Good morning and welcome to your Monday dose of Your Daily Meds.
Bonus Review: What are the actions of erythropoietin?
Answer: EPO is released from the kidney, circulates in blood and acts on immature erythroid cells in the bone marrow by binding to a cell-membrane EPO receptor. This results in differentiation and proliferation of these immature red cells into mature red cells.
Case:
A 12-year-old male presents to the General Practitioner with his mother complaining of sudden onset scrotal pain of three hours duration.
He reports associated severe nausea and vomiting.
On examination, the left hemi-scrotum is red and swollen and extremely tender. Which of the following is the most appropriate immediate management?
* Surgical referral for scrotal exploration
* Urine microscopy, culture, sensitivity
* Broad spectrum antibiotic
* Full blood count
* Ultrasound imaging of scrotum
Have a think.
Scroll for the chat.
Quick Case:
Consider the following ECG:
Which of the following is the most likely diagnosis?
* 1st degree atrioventricular block
* 2nd degree atrioventricular block with Mobitz I conduction
* 2nd degree atrioventricular block with Mobitz II conduction
* 3rd degree atrioventricular block
* Premature ventricular complexes
Have a think.
More scroll for more chat.
Torted:
Key to answering this question is recognising the likelihood diagnosis of torsion of the left testis. Made as a clinical diagnosis, this condition requires an urgent surgical opinion.
Investigating urine and blood are unlikely to be of assistance and will delay definitive management. Note that urinary tract infection and epididymo-orchitis would be considered more as differentials in adults.
(Bonus points if you considered other findings of a torted testis - like high-riding, or altered lie, or absent cremasteric reflex…)
Squiggly Lines:
This ECG shows an irregular, narrow complex rhythm with upright P-waves in lead II, suggesting a sinus origin. The QRS complexes are separated by non-conducted P-waves and the PR-interval increases within each group of QRS complexes.
This is characteristic of 2nd degree atrioventricular block with Mobitz I conduction, in which progressive prolongation of the PR interval culminates in a non-conducted P wave. Also known as a Wenckebach rhythm, this type of AV block can be caused by drugs such as beta blockers and calcium channel blockers; increased vagal tone, as in athletes; myocardial infarction or myocarditis; and following cardiac surgery.
A 1st degree atrioventricular block is characterised by a PR-interval of more than 200 ms (five small squares on the ECG trace).
A 2nd degree atrioventricular block with Mobitz II conduction is characterised by intermittent non-conduction of P-waves without progressive elongation of the PR-interval.
A 3rd degree atrioventricular block, or complete heart block, is characterised by complete dissociation between atria and ventricles, where the perfusing rhythm is maintained by a junctional or ventricular escape rhythm.
Premature ventricular complexes arise from an ectopic focus within the ventricles and are characterised by premature, broad QRS complexes (>120 ms) with abnormal morphology.
Bonus: What are platelets? Where do they come from? Where do they go?
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.
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Just credit us where credit is due.
