Issue #27 (December 2021)


Dear Reader, 

This year has been quite exciting at Medical Joyworks, with both good and non-so-good things. We surpassed 7 million app downloads. We doubled the size of our team. We released a new version of Clinical Odyssey.
We published our 700th learning module. We all got vaccinated (multiple times). We took to court the subsidiary of an Indian edtech unicorn for having stolen our IP (for more info visit: We sold our first turnkey solutions to medical and nursing schools. And so much more.

I admit, it has been intense, but VERY fun. Moreover, it is a real treat to appreciate how—even after 11 years in business—we continue to create products and services that stand out for their high quality and engaging nature. Just the other day a business associate mentioned how our MCQs library, despite its modest size, does not repeat vignettes or answer options anywhere, explains the subject matter with great precision, and even rarely has a typo. In his own words: "this product is far superior than most qbanks I used throughout my medical studies."

When I hear this I can only smile, because staying in business for over a decade (on our own dime) is an achievement. But what really satisfies me is knowing that Sandaruwan, Miguel, Poornima, Stan, Julia, Dilum, Sayuri, our writers and IMB members, and countless former colleagues and contributors have all succeeded in maintaining the highest standards for everything that we do. 

So as the year closes and the holiday season kicks into full gear, I can only say thank you to them for all their hard work and dedication. They really put our customers first, always.

As for our customers—THANK YOU for your continued business and enthusiasm towards what we do. Medical Joyworks is all about bringing joy to the medical profession. When we see that you are happy with our work, we know that we are fulfilling our mission.

Seasons Greetings,

Dr. Nayana Somaratna,
CEO & Co-Founder,
Medical Joyworks


The latest from MJ

  • Our first ever IMB Town Hall was a big success. Our IMB members will be hearing more about the experience from Julia in the coming weeks. If you missed it, no worries. We will have more IMB Town Halls soon.
  • To help us peer-review learning modules, we need specialists in: general surgery, orthopedic surgery, pediatrics, obstetrics and gynecology, neurosurgery, intensive care, critical care, psychiatry, urology, neurology, nephrology, endocrinology, and pulmonology. If you are a specialist (or specialist in training), or know of someone who fits the part, have them contact Julia Botija at


Q&As from our user community

Clinical Sense: Ingested (Poisoning, Acetaminophen - Acute)

Q: Why did you delay administration of N-acetyl-cysteine (NAC) until paracetamol levels were estimated? Why not just start it immediately?
A: No medication is without risk; and this holds true for NAC infusions. It is true that the risk of side effects and adverse reactions has decreased over time, thanks to new infusion protocols. However, this risk is still not zero.

Research indicates that acetaminophen (paracetamol)-induced hepatotoxicity does not occur before 8 hours post-ingestion; while peak plasma acitaminophen concentrations occur at ~4 hours after ingestion. Hence, there is little risk in witholding NAC until peak plasma concentrations are calculated.
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: Hyperactive (Graves' Disease)

Q: This patient with Graves' disease did not receive radioiodine therapy. Why did you start glucocorticoids?
A: As you have correctly implied, radioiodine therapy for Graves' disease should be accompanied by glucocorticoids. This is because radioiodine can worsen Graves ophthalmopathy (GO); glucocorticoids help alleviate this. However, this patient has moderate GO; in such individuals, guidelines recommend the use of glucocorticoids, even if radioiodine is not used. Note that if she had mild GO, glucocorticoids would not have been indicated.

The following recent article provides a meta-analysis of treatments for thyroid eye disease:
If you would like to play this scenario or join the conversation, go to the Prognosis: Your Diagnosis app in your mobile device.


Recently released stories

Complex - Play it free online
Lumpy - Play it in Clinical Odyssey
Adverse - Play it in Clinical Odyssey
Conundrum - Play it free online
Continuous - Play it in Clinical Odyssey
Yet more bleeding - Play it in Clinical Odyssey
Peptic ulcer disease - Read it free online
... and more.
That's all for now!

Tell us what you think or share valuable insights with the community by writing to us at:


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