blockVentricular rate 60/min; atrial fibrillation; right axis deviation; ischaemic changesHave a think.Do some counting.More scroll for more chat.The Environment:The principles of extrinsic or environmental management of delirium include:Quiet, well-lit rooms or cubicles, near windows to orient to time of dayOptimise hearing and visionRoom or cubicle near nursing station for closer observation and increased cares if agitatedFamily members present for reassurance and re-orientationFrequent orientation with clocks, calendars and remindersSo removing the patients’ seeing glasses is least likely to be an effective method of environmental, non-pharmacological management of delirium.It would probably just make them more crazy…Squiggly Lines:This ECG shows sinus rhythm with complete heart block and ventricular escape rhythm.So sinus rhythm because the sinus node is ticking away regularly giving P waves at a rate of approximately 90/min. But complete heart block because there seems to be no relationship between this sinus rhythm and the ventricular rhythm. So the ventricles will tick along at their own rate (the escape rhythm - which is slower than that of the atrial pacemakers).Note: there are three characteristics of complete heart block. These are A-V dissociation, atrial rate > ventricular rate, and a regular ventricular rate.The ventricular rate is approximately 40/min with sinus rhythm - yep. The QRS complexes are wide with left bundle branch block (LBBB) morphology - wide because the depolarisation is coming from the slow lumbering ventricles, not the snappy quick atria. The axis is normal. And there is a prolonged QT at 600ms.So this person probably looked quite sick…Bonus: What humoral factors stimulate parietal cell gastric acid production?Answer in Monday’s dose.Closing: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!Luke.Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks. Just credit us where credit is due. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit yourdailymeds.substack.com

Good morning and welcome to your Thursday dose of Your Daily Meds.Bonus Review: Which stomach cells secrete hydrogen ions? And where in the stomach are they located?Answer: The parietal cells. They secrete H+ and Cl- into the stomach. These parietal cells are located in the fundus and body of the stomach.Question:Which of the following is not considered a risk factor for chorioamnionitis?Multiparity Prolonged labourProlonged ruptured membranesCervical insufficiencyAlcohol usageHave a think.Scroll for the chat.Query:Which of the following clinical features is most characteristic of Type 1 Diabetes at initial presentation?Incidence increases with ageOften a family history of Type 1 DiabetesNo history of other autoimmune diseasesPresents with polyuria and polydipsiaLittle or no weight lossHave a think.More scroll for more chat.The Risk:Chorioamnionitis is an obstetric emergency characterised by tachycardia, fever and foetal distress. It may be caused by an ascending infection that affects the membranes and amniotic fluid before affecting the foetus and is managed urgently with broad spectrum antibiotics and delivery. Chorioamnionitis is a severe, non-sexually acquired form of pelvic inflammatory disease (PID). Other forms of PID include endometritis, salpingitis, tubo-ovarian abscesses and pelvic cellulitis or peritonitis.Important risk factors for the development of chorioamnionitis include prolonged labour and prolonged ruptured membranes. Other risk factors include cervical insufficiency, multiple digital vaginal examinations, nulliparity, meconium-stained amniotic fluid, internal foetal or uterine monitoring, alcohol and tobacco use, previous chorioamnionitis and the presence of genital tract pathogens, such as sexually transmitted infections, group B Streptococcus and bacterial vaginosis. Multiparity is not considered a risk factor for chorioamnionitis.Bitter Sweet:Classifying the type of diabetes is important when determining initial management such as the need for hospitalisation or insulin commencement. Further, longer term considerations are influenced by the type of diabetes, such as risks for other autoimmune diseases (as with Type 1 Diabetes) or other metabolic conditions (as with Type 2 Diabetes). Broadly, the typical features at initial presentation of Type 1 and Type 2 Diabetes can be classified as follows:So an acute presentation with polyuria and polydipsia would be most characteristic of an initial presentation of Type 1 Diabetes.Bonus: How is H+ produced in the stomach and secreted into the gastric lumen?Answer in tomorrow’s dose.Closing: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!Luke.Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks. Just credit us where credit is due. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit yourdailymeds.substack.com

Good morning and welcome to your Wednesday dose of Your Daily Meds.Bonus Review: What do platelets do?Answer: Haemostasis is the game here.Platelets are involved in primary haemostasis, from platelet adhesion to the vascular subendothelium through to formation of a platelet plug.Our platelets also release some vasoconstrictors, like thromboxane A2 and serotonin.Platelets also come back at the end, where they are essential for contraction of the final clot.Case:An 81-year-old male presents to his General Practitioner with a three-month history of cough, shortness of breath and subjective fevers. His chest x-ray is shown below:Which of the following is the most likely diagnosis for this man’s condition?Transudative pleural effusionExudative pleural effusionEmpyemaLung abscessLung cancerHave a look.Now look closely at the right hemithorax.Scroll for the chat.Query:Which of the following is the most common extra-articular feature of ankylosing spondylitis?Aortic insufficiencyAcute anterior uveitisCardiac conduction defectsApical pulmonary fibrosisAmyloidosisHave a think.More scroll for more chat.That Chest:The chest x-ray shows a round right-sided cavity containing a gas-fluid level that is suggestive of lung abscess.Lung abscesses are circumscribed collections of pus within the lungs. They are usually due to liquefactive necrosis of lung tissue. Primary abscesses develop as a result of a primary infection of the lung, most commonly due to aspiration, necrotising pneumonia or chronic pneumonia. Secondary abscesses