A to Easy

Gastro: 10. Harry and Sally discuss small and large bowel obstruction. They discuss the different underlying causes of the two, their symptoms, signs on examination, potential investigations and management plans. They also discuss ileus and pseudo-obstruction and some subtypes of Stomas. This episode was vetted by Miss Alexandra Cope, Consultant General & Colorectal Surgeon at Wexham Park Hospital, Berkshire.

*Also, Harry would like to apologise for any noticable audio issues with his microphone during this episode, will be fixed for next time.

Links:

Picture from Netter's Anatomy showing a Volvulus.

https://www.netterimages.com/volvulus-labeled-hansen-ca-2e-gastroenterology-frank-h-netter-40090.html

PRN: 5. Sally talks about making an assessment of a fallen patient and generating a management plan.

This is part of a subseries looking at key concepts for foundation year doctors. This episode was written by Dr Sally Barker. Disclaimer: PRN episodes are not vetted by senior clinicians. If you think there are any errors in PRN episodes, would like to give feedback or episode  suggestions - pleae email atoeasy@gmail.com

Links:

NICE CT head guidance for adults

https://www.nice.org.uk/guidance/cg176/resources/imaging-algorithm-pdf-498950893

PRN: 4. How to interpret basic pathology on abdominal radiographs for an undergraduate clinical exam. Harry talks about bowel-related pathology including large and small bowel obstruction, volvulus, perforation and complications of inflammatory bowel disease. 

This is part of a subseries looking at key concepts for foundation year doctors that are not common conditions. This episode was written by Dr Harry Kingsley-Smith. Disclaimer: PRN episodes are not vetted by senior clinicians. If you think there are any errors in PRN episodes, would like to give feedback or episode suggestions - please email atoeasy@gmail.com

Links:

Recommended radiology website (in no way affiliated with the podcast):

https://www.radiologymasterclass.co.uk/gallery/abdo/abdominal_xray/normal

Further reading about Abdominal radiograph interpretation:

https://geekymedics.com/abdominal-x-ray-interpretation/

Other resource used for fact checking (this resource is peer reviewed)

Closed loop bowel obstruction: https://www.ncbi.nlm.nih.gov/books/NBK441888/

PRN: 3. Tips for ePortfolio (in particular, Horus, used in England) during foundation training. Sally talks to Jess Caterson, another doctor who has recently completed her foundation training - to offer insights into to hopefully make Horus and ARCP easier for you. 

Links:

General ePortofolio guidance for doctors training in England:

https://foundationprogramme.nhs.uk/curriculum/e-portfolio/

Sumarry narratives examples:

https://www.scotlanddeanery.nhs.scot/media/547182/topic-8-example-summary-narrative-for-hlo-1.pdf

This part of a subseries looking at key concepts for foundation year that are not common conditions. The episode was written by Dr Sally Barker in conjunction with Dr Jess Caterson. Disclaimer: PRN episodes are not vetted by senior clinicians. If you think there are any errors in PRN episodes, would like to give feedback or episode suggestions - please email: 

atoeasy@gmail.com

Gastro 8: Harry and Dan talk about diverticulosis, diverticulitis and diverticular disease. They also talk about true and false diverticula - including a Meckel's diverticulum of the small bowel. They discuss the epidemiology, clinical presentation, investigations and management of diverticula pathology. Dan also makes an awful star wars reference. This episode was vetted by Miss Alexandra Cope, Consultant General & Colorectal surgeon at Wexham Park Hospital, Berkshire. 

Links:

Picture showing the difference between false and true diverticula (although I wouldn't really call the appendix a diverticulum):

https://www.pinterest.co.uk/pin/522839837983243297/

Endoscopy images of diverticula (looking from inside the bowel):

https://www.nejm.org/doi/10.1056/NEJMcp1800468

PRN: 2. How to use a Bleep. Sally talks about standard bleep etiquette and shares some tips about how to accept a job - including what to ask about the scenario and what to ask them to do next. 

This is part of a new subseries looking at key concepts for foundation year doctors that are not common conditions . This episode was written by Dr Sally Barker. Disclaimer: PRN episodes are not vetted by senior clinicians. If you think there are any errors in PRN episodes, would like to give feedback or episode suggestions - please email atoeasy@gmail.com

Haem: 1. Yvonne talks dan through the causes of microcytic anaemia and the basics of RBC transfusion. This episode was vetted by Dr Nina Salooja, Consultant Haematologist at Imperial College Healthcare NHS Trust, London. 

Cardio: 5. Dan talks Yvonne through the assessment and management of pulmonary oedema and Light's Criteria. This episode was vetted by a Consultant Cardiologist (who wishes to remain anonymous) at the Royal Brompton & Harefield NHS Trust, London. 

Links:

X-ray changes in pulmonary oedema (this website is very useful in general!)

https://www.radiologymasterclass.co.uk/gallery/chest/cardiac_disease/pulmonary_oedema

Nephrology/Urology: 2. Harry and Yvonne talk through the common causes of AKI as well as how to classify, investigate and treat it. aThis episode was vetted by Dr Peter Hill, Consultant Nephrologist and clinical lead for Interventional Nephrology at Hammersmith Hospital, London.

