A Journey Through Medicine: Recent Episodes
Shaun and Norm
Join two first year medical students from Australia as they delve into the depths of medicine, documenting their experiences and what they learn week-to-week.
Content covered:
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Formal thought disorder
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Acute psychosis, causes, differential diagnosis and treatment
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Schizophrenia and related disorders
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Mania
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First vs second generation antipsychotics including important indications and side affects
Special guest and psychiatry wizard Abdulla joins the lads as they discuss high yeild concepts pertaining to unipolar and bipolar mood disorders.
Content covered:
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Key DSM5 Criteria
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MDD
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BPAD 1 vs BPAD 2, mania vs hypomania
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Differential diagnosis of depressive and manic episodes
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Key principles of management
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Abdulla joins the lads as they reflect on their time in psychiatry placement, giving their thoughts and suggestions for those heading into their first psych term.
We are by no means experts, but thought some people might find this useful.
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Today the boys are joined by Ben to discuss the clinical features and pathology of Parkinson's disease. We discuss its course from initial autonomic dysfunction to the classical signs seen in textbooks and how it is different to the other common neurodegenerative diseases.
Content covered:
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Core concepts, similarities and classification of neurodegenerative diseases
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Parkinson's
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Dementia and its causes (Alzheimer's, Dementia with Lewy bodies, FTD, vascular dementia, etc)
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Huntington's disease as an example of hyperkinetic movement disorders
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Foundations of prion diseases including CJD and Kuru
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Todays episode is all about stroke. What actually is a stroke? How can it happen? What are some warning signs that someone may be having a stroke? The lads discuss these questions and more as they piece together what they have learnt about cerebrovascular diseases.Content covered: - Risk factors for the development of cerebrovascular disease- Pathogenesis of cerebrovascular disease- Ischaemic vs haemorragic strokes- Clinical presentation, prognosis and sequalae of stroke- Basic principles of management --- Send in a voice message: https://podcasters.spotify.com/pod/show/shaun--norm-and-terence/message
Listen carefully... as the lads revise what structures are involved in hearing and balance as well as how they work. Jack joins us for a journey through the outer, middle and inner ear as we explore the inner workings of the membranous labyrinth.
Content covered
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Anatomy of the vestibulocochlear system
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Functions of the cohlea, utricle, saccule and semicircular canals
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Basics of the auditory and vestibular projection pathways
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Conductive vs sensorineural hearing loss
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Basics of vertigo
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Let's break it down!
Pathology and biochem wizard Jonathan joins us as we do a deep dive into diseases that affect bone integrity on a cellular and metabolic level as well as their clinical presentations.
Content covered:
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Osteoporosis, Type 1 and Type 2
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Osteomalacia and Ricketts
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Hyperparathyroidism
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Paget's Disease of Bone
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Claire is back and guides the boys through the pathophysiology, clinical features and treatment of rheumatoid arthritis, one of the most common autoimmune conditions in Australia.
Content covered:
-Clinical presentation of RA including signs and symptoms
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Pathogenesis and pathological findings of RA
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EULAR 2020 RA treatment guidelines including the different classes of DMARDs (eg low-dose methotrexate, infliximab, tofacitinib, etc)
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TO CLARIFY: Arthralgia = the term for joint pain.Arthritis = a general term for diseases that have joint pain, leading to loss of function at the joint (+/- inflammation). Arthralgia = symptom, arthritis = diagnosis. The boys get their heads around what arthritis actually is and explore osteoarthritis (or degenerative joint diseases), one of the core MSK conditions!Content covered:- General arthritis findings- Pathophysiology of degenerative joint disease (osteoarthritis) and clinical presentation - Osteonecrosis and avascular necrosis. - Various other causes of arthritis--- Send in a voice message: https://podcasters.spotify.com/pod/show/shaun--norm-and-terence/message
Welcome back! The crew have returned a couple of weeks into their musculoskeletal block to chat about fractures and soft tissue injuries. Let this introduce you to orthopedic heaven.
Content covered:
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Different types of fractures
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Fracture healing process
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Complications of fractures
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Sprains vs strains
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Today the boys were joined by the legendary Jonathan as they discuss diabetes, a common chronic disease impacting millions worldwide.
