Welcome to the next episode of The Reveal where we take you inside the mind of a test-taker to deconstruct and connect the dots of a board-style question so you can become a better student, transform how you learn, and excel not only on high-stakes exams, but also in your general medical knowledge. Let’s get started.Episode 18 is limited to audio only, but video returns for episode 19.A 21-year-old woman presents with pain, tearing, photophobia, and left eye redness. She has been wearing her contact lenses continuously for the last two weeks. A slit lamp examination reveals a white, hazy opacity on the cornea at the 3 o’clock position of the cornea with associated limbal flush. Which of the following is the most appropriate pharmacotherapy?A. Topical acyclovirB. Topical amphotericin BC. Topical ciprofloxacinD. Topical cyclopentolateYou can find other episodes of The Rosh Reveal podcast here. Remember to subscribe to the podcast and leave us feedback!Apple podcastsAndroidGoogle podcastsFor more great Rosh Review content, including thousands of more questions, explanations, and custom teaching images, visit any of the pages below:  PA: Didactics, Rotation Exams, PANCE, PANRENurse Practitioner: Certification Exam, ENP Certification Exam, AGACNP Certification Exam, AGPCNP Certification Exam, CPNP-PC Certification Exam, PMHNP Certification ExamNursing: Certified Emergency Nurse (CEN) Certification ExamEmergency Medicine: In-Training Exam, Certification Exam, ConCertFamily Medicine: In-Training Exam, Certification ExamPediatrics: In-Training Exam, Certification ExamOB/GYN: In-Training Exam, Certification ExamInternal Medicine: In-Training Exam, Certification ExamPsychiatry: In-Training Exam, Certification ExamThe post What Is the First-Line Treatment for This Patient’s Eye Pain? appeared first on RoshReview.com.

<h6>Welcome to the next episode of The Reveal where we take you inside the mind of a test-taker to deconstruct and connect the dots of a board-style question so you can become a better student, transform how you learn, and excel not only on high-stakes exams, but also in your general medical knowledge. Let’s get started.</h6>Episode 18 is limited to audio only, but video returns for episode 19.A 21-year-old woman presents with pain, tearing, photophobia, and left eye redness. She has been wearing her contact lenses continuously for the last two weeks. A slit lamp examination reveals a white, hazy opacity on the cornea at the 3 o’clock position of the cornea with associated limbal flush. Which of the following is the most appropriate pharmacotherapy?A. Topical acyclovirB. Topical amphotericin BC. Topical ciprofloxacinD. Topical cyclopentolateYou can find other episodes of <a href="https://www.roshreview.com/vodcast/the-rosh-reveal/" rel="noreferrer noopener nofollow" target="_blank">The Rosh Reveal podcast here</a>. Remember to subscribe to the podcast and leave us feedback!<a href="https://podcasts.apple.com/us/podcast/the-reveal/id1449077287?ls=1&amp;mt=2#episodeGuid=https%3A%2F%2Fwww.roshreview.com%2F%3Fp%3D7799" rel="noreferrer noopener nofollow" target="_blank">Apple podcasts</a><a href="https://subscribeonandroid.com/www.roshreview.com/feed/thereveal/" rel="noreferrer noopener nofollow" target="_blank">Android</a><a href="https://podcasts.google.com/?feed=aHR0cHM6Ly93d3cucm9zaHJldmlldy5jb20vZmVlZC90aGVyZXZlYWw" rel="noreferrer noopener nofollow" target="_blank">Google podcasts</a>For more great Rosh Review content, including thousands of more questions, explanations, and custom teaching images, visit any of the pages below: PA: <a href="https://www.roshreview.com/specialties/physician-assistant/pa-d/" rel="noreferrer noopener nofollow" target="_blank">Didactics</a>, <a href="https://www.roshreview.com/specialties/physician-assistant/" rel="noreferrer noopener nofollow" target="_blank">Rotation Exams</a>, <a href="https://www.roshreview.com/specialties/physician-assistant/" rel="noreferrer noopener nofollow" target="_blank">PANCE</a>, <a href="https://www.roshreview.com/specialties/physician-assistant/pa-c/" rel="noreferrer noopener nofollow" target="_blank">PANRE</a>Nurse Practitioner: <a href="https://www.roshreview.com/fnp/" rel="noreferrer noopener nofollow" target="_blank">Certification Exam</a>, <a href="https://www.roshreview.com/specialties/nurse-practitioner/enp/" rel="noreferrer noopener nofollow" target="_blank">ENP Certification Exam</a>, <a href="https://www.roshreview.com/specialties/nurse-practitioner/agacnp/" rel="noreferrer noopener nofollow" target="_blank">AGACNP Certification Exam</a>, <a href="https://www.roshreview.com/specialties/nurse-practitioner/agpcnp/" rel="noreferrer noopener nofollow" target="_blank">AGPCNP Certification Exam</a>, <a href="https://www.roshreview.com/specialties/nurse-practitioner/cpnp-pc/" rel="noreferrer noopener nofollow" target="_blank">CPNP-PC Certification Exam</a>, <a href="https://www.roshreview.com/specialties/nurse-practitioner/pmhnp/" rel="noreferrer noopener nofollow" target="_blank">PMHNP Certification Exam</a>Nursing: <a href="https://www.roshreview.com/specialties/nurse-practitioner/cen/" rel="noreferrer noopener nofollow" target="_blank">Certified Emergency Nurse (CEN) Certification Exam</a>Emergency Medicine: <a href="https://www.roshreview.com/specialties/emergency-medicine/" rel="noreferrer noopener nofollow" target="_blank">In-Training Exam</a>, <a href="https://www.roshreview.com/specialties/emergency-medicine/" rel="noreferrer noopener nofollow" target="_blank">Certification Exam</a>, <a href="https://www.roshreview.com/specialties/emergency-medicine/" rel="noreferrer noopener nofollow" target="_blank">ConCert</a>Family Medicine: <a href="https://www.roshreview.com/specialties/family-medicine/" rel="noreferrer noopener nofollow" target="_blank">In-Training Exam,</a> <a href="https://www.roshreview.com/specialties/family-medicine/" rel="noreferrer noopener nofollow" target="_blank">Certification Exam</a>Pediatrics: <a href="https://www.roshreview.com/specialties/pediatric-medicine/" rel="noreferrer noopener nofollow" target="_blank">In-Training Exam</a>, <a href="https://www.roshreview.com/specialties/pediatric-medicine/" rel="noreferrer noopener nofollow" target="_blank">Certification Exam</a>OB/GYN: <a href="https://www.roshreview.com/specialties/obstetrics-gynecology/" rel="noreferrer noopener nofollow" target="_blank">In-Training Exam</a>, <a href="https://www.roshreview.com/specialties/obstetrics-gynecology/" rel="noreferrer noopener nofollow" target="_blank">Certification Exam</a>Internal Medicine: <a href="https://www.roshreview.com/specialties/internal-medicine/" rel="noreferrer noopener nofollow" target="_blank">In-Training Exam</a>, <a href="https://www.roshreview.com/specialties/internal-medicine/" rel="noreferrer noopener nofollow" target="_blank">Certification Exam</a>Psychiatry: <a href="https://www.roshreview.com/specialties/psychiatry/" rel="noreferrer noopener nofollow" target="_blank">In-Training Exam</a>, <a href="https://www.roshreview.com/specialties/psychiatry/" rel="noreferrer noopener nofollow" target="_blank">Certification Exam</a>The post <a href="https://www.roshreview.com/blog/vodcast/the-rosh-reveal/the-rosh-reveal-ep18" rel="nofollow" target="_blank">What Is the First-Line Treatment for This Patient’s Eye Pain?</a> appeared first on <a href="https://www.roshreview.com/blog" rel="nofollow" target="_blank">RoshReview.com</a>.

What Is the First-Line Treatment for This Patient’s Eye Pain?

Welcome back to RoshCast for Episode 52! For those of you taking the upcoming in-training exam, an early congratulations! All of your hard work will surely pay off soon. Remember to listen to this episode and old episodes as you get closer to the end for more review. Good luck from us at the RoshCast team!Begin to be now what you will be hereafter.–William JamesQuestion 1A 64-year-old woman presents to the emergency department with a right-sided headache. Past medical history includes hypertension, migraines, and polymyalgia rheumatica. Her symptoms started three days ago and have progressively worsened. She states that this headache is different from her previous migraines. It is frontal and she describes it as an ache without radiation of symptoms. She does describe worsening of symptoms with eating as well as when she brushes her hair. She admits to feeling more tired the last couple of days as well as having partial vision loss in the right eye. She denies any nausea or vomiting. Vital signs demonstrate a temperature of 38°C but otherwise are within normal limits. Physical examination is remarkable for tenderness to palpation over the right temple and visual acuities of 20/40 OS and 20/80 OD. What is the most appropriate next step in this patient’s management?A. Intravenous methylprednisoloneB. Obtain erythrocyte sedimentation rate and C-reactive protein to confirm the diagnosisC. Obtain temporal artery biopsyD. Oral prednisoneTeaching ImageQuestion 2A 42-year-old man presents to the emergency department with lower back pain that started acutely while lifting a couch. He complains of pain radiating to the right posterolateral calf. He denies any bowel or bladder incontinence. On examination, he has decreased plantar flexion at the right ankle and numbness of the right lateral foot. Disk herniation at which level is most likely responsible for his findings?A. L2–L3B. L3–L4C. L4–L5D. L5–S1Teaching ImageQuestion 3Which of the following is most likely to be seen in hepatorenal syndrome?A. Arteriolar congestionB. Histologically normal kidneysC. Necrosis of the renal tubulesD. Segmental sclerosis of the renal glomeruliTeaching ImageQuestion 4A 27-year-old man presents to the ED with left-hand pain. He was at work as an auto mechanic when he accidentally injected his left index finger with a grease gun. On physical exam, the digit is swollen with a central pinhole wound. The remainder of the hand exam is unremarkable. Which of the following will best determine the amount of tissue damage a substance will cause?A. Chemical properties of the substanceB. The pressure of the injectionC. The temperature of the substance injectedD. The volume of the substance injectedTeaching ImageQuestion 5A 5-year-old girl presents to the ED with a rash that started on her face and spread to her neck, axillae, and groin. Mom states that the patient had an upper respiratory infection one week prior. On examination, the patient’s rash is tender to the touch. Which of the following statements regarding the diagnosis of this patient’s condition is correct?A. Deep layers of the dermis are involvedB. It often leaves the patient disfigured from scarringC. Mucous membrane involvement is commonD. The disease is caused by an exotoxin producing bacteriaTeaching ImageQuestion 6A 22-year-old man complains of pain, photophobia, and vision loss in his eye. He has a history of sickle cell anemia. His vision is 20/200 in the affected eye. Intraocular pressure is 30 mm Hg in the affected eye. You see the above finding on physical exam. Which of the following medications should be immediately administered to this patient?A. Intravenous ketorolacB. Intravenous mannitolC. Topical acetazolamideD. Topical timololTeaching ImageVision loss is the most concerning clinical feature in patients with temporal arteritis, whereas jaw claudication is the clinical feature that is most likely associated with a positive temporal artery biopsy.S1 radiculopathy leads to decreased plantar flexion, numbness to the lateral foot, decreased sensation along the posterolateral calf, and decreased Achilles reflex.Hepatorenal syndrome leads to arteriolar constriction and the kidneys here would appear normal histologically.The chemical properties of the substance injected is the primary determinant of damage caused by high-pressure injection injury. While air and clean water have a benign course, paint solvents cause the most severe inflammation.Staph scalded skin syndrome presents in children less than 5 years old and often follows a URI. The rash starts on the face, neck, axillae, and groin, and there will be a positive Nikolsky sign.Patients with a spontaneous hyphema present with decreased visual acuity, elevated intraocular pressure, and an afferent pupillary defect. Immediate treatment is with agents that lower intraocular pressure including topical timolol.That wraps up RoshCast Episode 52! Creating and producing RoshCast has been a ton of fun, but it also takes a ton of time. We are unfortunately halting production for the time being to focus on other projects. We thank you all for your long-time listenership. And don’t forget that there are 51 other episodes. Listen and re-listen on your commute to work, at the gym, or even just at a desk during dedicated study time. A huge thanks also goes out to all of the folks at Rosh Review who have worked diligently to create high-quality clinical questions. If you need to reach us, please e-mail Nachi at nachig@gmail.com. Be sure to also check out the rest of the Rosh Review Blog for questions from prior episodes, related images, and tables, as well as bonus teaching points.Jeff, Megha, and NachiThe post Podcast Ep 52: Temporal Arteritis, Disc Herniations, Hepatorenal Syndrome, High Pressure Injection Injury, Pediatric Rash, Hyphema appeared first on RoshReview.com.