Links:

https://www.thinkkidneys.nhs.uk/

Gastro: 7. Harry and Dan talk through the causes, investigations and management of acute pancreatitis - alongside how to present such information in a clinical exam setting. This episode was vetted by Miss Alexandra Cope, Consultant General & Colorectal surgeon at Wexham Park Hospital, Berkshire.

Cardio: 4. Dan talks Harry through the Chronic side of Heart Failure - including the diagnosis and management of so called "HFrEF" and "HFpEF". Disclaimer: this episode is likely suitable for finals as well as first clinical year students. This episode was vetted by a Consultant Cardiologist (who wished to remain anonymous) at the Royal Brompton & Harefield NHS trust, London. 

Gastro: 6. Yvonne and Harry talk about gastric duodenal ulcers, their common causes and how to treat them. This episode was vetted by Dr. Jonathan Hoare, Consultant Gastroenterologist and Head of Endoscopy at St. Mary's Hospital, London. 

Season 2. Resp 4: Harry and Yvonne talk about COPD, its presentation and management in both primary and secondary care. This episode was vetted by Dr. Georgina Russell, Consultant Respiratory physician at Imperial College Healthcare NHS Trust, London. 

Neuro: 2. Sally and Harry talk through Dementia and its main subtypes: Alzheimer's, Dementia with Lewy Bodies, Vascular and Frontotemporal. This episode was vetted by Prof. Steve Gentleman, Professor of Neuropathology at Imperial College London. 

AMTS Mnemnonic: ABC (10 questions)

Age.

Birthday.

Count backwards from 20 to 1.

Date - current year.

Estimated time of day/day of week. 

First/Second world war date.

Geography - current location.

Home Address (check recall at end of test).

Identify two people in area by name (or profession).

Jingoism - Who is Prime Minister or on Throne.

Links:

AMTS: https://www.mdcalc.com/abbreviated-mental-test-amt-10

Histopathology of the Substantia Nigra in Parkinson's Disease: https://www.researchgate.net/profile/Liviu-Aron/publication/45314202/figure/fig1/AS:669388923482114@1536606164215/Loss-of-substantia-nigra-SN-neurons-causes-Parkinsons-disease-Pathological.jpg

Gasto: 5. Harry and Sally talk through Appendicitis, why it causes centralised to RIF pain and its key complications. This episode was vetted by Miss Alexandra Cope, Consultant General & Colorectal Surgeon at Wexham Park Hospital, Berkshire. 

Links:

Demonstration of Rovsing's, Psoas and Obturator Signs: https://www.youtube.com/watch?v=6LrL4ysi_AE

Nephrology/Urology: 1. Yvonne and Harry talk through renal stones, their types, underlying causes and the initial investigations and management. This episode was vetted by Mr Ranan Das Gupta, Consultant Urologist at Charing Cross Hospital, Imperial College Healthcare NHS Trust, London. 

Resp 3: Sally and Harry talk about Sepsis, the qSOFA score and the Sepsis Six. This episode was vetted by Dr. Meehar Shah, Consultant in Emergency Medicine at Chelsea & Westminster Hospital, London. 

Resp: 2. Yvonne and Harry talk through Pulmonary Embolism, its risk factors and management. This episode was vetted by Retesh Bajaj, Interventional Cardiology Fellow at Queen Mary University, London. 

Links:

ECG showing S1 Q3 T3: https://litfl.com/wp-content/uploads/2018/08/ECG-Massive-bilateral-pulmonary-embolus-2.jpeg

Chest Radiograph showing Westermark Sign: https://www.nejm.org/doi/full/10.1056/nejmicm1107936

(Modified) Well's Score calculator: https://www.mdcalc.com/wells-criteria-pulmonary-embolism

Harry's Mnemonic in full: CT S'il Vous Plait?

C: Cancer, Chemotherapy, Cardiac failure, COPD, Factor C deficiency

T: Trauma, Time (age), Thrombocytosis

S: Stasis, Surgery, Factor S deficiency

V: Varicosities, Virchow's Triad, Factor V Leiden

P: Pill (COCP), Pregnancy, Puerperium, Previous VTE, Polycythaemia, Paraprotein

Post-Show Notes: NICE 2020 guidance permits DOACs to be prescribed in stable PE as we have mentioned, however, know that LMWHs are still suitable. PE can cause haemoptysis through the ischaemia distal to the blockage. The ischaemia drives necrosis of the local tissue which manifests as bleeding. 

Gastro: 4. Sally and Yvonne talk through biliary colic, cholelithiasis and choledocholithiasis. This episode was vetted by Dr. Jonathan Hoare, Consultant Gastroenterologist and Head of Endoscopy at St. Mary’s Hospital, London.

Link for a reminder of the anatomy of the biliary system: https://teachmeanatomy.info/abdomen/viscera/gallbladder/

Gastro: 3. Yvonne and Harry talk through Colorectal Cancer including the NHS screening programme. This episode was vetted by Dr. Jonathan Hoare, Consultant Gastroenterologist and Head of Endoscopy at St. Mary's Hospital, London. 