Content covered:
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Diabetes insipidus
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Glucose homeostasis (insulin + glucagon) including some biochemistry
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Pathophysiology, diagnosis, clinical features and comparisons between Type 1 & 2 diabetes mellitus
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Complications of chronic hyperglycaemia (vascular, neural and immune)
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Hypoglycaemia
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Claire takes us on a tour through the drugs used to treat diabetes - a condition that affects 1 in 10 people globally!!Content covered in this episode includes:- Insulin regimens for Type 1 Diabetes- (Some) novel treatments for Type 1 Diabetes- Diagnostic criteria for T2DM- Metformin- SGLT2 inhibitors- Incretin-based therapies (inc. GLP-1 agonists and DPP-4 inhibitors)- Sulfonylureas- Thiazolidinediones - a-glucosidase inhibitors- Bariatric surgery!--- Send in a voice message: https://podcasters.spotify.com/pod/show/shaun--norm-and-terence/message
Welcome to our 30th episode!
Celebrate this milestone with us by letting out your inner Sherlock Holmes and try crack these (expertly crafted) cases of glomerulonephritis and other renal diseases. Learn about the differential diagnosis of nephritic vs nephrotic syndromes, acute vs chronic renal failure and some other related conditions.
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Today the boys are joined by Jack as they discuss renal physiology! Essentially, how your kidneys regulate blood volume, electrolytes and pH homeostasis while getting rid of toxic substances we don’t need. This knowledge is key to understanding renal pathology and pharmacology.Content covered in this episode: - The different segments of the nephron and their functions- Homeostatic control of electrolytes and blood volume - The formation of urine - Renin-angiotensin-aldosterone system- ANP and ADH- Matabolic acid - base balance --- Send in a voice message: https://podcasters.spotify.com/pod/show/shaun--norm-and-terence/message
Claire helps the boys out with the plethora of drugs that can be used to treat nausea, vomiting, reflux and more - and all their funky nuances.
Topics covered in this episode include: - General causal pathways of nausea and vomiting - Drugs used to treat nausea and vomiting - including 5HT3 antagonists, dopamine antagonists (metoclopramide and prochlorperazine), domperidone, steroids, NK-1 antagonists (aprepipant and fosaprepipant), hyoscine and lorazepam - Prescribing nausea and vomiting drugs in special populations i.e. pregnancy and children - Drugs used to treat GORD and reflux symptoms - NOT EXAMINABLE: Drugs used to treat hepatic encephalopathy
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In this special episode, Jarrod interviews our MD program coordinator - Helen, asking her about everything from her favourite experiences in medicine, to failure and about what makes good mental health!
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Today the legendary Mike Kendall imparts some wisdom on the boys as they revise the pathogenesis, clinical features and what differentiates the inflammatory bowel diseases and other non-neoplastic conditions of the bowel.
Content covered includes: - Crohn's disease and ulcerative colitis - Ischaemic colitis- Diverticular disease- Antibiotic-associated diarrhea and pseudomembranous colitis- Microscopic Colitis- Coeliac disease and its consideration in the differential diagnosis
Correction: Ipilimumab can cause an Autoimmune-like enterocolitis, not GVHD.
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Ben Earner accompanies the boys as their pathology journey through the GIT continues, this time diving head-first into the stomach!
Content covered in this episode includes: - Gastritis and causes of gastritis - Atrophic gastritis - Peptic ulcer disease - Benign neoplastic or neoplastic-like gastric lesions including: gastric hyperplastic polyp, fundic gland polyp and adenoma - Gastric cancers including tubular/intestinal type, poorly cohesive/diffuse adenocarcinoma, MALT lymphoma and GIST
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Retrosternal chest pain only has cardiac causes... right?
In this episode, the lads welcome back Ben Earner as they try to make sense of the important pathologies affecting the oesophagus and the differing signs and symptoms these could manifest as.