<h6>Welcome back to RoshCast for Episode 52! For those of you taking the upcoming in-training exam, an early congratulations! All of your hard work will surely pay off soon. Remember to listen to this episode and old episodes as you get closer to the end for more review. Good luck from us at the RoshCast team!</h6><blockquote>Begin to be now what you will be hereafter.–William James</blockquote><h6>Question 1</h6>A 64-year-old woman presents to the emergency department with a right-sided headache. Past medical history includes hypertension, migraines, and polymyalgia rheumatica. Her symptoms started three days ago and have progressively worsened. She states that this headache is different from her previous migraines. It is frontal and she describes it as an ache without radiation of symptoms. She does describe worsening of symptoms with eating as well as when she brushes her hair. She admits to feeling more tired the last couple of days as well as having partial vision loss in the right eye. She denies any nausea or vomiting. Vital signs demonstrate a temperature of 38°C but otherwise are within normal limits. Physical examination is remarkable for tenderness to palpation over the right temple and visual acuities of 20/40 OS and 20/80 OD. What is the most appropriate next step in this patient’s management?A. Intravenous methylprednisoloneB. Obtain erythrocyte sedimentation rate and C-reactive protein to confirm the diagnosisC. Obtain temporal artery biopsyD. Oral prednisone<a href="https://www.roshreview.com/wp-content/uploads/Ep52-Temporal-Arteritis.png" rel="nofollow" target="_blank">Teaching Image</a><h6>Question 2</h6>A 42-year-old man presents to the emergency department with lower back pain that started acutely while lifting a couch. He complains of pain radiating to the right posterolateral calf. He denies any bowel or bladder incontinence. On examination, he has decreased plantar flexion at the right ankle and numbness of the right lateral foot. Disk herniation at which level is most likely responsible for his findings?A. L2–L3B. L3–L4C. L4–L5D. L5–S1<a href="https://www.roshreview.com/wp-content/uploads/Ep52-Disc-Herniation.jpg" rel="nofollow" target="_blank">Teaching Image</a><h6>Question 3</h6>Which of the following is most likely to be seen in hepatorenal syndrome?A. Arteriolar congestionB. Histologically normal kidneysC. Necrosis of the renal tubulesD. Segmental sclerosis of the renal glomeruli<a href="https://www.roshreview.com/wp-content/uploads/Ep52-Hepatorenal-Syndrome.png" rel="nofollow" target="_blank">Teaching Image</a><h6>Question 4</h6>A 27-year-old man presents to the ED with left-hand pain. He was at work as an auto mechanic when he accidentally injected his left index finger with a grease gun. On physical exam, the digit is swollen with a central pinhole wound. The remainder of the hand exam is unremarkable. Which of the following will best determine the amount of tissue damage a substance will cause?A. Chemical properties of the substanceB. The pressure of the injectionC. The temperature of the substance injectedD. The volume of the substance injected<a href="https://www.roshreview.com/wp-content/uploads/Ep52-High-Pressure-Injection-Injury.png" rel="nofollow" target="_blank">Teaching Image</a><h6>Question 5</h6>A 5-year-old girl presents to the ED with a rash that started on her face and spread to her neck, axillae, and groin. Mom states that the patient had an upper respiratory infection one week prior. On examination, the patient’s rash is tender to the touch. Which of the following statements regarding the diagnosis of this patient’s condition is correct?A. Deep layers of the dermis are involvedB. It often leaves the patient disfigured from scarringC. Mucous membrane involvement is commonD. The disease is caused by an exotoxin producing bacteria<a href="https://www.roshreview.com/wp-content/uploads/Ep52-SSSS.png" rel="nofollow" target="_blank">Teaching Image</a><h6>Question 6</h6>A 22-year-old man complains of pain, photophobia, and vision loss in his eye. He has a history of sickle cell anemia. His vision is 20/200 in the affected eye. Intraocular pressure is 30 mm Hg in the affected eye. You see the above finding on physical exam. Which of the following medications should be immediately administered to this patient?A. Intravenous ketorolacB. Intravenous mannitolC. Topical acetazolamideD. Topical timolol<a href="https://www.roshreview.com/wp-content/uploads/Ep52-Hyphema.png" rel="nofollow" target="_blank">Teaching Image</a><ul><li>Vision loss is the most concerning clinical feature in patients with temporal arteritis, whereas jaw claudication is the clinical feature that is most likely associated with a positive temporal artery biopsy.</li><li>S1 radiculopathy leads to decreased plantar flexion, numbness to the lateral foot, decreased sensation along the posterolateral calf, and decreased Achilles reflex.</li><li>Hepatorenal syndrome leads to arteriolar constriction and the kidneys here would appear normal histologically.</li><li>The chemical properties of the substance injected is the primary determinant of damage caused by high-pressure injection injury. While air and clean water have a benign course, paint solvents cause the most severe inflammation.</li><li>Staph scalded skin syndrome presents in children less than 5 years old and often follows a URI. The rash starts on the face, neck, axillae, and groin, and there will be a positive Nikolsky sign.</li><li>Patients with a spontaneous hyphema present with decreased visual acuity, elevated intraocular pressure, and an afferent pupillary defect. Immediate treatment is with agents that lower intraocular pressure including topical timolol.</li></ul>That wraps up RoshCast Episode 52! Creating and producing RoshCast has been a ton of fun, but it also takes a ton of time. We are unfortunately halting production for the time being to focus on other projects. We thank you all for your long-time listenership. And don’t forget that there are 51 other episodes. Listen and re-listen on your commute to work, at the gym, or even just at a desk during dedicated study time. A huge thanks also goes out to all of the folks at Rosh Review who have worked diligently to create high-quality clinical questions. If you need to reach us, please e-mail Nachi at <a href="mailto:nachig@gmail.com">nachig@gmail.com</a>. Be sure to also check out the rest of the <a href="https://www.roshreview.com/blog/" rel="noreferrer noopener nofollow" target="_blank">Rosh Review Blog</a> for questions from prior episodes, related images, and tables, as well as bonus teaching points.Jeff, Megha, and NachiThe post <a href="https://www.roshreview.com/blog/podcast-ep-52-temporal-arteritis-disc-herniations-hepatorenal-syndrome-high-pressure-injection-injury-pediatric-rash-hyphema/" rel="nofollow" target="_blank">Podcast Ep 52: Temporal Arteritis, Disc Herniations, Hepatorenal Syndrome, High Pressure Injection Injury, Pediatric Rash, Hyphema</a> appeared first on <a href="https://www.roshreview.com/blog" rel="nofollow" target="_blank">RoshReview.com</a>.

Ep 52 Roshcast Emergency Board Review

A champion is defined not by their wins but by how they can recover when they fall.–Serena WilliamsWelcome back to RoshCast for Episode 51! For those of you taking the initial certification exam, you’re at the home stretch. Remember to listen to this episode and old episodes as you get closer to the end for more review. Good luck from us at the RoshCast team! We have a great episode for you to get you prepped in your final studies!Question 1A 46-year-old man presents with a progressive dull headache over the past 3 weeks. It is worse in the morning and with bending over or coughing. He denies any fever or congestion. For the last two days, he has had associated nausea and three episodes of vomiting. Which of the following characteristics seen on neuroimaging would be most consistent with a glioblastoma?A. Heterogenous mass with central necrosisB. Lack of enhancement with administration of contrastC. Presence of calcificationsD. Well circumscribed marginsTeaching ImageQuestion 2A 16-year-old African American boy presents with a scalp rash. On examination, it is a 5 x 5 cm boggy and thickened area of the right parietal cap with an overlying scaly and crusty plaque and hair loss. The lesion appears yellowish-green under a Wood’s lamp. What is the treatment of choice for this lesion?A. Clotrimazole ointmentB. Ketoconazole shampooC. Oral amphotericin BD. Oral griseofulvinTeaching ImageQuestion 3A 22-year-old man recently diagnosed with schizophrenia presents to the ED with altered mental status. His blood pressure is 160/80 mm Hg, pulse 130 beats per minute, and temperature is 39.5°C. He is noted to be confused and diaphoretic. He has muscle rigidity and a tremor in his hands. What is the most likely diagnosis?A. Malignant hyperthermiaB. Neuroleptic malignant syndromeC. Serotonin syndromeD. Tyramine reactionTeaching ImageQuestion 4A 21-year-old woman presents with painful urination. She has no vaginal discharge and is not sexually active. Which of the following is most sensitive for a urinary tract infection on urine dipstick testing?A. BacteriaB. BloodC. Leukocyte esteraseD. NitritesTeaching ImageQuestion 5Which of the following findings would be consistent with a diagnosis of tetralogy of Fallot?A. Bounding pulses and a continuous machine-like murmurB. Decreased pulses in lower extremitiesC. Increased pulmonary vascular markings on chest radiographyD. Loud, single second heart sound with a harsh systolic murmurTeaching ImageQuestion 6A 73-year-old man presents with painless vision loss in the right eye. Which of the following on funduscopic examination is most characteristic of central retinal vein occlusion?A. Cherry red foveaB. Pale retinaC. PapilledemaD. Retinal hemorrhagesTeaching ImageTeaching ImageTeaching ImageGlioblastoma is the most common primary malignant brain tumor in adults and presents as a heterogeneous mass with central necrosis.A kerion is a boggy, pus-filled lesion caused by a fungal infection on the scalp. It is treated with a 6 to 8-week course of oral griseofulvin.New antipsychotic medication administration and a presentation of altered mental status, muscle rigidity, hyperthermia, and autonomic instability is classic for the diagnosis of neuroleptic malignant syndrome.On urine dipstick, leukocyte esterase is sensitive while nitrites are specific for a urinary tract infection.Tetralogy of Fallot is the most common cyanotic congenital heart disease and is associated with a harsh systolic murmur that improves with squatting.Central retinal vein occlusion presents with sudden, painless, monocular vision loss with the classic “blood and thunder” appearance and retinal hemorrhages.That wraps up RoshCast Episode 51! Be sure to also check out the rest of the Rosh Review Blog for questions from prior episodes, related images, and tables, and bonus teaching points. There are also tons of other great free resources to help prepare you for the boards and the wards. Don’t forget to follow us on twitter @RoshCast. And you can always email us at RoshCast@RoshReview.com with any feedback, corrections, or suggestions. You can also help us pick questions by identifying ones you would like us to review. Write “RoshCast” in the submit feedback box as you go through the question bank. Lastly, if you have a minute, make sure to rate us and leave comments on iTunes to help spread the word about RoshCast.Megha and NachiThe post Podcast Ep 51: Glioblastoma, Kerion, Antipsychotics, Urine Dipstick, Tetalogy of Fallot, Central Retinal Vein Occlusion appeared first on RoshReview.com.