result from another condition such as bronchial obstruction due to carcinoma or haematogenous spread such as in bacterial endocarditis. Lung abscesses are usually managed with prolonged antibiotics and physiotherapy with postural drainage. Surgical resection is used in cases that are refractory to conservative management or those complicated by haemoptysis, empyema or suspected malignancy.Pleural effusions describe fluid in the pleural space. They are defined as transudate or exudate by Light’s criteria:Empyema describes infection in the pleural space and can be caused by lower respiratory tract infections, abdominal sepsis, traumatic causes or iatrogenic causes. Lung cancer is unlikely to have a gas-fluid level, making cancer an unlikely cause of the lung lesion on chest x-ray.Anteriorly Ankylosing: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. Acute anterior uveitis is the most common extra-articular manifestation of ankylosing spondylitis (AS) and is experienced by up to 30% of patients. In the case of sudden onset, unilateral eye pain, associated with photophobia and lacrimation, patients with AS should immediately seek medical advice and should be urgently referred to an ophthalmologist. Aortic insufficiency secondary to aortitis, cardiac conduction defects, apical pulmonary fibrosis and amyloidosis are extra-articular features of ankylosing spondylitis that are less common than acute anterior uveitis.Bonus: Which stomach cells secrete hydrogen ions? And where in the stomach are they located?Answer in tomorrow’s dose.Closing: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!Luke.Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks. Just credit us where credit is due. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit yourdailymeds.substack.com

Good morning and welcome to your Tuesday dose of Your Daily Meds.Bonus Review: What are platelets? Where do they come from? Where do they go?Answer: Well, platelets are small cellular fragments (2-4 micrometer diameter) that ‘bud off’ from megakaryocytes in the bone marrow. They have a life span of 8-12 days circulating in the blood. Mostly, old and abnormal platelets are removed by macrophages in the spleen.Kids Case:A 16-year-old female is brought to the Emergency Department with persistent vomiting for the last 2-days.She reports a history of malaise and fatigue for some months.On examination, she is haemodynamically unstable with a blood pressure of 90/60 mmHg and pulse rate of 130/min.Her serum sodium is 117 mmol/L (135-145), her serum chloride is 75 mmol/L (95-110) and urinalysis is normal.Which of the following is the most likely diagnosis?21-hydroxylase enzyme deficiencyAddison’s diseaseChronic fatigue syndromePhaeochromocytomaChronic reflux nephropathySheesh. Have a think.Remember some physiology.Scroll for the chat.Query:A 52-year-old female presents to the Emergency Department with fever, right upper quadrant pain and jaundice. After a surgical consult, empiric antibiotics are administered while further investigations are organised. Which of the following is the most suitable empiric antibiotic regimen in this case?Intravenous gentamicin and intravenous amoxycillinIntravenous metronidazoleOral amoxycillin and clavulanateOral trimethoprim and sulfamethoxazoleIntravenous amoxycillinHave a think.More scroll for more chat.The CrisisThis girl has features of an Addisonian crisis (Addison’s Disease gone bad in a time of physiological stress), including vomiting, circulatory decompensation with hypotension, hyponatraemia and hypochloraemia. The hypotension is likely due to the lack of adrenal steroid production in a time of stress. 21-hydroxylase enzyme deficiency is a cause of salt-losing congenital adrenal hyperplasia. It causes a defect in the glucocorticoid pathway and so results in a deficiency of cortisol and aldosterone. It normally manifests at an early age, often in the neonatal period. Chronic fatigue syndrome does not present with haemodynamic instability and investigation results are often normal. Phaeochromocytoma classically presents with episodes of palpitations, hypertension and anxiety and is unlikely to give the clinical history in this case. Chronic reflux nephropathy may account for the serum abnormalities but is more likely to present as normotensive or hypertensive.Right Upper:Key to answering this question is recognising the likelihood diagnosis of cholangitis. Fever, right upper quadrant pain and jaundice is consistent with Charcot’s triad in the description of cholangitis. The recommended empiric therapy for suspected cases of cholangitis is intravenous gentamicin and intravenous amoxycillin (or ampicillin).Plus having a chat with some surgeons…It is recommended that, if the results of susceptibility testing are not available within 72 hours and empiric therapy is still required, the gentamicin-containing regimen should be ceased and replaced with ceftriaxone, cefotaxime, piperacillin and tazobactam or ticarcillin and clavulanate. In patients with signs and symptoms of cholangitis with a history of chronic biliary obstruction, metronidazole should be added to regimes containing gentamicin and ceftriaxone or cefotaxime. Therapy should be changed to oral administration after clinical improvement and sensitivity testing.Thus, of the options listed, intravenous gentamicin and intravenous amoxycillin is the most suitable empiric antibiotic regimen in this case.Bonus: What do platelets do?Answer in tomorrow’s dose.Closing: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!Luke.Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks. Just credit us where credit is due. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit yourdailymeds.substack.com