Content covered:
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Signs/symptoms of oesophageal disease such as dyspepsia, dysphagia, odynophagia, waterbrash and the dreaded retrosternal chest pains
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Functional and mechanical obstructive disorders eg Achalasia and Schatzki rings
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Oesophageal Varices and portal hypertension
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Gastro-oesophageal reflux disease (GORD/GERD): causes and consequences
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Oesophagitis
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Barrett oesophagus
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Oesophageal adenocarcinoma
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Oesophageal squamous cell carcinoma
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In this episode, the lads revise the common pulmonary vascular diseases, and just how much can go wrong when you lose or impair that crucial part of your body's oxygen delivery mechanism.
Content covered in this episode: - Embolisms and infarcts associated with the lungs - Pathogenesis of DVT and PE and associated risk factors - Pulmonary Hypertension: causes and classifications - Signs and symptoms of right-heart failure / cor pulmonale - Goodpastures syndrome and granulomatosis with pulmonary angiitis
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How does your stomach begin the digestion process without digesting itself? What structures and cells are involved in the mechanical and chemical digestive processes in the stomach? In this episode, the boys discuss the anatomy and physiology of the stomach + a little bit of the gut. Featuring a colourful diagram from Terence to help us understand transport and creation of protons across parietal cells in the stomach! Shoutout to Jarrod for the 'chief likes pepsi' memory aide.
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Asthma and COPD are common chronic obstructive pulmonary diseases that place a high burden on the healthcare system and those affected. In this episode, Claire takes us through the treatment regiments commonly used to lighten the morbidity associated with these conditions.
Content covered:
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B2 antagonists
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Muscarinic antagonists
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Inhaled corticosteroids and systemic steroids
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Montelukast
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PDE4 inhibitors
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Antitussives and mucolytics
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Biological treatments
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Key principles of oxygen treatment in patients with chronic hypercapnia
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Norm, Terence and Shaun are joined by Saud as they work their way through the anatomy of the respiratory passageway and some of the mechanics of breathing. From the nose, through the conductive tubes and to areas of gas exchange, the lads talk about the key structures and what comprise them.
Content covered: - Nasal conchae and the paranasal sinuses - How air travels down the respiratory tract (and how food doesn't, hopefully) - Histological differences between conductive and respiratory structures - Innervation of the pleura and lungs - Ribs, the sternum and the sternocostal joints - Mechanics of breathing including the use of accessory muscles
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CORRECTION: Percussing over a puffed out cheek gives a 'tympanic sound', which correlates to air. The 'hyper-resonant' sound you find in emphysema, correlates to mostly air. Slight difference.
We are back from holiday! Take a deep breath as the lads explore obstructive pulmonary diseases, focusing on the relevant pathological findings and clinical presentations associated with each.
Content covered in this episode: - COPD: emphysema and chronic bronchitis - Asthma - Bronchiectasis
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The legendary Claire is back to help the boys make sense of the drug treatments clinicians should prescribe for the various pathologies that can affect the cardiovascular system.
Things covered include:
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Treatment of acute coronary syndromes and post MI treatment
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Antiarrhythmics
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Anticoagulant and antiplatelet therapy
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Diuretics and antihypertensives
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Lipid lowering therapies
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Digoxin!
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[Correction]: In an MI (or other ischaemic heart disease), the zone of necrosis spreads from the subendocardium outwards towards and through the myocardium.
Silent, but violent (not referencing Shaun's farts), hypertension is a key factor in the development of many pathologies affecting not only the cardiovascular system, but other organs such as the kidneys and brain. In this episode, Norm and Terence are joined by Jarrod as they discuss what hypertension is, why it can be bad and what it could result in.
Content covered in this episode includes:
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Causes and risk factors associated with hypertension
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Sequelae of chronic hypertension
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Hypertension and pregnancy
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Malignant hypertension
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RAAS system
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"Atheroscrulosis"? "Atheroscilosis"? However Norm says it, the boys examine the core pathophysiology of atherosclerosis - a stealthy condition that silently threatens the health of our arteries. Join us as we embark on a captivating journey through the underlying mechanisms, risk factors, and consequences associated with this disease process.Note: This podcast episode does not replace professional medical advice. Please consult a healthcare professional for personalized guidance and treatment options.
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The boys are joined by legend Ben Earner to discuss how the skin reacts to different offenders, but how it can also be prone to various autoimmune conditions.