<blockquote>A champion is defined not by their wins but by how they can recover when they fall.–Serena Williams</blockquote><h6>Welcome back to RoshCast for Episode 51! For those of you taking the initial certification exam, you’re at the home stretch. Remember to listen to this episode and old episodes as you get closer to the end for more review. Good luck from us at the RoshCast team! We have a great episode for you to get you prepped in your final studies!</h6>Question 1A 46-year-old man presents with a progressive dull headache over the past 3 weeks. It is worse in the morning and with bending over or coughing. He denies any fever or congestion. For the last two days, he has had associated nausea and three episodes of vomiting. Which of the following characteristics seen on neuroimaging would be most consistent with a glioblastoma?A. Heterogenous mass with central necrosisB. Lack of enhancement with administration of contrastC. Presence of calcificationsD. Well circumscribed margins<a href="https://www.roshreview.com/wp-content/uploads/Ep51-Glioblastoma-Multiforme.png" rel="nofollow" target="_blank">Teaching Image</a>Question 2A 16-year-old African American boy presents with a scalp rash. On examination, it is a 5 x 5 cm boggy and thickened area of the right parietal cap with an overlying scaly and crusty plaque and hair loss. The lesion appears yellowish-green under a Wood’s lamp. What is the treatment of choice for this lesion?A. Clotrimazole ointmentB. Ketoconazole shampooC. Oral amphotericin BD. Oral griseofulvin<a href="https://www.roshreview.com/wp-content/uploads/Ep51-Kerion.png" rel="nofollow" target="_blank">Teaching Image</a>Question 3A 22-year-old man recently diagnosed with schizophrenia presents to the ED with altered mental status. His blood pressure is 160/80 mm Hg, pulse 130 beats per minute, and temperature is 39.5°C. He is noted to be confused and diaphoretic. He has muscle rigidity and a tremor in his hands. What is the most likely diagnosis?A. Malignant hyperthermiaB. Neuroleptic malignant syndromeC. Serotonin syndromeD. Tyramine reaction<a href="https://www.roshreview.com/wp-content/uploads/Ep51-NMS.jpg" rel="nofollow" target="_blank">Teaching Image</a>Question 4A 21-year-old woman presents with painful urination. She has no vaginal discharge and is not sexually active. Which of the following is most sensitive for a urinary tract infection on urine dipstick testing?A. BacteriaB. BloodC. Leukocyte esteraseD. Nitrites<a href="https://www.roshreview.com/wp-content/uploads/Ep51-Urinalysis.png" rel="nofollow" target="_blank">Teaching Image</a>Question 5Which of the following findings would be consistent with a diagnosis of tetralogy of Fallot?A. Bounding pulses and a continuous machine-like murmurB. Decreased pulses in lower extremitiesC. Increased pulmonary vascular markings on chest radiographyD. Loud, single second heart sound with a harsh systolic murmur<a href="https://www.roshreview.com/wp-content/uploads/Ep51-Tetralogy-of-Fallot.png" rel="nofollow" target="_blank">Teaching Image</a>Question 6A 73-year-old man presents with painless vision loss in the right eye. Which of the following on funduscopic examination is most characteristic of central retinal vein occlusion?A. Cherry red foveaB. Pale retinaC. PapilledemaD. Retinal hemorrhages<a href="https://www.roshreview.com/wp-content/uploads/Ep51-CRVO.png" rel="nofollow" target="_blank">Teaching Image</a><a href="https://www.roshreview.com/wp-content/uploads/Ep51-CRAO.png" rel="nofollow" target="_blank">Teaching Image</a><a href="https://www.roshreview.com/wp-content/uploads/Ep51-Papilledema.jpg" rel="nofollow" target="_blank">Teaching Image</a><ul><li>Glioblastoma is the most common primary malignant brain tumor in adults and presents as a heterogeneous mass with central necrosis.</li><li>A kerion is a boggy, pus-filled lesion caused by a fungal infection on the scalp. It is treated with a 6 to 8-week course of oral griseofulvin.</li><li>New antipsychotic medication administration and a presentation of altered mental status, muscle rigidity, hyperthermia, and autonomic instability is classic for the diagnosis of neuroleptic malignant syndrome.</li><li>On urine dipstick, leukocyte esterase is sensitive while nitrites are specific for a urinary tract infection.</li><li>Tetralogy of Fallot is the most common cyanotic congenital heart disease and is associated with a harsh systolic murmur that improves with squatting.</li><li>Central retinal vein occlusion presents with sudden, painless, monocular vision loss with the classic “blood and thunder” appearance and retinal hemorrhages.</li></ul>That wraps up RoshCast Episode 51! Be sure to also check out the rest of the <a href="https://www.roshreview.com/blog/" rel="noreferrer noopener nofollow" target="_blank">Rosh Review Blog</a> for questions from prior episodes, related images, and tables, and bonus teaching points. There are also tons of other great free resources to help prepare you for the boards and the wards. Don’t forget to follow us on twitter <a href="https://twitter.com/roshcast?lang=en" rel="nofollow" target="_blank">@RoshCast</a>. And you can always email us at <a href="mailto:roshcast@roshreview.com">RoshCast@RoshReview.com</a> with any feedback, corrections, or suggestions. You can also help us pick questions by identifying ones you would like us to review. Write “RoshCast” in the submit feedback box as you go through the question bank. Lastly, if you have a minute, make sure to rate us and leave comments on <a href="https://itunes.apple.com/us/podcast/roshcast/id1156487141?mt=2" rel="noreferrer noopener nofollow" target="_blank">iTunes</a> to help spread the word about RoshCast.Megha and NachiThe post <a href="https://www.roshreview.com/blog/podcast-ep-51-glioblastoma-kerion-antipsychotics-urine-dipstick-tetalogy-of-fallot-central-retinal-vein-occlusion/" rel="nofollow" target="_blank">Podcast Ep 51: Glioblastoma, Kerion, Antipsychotics, Urine Dipstick, Tetalogy of Fallot, Central Retinal Vein Occlusion</a> appeared first on <a href="https://www.roshreview.com/blog" rel="nofollow" target="_blank">RoshReview.com</a>.

Ep 51 Roshcast Emergency Board Review

A hero is someone who has given his or her life to something bigger than oneself.–Joseph CampbellWelcome back to RoshCast for Episode 50! Wow!! We can’t believe we’re already at Episode 50. It’s been a real journey building this podcast from the original concept two years ago. And in the last year, we have seen some pretty big changes, including Megha joining the team. We are excited to see how RoshCast continues to evolve over the next fifty episodes and two years. None of this would be possible without you, our listeners. Your listenership and feedback is what drives us to keep delivering high-quality content! We value every moment you give your attention to us, and we try our best to design the episode to maximize your learning. We have a pretty involved process for choosing questions to present to you and for how we manipulate and deliver the content before we get it to your ears.With that, let’s kick off a great episode!Question 1A 70-year-old woman with history of coronary artery disease, hypertension, and diabetes presents to the emergency department with chest pressure and shortness of breath. Her exam is notable for a new holosystolic murmur best heard over the midaxillary line as well as diffuse bilateral rales. Which of the following is most likely to be seen on this patient’s ECG?A. Biventricular tachycardiaB. S1Q3T3 patternC. ST-depressions in I, V6, and aVL without ST-elevationsD. ST elevations in II, III, aVFTeaching ImageQuestion 2A 26-year-old woman with no medical history presents with bleeding gums after brushing her teeth for the last three days. Her complaint was preceded two weeks ago by a URI. Her examination is unremarkable except for oozing from the gums. Labs show a platelet count of 23,000. Which of the following is the most appropriate next step in management?A. IV immunoglobulinB. Platelet transfusionC. Steroids, IV immunoglobulinD. Steroids, IV immunoglobulin, and platelet transfusionTeaching ImageQuestion 3Which of the following is most suggestive of measles infection?A. A prodrome of fever, lymphadenopathy, and conjunctivitis followed by a maculopapular rash that starts on the face and spreads to the trunk and limbsB. Diffuse maculopapular rash with white spots on the buccal mucosaC. High fever for three days followed by the appearance of a pink maculopapular rash after defervescenceD. Presence of shallow ulcers on oral mucosa and vesicular lesions on the palms and solesTeaching ImageQuestion 4A 23-year-old man who has unprotected, receptive anal intercourse presents to the ED with two weeks of worsening rectal pain and dyschezia. On exam, he has numerous ulcers in the anorectal area and a crop of grouped vesicles containing clear fluid on an erythematous base. The surrounding skin shows no sign of cellulitis or abscess. Which of the following is the most appropriate next step?A. Refer the patient to a surgeon for operative interventionB. Send a serology testC. Send a Tzanck smearD. Treat with acyclovirQuestion 5A 5-year-old boy with von Willebrand disease presents with persistent bleeding after he lost a tooth 4 hours ago. Vital signs are unremarkable. Physical exam reveals oozing at the site of the tooth which persists despite pressure. Which of the following is the most appropriate treatment?A. DesmopressinB. Factor VIII concentrateC. Fresh frozen plasmaD. Vitamin KTeaching ImageQuestion 6A 70-year-old man with a history of chronic neck pain presents after a fall. On physical examination, he has a laceration on his chin. Motor strength is 2/5 in his upper extremities and 4/5 in his lower extremities. He has decreased sensation to soft touch in both legs. Which of the following is the most likely diagnosis?A. Anterior cord syndromeB. Brown-Sequard syndromeC. Cauda equina syndromeD. Central cord syndromeTeaching ImageA new holosystolic murmur over the midaxillary line, with signs of heart failure, is consistent with acute mitral valve regurgitation. Think of inferior stemi as a possible cause here.Immune thrombocytopenia presents with bleeding that is often preceded by a viral illness. It is treated with steroids and IVIG in most cases. For those with severe or life-threatening bleeding, platelet transfusion should be considered as well.Measles presents with a prodrome of fever and three Cs (coryza, cough, and conjunctivitis) followed by a diffuse maculopapular rash and Koplik spots.A painful vesicular rash on an erythematous base in the anorectal area is consistent with herpes simplex proctitis. Diagnosis is clinical. Treat with antivirals.von Willebrand disease presents with mucosal bleeding, and the first-line treatment is desmopressin.Central cord syndrome is often the result of a hyperextension injury to the cervical spine. It presents with bilateral motor dysfunction that is greater in the upper extremities than the lower extremities.That wraps up RoshCast Episode 50! Be sure to also check out the rest of the Rosh Review Blog for questions from prior episodes, related images and tables, and bonus teaching points. There are also tons of other great free resources to help prepare you for the boards and the wards. Don’t forget to follow us on twitter @RoshCast. And you can always email us at RoshCast@RoshReview.com with any feedback, corrections, or suggestions. You can also help us pick questions by identifying ones you would like us to review. Write “RoshCast” in the submit feedback box as you go through the question bank. Lastly, if you have a minute, make sure to rate us and leave comments on iTunes to help spread the word about RoshCast.Megha and NachiThe post Podcast Ep 50: Acute Mitral Regurgitation &amp; More appeared first on RoshReview.com.

