Antimicrobial Stewardship

Tired of getting yellow cards from the infectious diseases team for prescribing meropenem for 3 months?

Sick of Scott appearing behind you with a cat o’ nine tails to administer the requisite antibiotic punishment?

Well this episode has it all – what is antimicrobial stewardship? why do so many people care about it? what can you do to avoid being on the pharmacy’s wanted list? Most importantly, we expertly blend in some music and cold openings for the first time. Jump in, the water is warm!

Pacemakers

2023 got you feeling out of rhythm? Finding yourself a bit behind the beat when it comes to pacemakers? Pour yourself a frosty, frothy, fibre-filled glass of your favourite plum juice and strap on your electric earmuffs. We’re going charging on an audio adventure from cathode to anode with Scott and Rahul which will help you nail pacemakers with aplomb!

Hypothyroidism

You know that feeling when you find a surprise $100 note in a coat pocket you haven’t worn for a while? Yeah, we don’t either. But we can imagine it feels kind of like discovering we have a MedConversations episode we forgot to publish! Open this 2022 time capsule with us and treat your tympanic membranes to Bec and Scott talking all* things hypothyroidism. We open up a can of worms talking history of the thyroid, and introduce you to our case Nala the poet with enough heavy-handed use of metaphors to make your Grade 6 teacher proud. If you last till the end, please tell us what you think of the surprise concluding performance.

*Some exclusions may apply

Febrile neutropenia

Intimidated about caring for immunosuppressed patients full of mibs, mabs or stem cell jabs? Here is the infection protection guide to investigate and manage your patient’s neutropenic slump – without resorting to well-evidenced super foods like goji berries or sheep placenta extract

Depression Part 3 – Management

Psychiatry registrar Dr Dean Whitty is back on the MedConversational airwaves again to talk with Bec about taming the black dog in our final ep of the three-part depression series. Dean’s soothing voice takes us on a nice guided tour through lifestyle, psychotherapy, antidepressants and ECT. The content is great med school exam fodder but also broadly useful for anyone out there with Doctor on your name badge no matter what your field.

Dean is the only guest we’ve had so far on the show so please shoot us an email or a Facebook message to let us know what you think of the format!

Perioperative Medication Management

The MedConversations crew may not fly the surgical flag very much but we love flying into the melee of perioperative management. So get peri with Bec and Scott as we dance around and about* the drug chart of the pre-op patient and allay your surgery rotation pager fears.

*We take the scenic route through salmon sperm, bridge championships, dead rats and Romanesco broccoli.

Hypertension Part 3 (Assessment, Management and Secondary Causes)

Weary traveller, let Rahul, Bec and Jupiter’s 79 moons be your guides as we haul you up the third and final segment of the hypertension series. At the summit we take you on a high pressure hike through the assessment and secondary causes of the old HTN under the auspices of a curiously one dimensional character called Mountain.

COVID-19 – Clinical Diagnosis and Management

This episode is for everyone who is sick of COVID-19 but needs to finally learn how to diagnosis and manage it, rather than how to out-argue your uncle about whether the plan-demic will end democracy. We go through diagnosis, testing, and all the juicey new therapeutics available – enough mabs and mibs here to level up your wordle game.

Gram Negative Bacteria and Treatment

Nasty Bugs. You gotta treat ‘em! In this, truly, tremendous second antibiotic episode, Sleepy Scott, Deranged Davor, Crooked Bec (and Obama Zala) cover all the gram negative bacteria – from microbiology to antibiotics and resistance. Believe me, you’ll be tired of winning!

Depression part 2 – evaluation

This is part 2 of our series on depression. Davor and Dean chat about how to evaluate someone you think might have depression. As fascinating as part 1 was, this is much more clinically relevant. Filled with Dean’s wisdom and clinical pearls, listen on if you want to smash your psych OSCEs or perhaps even to be a better doctor.

Depression overview – definitions, epidemiology, pathophysiology

This episode is a bit of new thing we’re trying – interviews with our friends! As we’ve progressed in our careers, we’ve all started specializing and become increasingly unqualified to talk about large swathes of medicine. On the flipside, our mates have done the same thing in all manner of interesting fields, so we’ve decided to start utilizing this amazing resource.