Good morning and welcome to your Monday dose of Your Daily Meds.Bonus Review: What are the actions of erythropoietin?Answer: EPO is released from the kidney, circulates in blood and acts on immature erythroid cells in the bone marrow by binding to a cell-membrane EPO receptor. This results in differentiation and proliferation of these immature red cells into mature red cells.Case:A 12-year-old male presents to the General Practitioner with his mother complaining of sudden onset scrotal pain of three hours duration.He reports associated severe nausea and vomiting.On examination, the left hemi-scrotum is red and swollen and extremely tender. Which of the following is the most appropriate immediate management?Surgical referral for scrotal explorationUrine microscopy, culture, sensitivityBroad spectrum antibioticFull blood countUltrasound imaging of scrotumHave a think.Scroll for the chat.Quick Case:Consider the following ECG:Which of the following is the most likely diagnosis?1st degree atrioventricular block2nd degree atrioventricular block with Mobitz I conduction2nd degree atrioventricular block with Mobitz II conduction3rd degree atrioventricular blockPremature ventricular complexesHave a think.More scroll for more chat.Torted:Key to answering this question is recognising the likelihood diagnosis of torsion of the left testis. Made as a clinical diagnosis, this condition requires an urgent surgical opinion. Investigating urine and blood are unlikely to be of assistance and will delay definitive management. Note that urinary tract infection and epididymo-orchitis would be considered more as differentials in adults.(Bonus points if you considered other findings of a torted testis - like high-riding, or altered lie, or absent cremasteric reflex…)Squiggly Lines:This ECG shows an irregular, narrow complex rhythm with upright P-waves in lead II, suggesting a sinus origin. The QRS complexes are separated by non-conducted P-waves and the PR-interval increases within each group of QRS complexes. This is characteristic of 2nd degree atrioventricular block with Mobitz I conduction, in which progressive prolongation of the PR interval culminates in a non-conducted P wave. Also known as a Wenckebach rhythm, this type of AV block can be caused by drugs such as beta blockers and calcium channel blockers; increased vagal tone, as in athletes; myocardial infarction or myocarditis; and following cardiac surgery. A 1st degree atrioventricular block is characterised by a PR-interval of more than 200 ms (five small squares on the ECG trace).A 2nd degree atrioventricular block with Mobitz II conduction is characterised by intermittent non-conduction of P-waves without progressive elongation of the PR-interval. A 3rd degree atrioventricular block, or complete heart block, is characterised by complete dissociation between atria and ventricles, where the perfusing rhythm is maintained by a junctional or ventricular escape rhythm. Premature ventricular complexes arise from an ectopic focus within the ventricles and are characterised by premature, broad QRS complexes (>120 ms) with abnormal morphology.Bonus: What are platelets? Where do they come from? Where do they go?Answer in tomorrow’s dose.Closing: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!Luke.Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks. Just credit us where credit is due. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit yourdailymeds.substack.com

Good morning and welcome to your Friday dose of Your Daily Meds.Bonus Review: What is erythropoietin? Where is it produced? Answer: It is a glycoprotein hormone and is the main factor controlling red cell production.Regulation of erythropoietin (EPO) production controls red cell mass and then blood oxygen carrying capacity.In adults, EPO is produced mostly in the kidneys. In the foetus, the liver.(Us adults only have 10-15% of our EPO being produced in our livers)Case:A 45-year-old male presents with a 5-day history of malaise, productive cough and right-sided chest pain with fevers.He has a 20 pack-year history of smoking.On examination, his temperature is 38.1, HR 112, BP 115/78, RR 23/min, SpO2 93% on room air.Which of the following is the most likely diagnosis?Bronchial carcinomaCommunity acquired pneumoniaSarcoidosisTuberculosisWegener’s granulomatosisHave a think.Scroll for the chat.Query:During preoperative airway assessment, a clinician asks a patient to open his mouth and protrude his tongue as far as possible. During this process, the clinician visualises the following:Which of the following scores correctly describes this result?Mallampati 1Mallampati 2Mallampati 3ASA 1ASA 2Have a think.Open your mouth in front of a mirror.More scroll for more chat.Cough-y:Note that this man has symptoms of an acute infection. These include the history of fevers, and malaise with a likely chest focus. His smoking history also puts him at risk of community-acquired pneumonia, most commonly Streptococcus pneumoniae. Note that he has no signs of confusion nor any severe prognostic signs such as systolic BP < 90 or RR >30/min. Given these signs and this man’s age, it is likely that he will be able to be managed without admission. This man has a significant smoking history, however he is relatively young to be developing lung cancer. Further, the history is that of an acute illness not that of gradual decline. Sarcoidosis is unlikely as it rarely presents with an acute infective picture. Tuberculosis may be a reasonable diagnosis given the systemic symptoms and productive cough. Further travel and contact history would need to be taken. Further investigation of sputum, such as testing for acid-fast bacilli would be required. The short time course of the illness, however, makes a pneumonia more likely. Wegener’s granulomatosis is a vasculitis that can present with cough and haemoptysis on a chronic background, rather than acute onset.Wide Open:This question asks for assessment of the Mallampati score for preoperative assessment of an airway in the context of predicting difficult intubation. The Mallampati classification has four levels illustrated by the following:When asked to open the mouth and protrude the tongue as far as possible, the clinician judges the Mallampati score based of visualisation of features in the oral cavity and oropharynx as follows:Class 1 – Soft palate, uvula, fauces, pillars visibleClass 2 – Soft palate, uvula, fauces visibleClass 3 – Soft palate, base of uvula visibleClass 4 – Only hard palate visibleThe ASA score references the American Society of Anaesthesiologists physical status classification. It is a subjective assessment of a patient’s overall health:ASA I – patient is completely fit and healthyASA II – patient has mild systemic diseaseASA III – patient has severe systemic disease that is not incapacitatingASA IV – patient has incapacitating disease that is a constant threat to lifeASA V – a moribund patient who is not expected to live 24 hours without surgeryASA VI – a declared brain-dead patient whose organs are being removed for donor purposes(E – emergency surgery, an ‘E’ is placed after the Roman numeral)So this was Mallampati 2.Bonus: What are the actions of erythropoietin?Answer in Monday’s dose.Closing: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!Luke.Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks. Just credit us where credit is due. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit yourdailymeds.substack.com