<blockquote>A hero is someone who has given his or her life to something bigger than oneself.–Joseph Campbell</blockquote><h6>Welcome back to RoshCast for Episode 50! Wow!! We can’t believe we’re already at Episode 50. It’s been a real journey building this podcast from the original concept two years ago. And in the last year, we have seen some pretty big changes, including Megha joining the team. We are excited to see how RoshCast continues to evolve over the next fifty episodes and two years. </h6>None of this would be possible without you, our listeners. Your listenership and feedback is what drives us to keep delivering high-quality content! We value every moment you give your attention to us, and we try our best to design the episode to maximize your learning. We have a pretty involved process for choosing questions to present to you and for how we manipulate and deliver the content before we get it to your ears.With that, let’s kick off a great episode!Question 1A 70-year-old woman with history of coronary artery disease, hypertension, and diabetes presents to the emergency department with chest pressure and shortness of breath. Her exam is notable for a new holosystolic murmur best heard over the midaxillary line as well as diffuse bilateral rales. Which of the following is most likely to be seen on this patient’s ECG?A. Biventricular tachycardiaB. S1Q3T3 patternC. ST-depressions in I, V6, and aVL without ST-elevationsD. ST elevations in II, III, aVF<a href="https://www.roshreview.com/wp-content/uploads/Ep50-Acute-Mitral-Regurgitation.png" rel="nofollow" target="_blank">Teaching Image</a>Question 2A 26-year-old woman with no medical history presents with bleeding gums after brushing her teeth for the last three days. Her complaint was preceded two weeks ago by a URI. Her examination is unremarkable except for oozing from the gums. Labs show a platelet count of 23,000. Which of the following is the most appropriate next step in management?A. IV immunoglobulinB. Platelet transfusionC. Steroids, IV immunoglobulinD. Steroids, IV immunoglobulin, and platelet transfusion<a href="https://www.roshreview.com/wp-content/uploads/Ep50-ITP.png" rel="nofollow" target="_blank">Teaching Image</a>Question 3Which of the following is most suggestive of measles infection?A. A prodrome of fever, lymphadenopathy, and conjunctivitis followed by a maculopapular rash that starts on the face and spreads to the trunk and limbsB. Diffuse maculopapular rash with white spots on the buccal mucosaC. High fever for three days followed by the appearance of a pink maculopapular rash after defervescenceD. Presence of shallow ulcers on oral mucosa and vesicular lesions on the palms and soles<a href="https://www.roshreview.com/wp-content/uploads/Ep50-Measles.png" rel="nofollow" target="_blank">Teaching Image</a>Question 4A 23-year-old man who has unprotected, receptive anal intercourse presents to the ED with two weeks of worsening rectal pain and dyschezia. On exam, he has numerous ulcers in the anorectal area and a crop of grouped vesicles containing clear fluid on an erythematous base. The surrounding skin shows no sign of cellulitis or abscess. Which of the following is the most appropriate next step?A. Refer the patient to a surgeon for operative interventionB. Send a serology testC. Send a Tzanck smearD. Treat with acyclovirQuestion 5A 5-year-old boy with von Willebrand disease presents with persistent bleeding after he lost a tooth 4 hours ago. Vital signs are unremarkable. Physical exam reveals oozing at the site of the tooth which persists despite pressure. Which of the following is the most appropriate treatment?A. DesmopressinB. Factor VIII concentrateC. Fresh frozen plasmaD. Vitamin K<a href="https://www.roshreview.com/wp-content/uploads/Ep50-vWD.png" rel="nofollow" target="_blank">Teaching Image</a>Question 6A 70-year-old man with a history of chronic neck pain presents after a fall. On physical examination, he has a laceration on his chin. Motor strength is 2/5 in his upper extremities and 4/5 in his lower extremities. He has decreased sensation to soft touch in both legs. Which of the following is the most likely diagnosis?A. Anterior cord syndromeB. Brown-Sequard syndromeC. Cauda equina syndromeD. Central cord syndrome<a href="https://www.roshreview.com/wp-content/uploads/Ep50-Central-Cord-Syndrome.png" rel="nofollow" target="_blank">Teaching Image</a><ul><li>A new holosystolic murmur over the midaxillary line, with signs of heart failure, is consistent with acute mitral valve regurgitation. Think of inferior stemi as a possible cause here.</li><li>Immune thrombocytopenia presents with bleeding that is often preceded by a viral illness. It is treated with steroids and IVIG in most cases. For those with severe or life-threatening bleeding, platelet transfusion should be considered as well.</li><li>Measles presents with a prodrome of fever and three Cs (coryza, cough, and conjunctivitis) followed by a diffuse maculopapular rash and Koplik spots.</li><li>A painful vesicular rash on an erythematous base in the anorectal area is consistent with herpes simplex proctitis. Diagnosis is clinical. Treat with antivirals.</li><li>von Willebrand disease presents with mucosal bleeding, and the first-line treatment is desmopressin.</li><li>Central cord syndrome is often the result of a hyperextension injury to the cervical spine. It presents with bilateral motor dysfunction that is greater in the upper extremities than the lower extremities.</li></ul>That wraps up RoshCast Episode 50! Be sure to also check out the rest of the <a href="https://www.roshreview.com/blog/" rel="noreferrer noopener nofollow" target="_blank">Rosh Review Blog</a> for questions from prior episodes, related images and tables, and bonus teaching points. There are also tons of other great free resources to help prepare you for the boards and the wards. Don’t forget to follow us on twitter <a href="https://twitter.com/roshcast?lang=en" rel="nofollow" target="_blank">@RoshCast</a>. And you can always email us at <a href="mailto:roshcast@roshreview.com">RoshCast@RoshReview.com</a> with any feedback, corrections, or suggestions. You can also help us pick questions by identifying ones you would like us to review. Write “RoshCast” in the submit feedback box as you go through the question bank. Lastly, if you have a minute, make sure to rate us and leave comments on <a href="https://itunes.apple.com/us/podcast/roshcast/id1156487141?mt=2" rel="noreferrer noopener nofollow" target="_blank">iTunes</a> to help spread the word about RoshCast.Megha and NachiThe post <a href="https://www.roshreview.com/blog/podcast-ep-50-acute-mitral-regurgitation-immune-thrombocytopenia-measles-herpes-proctitis-von-willebrands-disease-spinal-injuries/" rel="nofollow" target="_blank">Podcast Ep 50: Acute Mitral Regurgitation &amp; More</a> appeared first on <a href="https://www.roshreview.com/blog" rel="nofollow" target="_blank">RoshReview.com</a>.

Ep 50 Roshcast Emergency Board Review

Life is like riding a bicycle. To keep your balance, you must keep moving.–Albert EinsteinWelcome back to RoshCast for Episode 49! We have a lot of exciting material in this episode. Definitely don’t skip this one! For those taking the initial certification exam, it’s just around the corner. Go back and listen to old episodes and review.Question 1A 14-year-old boy developed an itchy, painful, erythematous rash on his hands, forearms, and face about a day after hiking in nearby woods with some friends. Your exam shows linear erythematous papules over his forearms with similar swelling and erythema around his eyes (including eyelids), cheeks, and forehead. You suspect poison ivy that he reports he has had in the past. Which of the following is most likely to improve the course of his illness?A. Oral diphenhydramine every six hoursB. Three-week prednisone taperC. Topical 1% hydrocortisone three times dailyD. Topical calamine lotion twice dailyTeaching ImageQuestion 2Which of the following patients will benefit most from receiving tissue plasminogen activator for acute pulmonary embolism detected in the emergency department?A. 55-year-old man with a history of hypertension with vital signs showing HR 100/min, BP 80/40 mm Hg, R 24/min, and oxygen saturation 92%B. 55-year-old man with a history of hypertension with vital signs showing HR 145 bpm, BP 136/86 mm Hg, R 24/min, and oxygen saturation 92%C. 55-year-old woman with a history of hypertension and systemic lupus erythematosus with vital signs showing HR 100 bpm, BP 116/86 mm Hg, R 24/min, and oxygen saturation 85%D. 55-year-old woman with a history of hypertension with vital signs showing HR 110 bpm, BP 122/80 mm Hg, R 24/min, and oxygen saturation 92% with evidence of right ventricular dysfunction on echocardiogramTeaching ImageQuestion 3A 55-year-old woman presents to the emergency department unresponsive. She and her friend had finished eating 60 minutes earlier when the patient collapsed to the floor while talking. Which of the following foods is most likely the cause?A. Apricot kernelsB. Fava beansC. PeanutsD. Poppy seedsTeaching ImageQuestion 4Which of the following is due to the intense thermal radiation seen in lightning strikes?A. Cataract formationB. Hypertension and tachycardiaC. MydriasisD. Tympanic membrane ruptureTeaching ImageQuestion 5A 32-year-old woman with no past medical history presents to the emergency department with a four-day history of bloody diarrhea and abdominal cramping. She states that her boyfriend is having similar symptoms but did not want to come to the hospital. Their symptoms started two days after they shared a meal at their favorite fried chicken restaurant. The patient’s vital signs are 37.4℃, HR 89/min, BP 112/70 mm Hg, RR 17/min. Physical examination is significant for moist mucus membranes with brisk capillary refill and mild diffuse tenderness to palpation of the abdomen. Which of the following is the most appropriate management of this patient’s illness?A. Admit for IV azithromycin and rehydrationB. Admit for IV rehydration and observation for resolution of diarrheaC. Discharge home with ciprofloxacinD. Discharge home with metronidazoleTeaching ImageQuestion 6A 54-year-old man with a history of HIV and recent CD4 count of 85 presents with headache for 3 days. The patient’s sister says that he has been increasingly confused over the last 3 days. While in the emergency department, he has a seizure which resolves spontaneously. Electrolytes are within normal limits. A CT scan is performed and is shown above. Which of the following medication regimens should be given?A. Amphotericin BB. Ganciclovir and foscarnetC. Pyrimethamine, sulfadiazine, and leucovorinD. Trimethoprim-sulfamethoxazoleTeaching ImageLocalized reaction from poison ivy can be treated with topical high-potency corticosteroids. Extensive reactions or reactions involving the face or genitalia need a 2–3-week course of tapering systemic steroids.Persistent hypotension or shock due to acute pulmonary embolism is the only widely accepted indication for systemic thrombolysis.Severe metabolic acidosis is a hallmark feature of cyanide poisoning and treatment is with hydroxycobalamin.Lightning strikes cause injuries via both acute thermal radiation and widespread electrical damage. Intense thermal radiation can cause tympanic membrane perforation.Undercooked poultry is associated with infection from Campylobacter jejuni. This can present with bloody diarrhea, abdominal cramping, and vomiting. Treatment is with fluoroquinolones or azithromycin.Subcortical, ring-enhancing lesions on a CT of the brain in an HIV patient with a CD4 &lt; 100 is indicative of toxoplasmosis and treatment is with pyrimethamine, sulfadiazine, and leucovorin.CNS lymphoma also causes ring-enhancing lesions in patients with AIDS but lesions in this case are usually solitary and located in the periventricular white matter.  Symptoms are usually gradually progressive over months rather than days.That wraps up RoshCast Episode 49! Be sure to also check out the rest of the Rosh Review Blog for questions from prior episodes, related images and tables, as well as bonus teaching points. There are also tons of other great free resources to help prepare you for the boards and the wards. Don’t forget to follow us on twitter @RoshCast. And you can always email us at RoshCast@RoshReview.com with any feedback, corrections, or suggestions. You can also help us pick questions by identifying ones you would like us to review. Write “RoshCast” in the submit feedback box as you go through the question bank. Lastly, if you have a minute, make sure to rate us and leave comments on iTunes to help spread the word about RoshCast.Megha and NachiThe post Podcast Ep 49: Poison Ivy, tPA, Cyanide Poisoning, &amp; More appeared first on RoshReview.com.

<blockquote>Life is like riding a bicycle. To keep your balance, you must keep moving.–Albert Einstein</blockquote><h6>Welcome back to RoshCast for Episode 49! We have a lot of exciting material in this episode. Definitely don’t skip this one! For those taking the initial certification exam, it’s just around the corner. Go back and listen to old episodes and review.</h6>Question 1A 14-year-old boy developed an itchy, painful, erythematous rash on his hands, forearms, and face about a day after hiking in nearby woods with some friends. Your exam shows linear erythematous papules over his forearms with similar swelling and erythema around his eyes (including eyelids), cheeks, and forehead. You suspect poison ivy that he reports he has had in the past. Which of the following is most likely to improve the course of his illness?A. Oral diphenhydramine every six hoursB. Three-week prednisone taperC. Topical 1% hydrocortisone three times dailyD. Topical calamine lotion twice daily<a href="https://www.roshreview.com/wp-content/uploads/Ep49-Allergic-Contact-Dermatitis.png" rel="nofollow" target="_blank">Teaching Image</a>Question 2Which of the following patients will benefit most from receiving tissue plasminogen activator for acute pulmonary embolism detected in the emergency department?A. 55-year-old man with a history of hypertension with vital signs showing HR 100/min, BP 80/40 mm Hg, R 24/min, and oxygen saturation 92%B. 55-year-old man with a history of hypertension with vital signs showing HR 145 bpm, BP 136/86 mm Hg, R 24/min, and oxygen saturation 92%C. 55-year-old woman with a history of hypertension and systemic lupus erythematosus with vital signs showing HR 100 bpm, BP 116/86 mm Hg, R 24/min, and oxygen saturation 85%D. 55-year-old woman with a history of hypertension with vital signs showing HR 110 bpm, BP 122/80 mm Hg, R 24/min, and oxygen saturation 92% with evidence of right ventricular dysfunction on echocardiogram<a href="https://www.roshreview.com/wp-content/uploads/Ep49-Medical-Management-for-PE.png" rel="nofollow" target="_blank">Teaching Image</a>Question 3A 55-year-old woman presents to the emergency department unresponsive. She and her friend had finished eating 60 minutes earlier when the patient collapsed to the floor while talking. Which of the following foods is most likely the cause?A. Apricot kernelsB. Fava beansC. PeanutsD. Poppy seeds<a href="https://www.roshreview.com/wp-content/uploads/Ep49-Cyanide-Toxicity.png" rel="nofollow" target="_blank">Teaching Image</a>Question 4Which of the following is due to the intense thermal radiation seen in lightning strikes?A. Cataract formationB. Hypertension and tachycardiaC. MydriasisD. Tympanic membrane rupture<a href="https://www.roshreview.com/wp-content/uploads/Ep49-Lichtenberg-Figure.png" rel="nofollow" target="_blank">Teaching Image</a>Question 5A 32-year-old woman with no past medical history presents to the emergency department with a four-day history of bloody diarrhea and abdominal cramping. She states that her boyfriend is having similar symptoms but did not want to come to the hospital. Their symptoms started two days after they shared a meal at their favorite fried chicken restaurant. The patient’s vital signs are 37.4℃, HR 89/min, BP 112/70 mm Hg, RR 17/min. Physical examination is significant for moist mucus membranes with brisk capillary refill and mild diffuse tenderness to palpation of the abdomen. Which of the following is the most appropriate management of this patient’s illness?A. Admit for IV azithromycin and rehydrationB. Admit for IV rehydration and observation for resolution of diarrheaC. Discharge home with ciprofloxacinD. Discharge home with metronidazole<a href="https://www.roshreview.com/wp-content/uploads/Ep49-Campylobacter.png" rel="nofollow" target="_blank">Teaching Image</a>Question 6A 54-year-old man with a history of HIV and recent CD4 count of 85 presents with headache for 3 days. The patient’s sister says that he has been increasingly confused over the last 3 days. While in the emergency department, he has a seizure which resolves spontaneously. Electrolytes are within normal limits. A CT scan is performed and is shown above. Which of the following medication regimens should be given?A. Amphotericin BB. Ganciclovir and foscarnetC. Pyrimethamine, sulfadiazine, and leucovorinD. Trimethoprim-sulfamethoxazole<a href="https://www.roshreview.com/wp-content/uploads/Ep49-Cerebral-Toxoplasmosis.png" rel="nofollow" target="_blank">Teaching Image</a><ul><li>Localized reaction from poison ivy can be treated with topical high-potency corticosteroids. Extensive reactions or reactions involving the face or genitalia need a 2–3-week course of tapering systemic steroids.</li><li>Persistent hypotension or shock due to acute pulmonary embolism is the only widely accepted indication for systemic thrombolysis.</li><li>Severe metabolic acidosis is a hallmark feature of cyanide poisoning and treatment is with hydroxycobalamin.</li><li>Lightning strikes cause injuries via both acute thermal radiation and widespread electrical damage. Intense thermal radiation can cause tympanic membrane perforation.</li><li>Undercooked poultry is associated with infection from Campylobacter jejuni. This can present with bloody diarrhea, abdominal cramping, and vomiting. Treatment is with fluoroquinolones or azithromycin.</li><li>Subcortical, ring-enhancing lesions on a CT of the brain in an HIV patient with a CD4 &lt; 100 is indicative of toxoplasmosis and treatment is with pyrimethamine, sulfadiazine, and leucovorin.</li><li>CNS lymphoma also causes ring-enhancing lesions in patients with AIDS but lesions in this case are usually solitary and located in the periventricular white matter.  Symptoms are usually gradually progressive over months rather than days.</li></ul>That wraps up RoshCast Episode 49! Be sure to also check out the rest of the <a href="https://www.roshreview.com/blog/" rel="noreferrer noopener nofollow" target="_blank">Rosh Review Blog </a>for questions from prior episodes, related images and tables, as well as bonus teaching points. There are also tons of other great free resources to help prepare you for the boards and the wards. Don’t forget to follow us on twitter <a href="https://twitter.com/roshcast?lang=en" rel="nofollow" target="_blank">@RoshCast</a>. And you can always email us at <a href="mailto:roshcast@roshreview.com">RoshCast@RoshReview.com</a> with any feedback, corrections, or suggestions. You can also help us pick questions by identifying ones you would like us to review. Write “RoshCast” in the submit feedback box as you go through the question bank. Lastly, if you have a minute, make sure to rate us and leave comments on <a href="https://itunes.apple.com/us/podcast/roshcast/id1156487141?mt=2" rel="noreferrer noopener nofollow" target="_blank">iTunes</a> to help spread the word about RoshCast.Megha and NachiThe post <a href="https://www.roshreview.com/blog/podcast-ep-49-poison-ivy-tpa-cyanide-poisoning-lightning-strikes-diarrhea-ring-enhancing-lesions/" rel="nofollow" target="_blank">Podcast Ep 49: Poison Ivy, tPA, Cyanide Poisoning, &amp; More</a> appeared first on <a href="https://www.roshreview.com/blog" rel="nofollow" target="_blank">RoshReview.com</a>.

