Podcast 024: Orthopaedic Surgery With Dr Saqib Noor

Bones are the putative skeleton of the human body, so it’s important that they’re not broken. Hold on! They actually are the skeleton! That means we need orthopaedic surgery to fix them.

In this episode, Dr Saqib talks about orthopaedic surgery, charitable work and international inequalities in health care.

Podcast

About the guest speaker

Dr Saqib Noor is an orthopaedic surgeon and creative genius.

Dr Saqib has written a book, Surgery on the Shoulders of Giants, describing his life changing experiences as a surgeon in austere settings (http://mybook.to/SotSog) and has used these experiences to help start a new project dedicated to improving global surgery worldwide – One Surgery (https://one.surgery).

Music credits

Opening and closing themes by Lily Chen.

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Cardiac Valves

Which side of the heart does each atrioventricular valve correspond to? Memory aids enlighten us all!

Atrioventricular Valves

  • Tricuspid is in the right heart
  • Mitral is in the left heart

What about the semilunar valves? They must not be forgotten! And so they shan’t be!

Semilunar Valves

  • Pulmonary goes to the lungs and is on the right
  • Aortical goes to the rest of the body and is on the left

Broca And Wernicke Memory Aids

Facebook and Twitter! Two important procrastination tools of our time! Many a student has suffered gloriously from these distractions. Finally, they help us to learn medicine, just like you’ve always wanted.

Broca’s Area

Location

  • In the frontal lobe of the brain
  • Facebook
    • Frontal Broca
    • FB

Lesion

  • Broca’s aphasia is expressive aphasia
    • Patient understands things but cannot talk well

Wernicke’s Area

Location

  • In the temporal lobe of the brain
  • Twitter
    • Temporal Wernicke
    • TW

Lesion

  • Wernicke’s aphasia is receptive aphasia
    • Affectionately known as “word salad”
    • Patient says fluent gibberish but does not understand things

Unity

  • Both are usually on the left side
  • Connected by the arcuate fasciculus nerve fibres

References

  1. THE BRAIN FROM TOP TO BOTTOM. (n.d.). BROCA’S AREA , WERNICKE’S AREA, AND OTHER LANGUAGE-PROCESSING AREAS IN THE BRAIN. [online] Available at: http://thebrain.mcgill.ca/flash/d/d_10/d_10_cr/d_10_cr_lan/d_10_cr_lan.html [Accessed 26 Aug. 2018].

Warfarin And Antibiotics Interactions

Mechanisms

  • Antibiotics kills intestinal bacteria that make vitamin K
  • Antibiotics inhibit CYP450 enzymes that normally metabolise warfarin

Result

  • Increased INR

References

  1. Baillargeon, J., Holmes, H. M., Lin, Y., Raji, M. A., Sharma, G., & Kuo, Y.-F. (2012). Concurrent Use of Warfarin and Antibiotics and the Risk of Bleeding in Older Adults. The American Journal of Medicine, 125(2), 183–189. http://doi.org/10.1016/j.amjmed.2011.08.014

Potato Gems Of Medical Trivia

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