In this episode, Davor talks to senior psychiatry registrar Dean Whitty about depression. This episode is an overview of the Black Dog – definitions, burden of disease and pathophysiology. To be completely honest, only the first 20 minutes or so are directly clinically applicable. If you decide to stay onboard for the whole journey though, you’ll get Dean’s fascinating thoughts on whether you can make epidemiological conclusions across cultures, the different models of depression and how you might be able to unify them, as well the inherent tension between the biological and psychosocial approaches. We’re planning on following this one up with episodes on evaluation and management.

Gram Positive Bacteria

Welcome seeker. All the bacteria. All the antibiotics. Join us on our ambitious multi-episode trek to summarise all bacteria and their treatment starting this episode with gram positives. Your journey will teach the ancient wisdom that tazocin does not fix all problems and that “beta lactamase inhibitor” is not just a mantra ID registrars use to confuse you. At the pinnacle you will meet a new MedConversations member who will share her wisdom that a life well-lived involves hourly breaks for milk and urination.

Hypertension Part 2 (Drugs and their Mechanisms)

Image result for old people partying | Cool kids, Old people, University of  california irvine

Curious about what all those party drugs you’ve been taking with your grandma down at the local aged care facility are? Wondering why you always need to cough after you’ve taken your morning ramipril?

Jump on board the high pressure conga line with Rahul and Davor as we cover the ins, outs and sideways of hypertension therapy.

Radiculopathy

Episode on radiculopathy!

Davor, Bec and Scott sit down and chat about nerve roots. Well, to be honest, it’s more like Davor relentlessly interrogates Bec and Rahul about radiculopathy for an hour. Although ethically questionable, it appears to have worked because by the end they seemed to understand which nerve roots are damaged by which disc, how to differentiate between L5 and other causes of foot drop and lots of other cool stuff. Hopefully you will too!

This is also the first episode we recorded with our new equipment. We saw some of the feedback about audio issues, and we reckon things sound much, much better with our new gear. If you’ve stopped listening because you were sick of it sounding like one of us was in a different room, give this ep a whirl.

Hypertension Part 1

We’re back with a mammoth topic. Often consigned to a 1-liner in the past history – it’s time to find out just how little you know about the silent killer. Much like the mounds of hair that accumulate in your drain pipes, hypertension is known for a sudden and unexpected day-wrecking by blocking up your plumbing.

Sit back, grab the saltiest nuts you can find and prepare for part 1 of our bigger than Ben-Hur epic on the mechanisms and pathophysiology of hypertension.

Low back pain

Low back pain! Rahul and Davor discuss one of the most common presentations in medicine. What are the most common causes? What are the most serious causes? Who do you image? What on earth does Rahul mean when he says “test the anal reflex”? Listen in to find out the answers to these eternally-vexing questions and more.

Functional Neurology

See the source image

There’s been a lot of demand for off in the weeds neurology podcasts. Luckily we have our arcane neurology specialist Davor ‘The Slovenian Sledgehammer’ Pavlin-Premrl ready and waiting.

Rahul and Davor discuss cartesian dualism and hysteria, and then after about half an hour of philoso-broing we get to some stuff that might (emphasis on the might) be clinically useful

Apologies for the sound quality – we are still working out some remote-casting CoVID solutions

Obstructive Sleep Apnoea

We’re back in the COVID era all the way from dirty Melbourne to breathe around your masks and cough on your food.

Have you been fighting with your bed-partner about excessive nocturnal noise emissions? Struggling to stay alert whilst reviewing the latest hydroxychloroquine ‘Orange’ Paper from the White House?

Well we’ve got the podcast to get you inspired before you expire. Strap on your CPAP mask and get ready to fly the skies of knowledge with Bec, Scott and Rahul.

Infective Endocarditis

Drugs. Death. Hidden infections. Bad mix tapes.No, you’re not tripping out on LSD at your uncle’s mail-order bride wedding, you’re just listening to MedConversations’ latest educational podcast packed full of infective endocarditis wisdom and copyright infringing references to one of our most beloved fictional drug dabblers.