Ep 49 Roshcast Emergency Board Review

Success is not final, failure is not fatal: it is the courage to continue that counts.–Winston ChurchillWelcome back to RoshCast for Episode 48! We’re going to jump right into questions this week. Remember to send us feedback for any changes you would like to see at roshcast@roshreview.com.Question 1An 8-year-old previously healthy boy presents with back pain and fever for 4 days. He complains of pain in the low back, which is increased with bending or twisting. The pain radiates down into his left leg. He denies trauma. Physical exam is remarkable only for tenderness to palpation over the lumbar spine. What management is indicatedA. Ibuprofen and follow up with his pediatricianB. MRI of the lumbar spineC. Plain radiographs of the lumbar spineD. UrinalysisTeaching ImageQuestion 2A 40-year-old man is brought to the emergency department after being assaulted during a bar fight. He has proptosis of the right eye with a measured intraocular pressure of 50 mm Hg. A lateral canthotomy is started. Once the Kelly clamp is released from the lateral canthus, what is the appropriate next step?A. Clamp the medial canthusB. Cut the inferior crus of the lateral canthal tendonC. Cut the superior crus of the lateral canthal tendonD. Recheck intraocular pressureTeaching ImageQuestion 3A 25-year-old man presents to the emergency department after sustaining burns to the hands, legs, and chest after falling into a bonfire. On physical examination, there are partial-thickness burns on the upper half of the anterior torso along with the bilateral palms of the hands and bilateral anterior legs. He weighs 70 kg. You begin to initiate fluid resuscitation using the Parkland formula. How much fluid should this patient receive in the first eight hours?A. 10,640 mLB. 4,060 mLC. 5,320 mLD. 8,120 mLTeaching ImageQuestion 4A 64-year-old man presents to the emergency department with cough and shortness of breath that has progressively been worsening over the last several weeks. He has also been more fatigued and is unable to get around the house anymore. He denies fever and night sweats. He has a past medical history of hypertension and takes lisinopril daily. He is an immigrant from Argentina where he used to work as a miner. He denies tobacco use. What is the most likely diagnosis based on this chest radiograph?A. HistoplasmosisB. Miliary tuberculosisC. PneumoconiosisD. SarcoidosisTeaching ImageTeaching ImageTeaching ImageTeaching ImageQuestion 5A 53-year-old man presents with numbness to his right hand for three to four months. He states that he has numbness with waking up in the morning, which gets better when he shakes his hands. The patient indicates numbness to his first, second, and third digits on the right hand. Which of the following tests is most sensitive for this diagnosis?A. Finkelstein testB. Median nerve compression testC. Phalen testD. Tinel signTeaching ImageQuestion 6A young man is involved in a motor vehicle collision and sustains a severe head injury. In the ED, his GCS is 7. His blood pressure is 115/70 mm Hg and heart rate is 85 beats per minute. His pupils are 3 mm and equal and reactive to light. You intubate the patient and place him on a mechanical ventilator. The FAST ultrasound is negative and there are no other obvious injuries. Which of the following is the most important principle to follow in the management of this patient?A. Administer mannitolB. Avoid hypotensionC. HyperventilationD. Initiate induced hypothermiaDiscitis presents with severe localized radiating pain. The lumbar spine is most commonly involved, and treatment is with IV antibiotics.A lateral canthotomy is performed to relieve intraocular pressure from a retrobulbar hematoma or a postseptal hemorrhage. It is done by cutting the inferior crus of the lateral canthal tendon.The Parkland Formula is used to determine the volume of fluid required for resuscitation of burn patients. It is 4 mL x body weight in kg x % total body surface area of the burn. Half of this fluid is given within the first 8 hours and then other half over the next 16 hours.Pneumoconiosis is a restrictive lung disease that can be caused by inhalation of dust, often in mines. It presents with bilateral ground glass opacities on Chest X-ray.The Median Nerve Compression Test is the most sensitive test for confirming carpal tunnel syndrome. It consists of direct pressure application to the median nerve at the carpal tunnel.Hypotension and hypoxia have both been shown to have a devastating effect on the outcome of patients with traumatic brain injury.That wraps up RoshCast Episode 48! Be sure to also check out the rest of the Rosh Review Blog for questions from prior episodes, related images and tables, and bonus teaching points. There are also tons of other great free resources to help prepare you for the boards and the wards. Don’t forget to follow us on twitter @RoshCast. And you can always email us at RoshCast@RoshReview.com with any feedback, corrections, or suggestions. You can also help us pick questions by identifying ones you would like us to review. Write “RoshCast” in the submit feedback box as you go through the question bank. Lastly, if you have a minute, make sure to rate us and leave comments on iTunes to help spread the word about RoshCast.Megha and NachiThe post Podcast Ep 48: Pediatric Back Pain, Lateral Canthotomy, &amp; More appeared first on RoshReview.com.

<blockquote>Success is not final, failure is not fatal: it is the courage to continue that counts.–Winston Churchill</blockquote><h6>Welcome back to RoshCast for Episode 48! We’re going to jump right into questions this week. Remember to send us feedback for any changes you would like to see at <a href="mailto:roshcast@roshreview.com">roshcast@roshreview.com</a>.</h6>Question 1An 8-year-old previously healthy boy presents with back pain and fever for 4 days. He complains of pain in the low back, which is increased with bending or twisting. The pain radiates down into his left leg. He denies trauma. Physical exam is remarkable only for tenderness to palpation over the lumbar spine. What management is indicatedA. Ibuprofen and follow up with his pediatricianB. MRI of the lumbar spineC. Plain radiographs of the lumbar spineD. Urinalysis<a href="https://www.roshreview.com/wp-content/uploads/Ep48-Pediatric-Discitis.png" rel="nofollow" target="_blank">Teaching Image</a>Question 2A 40-year-old man is brought to the emergency department after being assaulted during a bar fight. He has proptosis of the right eye with a measured intraocular pressure of 50 mm Hg. A lateral canthotomy is started. Once the Kelly clamp is released from the lateral canthus, what is the appropriate next step?A. Clamp the medial canthusB. Cut the inferior crus of the lateral canthal tendonC. Cut the superior crus of the lateral canthal tendonD. Recheck intraocular pressure<a href="https://www.roshreview.com/wp-content/uploads/Ep48-Lateral-Canthotomy.jpg" rel="nofollow" target="_blank">Teaching Image</a>Question 3A 25-year-old man presents to the emergency department after sustaining burns to the hands, legs, and chest after falling into a bonfire. On physical examination, there are partial-thickness burns on the upper half of the anterior torso along with the bilateral palms of the hands and bilateral anterior legs. He weighs 70 kg. You begin to initiate fluid resuscitation using the Parkland formula. How much fluid should this patient receive in the first eight hours?A. 10,640 mLB. 4,060 mLC. 5,320 mLD. 8,120 mL<a href="https://www.roshreview.com/wp-content/uploads/Ep48-Parkland-Formula.png" rel="nofollow" target="_blank">Teaching Image</a>Question 4A 64-year-old man presents to the emergency department with cough and shortness of breath that has progressively been worsening over the last several weeks. He has also been more fatigued and is unable to get around the house anymore. He denies fever and night sweats. He has a past medical history of hypertension and takes lisinopril daily. He is an immigrant from Argentina where he used to work as a miner. He denies tobacco use. What is the most likely diagnosis based on this chest radiograph?A. HistoplasmosisB. Miliary tuberculosisC. PneumoconiosisD. Sarcoidosis<a href="https://www.roshreview.com/wp-content/uploads/Ep48-Radiographic-Characteristics-Pneumoconoisis.png" rel="nofollow" target="_blank">Teaching Image</a><a href="https://www.roshreview.com/wp-content/uploads/Ep48-Histoplasmosis.png" rel="nofollow" target="_blank">Teaching Image</a><a href="https://www.roshreview.com/wp-content/uploads/Ep48-Miliary-TB.png" rel="nofollow" target="_blank">Teaching Image</a><a href="https://www.roshreview.com/wp-content/uploads/Ep48-Sarcoidosis.png" rel="nofollow" target="_blank">Teaching Image</a>Question 5A 53-year-old man presents with numbness to his right hand for three to four months. He states that he has numbness with waking up in the morning, which gets better when he shakes his hands. The patient indicates numbness to his first, second, and third digits on the right hand. Which of the following tests is most sensitive for this diagnosis?A. Finkelstein testB. Median nerve compression testC. Phalen testD. Tinel sign<a href="https://www.roshreview.com/wp-content/uploads/Ep48-Carpal-Tunnel-Syndrome.png" rel="nofollow" target="_blank">Teaching Image</a>Question 6A young man is involved in a motor vehicle collision and sustains a severe head injury. In the ED, his GCS is 7. His blood pressure is 115/70 mm Hg and heart rate is 85 beats per minute. His pupils are 3 mm and equal and reactive to light. You intubate the patient and place him on a mechanical ventilator. The FAST ultrasound is negative and there are no other obvious injuries. Which of the following is the most important principle to follow in the management of this patient?A. Administer mannitolB. Avoid hypotensionC. HyperventilationD. Initiate induced hypothermia<ul><li>Discitis presents with severe localized radiating pain. The lumbar spine is most commonly involved, and treatment is with IV antibiotics.</li><li>A lateral canthotomy is performed to relieve intraocular pressure from a retrobulbar hematoma or a postseptal hemorrhage. It is done by cutting the inferior crus of the lateral canthal tendon.</li><li>The Parkland Formula is used to determine the volume of fluid required for resuscitation of burn patients. It is 4 mL x body weight in kg x % total body surface area of the burn. Half of this fluid is given within the first 8 hours and then other half over the next 16 hours.</li><li>Pneumoconiosis is a restrictive lung disease that can be caused by inhalation of dust, often in mines. It presents with bilateral ground glass opacities on Chest X-ray.</li><li>The Median Nerve Compression Test is the most sensitive test for confirming carpal tunnel syndrome. It consists of direct pressure application to the median nerve at the carpal tunnel.</li><li>Hypotension and hypoxia have both been shown to have a devastating effect on the outcome of patients with traumatic brain injury.</li></ul>That wraps up RoshCast Episode 48! Be sure to also check out the rest of the <a href="https://www.roshreview.com/blog/" rel="noreferrer noopener nofollow" target="_blank">Rosh Review Blog </a>for questions from prior episodes, related images and tables, and bonus teaching points. There are also tons of other great free resources to help prepare you for the boards and the wards. Don’t forget to follow us on twitter <a href="https://twitter.com/roshcast?lang=en" rel="nofollow" target="_blank">@RoshCast</a>. And you can always email us at <a href="mailto:roshcast@roshreview.com">RoshCast@RoshReview.com</a> with any feedback, corrections, or suggestions. You can also help us pick questions by identifying ones you would like us to review. Write “RoshCast” in the submit feedback box as you go through the question bank. Lastly, if you have a minute, make sure to rate us and leave comments on <a href="https://itunes.apple.com/us/podcast/roshcast/id1156487141?mt=2" rel="noreferrer noopener nofollow" target="_blank">iTunes</a> to help spread the word about RoshCast.Megha and NachiThe post <a href="https://www.roshreview.com/blog/podcast-ep-48-pediatric-back-pain-lateral-canthotomy-parkland-formula-lung-disease-nerve-compression-tbi/" rel="nofollow" target="_blank">Podcast Ep 48: Pediatric Back Pain, Lateral Canthotomy, &amp; More</a> appeared first on <a href="https://www.roshreview.com/blog" rel="nofollow" target="_blank">RoshReview.com</a>.