Inflammatory skin conditions can be a source of immense discomfort and distress, affecting millions of people worldwide. In this episode we explore some of the most common inflammatory skin conditions including eczema, psoriasis, infections, and dermatitis.
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In this episode, we dive into the world of benign and malignant skin lesions, including the most dangerous of all, melanoma. Learn about the diverse clinical presentations and histology features for these conditions, and gain a deeper understanding of how to differentiate benign and malignant lesions.
Content covered in this episode:
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Macroscopic and microscopic differences between benign and malignant skin lesions differences
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Disorders of pigmentation including vitiligo, melasma, naevi, etc
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Melanoma: phases of growth and different presentations
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Squamous Cell Carcinoma
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Basal Cell Carcinoma
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Keratoacanthoma
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[We forgot to mention that the stratum granulosum is the last layer of nucleated cells located deep to the stratum corneum/lucidum]
Norm, Terence and Shaun start the systems component of MD1, looking at our body's largest organ and how it works!
The skin is more than just a protective outer layer of our body. It is a complex organ with a myriad of functions, including regulating body temperature, protecting against pathogens, and providing sensory information. In this episode, we explore the fascinating anatomy physiology of the skin, laying the foundational knowledge required to understand pathologies associated with skin.
Content covered in this episode:
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Layers of the epidermis and what cells are found within each
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Layers of the dermis and what's found in each
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Subcutaneous tissue
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How your skin works to keep you warm/cool
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What happens to your skin during a sympathetic response
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The lads are joined by Michael who has over 10 years of nursing experience across Australia and the UK as they begin preparations for their upcoming OSCE. Both the history of the presenting complaint and comprehensive history are integral parts of medical practice, being skills clinicians use on a daily basis. Listen as Michael provides a solid example of these and Norm botches his attempt by laughing at the patient.
Shout-out to Ben Earner!
Content covered in this episode:
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History of the presenting complaint (SOCRATES)
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Comprehensive history taking (eg, social, familial and past medical history)
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The lads are joined by Jarrod as they put their recently acquired knowledge of gram-negative bacterial infections to the test by going through some case reports. Follow along and see if you can identify the most likely bacterial causes of the cases presented.
Shout-out to Ben Earner!
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Norman struggles to pronounce various species names (all of them), as he, Terence, Jarrod and Shaun explore the pathogens that comprise the Gram-positive rods, as well as the types of infections they can cause.
Shout - out to Ben Earner!
Content covered in this episode:
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Endospore formers: Bacillus and Clostridium
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Non - endospore formers (eg Lactobacillus, Listeria, Cornybacterium, Actinomyces, Nocardia)
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In this episode the lads try to wrap their heads around some of the most common and clinically important bacteria as well as some of the infections they can cause. FUN FACT: Healthcare workers are consistently found to have some of the highest rates of Staph aureus carriage in the population.
Shout-out to Ben Earner!
Content covered in this episode:
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How gram-positive cocci are classified (gram-stain, catalase and coagulase tests, haemolysis of blood agar, Lancefield grouping, etc)
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Common infections and pathologies associated with:
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Staph. Aureus
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Staph. Saprophyticus and Staph. Epidermidis
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The Viridans group Streptococci
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Strep. Pneumoniae
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Enterococcus Faecalis and Faecium
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The lads are joined by pharmacist (and pharmacology expert) Claire to discuss how drugs go through our bodies and how certain substances can alter or maintain the balance in our autonomic nervous systems! (Trigger warning: mentions suicide.)
Shout-out to Ben Earner!
Things covered in this episode include:
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The potential dangers of grapefruit juice in altering the metabolism of medications
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An overview of pharmacokinetics (absorption, distribution, metabolism and excretion of drugs)
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Core concepts of pharmacogenomics, drug-drug-interactions and toxicology
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ANS pharmacology core concepts (sympathetic vs parasympathetic nervous systems)
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Adrenergic receptor agonists & antagonists, their effects and clinical uses
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Cholinergic receptor agonists & antagonists, their effects and clinical uses
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Acetylcholinesterase inhibitors, their effects and clinical uses
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How amphetamines work
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Some of the drugs covered: adrenaline, noradrenaline, phenylephrine, salbutamol, propranolol, metoprolol, pilocarpine, atropine, tiotropium, amphetamines, pseudoephedrine, neostigmine
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This episode is all about how our skeletal muscles can take us from point A to point B! Norm, Shaun and Terence are joined by fellow medical student Jasper, who has a honours degree in skeletal muscle physiology to talk about how these voluntary muscles can contract and what molecules are involved.
