Good morning and welcome to your Monday dose of Your Daily Meds.

Bonus Review: What happens during a cough?

Answer: The cough reflex is a protective mechanism of the airway, used to expel irritating material with a high velocity turbulent gas stream.

A rough guide would involve -

* Inspiration

* Epiglottis and cords close very tightly

* Abdominal muscles contract forcefully

* Pressure within the chest can rise to 100mmHg

* Cords and epiglottis suddenly open

* Rapid exit of high pressure gas from the lungs occurs

Anatomy-ish Case:

A middle-aged fellow comes to the Emergency Department after being stabbed in the back during a mugging.

On examination, there is upper motor neuron weakness, loss of vibration and proprioception sense in the left lower limb; and a loss of pain and temperature sensation in the right lower limb. Where is the most likely location of the pathology?

* Posterior spinal cord

* Left spinal cord

* Right spinal cord

* Anterior spinal cord

* Central canal of spinal cord

Have a think.

Remember all the silly multicoloured spinal cord tracts from the textbooks.

Have a think.

Scroll for the chat.

Quick Question:

In a community acquired pneumonia (CAP), which of the following patient characteristics is least suggestive of severe disease that will require inpatient management?

* Respiratory rate > 30 breaths per minute

* Systolic blood pressure < 90 mmHg

* Heart rate > 100 beats per minute

* Subjective dyspnoea at rest

* Multilobar involvement on chest x-ray

Have a think.

More scroll for more chat.

Stabbing Back Pain:

This scenario describes Brown-Séquard syndrome, due to pathology to one half of the spinal cord; in this case, most likely a stab wound affecting the left half of the spinal cord.

Pain and temperature sensation are carried in the spinothalamic tract, the fibres of which decussate at the level of the spinal cord. In this case, an injury to the left half of the spinal cord would explain the loss of these sensations on the right.

Fibres carrying light touch, vibration and proprioception sense are carried in the dorsal column-medial lemniscus pathway, which decussates at the level of the medulla. In this case, an injury to the left half of the spinal cord would explain the loss of these sensations in the left lower limb.

Furthermore, in Brown-Séquard syndrome, a region of complete sensory loss can be detected on the same side as the lesion at the level of the lesion.

See the pretty pictures:

A Bit Chesty:

The features of community acquired pneumonia (CAP), that are viewed as ‘red flags’ and are suggestive of the need for inpatient management include:

* Respiratory rate > 30 breaths per minute

* Systolic blood pressure < 90 mmHg

* Oxygen saturation < 92%

* Acute onset confusion

* Heart rate > 100 beats per minute

* Multilobar involvement on chest x-ray

These features are suggestive of more severe disease.

Patients with these features, in the context of CAP, require close clinical review.

Of the options listed, subjective dyspnoea at rest is least suggestive of severe CAP requiring inpatient management.

Bonus: What is CSF?

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.

Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks.

Just credit us where credit is due.

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