The Medical Joyworks Monthly

 

Connect to MJ's thriving community

Issue #8 (May 2020)

IN THE NEWS

The latest from MJ

  • As the COVID-19 pandemic continues its course, many of our colleagues are still responding to the emergency in their respective communities. Therefore, we've doubled down on updating our existing Clinical Sense, Explain Medicine and Prognosis: Your Diagnosis content - which is plenty.  
     
  • Despite our focus on existing content, we remain committed to developing new learning modules that will be released in the coming weeks. If you'd like to see a new Clinical Sense scenario, Explain Medicine entry, or Prognosis case on any given condition, please let us know. Simply send us a message with your request to penelope@medicaljoyworks.com.
     
  • That's it for now. Stay healthy, and curious!

DOCTORS' LOUNGE

Q&As from our user community

Clinical Sense: Cough cough (Bronchiolitis)

Q: Isn't an SaO2 of 93% low enough to warrant use of supplemental oxygen - especially since respiratory distress is evident? In pediatric practice in Cameroon we use a cutoff SaO2 of 95% on ambient air.
A: The exact cutoffs vary by country. Most do not recommend administration of oxygen unless saturations are <90-92%. For example:

UK: https://www.nice.org.uk/guidance/ng9

Australia: https://www.rch.org.au/clinicalguide/guideline_index/Bronchiolitis/
If you would like to play this scenario or join the conversation, go to the Clinical Sense app in your mobile device.

Prognosis: Your Diagnosis: With time (Geriatric musculoskeletal pain)

Q: This case more likely describes ankylosing spondylitis, not osteoarthritis. NSAIDs are first line Rx, and remittive Rx with MTX. Turmeric is equal to NSAIDs for knee osteoarthritis but theoretically should be used with caution when patients are anticoagulants
A: Her presentation is more consistent with diffuse osteoarthritis. It would be unusual for ankylosing spondylitis to present in an 88 year old, and the normal ESR and imaging findings go against this diagnosis. The exacerbation with activity, stiffness,  examination findings, imaging findings, and normal bloodwork are all consistent with severe osteoarthritis.

The first-line management is non-pharmacological and includes physiotherapy and weight loss. Simple analgesia or topical analgesia is the next step - however, given her age and ischemic heart disease, NSAIDs are best avoided. Localized steroid injections can be very effective as the next step in management. Regarding turmeric, there is some emerging evidence, but this is still insufficient for incorporation into most national guidelines.

Please see the American College of Rheumatology (ACR) guidelines here: https://www.rheumatology.org/Portals/0/Files/Osteoarthritis-Guideline-Early-View-2019.pdf
If you would like to play this scenario or join the conversation, go to the Prognosis: Your Diagnosis app in your mobile device.

IN CASE YOU MISSED THEM

Recently released stories

Clinical Sense

Medicine
Reactive (updated)
Medicine
Weak
That's all for now!

Tell us what you think or share valuable insights with the community by writing to us at: penelope@medicaljoyworks.com.

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