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 ability
Lower glucose concentration
[Cl-] is higher by about 10% and [K+] is lower by about 40%
Very low cholesterol content
Psych 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 threat
Response continues until removal of the threat
Response becomes generalised to other similar or dissimilar situations
Social or occupational function is impaired
Comorbid with substance use and depression
Have 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 paraesthesia
Hoarseness
Dysphagia
Seroma formation
Ptosis
Have 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 threat
Response continues beyond existence of threat
Response becomes generalised to other similar or dissimilar situations
Social or occupational function is impaired
Comorbid with substance use and depression
So 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.
Your Daily Meds - 2 December, 2021