Good morning and welcome to your Thursday dose of Your Daily Meds.Bonus Review: Why are newborn infants susceptible to Vitamin K deficiency?Answer: Firstly, Vitamin K deficiency in the newborn can result in haemorrhagic disease of the newborn, resulting in neonates bleeding to death…Not good.Neonates are Vitamin K deficient as - Vitamin K does not cross the placenta in sufficient amounts = neonatal hepatic stores are low as are their stores of clotting factors 2, 7, 9 and 10The neonatal bowel is initially sterile, so they don’t even get that little bit of bacterial production of Vitamin KBreast milk is low in Vitamin KHappily, bacteria colonise the neonatal colon in the first week and start to produce some Vitamin K.Case:A 16-year-old female presents to the Emergency Department complaining of diffuse abdominal pain, anorexia and vomiting. On examination, she was febrile to 38°C and the abdomen was tender, especially over the right iliac fossa. The which of the following would not be considered a sign of peritonism in this patient?RigidityInvoluntary guardingMurphy’s signRebound tendernessPercussion tendernessHave a think.Scroll for the chat.Something Obstetric:A 32-year-old female presents to the Emergency Department complaining of vaginal bleeding. She is in the third trimester of her second pregnancy. She reports no pain with the bleeding and no other discharge. She reports a large volume of bright red blood in an episode of bleeding prior to presentation to the ED. On examination, she is afebrile, hypotensive and tachycardic. In which of the following differential diagnoses for this complaint would a digital examination be contraindicated?Vasa praeviaAbruptio placentaeSpontaneous abortionAtrophic vaginitisPlacenta previaHave a think.Remember some Latin (or Greek…I dunno).More scroll for more chat.McMurphy:Key to answering this question is recognising the likelihood diagnosis of appendicitis and the risk of peritonitis with inflammation and rupture.The classical history of diffuse abdominal pain that eventually localises to the right iliac fossa describes the process of inflammation spreading from visceral peritoneum to parietal peritoneum. The sensory input from the visceral peritoneum is vague, while the sensation associated with parietal peritoneum inflammation is well-localised and distinct. Peritonism describes the painful sensation resulting from when inflamed peritoneal surfaces are moved relative to each other. Rigidity, a tendency for the patient to remain very still, and involuntary guarding, an inability to relax the abdominal wall even with distraction, are associated with peritonitis. Rebound tenderness, tenderness felt on the quick release after firm palpation, and percussion tenderness also suggest peritonism.Murphy’s sign describes the cessation of inhalation during palpation of the right upper quadrant and is sensitive for acute cholecystitis.The Preview:Placenta praevia is an obstetric complication of placental implantation into the uterine wall such that it is near or covering the internal cervical os. Complete praevia is a complete covering of the os by the placenta. A marginal praevia is when the placenta is less than 2cm from the internal os, but not covering it. Placenta praevia has an inherent risk for haemorrhage.Because of the risk of uncontrolled bleeding, digital examination of the vagina is contraindicated until placenta praevia is excluded. Any pregnant woman beyond the first trimester presenting with vaginal bleeding should have a speculum examination and diagnostic ultrasonography. If ultrasonography is unavailable and a digital examination is necessary, it should be performed in a theatre prepared for emergent caesarean delivery if at a suitable gestation.Vasa praevia is a condition in which the blood vessels supplying the foetus run adjacent or over the internal cervical os. Vasa previa may be associated with a low-lying placenta. There is a risk of foetal exsanguination due to vessel damage when the membranes rupture. The vessels can also be compressed by the foetus during labour.Abruptio placentae is the premature separation of the placenta from the uterus. Patients present with bleeding, uterine contractions and foetal distress.Spontaneous abortion, a process of early pregnancy loss, is associated with a history of vaginal bleeding, abdominal pain and passage of tissue. The vaginal bleeding and abdominal pain tends to subside when the tissue has passed.Atrophic vaginitis is characterised by vaginal soreness, postcoital burning, dyspareunia, burning leukorrhoea and occasional spotting.Bonus: What is erythropoietin? Where is it produced?Answer in tomorrow’s dose.Closing: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!Luke.Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks. Just credit us where credit is due. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit yourdailymeds.substack.com

Good morning and welcome to your Wednesday dose of Your Daily Meds.Bonus Review: Where does Vitamin K come from? Where is it absorbed? Why is it called Vitamin K?Answer: We need dietary Vitamin K. We get most of our dietary Vitamin K from leafy green vegetables and meats. Large amounts of menaquinone (Vitamin K2) is produced by bacterial action in the colon - unfortunately Vitamin K absorption does not occur in the colon. Some of the bacterially-produced Vitamin K is absorbed in the terminal ileum where there are some bile salts present. But, again, we need dietary Vitamin K.The absorption of dietary Vitamin K is from the small intestine. Remember that Vitamin K is fat soluble and so needs bile salts so that it can initially be solubilised into micelles which facilitates absorption into the circulation (via chylomicron form in the lymphatics).So, in patients with obstructive jaundice and an absence of bile salts in the small intestine, Vitamin K absorption will be impaired. They might even need some intravenous Vitamin K.Or what about