Your Daily Meds

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Your Daily Meds - 15 December, 2022

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Your Daily Meds - 15 December, 2022

Luke Reynolds
Dec 16, 2022
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Your Daily Meds - 15 December, 2022

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Good afternoon and welcome to your late Thursday dose of Your Daily Meds.



Bonus Review: What is autoregulation?

Answer: It is just the tissue’s ability to regulate its own blood supply to the level required for tissue function. It is a process specific to each tissue/organ and is separate from nervous or humoral factors affecting arteriolar resistance.



Scaly Skin:

Consider this - 

Which of the following is least likely to be associated with this skin?

  1. Pernicious anaemia

  2. Inflammatory bowel disease

  3. Uveitis

  4. Coeliac disease

  5. Metabolic syndrome

Have a think and meet me further down.




Practice Case:

You are working in Emergency when you meet a young male brought in after a seizure event. You note that he has a diagnosis of epilepsy and was last in ED with a seizure two years ago.

What would you include in a focussed seizure history? 

What would you like to know?




Salmon…:

This looks like psoriasis - salmon-red scaly plaques.

Psoriasis is a multifactorial disorder, classified as an immune-mediated inflammatory disease. 

Conditions associated with a concurrent diagnosis of psoriasis include:

  • Psoriatic arthritis and spondyloarthropathy

  • Inflammatory bowel disease

  • Uveitis

  • Coeliac disease

  • Metabolic syndrome

So of the options listed, pernicious anaemia is least likely to be associated with psoriasis.

(Pernicious anaemia - a cause of vitamin B12 deficiency and anaemia due to autoantibodies targeting intrinsic factor and inhibiting B12 absorption.)




Back to Seizure Man:

In a focussed seizure history in a patient with known epilepsy, you might like to know:

  • Some history of the event:

    • Extent of recollection

    • Presence of preceding symptoms

    • Extent of memory of event

    • Post-ictal phase

    • Pathognomic features of seizure including tongue biting, urinary incontinence

    • Information from witnesses

      1. Especially the duration of the event

  • History of aura – to try and distinguish between generalised and focal seizure

    • Auras represent simple partial seizure/focal aware seizure – reliable history of aura signifies partial, not generalised seizures

    • Any history of clear aura symptoms such as

      1. Rising feeling in stomach

      2. Déjà vu

      3. Unusual smells or tastes

      4. Sudden intense feelings eg fear or joy

      5. Stiffness or twitching of a body part

      6. Numbness or tingling

      7. Vision change – such as coloured or flashing lights

  • Diagnosed epilepsy history

    • Date of diagnosis

    • Current care

      1. Neurology input

      2. Current medications

    • Prior investigations

  • Known causes or triggers of seizure

    • Not taking medications regularly or at all

    • Rarely, medication toxicity

    • Sleep change or disturbance

    • Alcohol abuse – excess or withdrawal

    • Other substance abuse

    • Intercurrent infection – such as meningitis

    • Head injury

    • Hypoglycaemia

Among others that you may have thought of…



Bonus: Are there tissues where pressure autoregulation does not occur?

Answer in tomorrow’s dose.



News: I made a little Ward Call Course for you all. It maps out an Evening Ward Call shift and covers a bunch of common tasks that you may need to do, like:

  • Deteriorating Patients

  • Heparin Infusions

  • Fluid Orders

  • Electrolyte Replacement

  • Difficult patients - Discharge Against Medical Advice, Ryan’s Rule

  • End of Life etc

You can find the course page here:

Ward Call Preparedness

It’s free and always will be. Let me know what you think.


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Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks.

As always, please contact me with any questions, concerns, tips or suggestions. Have a great day!

Luke.

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Your Daily Meds - 15 December, 2022

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