Your Daily Meds - 2 December, 2022
Good morning and welcome to your Friday dose of Your Daily Meds.
Bonus Review: What would happen to the cardiac output in a young healthy person if you gave them a whack of Atropine to increase their heart rate from 60 to 120 beats per minute?
Answer: Nothing, probably.
If there is no increased demand from the tissues of the body, then the stroke volume would halve in this case (since the rate has doubled) resulting in no change to cardiac output.
Case:
Consider the following skin lesion on the nose of a 42-year-old male:
Which of the following skin conditions is the lesion in the image above most likely a precursor for?
Squamous cell carcinoma
Basal cell carcinoma
Melanocytic naevi
Seborrhoeic keratosis
Epidermoid cyst
Have a think.
Scroll for the chat.
Eponym:
Your General Surgery Consultant turns to you, mid-surgery, and calmly but somewhat menacingly suggests “tell me about Charcot’s Triad”.
Have a think, and meet me further down for the answer.
Scaly Bump:
Key to answering this question is recognising the likelihood diagnosis of the skin lesion shown as an actinic keratosis.
Actinic (solar) keratoses are the most common precursor skin lesion for the development of squamous cell carcinomas.
Actinic keratoses are found on sun-exposed sites, including the face (nose, as in this question), ears and hands. They appear scaly without induration and the lesions may remit spontaneously. Histologically, they involve atypical keratinocytes in the basal layer of the epidermis.
Melanocytic naevi, moles, may be congenital or acquired. Sun exposure can promote new naevi to develop during adolescence and can induce mutations in the melanocytes predisposing to the development of melanoma.
Seborrhoeic keratoses appear as stuck-on, waxy, warty plaques; and are common on the face, neck and trunk in those over 40 years of age. They classically do not affect non-hair bearing regions such as the soles and palms.
Epidermoid cysts, or stratified squamous epithelial cysts, are walled-off cavities filled with keratin and are derived from the hair-follicle unit. These cysts may be found on the face and upper trunk and can become inflamed when ruptured.
As we return to Answering Eponyms:
You smoothly raise your eyes from the surgical field and answer:
“Charcot’s Triad, named after Jean-Martin Charcot (French Neurologist and Professor of Anatomical Pathology) is characterised by Jaundice, Fevers and RUQ Pain and is characteristic of Ascending Cholangitis. Further, when Charcot’s Triad is accompanied by hypotension (shock) and altered consciousness, the condition is described as Reynolds’ Pentad.”
Then, mic’ sufficiently dropped, you lower your eyes and continue the surgical case.
FOAMED Friday:
Hypoxic Pulmonary Vasoconstriction and Calcium Channel Blockers…
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:
It’s free and always will be. Let me know what you think.
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.