the intubated malnourished patient with terminal ileitis from Crohn’s Disease. He has normal small bowel bile salts but no dietary Vitamin K? And naturally that little bit of bacterially produced Vitamin K are not going to be absorbed in the terminal ileum…let’s watch his INR go up…Also the ‘K’ in Vitamin K comes from the German ‘Koagulation’…Case:Consider the following ECG:What is the correct rate, axis and interpretation, respectively?100/min; normal axis; left bundle branch block120/min; normal axis; atrial flutter120/min; left axis deviation; atrial flutter with ectopic beats120/min; normal axis; atrial fibrillation with rapid ventricular rate100/min; right axis deviation; sinus rhythmHave a think.Count some little squares and look at the squiggles.Scroll for the chat.Investigation:A 25-year-old male is being worked up for an obstructive respiratory condition. Which of the following respiratory function test results would be most indicative of asthma.(FEV1 = forced expiratory volume in 1 second; VC = vital capacity; TLCO = carbon monoxide transfer factor; KCO = carbon monoxide transfer factor per unit lung volume; TLC = total lung capacity; RV = residual volume) FEV1 ↓↓; VC ↓; FEV1/VC ↓; TLCO →; KCO →/↑; TLC →/↑; RV →/↑ FEV1 ↓↓; VC ↓; FEV1/VC ↓; TLCO →; KCO →; TLC ↑; RV ↑FEV1 →; VC →; FEV1/VC →; TLCO →; KCO →; TLC →; RV →FEV1 ↓↓; VC ↓; FEV1/VC ↓; TLCO ↓↓; KCO ↓; TLC ↑↑; RV ↑↑FEV1↓; VC ↓↓; FEV1/VC →/↑; TLCO↓↓; KCO→/↓; TLC ↓; RV ↓(And where down arrow means decreased, sideways arrow means normal/stable etc…)Have a think.Remember those flow-volume curve/loop things.More scroll for more chat.Rapidamente:This ECG shows atrial fibrillation with rapid ventricular rate. The rate is approximately 120/min and with clear atrial fibrillation as P waves are not seen. The QRS complex is narrow at approximately 80ms. The axis is normal. Note there is mild horizontal ST depression in V4, V5 and V6 which is likely rate-related, not due to ischaemia.Vitality:Answer a) is most suggestive of asthma. The greatly reduced FEV1 is suggestive of airflow obstruction, as in asthma and COPD. To differentiate asthma from chronic bronchitis and emphysema, it is important to note the carbon monoxide transfer capacity, greatly reduced in emphysema, and the TLC and RV, which is not necessarily increased in asthma, unlike chronic bronchitis.Thus, answer a) is most suggestive of asthma;answer b) most suggestive of chronic bronchitis, answer c) is most likely a normal respiratory function test result; answer d) is suggestive of emphysema; and answer e) is suggestive of pulmonary fibrosis.In the case of asthma, lung function tests should be repeated after administration of a short-acting beta-2-adrenoreceptor agonist, such as salbutamol, to observe for any reversibility, such as a large improvement in FEV1 (eg 400mL). Bonus: Why are newborn infants susceptible to Vitamin K deficiency?Answer in tomorrow’s dose.Closing: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!Luke.Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks. Just credit us where credit is due. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit yourdailymeds.substack.com

Good morning and welcome to your Tuesday dose of Your Daily Meds.Bonus Review: Ok so what is the difference between a Hormone and a Vitamin?Answer: A few things - A Hormone = endogenous chemical messenger which…Is secreted into the blood by a ductless glandCombines with a specific receptor on a distant cell and;Produces a change in the metabolism of that distant cellWhile a Vitamin = an organic substance which…The body cannot produceMust come from an exogenous source (yes, usually diet)Is only required in small amountsIs usually essential for survivalAffects specific biochemical reactionsIs not a caloric sourceCase:You meet a 45-year-old male in the Emergency Department.He has a long history of peptic ulcer disease.He tells you of severe, sudden onset epigastric pain.And on examination, there is involuntary rigidity and percussion tenderness over the upper abdomen.His erect chest/abdominal x-ray is shown below:Given this man’s history and examination, what is the key finding in this x-ray?Omental fat between liver and diaphragmPneumothoraxEnlarged gastric bubbleSubdiaphragmatic free gasSubdiaphragmatic abscessWard Call:A nurse calls you quite concerned from the medical ward:Doctor, could you please come and review Mr Smith urgently. I think he has haematuria. I just looked in his indwelling catheter drainage bag and his urine is dark red. So I am quite worried.While you ponder this, otherwise calmly watching a soap opera in the on-call room, what are some questions you could ask over the phone to decide if you should go and review this chap, or wait until the next ad break?Have a think.More scroll for more chat.That X-RayThis man has a history of peptic ulcer disease and signs of peritonitisThe main concern should be an acutely perforated ulcer.This would allow a communication between the stomach or duodenum with the peritoneal space, irritating the peritoneum and causing peritonitis.The x-ray shows free gas under both domes of the diaphragm.This is Pneumoperitoneum.Also note a nasogastric tube in situ.On Haematuria:Some questions you could ask include:When did this ‘haematuria’ start and has it happened before?Are there any associated symptoms?eg colicky flank pain suggesting a renal tract stone. Dysuria and frequency of a UTI.We have been told there is a urinary catheter in place, but was this recently inserted?Traumatic or inexperienced IDC insertions may lead to bleeding.Has the patient had recent surgery?Procedures on the bladder and kidneys are associated with transient bleeding.Low gastrointestinal surgeries sometimes place the bladder at risk of injury, so an IDC may be left in situ for the actual purpose of checking for haematuria as a surrogate of bladder injury. A conversation with your surgical registrar may ensue.Same for women post-caesarean section - ongoing haematuria may signify damage to the at-risk bladder in surgery.Is the patient anti-coagulated?Anticoagulants may require reversal in the actively bleeding patient.Or withholding of those anticoagulants that cannot be reversed.Or, combine a couple of ideas, has this patient recently had surgery and now has ‘haematuria’ after restarting their anticoagulants (that had been withheld over the preoperative period)?What