Day-to-day medicine for medical students, interns and enthusiastic doctors!

A 52 years old patient with well controlled diabetes mellitus came to see his family doctor on a Sunday morning. He has developed a mild chest pain last night which lasted only for a few minutes. Pain was central, without any radiation or autonomic features. However, he had experienced a similar pain about a month back when he was running to catch a train. At the time of consultation there was no pain whatsoever. An ECG was taken. In view of the mild T inversions, the GP asked to check a troponin level, which was normal. He started the patient on Aspirin and increased his usual atorvastatin dose to 40mg. He also prescribed sublingual GTN to be used SOS. If you were the GP, what would you have done? This is Wellens syndrome! What is it? It is a characteristic ECG pattern which indicates critical stenosis of the proximal Left Anterior Descending artery. What would happen if you miss it? Unless proper intervention is done, it will progress into a anterior ST ele...

It is a very common infection seen in all parts of Sri Lanka. USUAL PRESENTATION is with abrupt onset fever with marked myalgia and headache. Main differential diagnoses to be considered are, Dengue fever Typhus fever Hanta virus infection In many patients conjunctival suffusion and occasionally conjunctival haemorrhages can be seen. Major life threatening complications include Weil's disease (Jaundice with acute renal failure) Pulmonary haemorrhages. Acute respiratory distress syndrome Myocarditis DIC MCQ points Hypokalemia is a well known feature ALT > AST (This is in contrast to dengue) Thrombocytopenia is common Some can develop aseptic meningitis DIAGNOSIS of leptospirosis is mostly done serologically. Antibody tests have to be done after 5 days of illness. Microscopic agglutination test (MAT) is the reference investigation. (Available in Medical research institute - MRI Colombo) Pulmonary haemorrhages ELISA is available in m...

Treatment of thyrotoxicosis has several aspects 1. Symptomatic relief Beta-blockers are the first line. Beta-blockers can be started even before the diagnosis is confirmed. When you suspect thyrotoxicosis start beta-blockers before reviewing the patient with TSH and Free T4 reports. The usual dose is Propranolol 20-40mg three to four times a day. Make sure the patient does not have bronchial asthma! 2. Reduce thyroid hormone synthesis Thionamides are safe and have a quick onset of action Carbimazole is the commonly used drug The usual dose is 10mg three times a day, but according to the initial Free T4 level, the dose can be adjusted. The maintenance dose should be continued for a year or two before considering stopping the treatment. Many patients will relapse requiring other definitive treatments MCQ tip Agranulocytosis is a 'favorite' complication of thionamides The patient should be advised to stop taking carbimazole and immediately come to the hos...