Links:

Duke's Staging: https://www.cancerresearchuk.org/about-cancer/bowel-cancer/stages-types-and-grades/dukes-staging

Apple Core Sign on Barrium Swallow: https://radiopaedia.org/articles/apple-core-sign-colon-1

ENT: 1. Harry and Yvonne talk through tonsilitis, pharyngitis, strep throat and glandular fever. This episode was vetted by Mr. Matthew Rollin, Consultant ENT Surgeon at Imperial College Healthcare NHS Trust, London. 

Links:

FeverPAIN score for Strep Throat: https://www.mdcalc.com/feverpain-score-strep-pharyngitis

Atypical lymphocytes on blood film: https://webpath.med.utah.edu/HEMEHTML/HEME013.html

Throat examination of kissing tonsils: http://www.ghorayeb.com/KissingTonsils.html

Throat examination of a quinsy (3rd image): http://www.clinicaljunior.com/entoncallquinsy.html

Resp: 1. Sally and Yvonne talk through typical community acquired pneumonia (CAP) and the CURB-65 score. This episode was vetted by Dr. Laura Martin and Dr. Georgina Russell, Consultant Respiratory Physicians at Imperial College Healthcare NHS Trust, London. 

Links:

CURB-65 parameters and interpretation: https://www.mdcalc.com/curb-65-score-pneumonia-severity#evidence

Bronchial vs. Vesicular breathing: https://www.youtube.com/watch?v=Vd0sIgncxx0

Examples of different types of lobar consolidation on chest radiograph: https://radiopaedia.org/articles/lobar-consolidation

Musculoskeletal: 1. Sally and Harry talk through Septic arthritis and how to differentiate it from other forms of arthritis. This episode was vetted by Mr. Tim Halsey, Consultant Trauma & Orthopaedic Surgeon at Chelsea and Westminster Hospital, London.

Links:

Photograph of septic joint aspirate: https://en.wikipedia.org/wiki/Septic_arthritis#/media/File:SepticJointFluid.jpg

Fig. 1: A knee radiograph showing chondrocalcinosis (a chronic joint pathology). https://rheumatology.medicinematters.com/crystal-arthropathies/gout/hyperuricemia-and-chondrocalcinosis--a-clinical-challenge-for-di/16208790

Cardio: 3. Yvonne and Sally talk through the Acute Coronary Syndromes. This episode was vetted by Retesh Bajaj, Interventional Cardiology Fellow at Queen Mary University, London. 

Links:

ECG showing a pathological q wave: https://ddxof.com/ecg-guide-part-ii/hcm/

ECG showing ST elevation in leads II, III and avF, in keeping with an inferior STEMI: https://litfl.com/wp-content/uploads/2018/08/ECG-Inferior-AMI-STEMI.jpg

Gastro: 2. Harry and Yvonne talk about the other half of IBD - Crohn's disease. They also cover the extra-gastrointestinal features of IBD. This episode was vetted by Dr Jonathan Hoare, Consultant Gastroenterologist at St. Mary's Hospital, London. 

Links:

Pyoderma Gangrenosum: https://dermnetnz.org/topics/pyoderma-gangrenosum/

Erythema Nodosum: https://dermnetnz.org/topics/erythema-nodosum-images/

Anterior Uveitis: https://commons.wikimedia.org/wiki/File:Anterior-uveitis.jpg

Episcleritis: https://www.sciencephoto.com/media/1051725/view/episcleritis

Neuro: 1. Sally and Harry talk through Stroke medicine - in particular anterior circulation strokes. This episode was vetted by Dr. Harri Jenkins, Consultant Neurologist & Stroke Physician at Imperial College Healthcare NHS Trust, London. 

Links:

Bamford classification: https://geekymedics.com/stroke-classification/

Images of the Motor and Sensory hormunculus of the brain: https://en.m.wikipedia.org/wiki/Cortical_homunculus

Cardio: 2. Harry and Sally talk through Pericarditis. This episode was vetted by Dr. Retesh Bajaj, Interventional Cardiology Fellow at Queen Mary University, London. 

Links:

ECG of Pericarditis, multiple examples including Example 3: https://litfl.com/pericarditis-ecg-library/  

Audio clip of Pericardial rub: https://www.youtube.com/watch?v=-DB_8zyg9W8

Cardio: 1. Yvonne and Sally talk through Atrial Fibrillation. This episode was vetted by Dr. Retesh Bajaj, Interventional Cardiology Fellow at Queen Mary University, London. 

Link:

ECG of AF, multiple examples including Example 4: https://litfl.com/atrial-fibrillation-ecg-library/

Gastro: 1.  Harry and Yvonne talk though one half of inflammatory bowel disease.  This episode was vetted by Dr. Jonathan Hoare, Consultant Gastroenterologist at St. Mary's Hospital, London. 

Links:

Abdominal radiograph of Lead Pipe sign, Case 3: https://radiopaedia.org/articles/lead-pipe-sign-colon?lang=gb

Abdominal radiograph of Toxic Megacolon, Case 4: https://radiopaedia.org/articles/toxic-megacolon?lang=us