are the vital signs?Hypotension and tachycardia of significant blood loss.Fever of urosepsis.What was the reason for admission?Ok so I have written ‘haematuria’ with the squiggles (‘‘) a couple of times above. Haematuria probably gets used a bit too often to describe dark urine.Because there is a difference between the concentrated urine of dehydration (or the anti-diuretic state), the coca-cola urine of bilirubinuria, microscopic haematuria from laboratory microscopy (the urine looks normal to the eye), macroscopic haematuria (the urine looks dark and there is blood on the dipstick and microscopy) and frank haematuria (the patient is literally bleeding fresh blood from their urethra).Again, dark red cordial urine is still not necessarily frank haematuria - a tiny bit of bleeding will stain a bladder full of urine to a concerning colour.Naturally, an apparent connection between the left ventricle and urethra resulting in haemodynamic instability secondary to haemorrhage of fresh blood should warrant more concern than trace blood from a recently inserted indwelling catheter.So those simple questions of - when was IDC inserted, reason for admission, vital signs, how does patient look - will probably give you most bang for your buck.You will probably have to go and look at that urine at some point, however, and nursing concern should not be ignored.But maybe it can wait until the next ad break…Bonus: Where does Vitamin K come from? Where is it absorbed? Why is it called Vitamin K?Answer in tomorrow’s dose.Closing: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!Luke.Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks. Just credit us where credit is due. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit yourdailymeds.substack.com

Good morning and welcome to your Monday dose of Your Daily Meds.Bonus Review: Consider a Rhesus (Rh) positive foetus being carried by a Rh negative mother in her first pregnancy. Would that foetus be affected by the mother’s antibodies against foetal red blood cells? Answer: In short, probably not.Given this is her first pregnancy, the mother will probably not have any Rhesus antibodies (Anti-D antibodies). She could have developed these antibodies if she had been exposed to Rh positive blood in the past, such as in a previous pregnancy with an Rh positive foetus or an Rh positive blood transfusion.So, by considering the use of Anti-D passive immunisation in the event of a sensitising event in a pregnant woman of this status; and avoiding Rh positive transfusions in women of child-bearing age, we can reduce the risk of blowing up foetal red blood cells…Case:A 34-year-old male is brought into the Emergency Department via ambulance after a high-speed motor vehicle accident.On assessment:There is no eye openingIncomprehensible sounds are notedHe pulls his hand away when you firmly squeeze his nailbed with a pen.Which of the following correctly describes this man’s GCS score?GCS 7 – E 1; V 2; M 4GCS 7 – E 1; V 2; M 4GCS 7 – E 1; V 2; M 4GCS 7 – E 1; V 2; M 4GCS 7 – E 1; V 2; M 4Have a think.Scroll for the chat.Paediatrics:Which of the following is not considered in the calculation of an Apgar Score for a neonate?Heart rateRespiratory effortMuscle toneTemperatureReflex responseHave a think.More scroll for more chat.What the GCS?:The Glasgow Coma Scale is used as a neurological scoring system and assesses the patient’s best eye response, best vocal response and best motor response.It is scored out of 15, with the eye component scored out of 4, the verbal component out of 5 and the motor component out of 6.In this case, there is no eye opening (E 1), there are incomprehensible sounds verbalised (V 2), and the patient withdraws from painful stimulus (M 4). This results in a total GCS of 7.A GCS of 8 or less is often used as a marker for the need for intubation in the setting of an unprotected airway.Remember, the minimum GCS is 3, not 0.Toasters have a GCS of 3. As do logs.The GCS marking criteria are shown below for reference:APGARing:The Apgar Score comprises the assessment of neonatal heart rate, respiratory effort, muscle tone, colour and reflex response; with each criterion scored from 0-2 with a maximum score of 10. Not Temperature.Consider the table below:The score is based on the degree of cardiorespiratory and neurological depression present in the neonate and is measured at 1 and 5 (and sometimes 10) minutes after birth. A normal Apgar score is between 7 to 10. Apgar score of 4 to 6 indicate moderate depression; and 0 to 3 indicates severe depression. Bonus: Ok so what is the difference between a Hormone and a Vitamin?Answer in tomorrow’s dose.Closing: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!Luke.Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks. Just credit us where credit is due. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit yourdailymeds.substack.com

Good morning and welcome to your Friday dose of Your Daily Meds.Bonus Review: What are the major blood groups? How are they determined and why are they important?Answer: ‘Blood groups’ is a term that is used to refer to the genetically determined antigens that are present in the membranes of red blood cells. The importance of these ‘groups’ then, is related to the degree of antigenicity of these antigens in the membrane.The ABO grouping system are the most important because they are the most antigenic. The Rhesus (Rh) grouping system also has significant antigenicity.Then there are many other descriptors and systems of blood grouping which describe antigens of much lower clinical importance.Case:Which of the following patterns of serological test results indicates vaccination against hepatitis B virus infection?HBsAg negative; Anti-HBc positive; Anti-HBs positiveHBsAg negative; Anti-HBc negative; Anti-HBs negativeHBsAg negative; Anti-HBc negative; Anti-HBs positiveHBsAg positive; Anti-HBc positive; Anti-HBs negativeHBsAg positive; Anti-HBc negative; Anti-HBs positive(Where: HBsAg = hepatitis B surface antigen; Anti-HBc = antibodies to hepatitis B core antigen; Anti-HBs = antibodies to hepatitis B surface antigen)Pause for a moment.Sift through this pile of acronyms.And scroll for the chat.Ward Call:You have just arrived to start your evening shift when you receive a call from the maternity ward about a patient who is receiving a blood transfusion.Hi Doctor, could you