Author Archives: Simon Downes, MD, PhD

Medical educator

Pilocarpine in Emergency Glaucoma Treatment: Key Insights

Pilocarpine is a muscarinic agonist that helps in acute angle-closure glaucoma (AACG) by relieving intraocular pressure. Here’s how it works: Mechanism of Action in AACG Why is Pilocarpine Used in Acute Attacks? Limitations & Contraindications Final Note: While pilocarpine is useful in breaking an acute attack, the definitive treatment for AACG is laser peripheral iridotomy…More

A 28-year-old male presents with sudden-onset chest pain and shortness of breath

Question: A 28-year-old male presents with sudden-onset chest pain and shortness of breath. He has no significant medical history. A chest X-ray is performed, which is shown below. What is the most likely diagnosis? Options: A) Pulmonary embolismB) PneumothoraxC) Acute myocardial infarctionD) PneumoniaE) Pleural effusion Image: Chest X-ray showing a large pneumothorax on the right…More

Comparing USMLE and AMC multiple-choice question formats

This document presents a clinical scenario of a 55-year-old male with community-acquired pneumonia and pleural effusion. The recommended management involves initiating empiric antibiotic therapy. It contrasts AMC and USMLE question styles, highlighting the latter’s focus on detailed diagnostic interpretation and complex clinical decision-making in patient care.More

Understanding Left Bundle Branch Block in Heart Failure

A 68-year-old man with dyspnea and lightheadedness shows signs of heart failure and left bundle branch block (LBBB) on ECG. Given his symptoms and reduced ejection fraction, the most appropriate management step is Cardiac Resynchronization Therapy (CRT), which enhances cardiac function and alleviates heart failure symptoms.More

58 yo male describes his symptomatic LBBB (left bundle branch block) to AI

Case: 58 yo male with no previous cardiac history, not taking an medications. Pt statement: “I have a normal cardiac MRI and echo. Since COVID and the vaccine, I’ve experienced transient chest pain with LBBB, sometimes with mild shortness of breath, resolving within 30 seconds. It worsened with exercise, leading to a serious episode that…More

Key Differences Between Polymyalgia Rheumatica and Rheumatoid Arthritis

Polymyalgia rheumatica (PMR) and rheumatoid arthritis (RA) are both inflammatory conditions that can cause joint pain and stiffness, but they have key differences in presentation, pathology, and management. Key Differences Between Polymyalgia Rheumatica and Rheumatoid Arthritis Feature Polymyalgia Rheumatica (PMR) Rheumatoid Arthritis (RA) Onset Sudden or subacute Gradual and insidious Age Group >50 years (usually…More

Is it still worth going to a carribean medical school?

Why Going to Medical School is Worth It—Even If It’s a Caribbean School or Takes a Long Time Pursuing a medical degree is one of the most rewarding and fulfilling decisions one can make. While attending a top-tier U.S. or European medical school is the ideal path for many, there are plenty of reasons why…More

Are they close to develping effective medicines for long covid?

As of January 2025, the development of effective treatments for long COVID remains a significant challenge. While various therapeutic approaches are under investigation, no universally effective treatment has been identified to date. The National Institutes of Health (NIH) has initiated clinical trials to explore potential treatments targeting specific symptoms of long COVID, such as sleep…More