Glomerulonephritis Part 2 – Nephritic Syndromes

If you naively thought that part 2 of glomerulonephritis would never come and you could spend the rest of your summer wallowing in glorious ignorance of those confusing glomerulonephritidis then you were wrong. Here are the rest of the nephritic syndromes in all their rosé tinted beauty.

https://media.blubrry.com/medconversations/content.blubrry.com/medconversations/Glomerulonephritis_Part_2-Nephritic.mp3

Polyneuropathies

Davor’s back doing his Davor thing and sprucing neurology to the world (whether they want to hear about it or not).

So, if the holiday blues have you feeling numb to the world or passion for the new year has you unexpectedly weak at the knees then tune in because, as usual, we’ve got the balm for your blues.

Join Rahul and Davor as they lead you with a high-stepping gait through the world of peripheral neuropathies. Perhaps after this you won’t feel so lost in the nerve network…Emphasis on the perhaps.


Fluid Assessment

Has your troubled history of pot plant homicide led to legal action over your plant carer registration AND/OR  your grandmother giving up on you and gifting all her cuttings to her previously second favourite grandchild? We can’t help you with your congenitally absent green thumb AND/OR unlovable personality but this practical episode on clinical fluid assessment will keep your patients from either wilting away or drowning in bottomless bags of normal saline.  

Hypercalcaemia

Dust off your ear horn, ruffle up your ruffles and prepare your first-born son for a painful but career-favouring transition. Bec and Scott are back and hitting every high note as they croon, roar and trill their way through hypercalcaemia

Glomerulonephritis Part 1 – Nephrotic Syndromes

Get your amphora ready to catch some of the golden stuff and see if you have the blood and the protein to raise some nephrologist eyebrows. We’ve heard the requests of the people and taken on GN in an epic two-part podcast. This podcast will deal with general approach to glomerulonephritis as well as nephrotic syndromes.

On another note, despite the fact that we are known for our outstanding sound quality we are looking to improve the quality of MedConversations. This means more frequent episodes with better sound.

We’ve started a Patreon page where you can donate as little or as much as you like to help the cause. Any amount at all is super appreciated and all funds will go towards improving the podcast.

Find us on Patreon at https://patreon.com/medconversations

Epilepsy Syndromes

Think you might have what it takes to join the extraordinary league of gentle-people against epilepsy? Well you’ll need some training first. Come join Davor and Rahul for a shake-down of the epilepsy world.

P.S. I tried my best to stop Davor from inflicting another neurology episode on us all, but the man is just so damn charismatic.

Diffuse Parenchymal Lung Disease (Interstitial Lung Disease)

Free your mind from the tyranny of the Lamestream media and discover the TRUTH about diffuse parenchymal lung disease (ILD) with your snowflake bustin’ hosts Rahul and Scott!

Its a long one, so buckle down with your extra doomsday preppin’ supplies.

Inflammatory Bowel Disease – Xmas Edition!

Merry Christmas from Medconversations with our long awaited ep on inflammatory bowel disease. Fake a smile and pretend its just the gift you wanted as Scott and Rahul explore the length of the disease from the mouth to the azathioprine. Get into the consumerist holiday spirit and share/comment this status for a chance to win an authentic Santa toilet seat cover to keep your own cheeks rosy this Christmas!

MET calls: what you can bring (even when you don’t know a thing)

You know when people invite you to dinner and tell you not to bring anything, but actually if you got your act together and brought a salad they’d be really glad? MET calls and interns are kind of like that. This ep is for the interns-in-gestation: we teach you how to make salad.

(Anyone disappointed in the low salad content of this ep should head here afterwards for an unrivalled culinary delight brought to you by MedConversations. And Ottolenghi. You’re welcome.)

Hepatitis C

Call up your injection crew and gather around the gramophone, it’s time for Scott and Rahul to bring you the good news about Hepatitis C – there’s a cure and we’ve distilled it here ready for an acoustic injection. Keep the naloxone on standby, we’ll be your spiritual guides as we go deep!

Answer – HIV PEP Post 16/5/18

Which exposure would NOT be an indication for Post Exposure Prophylaxis (PEP) in an Australian (low HIV prevalence) context?