please come and review Mrs Smith in the maternity ward? We started a blood transfusion for her approximately 15 minutes ago and now she is a bit unsettled. She is a little bit warm at 37.9 degrees and looks a bit flushed across her chest. I am worried she is having a transfusion reaction.While you have this nurse on the phone, what further questions could you ask to triage this concern?Have a think.More scroll for more chat.The Big B:The pattern of serological investigations in the patient vaccinated against hepatitis B virus infection is characterised by the patient testing negative for hepatitis B surface antigen (HBsAg), negative to antibodies to hepatitis B core antigen (anti-HBc) and positive for antibodies to hepatitis B surface antigen (anti-HBs). The patterns of serological test results for hepatitis B infection are given in the following table:Hot and Bothered:Alright. Some questions you could ask over the phone to triage your concern regarding a transfusion reaction include:What symptoms does the patient have?Fevers, chills, chest pain, back pain, diaphoresis and dyspnoea can all be manifestations of a transfusion reaction.What are the vital signs?Need to know as anaphylaxis will look very different to fever alone.Which blood product is being transfused?How long ago was it started?Instant anaphylaxis reaction versus effects of fluid overload etc.What was the reason for admission?Symptomatic anaemia post caesarean section versus ongoing haemorrhage etcMost transfusion reactions are non-haemolytic febrile reactions, especially if this is a multi-transfused or multiparous patient, and are due to WBC antigen-antibody reactions or cytokines. The transfusion does not need to be stopped and she may just need some paracetamol and promethazine.BUTThe reason you are asking some questions over the phone is because the major threats to life with transfusions include:Anaphylaxis = deadnessAcute Haemolytic Reaction - can cause Disseminated Intravascular Coagulation (DIC) = deadnessTransfusion-Related Acute Lung Injury (TRALI) - respiratory failure = deadnessTransfusion-Associated Circulatory Overload (TACO) - circulatory failure = deadnessBacterial contamination - septic shock = deadnessBonus: Consider a Rhesus (Rh) positive foetus being carried by a Rh negative mother in her first pregnancy. Would that foetus be affected by the mother’s antibodies against foetal red blood cells?Answer in Monday’s dose.Closing: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!Luke.Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks. Just credit us where credit is due. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit yourdailymeds.substack.com

Good morning and welcome to your Thursday dose of Your Daily Meds.Bonus Review: How is iron carried (or transferred) in the blood? Answer: Fe2+ is converted into Fe3+ Which is then carried on transferrin. Transferrin is a plasma protein, of the B-1 globulin class and is produced in the liver.Quick Question:In approximately what proportion of pregnancies does a single loop of umbilical cord around the foetal neck occur?0.5%2%12%15%25%Have a think.Have a guess.Scroll for the chat.Psyche:When considering schizoid personality disorder, which of the following correctly describes the expected thought form, thought content and relationships that patients may express?(I shall be trying to confuse you between schizoid and schizotypal personality disorders; and schizophrenia with these answer options…)Thought form organised; thought content without psychosis; no desire for social relationshipsThought form vague and circumstantial; thoughts of odd beliefs and magical thinking; socially ineptThought form disorganised; psychotic thought content; socially marginalised, not by choiceThought form disorganised; thought content without psychosis; socially marginalised, not by choiceThought form organised; psychotic thought content; socially ineptHave a think.More scroll for more chat.Looping Back:One loop of umbilical cord around the foetal neck occurs in approximately 25% of pregnancies. The rates for second and third loops are much lower, at 2.5% and 0.5% respectively. Furthermore, a loop of umbilical cord around the foetal body occurs in 4% of pregnancies.It is important to note that true knots of the umbilical cord occur in 1% of pregnancies but are overrepresented in stillbirths, where they occur at an incidence of 4%.On the Clusters:Schizoid personality disorder is a Cluster A personality disorder, characterised by a lack of desire or enjoyment in close relationships and lifelong pattern of social withdrawal. They often have a detached or flat affect and may be described as emotionally cold. They rarely have close friends and take pleasure in few, if any, activities.In contrast to schizotypal personality disorder, another Cluster A disorder, and schizophrenia (not a personality disorder, a distinct disorder of reality testing), people with schizoid personality disorder have organised thoughts, no psychosis and have no desire for close relationships.Check out my hastily created reference table:Bonus: What are the major blood groups? How are they determined and why are they important?Answer in tomorrow’s dose.Closing: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!Luke.Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks. Just credit us where credit is due. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit yourdailymeds.substack.com

