Urinary Tract Infections

The urinary tract is divided into two parts:

  • Upper
    • Kidneys
    • Ureters
  • Lower
    • Bladder
    • Urethra

Uncomplicated UTIs occur when there isn’t a functional or anatomical abnormality. Females are the main target.

Complicated UTIs occur when there’s a functional or anatomical abnormality, such as bladder issues, kidney stones or diabetes mellitus.

In both forms, the most common bacterial cause of UTIs is Pee coli. That is, E. coli. Multidrug-resistant strains are emerging.

Acute pyelonephritis

Pyelonephritis means inflammation of the renal pelvis. Causes include:

  • Ascending UTI, where bacteria march up the urinary tract
  • Vesicoureteral reflux, which is where urine goes the wrong way up the urinary tract, due to an anatomical abnormality or blockage

Symptoms include:

  • Fever and chills
  • Flank pain
  • Nausea and vomiting

Investigations can show leukocytes in the urine and blood, plus other generic markers of infection.

For treatment, collect urine samples before administering antibiotics. For mild cases, oral antibiotics are sufficient. For severe cases, IV antibiotics are warranted.

Acute cystitis

Cystitis means inflammation of the bladder.

Empirical treatment can be started in non-pregnant females with uncomplicated cystitis. In other cases, collect urine samples before administering antibiotics.

References

  1. Urinary tract infections [revised 2015 Oct]. In: eTG complete [Internet]. Melbourne: Therapeutic Guidelines Limited (eTG November 2017 edition); 2017 Nov.
  2. Manski, D. (2017). Acute Pyelonephritis: Definition and Causes. [online] Urology Textbook. Available at: http://www.urology-textbook.com/acute-pyelonephritis.html [Accessed 29 Dec. 2017].
  3. Shah, V. and Gaillard, F. (2017). Acute pyelonephritis. [online] Radiopaedia. Available at: https://radiopaedia.org/articles/acute-pyelonephritis-1 [Accessed 29 Dec. 2017].
  4. Better Health Channel. (2017). Cystitis. [online] Available at: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/cystitis [Accessed 29 Dec. 2017].
  5. Mayo Clinic. (2017). Vesicoureteral reflux. [online] Available at: https://www.mayoclinic.org/diseases-conditions/vesicoureteral-reflux/symptoms-causes/syc-20378819 [Accessed 29 Dec. 2017].
  6. Healthline. (2017). Pyelonephritis | Definition & Patient Education. [online] Available at: https://www.healthline.com/health/pyelonephritis#risk-factors [Accessed 29 Dec. 2017].
  7. Colgan, R., Williams, M. and Johnson, J. R. (2011). Diagnosis and Treatment of Acute Pyelonephritis in Women. [online] American Family Physician. Available at: https://www.aafp.org/afp/2011/0901/p519.html [Accessed 29 Dec. 2017].
  8. Harding, M. (2016). Pyelonephritis. [online] Patient. Available at: https://patient.info/doctor/pyelonephritis [Accessed 29 Dec. 2017].

Sprains Versus Strains

Nobody cares about Marvel versus DC. It’s Marvel, by the way; superheroes who wear their underwear on the outside automatically can’t win.

No, what people care about are confusingly similar medical terms that mean almost the same thing.

Enter the arena: sprains and strains.

Sprain

  • Stretch or tear of a ligament
    • Ligaments connect bone with bone
    • LBB, which is almost LLB, which stands for Bachelor Of Laws if you have any legal-minded friends
  • Memory aid: sprain doesn’t have a t in it, so it refers to the one that’s not about tendons

Strain

  • Stretch or tear of a muscle or tendon
    • Tendons connect muscle with bone
    • TMB, as in too much bother, which is sometimes the case with all this intellectual medicine business
  • Memory aid: strains correlate with tendons, which are related to muscles

Initial treatment

  • RICE for the first 48 hours
    • Rest
    • Ice
    • Compression
    • Elevation
  • Analgesia
    • Paracetamol
    • Then consider NSAIDs if pain persists
  • Movement
    • Early mobilisation and passive movement as soon as pain allows it

References

  1. Mayo Clinic. (2017). Sprains and strains – Symptoms and causes – Mayo Clinic. [online] Available at: https://www.mayoclinic.org/diseases-conditions/sprains-and-strains/symptoms-causes/syc-20377938 [Accessed 26 Dec. 2017].
  2. Acute pain: minor trauma [revised 2015 Feb]. In: eTG complete [Internet]. Melbourne: Therapeutic Guidelines Limited (eTG November 2017 edition); 2017 Nov.

Pathological Scars

No one like cuts unless they’re cold cuts of meat. Even then, it’s only if they’re free and accompanied by a cheese platter.

After all, cuts lead to scarring.

Scarring can lead to recovery; time heals some wounds, while medicine and surgery handle the rest. However, there are risks involved with that.

Just as there’s such a thing as too much scarring, it’s possible to have too much healing.

Hypertrophic scar

  • Confined to original wound
  • Memory aid: held in to the injury

Keloid scar

  • Extends beyond borders of original wound
  • Memory aid: travels kilometres outside the injury

References

  1. Medicine Hack. (2017). Differences between hypertrophic scar and keloid scar. [online] Available at: http://www.medicinehack.com/2012/03/differences-between-hypertrophic-scar.html [Accessed 25 Dec. 2017].

Heart Failure Treatment Acronyms

Medications don’t cure people. Acronyms do.

Well, maybe medications do a little bit.

Maybe.

Anyway, here’s how to remember how to treat acute heart failure in an examination setting.