  1. A man presents after sharing needles with another man who he believes may be HIV positive.
  2. A woman presents following receptive anal intercourse with a HIV + source known to be well controlled on antiretroviral therapy
  3. A lady presents after unprotected vaginal intercourse with a man from a high HIV prevalence country
  4. A healthcare worker presents following a needlestick injury in a patient with poorly controlled HIV’

 

Answer B

New evidence from the partner study suggests that the chance of HIV transmission from a viral load suppressed source is negligible. This groundbreaking study of 1166 serodiscordant partners in whom the HIV+ partner had viral suppression reported 0 cases of HIV transmission between the partners, despite 22,000 condomless sex acts among MSM and 36000 among heterosexual partners. The study was powered to give a 95% upper confidence of 0.3/100 couple years of condomless sex, suggesting that the risk is lower than it was previously thought to be a few years ago.

Add in the the weight of new evidence about the morbidity benefits of ART in the SMART and TEMPRANO trials has led to recent changes in WHO and Australian ASHM, which now recommend starting antiretroviral therapy in almost all HIV patients.

A, C, and D would all be indications for PEP by Australian guidelines. B would not be a indication, nor would even unprotected receptive anal sex with a source with unknown HIV status from the standard Australian low prevalence community – although it could be considered if the source was from a higher prevalence group – eg a country with higher prevalence or a subgroup like IVDU. Remember, this more conservative administration of PEP reflects both new evidence and low Australian prevalence, and many countries might have higher prevalence or not have updated older more conservative guidelines yet.

 

For tons of extra information including probabilities of  transmission risks by different exposures and current indications for PEP check out ASHMs great guidelines here.

http://www.ashm.org.au/products/product/978-1-920773-47-2

And the 2016 WHO guidelines here

http://www.who.int/hiv/pub/arv/arv-2016/en/

THe PARTNER study is here

https://jamanetwork.com/journals/jama/fullarticle/2533066

HIV

Dont forget your PrEP and barrier protection for this intimate all-male episode as Scott and Rahul take you through the racey fundamentals of HIV –  from virology and antivirals to the unadulterated thrill of municipal libraries.

And keep the knowledge pot simmering with Lucy’s great summary here

HIV-Summary-MEDCONVERSATIONS

Research – The How and Why

Ever pondered whether you might suit the professorial lifestyle? This episode, featuring special guests Dr. Adam Brown and Dr. Nitesh Nerlekar, will run through what the appeals of including research in your career are and some basics on how to get started. Drs. Brown and Nitesh are academic cardiologists from Monash Health in Melbourne and have mentored many medical students, junior doctors and PhD candidates in their nascent careers. So sit back, grab a Pina Colada and get caught in the research rain. 

Nitesh, Adam and Rahul (alongside a few other academic doctors) are running a research skills course in Melbourne at the Alfred Hospital over the weekend of May 19-20. This course will provide a more in-depth guide on the skills needed get some publications to your name and avoid some of the traps that many young doctors fall into. You can sign up at www.medcube.com.au

Primary Biliary Cholangitis (née Cirrhosis)

Scratch the itch: let’s get biliary.

Join Bec and Scott on a scintillating exploration of the key TLA’s of gastro: PBC, ANA, AMA, PSC, IgM and LFTs.

 

Test yourself with the Quizlet

And here’s a summary of the topic from the fantastic Lucy Desmond, intern extraordinaire.

Staph Aureus Bacteraemia

Wash your hands before and after Scott and Bec lead you through this sticky podcast on staph aureus bacteraemia. Just like your momma tried and failed to teach you.

Rheumatic fever and rheumatic heart disease

If you’re jonesing for some teaching on rheumatic fever, we’ve got the podcast for you.

 

Link dump:

Clinical manifestations of rheumatic fever by time course

 

Cirrhosis part 1: pathophysiology, aetiology and clinical features

Rahul is temporarily back in our fair island nation, so here’s a cis-pacific podcast on cirrhosis. Part two will follow eventually, but like the course of this chronic disease, you probably know that the natural history of MedConversations can sometimes be slow and unpredictable. Sorry about that.

Asthma

 

Another breathtaking pedagogical podcast from the MedConvos team as we wheeze our way through an approach to asthma.

 

 

Link dump:

Asthma handbook – all you need to know (especially good for management)

(The quizlet will be with you shortly)

Sarcoidosis

Frequently thought of, infrequently seen. Have a listen so you too can chip in with “could it be sarcoid?” at roughly appropriate times.