Good morning and welcome to your Wednesday dose of Your Daily Meds.Bonus Review: At what level in the body does control of iron stores occur? Answer: Control of iron in the body occurs at the level of the small bowel mucosal cells. These enterocytes are responsible for the control of iron absorption. When body iron stores are low - plasma transferrin is high, its iron saturation is low, more iron passes from ferritin in the eneterocytes to transferrin in bloodWhen body iron stores are adequate - transferin saturation is higher, the iron remains in the enterocyte and the unwanted iron is lost from the available absorption pool when the enterocyte is shedRemember that iron is readily absorbed by these enterocytes, but the absorption across the enterocyte basal membrane is regulated by levels of ferritin and transferrin and transferrin saturation.If we overload this mucosal block with excessive iron supplementation, we will absorb excess ironOr if the function of the control mechanism is defective, such as in haemochromatosis, we will be overloaded with iron, resulting in iron deposition in the tissuesCase:A 45-year-old male is brought to the Emergency Department by ambulance.On examination, he has a temperature of 38.2°C and is agitated.There is tremor, muscle rigidity and a marked deep tendon hyperreflexia of the lower limbs more so than the upper limbs.His pupils are dilated and mucus membranes dry.Relatives at his home informed the paramedics that he has a history of depression for which he is known to a Psychiatrist.Which of the following is the most likely diagnosis?Serotonin syndromeNeuroleptic malignant syndromeMalignant hyperthermiaSympathomimetic toxicitySeizureHave a think.Scroll for the chat.Procedure:Alright then.As if in an OSCE situation, tell me how you would approach, prepare for and conduct the ‘procedure’ of local anaesthetic infiltration.Have a think.Jot some things down.Scroll for the chat.The Syndrome:This man has signs suggestive of serotonin syndrome.Serotonin syndrome can be a life-threatening condition with increased serotonergic activity in the central nervous system. It can be caused by therapeutic medication use, interactions between medications and intentional overdose. Classically, serotonin syndrome is a clinical diagnosis of mental status changes, autonomic hyperactivity and neuromuscular abnormalities. In this case, serotonin syndrome is manifested by hyperthermia, agitation, muscular rigidity and hyperreflexia, along with the history of antidepressant use. Common antidepressants like Sertraline are Selective Serotonin Reuptake Inhibitors (SSRIs), which increase the extracellular levels of serotonin and serotonergic neurotransmission in the brain. Neuroleptic malignant syndrome is a life-threatening neurological emergency associated with the use of neuroleptic medication. It is characterised by mental status change, rigidity, fever and dysautonomia. In this case, the physical signs more prominent in the lower limbs and the associated SSRI usage are more suggestive of serotonin syndrome. Malignant hyperthermia is characterised by hypermetabolic crisis when a susceptible individual is exposed to a volatile anaesthetic agent, which is unlikely given the history in this case.Sympathomimetic toxicity is manifested by stimulation of alpha- and beta-adrenergic receptors and characterised by typical adrenergic signs and symptoms, including hyperthermia, tachycardia, diaphoresis, hypertension and cardiac arrhythmias. Sympathomimetic toxicity can be caused by prescribed and non-prescribed substances, such as ecstasy.Seizure is unlikely given the autonomic changes and neuromuscular abnormalities in this patient.Infiltration:Ok, so lets start with Indications:Local anaesthesia (LA) for painful procedures egSuturingDebridement of woundForeign body removalReduction of disclocated small jointArterial punctureThen some Contraindications:Local anaesthetic allergy - rareAvoid lignocaine with adrenaline in areas of end-arterial supply eg:FingersToesPenisPinnaNose(Even though amputated digits can be reattached (after a period of literally zero blood supply) and adrenaline is used in local anaesthetics for digital blocks of fingers and toes… best stick to the safe answer in the test…)Equipment:Alcohol swabSkin cleansing solution eg some chlorhexidineLocal Anaesthetic agent of choiceSyringe: 5mL or 10mLNeedle: 25G and 21GChoice:Small volumes of concentrated anaesthetic for small areas or jointsLarge volumes of less concentrated anaesthetic for large areas or jointsSelect adrenaline-containing anaesthetic for vascular sites - causes vasoconstrictionLikely help reduce bleedingReduce systemic absorption of lignocaineMaintain higher anaesthetic concentration near nerve fibresProlong local anaesthetic conduction blockadeLignocaine is most commonly usedBupivacaine and Ropivacaine are longer acting, usually used for nerve blocks or epiduralsCalculate:Maximum safe dose of your chosen agent:Lignocaine - Max dose 3mg/kg - Duration 0.5-1 hourLignocaine with adrenaline - Max dose 7mg/kg - Duration 2-5 hoursThis means you will need to do some maths to work out how many mL of a particular % concentration lignocaine +/- adrenaline you can safely inject.Just make sure you calculate your maximum mg for the particular patient FIRST, then work out the mL from the bottle SECOND.Procedure:Consent, explain procedure blah blah blahClean the siteRecheck dose, safe maximum, dilution, allergies etcDraw LA into syringe with 25G needleEnter dermis of skin at 45deg, aspirate to ensure needle not in blood vesselInfiltrate 1-2mL of LA to make a blebExchange 25G for 21G needleEnter skin through previously anaesthetised bleb siteAdvance subcutaneously, aspirate and injectRepeat: Advance, aspirate, injectIf you aspirate blood, withdraw a bit, aspirate then inject and continueRepeat such that the desired area is infiltrated with LAWait at least two minutes to take effectThen get on to cutting or suturing or realigning or whatever.Bonus: How is iron carried (or transferred) in the blood? Answer in tomorrow’s dose.Closing: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!Luke.Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks. Just credit us where credit is due. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit yourdailymeds.substack.com

Good morning and welcome to Your Daily Meds for Tuesday the 2nd of November, 2021.I am planning on releasing an audio companion version of the daily newsletter that can be taken together or consumed on its own and will effectively be a transcript of the text.I want you all to have the option of being able to listen to the audio version of the content while doing other things rather than having to carve out time to sit and read.Allegedly these recordings will show up in podcast players, but you will all receive them in an email form along with the text version.Now I have never recorded anything before so this will likely be a little clunky until I figure out how it all works.So, forgive me in advance for the cheesy royalty free musical interludes and poor scripting.Today should be the only day that you receive two separate emails. I should be able to include the audio and text in a single email from here on out.Luke. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit yourdailymeds.substack.com