Ep 48 Roshcast Emergency Board Review

If you fell down yesterday, stand up today. –H. G. WellsWelcome back to RoshCast for Episode 47! Let’s kick off this episode with a review of Neisseria meningitides, an important topic for clinical practice and personal safety.Neisseria meningitides is highly contagious and antibiotic prophylaxis is indicated for close contacts of an infected patient, including those in contact with secretions as well as members of the same household or daycare center.Healthcare workers with close contact with the patient’s secretions should also receive prophylaxis.There are three options for prophylaxis: Rifampin is administered at a dose of 10 mg/kg with a max dose of 600 mg every 12 hours for 4 doses, and this is 100% effective as far as we know.Ceftriaxone 250 mg IM can be given for 1 dose, which is 97–100% effective.The least effective option is Ciprofloxacin 500 mg PO for 1 dose, and that’s 90–95% effective. Even though rifampin is the most effective, be wary of its side effects, which include turning secretions like tears and urine orange. Contact lens wearers should be warned of permanent staining.Teaching ImageNow onto this week’s podcastQuestion 1A 33-year-old woman presents to the ED with agitation and severe respiratory distress. She has been taking a significant amount of “pain medication” for low back pain, according to her son. The patient is screaming about her “ears ringing.” Vital signs are BP 100/60 mm Hg, HR 140 beats per minute, RR 35 breaths per minute, and T 100.1°F. Which of the following complications is she at risk of developing?A. Hemodynamically significant lower gastrointestinal bleedingB. Increased intracranial pressureC. Noncardiogenic pulmonary edemaD. Urinary retention requiring catheterizationTeaching ImageQuestion 2Which of the following is associated with carbon monoxide poisoning?A. Bilateral basal ganglia hypodensitiesB. Elevated pHC. Low PO2D. Odor of bitter almondsTeaching ImageQuestion 3A 62-year-old woman presents to the emergency department with dizziness. She describes the events as a spinning sensation that is worse with position changes. The dizziness is associated with hearing loss as well as tinnitus and vomiting. She notes it started three days ago and that she has had multiple episodes all lasting less than a day since that time. On physical examination, horizontal nystagmus is present as is decreased hearing on the left. The remainder of the ear and neurologic examination is within normal limits. A head CT and brain MRI are performed and are negative. Which of the following is the most likely diagnosis?A. Acoustic neuromaB. LabyrinthitisC. Meniere diseaseD. Vestibular neuritisTeaching ImageTeaching ImageTeaching ImageQuestion 4A 28-year old woman presents with several painful ulcers she has developed in the vaginal area. Examination reveals multiple 0.5 cm to 1.5 cm oval ulcers with sharply defined borders and a yellowish-white membrane. She denies recent sexual activity. Except for recurring aphthous ulcers of her mouth, her past history is unremarkable. At this time, which of the following is the most likely diagnosis?A. Behcet syndromeB. Herpes simplexC. Reactive arthritisD. SyphilisTeaching ImageQuestion 5A 65-year-old man on peritoneal dialysis presents because his dialysis effluent is cloudy. You send it for culture and Gram staining, which returns with a preliminary result of gram-positive cocci in clusters. Vital signs are BP 125/70 mm Hg, HR 80 bpm, RR 14/min, and T 98.5°F. Other than abdominal ascites, the physical exam is unremarkable. Which of the following is the most appropriate management for this condition?A. Inpatient management with antibiotics and temporary hemodialysisB. Inpatient management with IV antibioticsC. Outpatient management with intraperitoneal antibioticsD. Outpatient management with oral antibioticsTeaching ImageQuestion 6Which of the following historical features is most consistent with infantile spasms?A. Occur in clusters lasting a few minutes at a timeB. Occur more frequently during sleepC. Onset between 12 and 18 months of ageD. Precipitated by loud noises or handlingTeaching Image Salicylates, opioids, naloxone, phencyclidine, and meprobamate can cause noncardiogenic pulmonary edema.Patients with acute salicylate toxicity with levels greater than 100 mg/dL and chronic toxicity with levels greater than 60 mg/dL require dialysis.Neurologic sequelae from carbon monoxide poisoning can be identified radiographically within 12 hours of exposure as symmetric hypodense lesions in the basal ganglia.Meniere disease is a set of episodic symptoms including vertigo, hearing loss, tinnitus, and a sense of fullness in the ear.  Episodes last anywhere from 20 minutes to 4 hours.Behcet syndrome presents as recurring genital and oral ulcerations and also relapsing uveitis.Peritonitis is the most common complication of peritoneal dialysis, and it can often be treated with intraperitoneal antibiotics as an outpatient.Infantile spasms present before the age of one and EEG shows hypsarrhythmia. This is treated with corticotropin.That wraps up RoshCast Episode 47! Be sure to also check out the rest of the Rosh Review Blog for questions from prior episodes, related images and tables, and bonus teaching points. There are also tons of other great free resources to help prepare you for the boards and the wards. Don’t forget to follow us on twitter @RoshCast. And you can always email us at RoshCast@RoshReview.com with any feedback, corrections, or suggestions. You can also help us pick questions by identifying ones you would like us to review. Write “RoshCast” in the Submit Feedback box as you go through the question bank. Lastly, if you have a minute, make sure to rate us and leave comments on iTunes to help spread the word about RoshCast.Megha and NachiThe post Podcast Ep 47: Salicylate Toxicity, Carbon Monoxide Poisoning, &amp; More appeared first on RoshReview.com.

<blockquote>If you fell down yesterday, stand up today. –H. G. Wells</blockquote><h6>Welcome back to RoshCast for Episode 47! Let’s kick off this episode with a review of Neisseria meningitides, an important topic for clinical practice and personal safety.</h6><ul><li>Neisseria meningitides is highly contagious and antibiotic prophylaxis is indicated for close contacts of an infected patient, including those in contact with secretions as well as members of the same household or daycare center.</li><li>Healthcare workers with close contact with the patient’s secretions should also receive prophylaxis.</li><li>There are three options for prophylaxis: <ul><li>Rifampin is administered at a dose of 10 mg/kg with a max dose of 600 mg every 12 hours for 4 doses, and this is 100% effective as far as we know.</li><li>Ceftriaxone 250 mg IM can be given for 1 dose, which is 97–100% effective.</li><li>The least effective option is Ciprofloxacin 500 mg PO for 1 dose, and that’s 90–95% effective. </li></ul></li><li>Even though rifampin is the most effective, be wary of its side effects, which include turning secretions like tears and urine orange. Contact lens wearers should be warned of permanent staining.</li></ul><a href="https://www.roshreview.com/wp-content/uploads/Ep47-Chemoprophylaxis-Neisseria-Meningitis.jpg" rel="nofollow" target="_blank">Teaching Image</a>Now onto this week’s podcastQuestion 1A 33-year-old woman presents to the ED with agitation and severe respiratory distress. She has been taking a significant amount of “pain medication” for low back pain, according to her son. The patient is screaming about her “ears ringing.” Vital signs are BP 100/60 mm Hg, HR 140 beats per minute, RR 35 breaths per minute, and T 100.1°F. Which of the following complications is she at risk of developing?A. Hemodynamically significant lower gastrointestinal bleedingB. Increased intracranial pressureC. Noncardiogenic pulmonary edemaD. Urinary retention requiring catheterization<a href="https://www.roshreview.com/wp-content/uploads/Ep47-Aspirin-Toxicity.png" rel="nofollow" target="_blank">Teaching Image</a>Question 2Which of the following is associated with carbon monoxide poisoning?A. Bilateral basal ganglia hypodensitiesB. Elevated pHC. Low PO2D. Odor of bitter almonds<a href="https://www.roshreview.com/wp-content/uploads/Ep47-Carbon-Monoxide-Poisoning.png" rel="nofollow" target="_blank">Teaching Image</a>Question 3A 62-year-old woman presents to the emergency department with dizziness. She describes the events as a spinning sensation that is worse with position changes. The dizziness is associated with hearing loss as well as tinnitus and vomiting. She notes it started three days ago and that she has had multiple episodes all lasting less than a day since that time. On physical examination, horizontal nystagmus is present as is decreased hearing on the left. The remainder of the ear and neurologic examination is within normal limits. A head CT and brain MRI are performed and are negative. Which of the following is the most likely diagnosis?A. Acoustic neuromaB. LabyrinthitisC. Meniere diseaseD. Vestibular neuritis<a href="https://www.roshreview.com/wp-content/uploads/Ep47-Vestibular-Schwannoma.png" rel="nofollow" target="_blank">Teaching Image</a><a href="https://www.roshreview.com/wp-content/uploads/Ep47-Labyrinthitis.png" rel="nofollow" target="_blank">Teaching Image</a><a href="https://www.roshreview.com/wp-content/uploads/Ep47-Meniere-Disease.png" rel="nofollow" target="_blank">Teaching Image</a>Question 4A 28-year old woman presents with several painful ulcers she has developed in the vaginal area. Examination reveals multiple 0.5 cm to 1.5 cm oval ulcers with sharply defined borders and a yellowish-white membrane. She denies recent sexual activity. Except for recurring aphthous ulcers of her mouth, her past history is unremarkable. At this time, which of the following is the most likely diagnosis?A. Behcet syndromeB. Herpes simplexC. Reactive arthritisD. Syphilis<a href="https://www.roshreview.com/wp-content/uploads/Ep47-Behcet-Syndrome.jpg" rel="nofollow" target="_blank">Teaching Image</a>Question 5A 65-year-old man on peritoneal dialysis presents because his dialysis effluent is cloudy. You send it for culture and Gram staining, which returns with a preliminary result of gram-positive cocci in clusters. Vital signs are BP 125/70 mm Hg, HR 80 bpm, RR 14/min, and T 98.5°F. Other than abdominal ascites, the physical exam is unremarkable. Which of the following is the most appropriate management for this condition?A. Inpatient management with antibiotics and temporary hemodialysisB. Inpatient management with IV antibioticsC. Outpatient management with intraperitoneal antibioticsD. Outpatient management with oral antibiotics<a href="https://www.roshreview.com/wp-content/uploads/Ep47-Peritoneal-Dialysis.jpg" rel="nofollow" target="_blank">Teaching Image</a>Question 6Which of the following historical features is most consistent with infantile spasms?A. Occur in clusters lasting a few minutes at a timeB. Occur more frequently during sleepC. Onset between 12 and 18 months of ageD. Precipitated by loud noises or handling<a href="https://www.roshreview.com/wp-content/uploads/Ep47-Infantile-Spasms.png" rel="nofollow" target="_blank">Teaching Image</a><ul><li> Salicylates, opioids, naloxone, phencyclidine, and meprobamate can cause noncardiogenic pulmonary edema.</li><li>Patients with acute salicylate toxicity with levels greater than 100 mg/dL and chronic toxicity with levels greater than 60 mg/dL require dialysis.</li><li>Neurologic sequelae from carbon monoxide poisoning can be identified radiographically within 12 hours of exposure as symmetric hypodense lesions in the basal ganglia.</li><li>Meniere disease is a set of episodic symptoms including vertigo, hearing loss, tinnitus, and a sense of fullness in the ear.  Episodes last anywhere from 20 minutes to 4 hours.</li><li>Behcet syndrome presents as recurring genital and oral ulcerations and also relapsing uveitis.</li><li>Peritonitis is the most common complication of peritoneal dialysis, and it can often be treated with intraperitoneal antibiotics as an outpatient.</li><li>Infantile spasms present before the age of one and EEG shows hypsarrhythmia. This is treated with corticotropin.</li></ul>That wraps up RoshCast Episode 47! Be sure to also check out the rest of the <a href="https://www.roshreview.com/blog/" rel="noreferrer noopener nofollow" target="_blank">Rosh Review Blog </a>for questions from prior episodes, related images and tables, and bonus teaching points. There are also tons of other great free resources to help prepare you for the boards and the wards. Don’t forget to follow us on twitter <a href="https://twitter.com/roshcast?lang=en" rel="nofollow" target="_blank">@RoshCast</a>. And you can always email us at <a href="mailto:roshcast@roshreview.com">RoshCast@RoshReview.com</a> with any feedback, corrections, or suggestions. You can also help us pick questions by identifying ones you would like us to review. Write “RoshCast” in the Submit Feedback box as you go through the question bank. Lastly, if you have a minute, make sure to rate us and leave comments on <a href="https://itunes.apple.com/us/podcast/roshcast/id1156487141?mt=2" rel="noreferrer noopener nofollow" target="_blank">iTunes</a> to help spread the word about RoshCast.Megha and NachiThe post <a href="https://www.roshreview.com/blog/podcast-ep-47-salicylate-toxicity-carbon-monoxide-poisoning-dizziness-painful-ulcers-peritonitis-infantile-spasms/" rel="nofollow" target="_blank">Podcast Ep 47: Salicylate Toxicity, Carbon Monoxide Poisoning, &amp; More</a> appeared first on <a href="https://www.roshreview.com/blog" rel="nofollow" target="_blank">RoshReview.com</a>.