Parkinson’s disease

Movement disorders – one of the last bastions of medicine where clinician is king. Listen to this podcast and learn how to make this important diagnosis equipped with little more than a keen eye

Here’s the quizlet

Medication management in acute kidney injury

This one’s a shout out to the new interns, the soon-to-be interns and anyone who needs a refresher. But mostly it’s for the pharmacists, who are worried about using up the national stocks of purple ink.

 

Quiz yourself here

Syphilis

Ah, the rich tapestry of the great imitator. Here we talk about 15th century nationalism, disgustingly unethical experiments and Nietzsche. And syphilis.

Revision quizlet is here.

Also, speaking of transmission…help spread the word on MedConversations and shoot us a review on iTunes if you like us and can tolerate dubious segways like this one.

Gout

the_gout_james_gillray

Benjamin Franklin once wrote a play. The two main characters were himself, and gout, and most of the dialogue is along the lines of “eh! oh! eh!”. If you want to learn about gout, probably just read that. But here’s a podcast episode to supplement your learnings.

 

Excerpt from Dialogue Between Franklin and the Gout

Benjamin Franklin, midnight, 22nd October, 1780

 

FRANKLIN. Eh! Oh! Eh! What have I done to merit these cruel sufferings?

GOUT. Many things; you have ate and drank too freely, and too much indulged those legs of yours in their indolence.

FRANKLIN. Who is it that accuses me?

GOUT. It is I, even I, the Gout.

FRANKLIN. What! my enemy in person?

GOUT. No, not your enemy.

FRANKLIN. I repeat it; my enemy; for you would not only torment my body to death, but ruin my good name; you reproach me as a glutton and a tippler; now all the world, that knows me, will allow that I am neither the one nor the other.

GOUT. The world may think as it pleases; it is always very complaisant to itself, and sometimes to its friends; but I very well know that the quantity of meat and drink proper for a man who takes a reasonable degree of exercise, would be too much for another, who never takes any.

 

Read the rest of Franklin’s gout play script here

Acute Promyelocytic Leukaemia

Former Aus Prime Minister Johnny Howard, should have been a haematologist

Former Aus Prime Minister Johnny Howard, should have been a haematologist

Make like John Howard and get to the patient quickly to reach this diagnosis ASAP…one of the most treatable leukaemias but has disastrous consequences if your tracksuit doesn’t get you there in time.

Multiple sclerosis

readathon

An awful disease particularly relevant in cold Melbourne. Promising therapies on the horizon though, and I like to think my scamming of the readathon as a 9 year old to get some sweet loot played a part.

Here’s the quizlet

A video of pendular nystagmus

The excellent radiopaedia page on multiple sclerosis

Pulmonary hypertension

pix1

Why would anyone consume something called toxic rapeseed oil?

We don’t know either, but apparently it can cause pulmonary hypertension. More useful facts lie ahead if you consume this episode instead.

Here’s the quizlet

 

 

Heart failure evaluation

7x5_Giant_Stethoscope

So your heart failure sense is tingling, but how do you know for sure? Rahul and Davor take you through how to work up someone with suspected heart failure.

Here’s the quizlet

And some links:

Good resources that show how to evaluate chest X-rays for pulmonary oedema can be found here and here

American Journal of Medicine paper of clinical heart failure evaluation

Heart failure aetiology

heart failure

Why are people mean to each other? Why can’t we all be friends?

We in no way address those questions, but we do have some lists that any self-respecting young doctor should have readily accessible.

Here’s the quizlet

Hyperkalemia

banana-1-bmp

Hyperkalemia is a nasty surprise often found on routine biochemistry. Who is putting all this extra potassium in our patients’ blood? We attempt to solve the mystery and tell you what to do about it.

Here are some digitalis flashcards

Tremor

shakennotstirred

On this podcast, we tell you about Dianne’s debilitating hand tremor and the basics of diagnosing tremor, as well as a bit about how Dianne’s problem might be managed.

Here are some flashcards to practice with

Link dumping ground:

Video of essential tremor examination

Were James Bond’s drinks shaken because of alcohol induced tremor?

 

Renal failure and Acute Tubular Necrosis

Our first podcast is about kidneys. To get you in the mood, we recommend you listen to this song. If that doesn’t work, we’re not sure what will. Continue reading