Your Daily Meds - 30 November, 2022
Good morning and welcome to your late Wednesday dose of Your Daily Meds.
Bonus Review: When do the first and second heart sounds occur?
Answer: The first heart sound - occurs with the closing of the A-V valves at the start of systole.
The second heart sound - occurs with closing of the aortic and pulmonary valves at the end of ejection.
Query:
When considering factitious disorder, which of the following correctly describes the expected somatic symptoms, manner in which symptoms are produced and physical findings respectively?
Somatic symptoms psychological or physical; symptoms produced consciously; physical findings possible
Somatic symptoms mild or absent; symptoms produced unconsciously; physical findings absent
Somatic symptoms present; symptoms produced unconsciously; physical findings incompatible
Somatic symptoms psychological or physical; symptoms produced unconsciously; physical findings possible
Somatic symptoms neurologic; symptoms produced unconsciously; physical findings incompatible
Have a think.
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Question:
Kernicterus describes damage to the neonatal brain’s cellular metabolism by the inhibition of essential enzymes, resulting in brain damage. Which of the following is responsible for the condition of Kernicterus in the newborn?
Conjugated bilirubin
Plasma-bound unconjugated bilirubin
Free unconjugated bilirubin
Neonatal infection with cytomegalovirus
Haemolytic disease of the newborn
Have a think.
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Factitiously Fictional:
Factitious disorder describes the intentional production or faking of physical or psychological signs or symptoms. In factitious disorder, the symptoms are produced consciously and physical findings are possible as the patient may attempt to falsify.
See the table below for a comparison of somatic symptom disorder and related disorders:
So, to answer: Somatic symptoms psychological or physical; symptoms produced consciously; physical findings possible.
Too Yellow:
Kernicterus is caused by high levels of free unbound unconjugated bilirubin, after high levels of unconjugated bilirubin have exceeded the neonate’s plasma capacity to bind. This unbound form of bilirubin is free to cross lipid membranes such as the blood-brain barrier. Transient encephalopathy or permanent brain damage may result. The neonate may become lethargic then hypertonic with abnormal extended posturing. Kernicterus often results in death of the newborn.
While neonatal infection with cytomegalovirus and haemolytic disease of the newborn may be responsible for neonatal jaundice and increased levels of bilirubin, it is the specific free unbound unconjugated bilirubin that causes Kernicterus.
Bonus: The normal cardiac output for a young subject at rest is about 5 litres per minute. To what value can the cardiac output increase in an athlete under strenuous exertion?
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:
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.