Good morning and welcome to your Wednesday dose of Your Daily Meds.
Bonus Review: What do platelets do?
Answer: Haemostasis is the game here.
Platelets are involved in primary haemostasis, from platelet adhesion to the vascular subendothelium through to formation of a platelet plug.
Our platelets also release some vasoconstrictors, like thromboxane A2 and serotonin.
Platelets also come back at the end, where they are essential for contraction of the final clot.
Case:
An 81-year-old male presents to his General Practitioner with a three-month history of cough, shortness of breath and subjective fevers. His chest x-ray is shown below:
Which of the following is the most likely diagnosis for this man’s condition?
* Transudative pleural effusion
* Exudative pleural effusion
* Empyema
* Lung abscess
* Lung cancer
Have a look.
Now look closely at the right hemithorax.
Scroll for the chat.
Query:
Which of the following is the most common extra-articular feature of ankylosing spondylitis?
* Aortic insufficiency
* Acute anterior uveitis
* Cardiac conduction defects
* Apical pulmonary fibrosis
* Amyloidosis
Have a think.
More scroll for more chat.
That Chest:
The chest x-ray shows a round right-sided cavity containing a gas-fluid level that is suggestive of lung abscess.
Lung abscesses are circumscribed collections of pus within the lungs. They are usually due to liquefactive necrosis of lung tissue. Primary abscesses develop as a result of a primary infection of the lung, most commonly due to aspiration, necrotising pneumonia or chronic pneumonia. Secondary abscesses result from another condition such as bronchial obstruction due to carcinoma or haematogenous spread such as in bacterial endocarditis. Lung abscesses are usually managed with prolonged antibiotics and physiotherapy with postural drainage. Surgical resection is used in cases that are refractory to conservative management or those complicated by haemoptysis, empyema or suspected malignancy.
Pleural effusions describe fluid in the pleural space. They are defined as transudate or exudate by Light’s criteria:
Empyema describes infection in the pleural space and can be caused by lower respiratory tract infections, abdominal sepsis, traumatic causes or iatrogenic causes.
Lung cancer is unlikely to have a gas-fluid level, making cancer an unlikely cause of the lung lesion on chest x-ray.
Anteriorly Ankylosing:
Ankylosing spondylitis (AS) is predominantly a disorder of men and affects up to 0.5% of the general population. The inflammation in AS is focussed, initially, at the sacroiliac joints before moving to the lumbar, thoracic and cervical spine.
Enthesitis, inflammation at an insertion point of tendon or ligament to bone, is a common feature of the disease.
Acute anterior uveitis is the most common extra-articular manifestation of ankylosing spondylitis (AS) and is experienced by up to 30% of patients. In the case of sudden onset, unilateral eye pain, associated with photophobia and lacrimation, patients with AS should immediately seek medical advice and should be urgently referred to an ophthalmologist.
Aortic insufficiency secondary to aortitis, cardiac conduction defects, apical pulmonary fibrosis and amyloidosis are extra-articular features of ankylosing spondylitis that are less common than acute anterior uveitis.
Bonus: Which stomach cells secrete hydrogen ions? And where in the stomach are they located?
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.