Ep 47 Roshcast Emergency Board Review

Only those who dare to fail greatly can ever achieve greatly.–Robert F. KennedyWelcome back to RoshCast for Episode 46! Let’s kick off this episode with a rapid review of molluscum contagiosum.Molloscum contagiosum is caused by poxvirus. It is seen in children, sexually active adults, and immunocompromised patients like those with HIV.The rash presents as painless, pearly, umbilicate papules, and it is spread by direct skin-to-skin contact.Children present with lesions on the face, trunk, and extremities, whereas sexually active adults can present with lesions in the genital regions, lower abdomen, and thighs. The rash tends to spare the palms and soles.Most patient will not require therapy with spontaneous resolution occurring in months. Those with extensive lesions may benefit from cryotherapy.HIV positive patients with a CD4 count less than 100 are at greater risk for developing molluscum contagiosum.Teaching ImageNow onto this week’s podcastQuestion 1Which of the following organisms is one of the most commonly implicated in the development of a lung abscess?A. Klebsiella pneumoniaeB. PeptostreptococcusC. Staphylococcus aureusD. Streptococcus pneumoniaeTeaching ImageQuestion 2A 26-year-old man presents to the ED after being hit in the head by a foul baseball. The patient was initially alert and talking to you. He is now becoming progressively more somnolent. Which of the following would you expect to see on a non-contrast computed tomography scan of the head?A. A collection of blood layering in the basilar cisternsB. A crescent-shaped frontal hematoma crossing suture linesC. A lenticular-shaped hematoma in the temporal regionD. An intraparenchymal hemorrhage within the frontal lobeTeaching ImageQuestion 3A 55-year-old man who is taking several antihypertensive medications presents to the ED with nausea, vomiting, shortness of breath, and a rash after eating a home-cooked Thai meal at a friend’s house about one hour ago. The symptoms began within seconds of the first bite of his meal. Despite the patient being administered 2 doses of intramuscular epinephrine, diphenhydramine, dexamethasone, and crystalloid fluids, his blood pressure remains at 75/38 mm Hg. Which other medication should be considered in this patient?A. CimetidineB. GlucagonC. NorepinephrineD. OctreotideQuestion 4A 36-year-old man presents to the ED after having a seizure. He has a folder full of medical records dating back 15 years. Several of the records are from other cities and states. It is now 11:00 pm on a Friday night. His primary care physician, neurologist, and psychiatrist are “out of town,” and he believes that he needs to be admitted for the duration of the weekend. He has another episode in the ED and immediately following this he returns to his baseline. He is now awake and alert. You immediately draw a serum lactate and it is normal. Which of the following diagnoses should be strongly considered in this patient?A. Conversion disorderB. HypochondriasisC. Munchausen syndromeD. SomatizationTeaching ImageQuestion 5A 4-year-old boy is brought to the emergency department by his parents after they found him in the backyard shed choking and gagging. Before this event, he was otherwise healthy. His temperature is 101°F, heart rate is 95 bpm, blood pressure is 100/60 mm Hg, and respiratory rate 40/min. On exam, he appears sleepy but continues to cough. Pulmonary findings include moderate retractions and diffuse wheezes. A chest X-ray shows patchy infiltrates. What is the most likely diagnosis?A. Foreign body aspirationB. Hydrocarbon ingestionC. Organophosphate ingestionD. Status asthmaticusTeaching ImageQuestion 6A 12-year-old boy presents to the ED after his brother bumped into his elbow while he was using a cotton-tipped swab to clean out his ear. He denies dizziness, vertigo, nausea, or hearing loss. On exam, you note a tear of the tympanic membrane and a small amount of blood in the external canal. Which of the following is the most appropriate next step in management?A. Begin antibioticsB. Discharge with instructions to keep the ear canal dryC. Emergency department consultation to ENTD. Pack the ear with gauzeTeaching ImageAnaerobes like Prevotella, Bacteroides, Fusobacterium, and Peptostreptococcus are the most common organisms found in a lung abscess.On chest radiograph, lung abscesses present as a consolidation with an air fluid level inside a cavitary lesion.An epidural hematoma presents as a hyperdense lenticular-shaped hematoma in the temporal region, and it is caused by a tear in the middle meningeal artery. A lucid interval is often associated with this bleed.Patients taking beta-blockers for hypertension may exhibit persistent hypotension in the setting of anaphylactic shock. They should be treated with glucagon to free up the beta receptor and potentiate the circulating epinephrine to restore vasomotor tone.In Munchausen syndrome, the individual feigns disease in an attempt to gain attention, sympathy, or reassurance.Somatization disorder is characterized by unexplained physical symptoms that lead to significant social and occupational impairment.Conversion disorder is characterized by an unexplained neurologic symptom triggered by a psychological stressor.Hydrocarbon ingestion can cause pneumonitis, and the chest X-ray can show diffuse bilateral infiltrates.Patients with asymptomatic ruptured tympanic membranes can be discharged home with instructions to keep the canal dry. Symptomatic patients require emergent ENT consultation.That wraps up RoshCast Episode 46! Be sure to also check out the rest of the Rosh Review Blog for questions from prior episodes, related images and tables, and bonus teaching points. There are also tons of other great free resources to help prepare you for the boards and the wards. Don’t forget to follow us on twitter @RoshCast. And you can always email us at RoshCast@RoshReview.com with any feedback, corrections, or suggestions. You can also help us pick questions by identifying ones you would like us to review. Write “RoshCast” in the Submit Feedback box as you go through the question bank. Lastly, if you have a minute, make sure to rate us and leave comments on iTunes to help spread the word about RoshCast.Megha and NachiThe post Podcast Ep 46: Lung Abscesses, Head Injuries, Anaphylaxis &amp; More appeared first on RoshReview.com.

<blockquote>Only those who dare to fail greatly can ever achieve greatly.–Robert F. Kennedy</blockquote><h6>Welcome back to RoshCast for Episode 46! Let’s kick off this episode with a rapid review of molluscum contagiosum.</h6><ul><li>Molloscum contagiosum is caused by poxvirus. It is seen in children, sexually active adults, and immunocompromised patients like those with HIV.</li><li>The rash presents as painless, pearly, umbilicate papules, and it is spread by direct skin-to-skin contact.</li><li>Children present with lesions on the face, trunk, and extremities, whereas sexually active adults can present with lesions in the genital regions, lower abdomen, and thighs. The rash tends to spare the palms and soles.</li><li>Most patient will not require therapy with spontaneous resolution occurring in months. Those with extensive lesions may benefit from cryotherapy.</li><li>HIV positive patients with a CD4 count less than 100 are at greater risk for developing molluscum contagiosum.</li></ul><a href="https://www.roshreview.com/wp-content/uploads/Ep46-Molluscum-Contagiosum.png" rel="nofollow" target="_blank">Teaching Image</a>Now onto this week’s podcastQuestion 1Which of the following organisms is one of the most commonly implicated in the development of a lung abscess?A. Klebsiella pneumoniaeB. PeptostreptococcusC. Staphylococcus aureusD. Streptococcus pneumoniae<a href="https://www.roshreview.com/wp-content/uploads/Ep46-Lung-Abscess.png" rel="nofollow" target="_blank">Teaching Image</a>Question 2A 26-year-old man presents to the ED after being hit in the head by a foul baseball. The patient was initially alert and talking to you. He is now becoming progressively more somnolent. Which of the following would you expect to see on a non-contrast computed tomography scan of the head?A. A collection of blood layering in the basilar cisternsB. A crescent-shaped frontal hematoma crossing suture linesC. A lenticular-shaped hematoma in the temporal regionD. An intraparenchymal hemorrhage within the frontal lobe<a href="https://www.roshreview.com/wp-content/uploads/Ep46-Cerebral-Hemorrhages.png" rel="nofollow" target="_blank">Teaching Image</a>Question 3A 55-year-old man who is taking several antihypertensive medications presents to the ED with nausea, vomiting, shortness of breath, and a rash after eating a home-cooked Thai meal at a friend’s house about one hour ago. The symptoms began within seconds of the first bite of his meal. Despite the patient being administered 2 doses of intramuscular epinephrine, diphenhydramine, dexamethasone, and crystalloid fluids, his blood pressure remains at 75/38 mm Hg. Which other medication should be considered in this patient?A. CimetidineB. GlucagonC. NorepinephrineD. OctreotideQuestion 4A 36-year-old man presents to the ED after having a seizure. He has a folder full of medical records dating back 15 years. Several of the records are from other cities and states. It is now 11:00 pm on a Friday night. His primary care physician, neurologist, and psychiatrist are “out of town,” and he believes that he needs to be admitted for the duration of the weekend. He has another episode in the ED and immediately following this he returns to his baseline. He is now awake and alert. You immediately draw a serum lactate and it is normal. Which of the following diagnoses should be strongly considered in this patient?A. Conversion disorderB. HypochondriasisC. Munchausen syndromeD. Somatization<a href="https://www.roshreview.com/wp-content/uploads/Ep46-Munchausen-Syndrome.png" rel="nofollow" target="_blank">Teaching Image</a>Question 5A 4-year-old boy is brought to the emergency department by his parents after they found him in the backyard shed choking and gagging. Before this event, he was otherwise healthy. His temperature is 101°F, heart rate is 95 bpm, blood pressure is 100/60 mm Hg, and respiratory rate 40/min. On exam, he appears sleepy but continues to cough. Pulmonary findings include moderate retractions and diffuse wheezes. A chest X-ray shows patchy infiltrates. What is the most likely diagnosis?A. Foreign body aspirationB. Hydrocarbon ingestionC. Organophosphate ingestionD. Status asthmaticus<a href="https://www.roshreview.com/wp-content/uploads/Ep46-Hydrocarbon-Pneumonitis.jpg" rel="nofollow" target="_blank">Teaching Image</a>Question 6A 12-year-old boy presents to the ED after his brother bumped into his elbow while he was using a cotton-tipped swab to clean out his ear. He denies dizziness, vertigo, nausea, or hearing loss. On exam, you note a tear of the tympanic membrane and a small amount of blood in the external canal. Which of the following is the most appropriate next step in management?A. Begin antibioticsB. Discharge with instructions to keep the ear canal dryC. Emergency department consultation to ENTD. Pack the ear with gauze<a href="https://www.roshreview.com/wp-content/uploads/Ep46-Perforated-Tympanic-Membrane.png" rel="nofollow" target="_blank">Teaching Image</a><ul><li>Anaerobes like Prevotella, Bacteroides, Fusobacterium, and Peptostreptococcus are the most common organisms found in a lung abscess.</li><li>On chest radiograph, lung abscesses present as a consolidation with an air fluid level inside a cavitary lesion.</li><li>An epidural hematoma presents as a hyperdense lenticular-shaped hematoma in the temporal region, and it is caused by a tear in the middle meningeal artery. A lucid interval is often associated with this bleed.</li><li>Patients taking beta-blockers for hypertension may exhibit persistent hypotension in the setting of anaphylactic shock. They should be treated with glucagon to free up the beta receptor and potentiate the circulating epinephrine to restore vasomotor tone.</li><li>In Munchausen syndrome, the individual feigns disease in an attempt to gain attention, sympathy, or reassurance.</li><li>Somatization disorder is characterized by unexplained physical symptoms that lead to significant social and occupational impairment.</li><li>Conversion disorder is characterized by an unexplained neurologic symptom triggered by a psychological stressor.</li><li>Hydrocarbon ingestion can cause pneumonitis, and the chest X-ray can show diffuse bilateral infiltrates.</li><li>Patients with asymptomatic ruptured tympanic membranes can be discharged home with instructions to keep the canal dry. Symptomatic patients require emergent ENT consultation.</li></ul>That wraps up RoshCast Episode 46! Be sure to also check out the rest of the <a href="https://www.roshreview.com/blog/" rel="noreferrer noopener nofollow" target="_blank">Rosh Review Blog </a>for questions from prior episodes, related images and tables, and bonus teaching points. There are also tons of other great free resources to help prepare you for the boards and the wards. Don’t forget to follow us on twitter <a href="https://twitter.com/roshcast?lang=en" rel="nofollow" target="_blank">@RoshCast</a>. And you can always email us at <a href="mailto:roshcast@roshreview.com">RoshCast@RoshReview.com</a> with any feedback, corrections, or suggestions. You can also help us pick questions by identifying ones you would like us to review. Write “RoshCast” in the Submit Feedback box as you go through the question bank. Lastly, if you have a minute, make sure to rate us and leave comments on <a href="https://itunes.apple.com/us/podcast/roshcast/id1156487141?mt=2" rel="noreferrer noopener nofollow" target="_blank">iTunes</a> to help spread the word about RoshCast.Megha and NachiThe post <a href="https://www.roshreview.com/blog/podcast-ep-46-lung-abscesses-head-injuries-anaphylaxis-psychiatric-disorders-pneumonitis-ruptured-tympanic-membranes/" rel="nofollow" target="_blank">Podcast Ep 46: Lung Abscesses, Head Injuries, Anaphylaxis &amp; More</a> appeared first on <a href="https://www.roshreview.com/blog" rel="nofollow" target="_blank">RoshReview.com</a>.