Shout-out to Ben Earner!
FUN FACT: The ryanodine receptor is activated by caffeine and no one knows exactly how (except maybe Norm).
Content covered in this episode includes:
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The process of excitation-contraction coupling, including action potential propagation, the roles of ATP and calcium and the sarcomere.
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The length-tension curve relationship and the difference between active and passive tension
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Motor unit recruitment patterns and muscle fibre types
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Dexterity vs strength
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The myotactic (catch) and inverse myotactic (drop) reflexes
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On this episode, Norman, Shaun and Terence talk about the fundamentals of pathology! We explain how cells adapt and change in response to different stimuli as well as what happens to a cell once it is irreversibly injured. These concepts cover the basics of many clinical conditions that we will be covering through this podcast.
Shoutout to Ben Earner!
Topics covered in this episode includes:
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Adaptations to cellular stress including hypertrophy, hyperplasia and metaplasia
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The mechanisms of the different types of cell death (apoptosis, necrosis and autophagy)
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Different types of necrosis and clinical examples including gangrene, myocardial infarction, fibrinoid and caseous necrosis.
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[CORRECTION: The brachialis muscle in the arm is innervated by the musculocutaneous nerve on the medial part and the radial nerve on the lateral part.)
Shaun, Norman and Terence extend themselves and try to leg it through the anatomy of the limbs! We talk about how to learn anatomy more effectively by memorising as little as possible.
Thanks again to Ben Earner for being a legend!
Concepts covered in this episode:
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Different types of joints including synovial, synchondrosis, symphisis, syndesmosis, sutures, etc
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Development of the limbs from the body wall
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Dorsal vs ventral muscles and actions
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Innervation of the forelimbs and hindlimbs as well as most muscles and bones
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Norman and Terence teach Shaun about the thorax and abdomen, regions of the body containing some of our most important organs.
Thanks again to Ben Earner for helping out with the editing of this episode!
Content covered in this episode:
Thorax
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The regions of the mediastinum
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Anatomy of the lungs, ribs, diaphragm, heart and associated vessels
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Nerves of the region including the Phrenic and Vagus
Abdomen
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Organs of the foregut, midgut, hindgut and their respective blood supplies
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Anatomy of the liver, stomach and intestines
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Mesenteries
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Blood supply and drainage of the paired glands and anus
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Nearly everything in your body is governed by action potentials. In this episode, Norman, Shaun and Terence are joined by Jenny as they discuss the basic physiology behind how humans move, feel, talk, and do pretty much everything. They also introduce the study of pharmacodynamics, a branch of pharmacology encompassing the effect of drugs on the body.
We would all like to thank Ben Earner for helping us out with the editing of this episode - absolute legend!
Topics covered in this episode include:
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How action potentials are triggered
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The communication of nerves via neurotransmission
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Excitatory and inhibitory post synaptic potentials
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Saltatory conduction
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The fundamentals of pharmacodynamics (affinity, efficacy, potency, dose-response relationship, etc)
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Norm hosts a mini game show where Shaun, Terence and newbie Jarrod test their knowledge of some pathological jargon. Terence explains how Viagra works to introduce smooth muscle dilation and intracellular signalling cascades. Finally, the boys continue the conversation on human development, in particularly what the three unique embryological layers (ectoderm, mesoderm and endoderm) end up forming in the human body.
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Norman and Shaun are joined by embryology wizard Terence as they try to make sense of the first few weeks of human development. Topics covered in this episode include: zygote formation, cleavage, implantation, formation of a bilaminar disk, gastrulation, neurulation, lateral folding, head-tail folding and the development of the diaphragm and body cavities.
Norm and Shaun talk about the idea behind A Journey Through Medicine and their first week in MD1.