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.

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

Colon Cancer Polyp Conditions

Familial Adenomatous Polyposis

  • Many benign polyps form in the colon, but they can become malignant if the colon is not removed
  • Average age of affected individual developing colon cancer is 39
  • Mostly commonly, is due to autosomal dominant mutation in APC gene
  • Memory aid: FAP and APC both have 3 letters

Hereditary Non-Polyposis Colorectal Cancer

  • Also called Lynch syndrome
  • Increased risk of colorectal cancer and other cancers
  • Associated with increased risk of endometrial cancer in females
  • Colon polyps can occur earlier than in the general population but not in greater numbers
  • Autosomal dominant inheritance but can be due to mutations in a variety of genes, some of which have 3 or 5 letters
  • Memory aid: the one that’s not FAP

References

  1. Genetics Home Reference. (2018). Familial adenomatous polyposis. [online] Available at: https://ghr.nlm.nih.gov/condition/familial-adenomatous-polyposis#genes [Accessed 22 Jul. 2018].
  2. Genetics Home Reference. (2018). Lynch syndrome. [online] Available at: https://ghr.nlm.nih.gov/condition/lynch-syndrome#genes [Accessed 22 Jul. 2018].

Podcast 023: Pathology With Dr Nicky Graf

There are many things that can go wrong in the human body. Luckily, there’s a specialty that studies it: pathology. After all, a tissue diagnosis must be made! The show must go on!

In this episode, Dr Nicky talks about work, microscopes and social interaction in the specialty of pathology.

Podcast

About the guest speaker

Dr Nicky Graf completed her pathology training in 2000, and has been a staff specialist (Anatomical Pathology) at The Children’s Hospital at Westmead since 2001, with a specialty focus of paediatric and perinatal pathology. She has been the department head for the past 10 years (since Oct 2007).

Dr Nicky has a particular interest in paediatric tumour pathology and renal pathology, but covers all areas of paediatric and perinatal pathology practice. Her department is one of three sites (although the largest with regards to case load) servicing the newly created state-wide perinatal pathology service.

Dr Nicky’s interests are reading, spending time with her family, skiing (snow) and travel (recently went to Antarctica – amazing!).

Music credits

Opening and closing themes by Lily Chen.