A man walks into Bar UC for refuge. The bartender, Sanjay, provides him with a pocket translator his work experience apprentice fetched for him and the man places his order.

Gynaecomastia

• Benign proliferation of male breast tissue
• Caused by hormonal imbalance
  • Not enough testosterone compared to oestrogen
  • Medications inducing this include: spironolactone, cimetidine, TCAs, digoxin chemotherapy, metoclopramide and anabolic steroids
  • Conditions inducing this include: liver cirrhosis through SHBG disturbance, hypogonadism, ageing, tumours, renal failure, hyperthyroidism, starvation because testosterone levels drop but oestrogen remains the same
• Pseudogynaecomastia is fat
• Imitators: pseudogynaecomastia, breast cancer, mastitis

Cyclophosphamide

• Affects rapidly dividing cells, like cancer, hair and gut
• Side effects:
  • Gastrointestinal: nausea, vomiting, loss of appetite, diarrhoea
  • Hair loss
  • Poor wound healing
  • Weird skin and nails

A lady who is almost 80, her wheelchair and her son pass by the bar. She tells bystanders, “Life is quick! You know why? There is too much sin in the world!”

Pulmonary Hypertension

• High blood pressure in arteries of the lung
• Causes:
  • Idiopathic
  • Left heart disease
  • Lung disease
  • Pulmonary emboli
  • Secondary to other random conditions
• Can lead to right heart failure

Sildenafil

• Trade name: Viagra
• PDE5 inhibitor
  • Memory aid: PDE5 and Viagra
  • Mechanism: inhibition of PDE5 enzyme –> inhibits second messenger cGMP breakdown —> nitric oxide-mediated vasodilation
• Indications: pulmonary hypertension, erectile dysfunction

One of the patrons, an overweight redneck, appears to have something stuck in his ears. His wife looks on unsympathetically.

Corticosteroids

• Many side effects

An irritated farmer waving a pitchfork is on the television in the bar.

Giant Cell Arteritis

• Average onset age is 72 and minimum is generally 50
• Symptoms:
  • Headache
  • Joint pain of shoulders and hips, like polymyalgia rheumatica
  • Facial pain, like jaw claudication
  • Scalp pain
  • Visual changes, like blurred vision and blindness
  • Fever
• Look for temporal artery biopsy and ESR
• Treat with corticosteroids