LMNOP

  • Lasix
  • Morphine
  • Nitrates
  • Oxygen
  • Position

POND

  • Position and positive pressure ventilation
  • Oxygen
  • Nitrates
  • Diuretics

References

  1. SOCMOB Blog. (2017). Evidence Based Management of Acute Heart Failure: Forget LMNOP, think POND! – SOCMOB Blog. [online] Available at: http://socmob.org/2013/04/evidence-based-management-of-acute-heart-failure-forget-lmnop-think-pond/ [Accessed 24 Dec. 2017].
  2. Time of Care. (2017). LMNOP – For Congestion in Acute Decompensated Hear Failure. [online] Available at: https://www.timeofcare.com/lmnop-for-congestion-in-acute-decompensated-hear-failure/ [Accessed 24 Dec. 2017].

Podcast 012: Manufacturing Pharmacy With Allan Fong

Your greatest nightmare is here, except this time you’re wearing pants!

You’re a doctor whose patient has a rare case of Aafkhajsdklashkjdasodhsouheihterl Fever. Conventional medicines aren’t effective in treating it, so you’ll need something more powerful. Something not in commercial existence.

Who could possibly help you? A pharmacist!

That’s where hospital pharmacy comes in. It’s a safe haven that doctors and other health professionals can consult for advice on medications. Manufacturing pharmacy is a subspecialty of hospital pharmacy that deals with individualised medications for patients. That could be just the cure for Aafkhajsdklashkjdasodhsouheihterl Fever!

In this episode, Allan talks about hospital pharmacy, how he helps doctors by mixing up customised medications for sick patients and common mistakes doctors make in prescribing.

Podcast

About the guest speaker

Allan Fong is currently employed at Westmead Hospital as the Manufacturing Pharmacist. He graduated from The University of Sydney in pharmacy in 1986 and has since had 20 years’ experience working in various community pharmacies and 10 years’ experience working in hospital pharmacy.

Outside health care, Allan is an amateur musician, currently playing flute and tuba in two community concert bands. But wait, there’s more! He also plays piccolo, bass clarinet, oboe, euphonium and saxophone.

Allan loves gardening and owns two cats: Ava and Mia.

Music credits

Opening and closing themes by Lily Chen.

Podcast 011: Clinical Psychology With Juliette Drobny

Patients with mental health illnesses can be treated with medication, psychological therapy or a combination of both.

But what exactly do psychologists do? Which patients go to them? Which doctors interact with them?

In this episode, Juliette talks about what clinical psychology is, why she hasn’t locked her car lately and how examination stress can affect doctors and medical students.

Podcast

About the guest speaker

Juliette Drobny is a Senior Clinical Psychologist and lecturer at the University of Sydney, where she obtained her PhD. Formerly the Head of the Anxiety Treatment and Research Unit at Westmead Hospital, she is involved in the development of educational and training materials for doctors and allied health professionals. She also runs her own private practice focussing on anxiety disorders, OCD, PTSD and depression.

Juliette particularly enjoys working with young people and students, helping them overcome problems with study and procrastination, borrowing from her own experience as a PhD student where she became highly proficient in playing the first movement of Beethoven’s Sonata Pathetique (despite being a very amateur pianist) as a consequence of her own procrastination. She recently adopted an anxious rescue cat believing her skills would make for a good marriage. It was.

Music credits

Opening and closing themes by Lily Chen.

Schizophrenia Derivatives

Schizophrenia is a thought disorder characterised by positive symptoms and negative symptoms.

Positive symptoms mean too much abnormal behaviour, like hallucinations and delusions. Psychosis! Disrupted perceptions of reality! That sort of thing.

Negative symptoms mean not enough normal behaviour, like flattened affect and alogia. Things starting with “a”! Amotivation! Avolition! Anhedonia! That sort of thing.

Like a massive tree of mental health, schizophrenia has partially related disorders and terms that branch out from it.

Behold! The many children of schizophrenia!

Here’s a simplified summary of it all.

Schizophrenia

Brief psychotic disorder is schizophrenia symptoms < 1 month.

Schizophreniform disorder is schizophrenia symptoms < 6 months.

Schizophrenia is schizophrenia symptoms > 6 months.

Mood Disorders

Schizoaffective disorder is schizophrenia symptoms with mood disorder. The psychosis is present without the mood component for > 2 weeks.

Mood disorder with psychotic features is what it says it is. Surprise!

Personality Disorders

schizoid person avoids social interaction. Think limited emotional expression.

A schizotypal person is a weird type of person. Think oddness and magical thinking.

Paper Bag Rebreathing Is A Lie

Save your paper bags for your lunches!

Panic attacks can involve people hyperventilating, which means they breathe too much and end up exhaling more carbon dioxide than normal. The low carbon dioxide level results in symptoms like dizziness and lightheadedness.

Breathe into a paper bag, they said. Let the recirculated carbon dioxide increase the carbon dioxide levels in the person’s body, they said.

Is this really effective?

Critics say this is not the case because hyperventilation doesn’t reliably induce panic attacks. They add that high carbon dioxide levels are more associated with impending suffocation, such as from situations of hypoxia or hypoventilation.

In fact, because panic attacks are fleeting by nature, it can be a sort of placebo effect that makes paper bags look like winners. The panic attack was going to pass anyway, so the panic fading just happened to coincide with the use of the paper bag.

References

  1. Allstetter, W. (n.d.). Panic Attacks and “Suffocation Alarm Systems”. [online] The Journal of the College of Physicians and Surgeons of Columbia University. Available at: http://www.cumc.columbia.edu/psjournal/archive/archives/jour_v19no1/theories.html [Accessed 11 Nov. 2017].