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 carcinoma
* Community acquired pneumonia
* Sarcoidosis
* Tuberculosis
* Wegener’s granulomatosis
Have 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 1
* Mallampati 2
* Mallampati 3
* ASA 1
* ASA 2
Have 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 visible
* Class 2 – Soft palate, uvula, fauces visible
* Class 3 – Soft palate, base of uvula visible
* Class 4 – Only hard palate visible
The 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 healthy
* ASA II – patient has mild systemic disease
* ASA III – patient has severe systemic disease that is not incapacitating
* ASA IV – patient has incapacitating disease that is a constant threat to life
* ASA V – a moribund patient who is not expected to live 24 hours without surgery
* ASA 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.