Ep 46 Roshcast Emergency Board Review

There is only one corner of the universe you can be certain of improving, and that’s your own self.–Aldous HuxleyWelcome back to RoshCast for Episode 45! Let’s start out with a review of rabies before getting to core content Q&amp;A.The most common wild reservoirs of rabies are raccoons, skunks, bats, foxes, and coyotes. Domestic animals like cats, dogs, and cattle can also get rabies. Rodents, reptiles, and birds on the other hand are not carriers and cannot transmit rabies.One important factor in deciding if you get rabies postexposure prophylaxis is whether the animal can be found and held for observation.The rabies postexposure prophylaxis has two parts: the immunoglobulin and the vaccine.When giving rabies postexposure prophylaxis, inject the immunoglobulin into the wound and start the rabies vaccine series which the patient will receive on days 1, 3, 7, 14, and 28.Now onto this week’s podcastQuestion 1Which of the following is true regarding acute respiratory distress syndrome?A. Define as PaO2:FiO2 &gt; 300B. Empiric corticosteroids should be givenC. Positive end-expiratory pressure should be increased with increases in FiO2D. Tidal volume should be started at 10 mL/kg in intubated patientsTeaching ImageQuestion 2A 35-year-old man presents to the ED after being assaulted in a bar fight. He has signs of significant facial trauma. On physical exam, you note a tooth fracture through the enamel and dentin but does not involve the pulp. Which of the following is the most appropriate next step in management of his dental injury?  A. Calcium hydroxide pasteB. Extract the toothC. Immediate dental consultD. Pencillin VKTeaching ImageQuestion 3A 62-year-old man presents with acute onset of chest pain with radiation to the shoulders and nausea while walking his dog. On examination, he is diaphoretic with heart rate 94 bpm, respiratory rate 20 bpm, blood pressure 92/59 mm Hg, and oxygen saturation 96% on room air. His ECG reveals 2 mm elevation in aVR. Occlusion of which coronary artery is most likely responsible for this patient’s presentation?A. Left anterior descending arteryB. Left circumflex arteryC. Left main coronary arteryD. Right coronary arteryTeaching ImageQuestion 4A 62-year-old man presents for evaluation of chest pain. Approximately three weeks ago the patient had a myocardial infarction with stent placement. Last evening he developed pleuritic chest pain and fever. He has no cough and does not feel short of breath. His ECG is shown above. Which of the following is the most likely diagnosis?A. Dressler syndromeB. Infarct pericarditisC. Left ventricular aneurysmD. ST segment elevation myocardial infarctionTeaching ImageQuestion 5A 45-year-old man with a history of hypercholesterolemia presents with acute onset of anterior chest pain, nausea, and diaphoresis. His ECG is distinct for upsloping ST elevation in AVR (≥ 1 mm) with ST depressions and tall T waves in the precordial leads. What is the most likely diagnosis?A. Occlusion of the left circumflex arteryB. Occlusion of the left main coronary arteryC. Occlusion of the proximal left anterior descending arteryD. Occlusion of the right coronary arteryTeaching ImageQuestion 6A 25-year-old man presents the emergency department with knee pain. This morning he slipped on the ice and felt a pop in his knee. On physical exam his left knee appears to have a moderate effusion with limited range of motion and medial joint line tenderness. An X-ray of the left knee is performed. A pedunculated, bony exostosis with well-defined margins is seen along the distal lateral femur on the AP view of the knee. What is the most likely diagnosis of the incidental bone lesion?A. Aneurysmal bone cystB. OsteochondromaC. Osteoid osteomaD. OsteosarcomaTeaching ImageTeaching ImageTeaching ImageIntubated patients with ARDS should be started on low tidal volumes of 6–8 cc/kg of ideal body weight, and the PEEP and FiO2 should be titrated up together.The PaO2 to FiO2 ratio in patients with ARDS is &lt; 300. The lower the ratio, the worse the disease process.There are three classes of dental fractures: Ellis Class I involves injury to the enamel alone and is treated by smoothing any rough edges.Ellis Class II involves injury to the dentin and enamel. This is treated by covering exposed dentin with calcium hydroxide.Ellis Class III involves the pulp along with the dentin and enamel. These usually require antibiotics and immediate dental consult. ST segment elevation in aVR greater than 1 mm or greater than the ST segment elevation in V1 is most concerning for occlusion of the left main coronary artery.Dressler syndrome is pericarditis occuring one week to several months after an MI.A left ventricular aneurysm is a complication of a large anterior wall MI. EKG shows ST segment elevations in the anterior leads.De Winter ECG patterns presents with tall, prominent symmetric T waves in the precordial leads with upsloping ST segment depression greater than 1mm at the J point and ST segment elevation may be seen in aVRDe Winter EKG is a STEMI equivalent and represents acute LAD occlusion.Aneurysmal bone cyst, osteochondroma, and osteoid osteoma are benign bone lesions.Osteosarcoma is a malignant bone lesion seen on X-ray as a lytic lesion, a blastic lesion, or a heavily ossified mass.That wraps up RoshCast Episode 45! Be sure to also check out the rest of the Rosh Review Blog for questions from prior episodes, related images and tables, as well as bonus teaching points. There are also tons of other great free resources to help prepare you for the boards and the wards. Don’t forget to follow us on twitter @RoshCast and @RoshReview. And you can always email us at RoshCast@RoshReview.com with any feedback, corrections, or suggestions. You can also help us pick questions by identifying ones you would like us to review. Write “RoshCast” in the submit feedback box as you go through the question bank. Lastly, if you have a minute, make sure to rate us and leave comments on iTunes to help spread the word about RoshCast. We’re also launching on Google Play in the near future.Megha and NachiThe post Podcast Ep 45: ARDS, Dental Fractures, STEMIs, Pericarditis, &amp; More appeared first on RoshReview.com.

<blockquote>There is only one corner of the universe you can be certain of improving, and that’s your own self.–Aldous Huxley</blockquote><h6>Welcome back to RoshCast for Episode 45! Let’s start out with a review of rabies before getting to core content Q&amp;A.</h6><ul><li>The most common wild reservoirs of rabies are raccoons, skunks, bats, foxes, and coyotes. Domestic animals like cats, dogs, and cattle can also get rabies. Rodents, reptiles, and birds on the other hand are not carriers and cannot transmit rabies.</li><li>One important factor in deciding if you get rabies postexposure prophylaxis is whether the animal can be found and held for observation.</li><li>The rabies postexposure prophylaxis has two parts: the immunoglobulin and the vaccine.</li><li>When giving rabies postexposure prophylaxis, inject the immunoglobulin into the wound and start the rabies vaccine series which the patient will receive on days 1, 3, 7, 14, and 28.</li></ul>Now onto this week’s podcastQuestion 1Which of the following is true regarding acute respiratory distress syndrome?A. Define as PaO2:FiO2 &gt; 300B. Empiric corticosteroids should be givenC. Positive end-expiratory pressure should be increased with increases in FiO2D. Tidal volume should be started at 10 mL/kg in intubated patients<a href="https://www.roshreview.com/wp-content/uploads/Ep45-Berlin-Criteria.png" rel="nofollow" target="_blank">Teaching Image</a>Question 2A 35-year-old man presents to the ED after being assaulted in a bar fight. He has signs of significant facial trauma. On physical exam, you note a tooth fracture through the enamel and dentin but does not involve the pulp. Which of the following is the most appropriate next step in management of his dental injury?  A. Calcium hydroxide pasteB. Extract the toothC. Immediate dental consultD. Pencillin VK<a href="https://www.roshreview.com/wp-content/uploads/Ep45-Tooth-Fracture.png" rel="nofollow" target="_blank">Teaching Image</a>Question 3A 62-year-old man presents with acute onset of chest pain with radiation to the shoulders and nausea while walking his dog. On examination, he is diaphoretic with heart rate 94 bpm, respiratory rate 20 bpm, blood pressure 92/59 mm Hg, and oxygen saturation 96% on room air. His ECG reveals 2 mm elevation in aVR. Occlusion of which coronary artery is most likely responsible for this patient’s presentation?A. Left anterior descending arteryB. Left circumflex arteryC. Left main coronary arteryD. Right coronary artery<a href="https://www.roshreview.com/wp-content/uploads/Ep45-Left-Main-Coronary-Artery-Occlusion.png" rel="nofollow" target="_blank">Teaching Image</a>Question 4A 62-year-old man presents for evaluation of chest pain. Approximately three weeks ago the patient had a myocardial infarction with stent placement. Last evening he developed pleuritic chest pain and fever. He has no cough and does not feel short of breath. His ECG is shown above. Which of the following is the most likely diagnosis?A. Dressler syndromeB. Infarct pericarditisC. Left ventricular aneurysmD. ST segment elevation myocardial infarction<a href="https://www.roshreview.com/wp-content/uploads/Ep45-Dressler-Syndrome.png" rel="nofollow" target="_blank">Teaching Image</a>Question 5A 45-year-old man with a history of hypercholesterolemia presents with acute onset of anterior chest pain, nausea, and diaphoresis. His ECG is distinct for upsloping ST elevation in AVR (≥ 1 mm) with ST depressions and tall T waves in the precordial leads. What is the most likely diagnosis?A. Occlusion of the left circumflex arteryB. Occlusion of the left main coronary arteryC. Occlusion of the proximal left anterior descending arteryD. Occlusion of the right coronary artery<a href="https://www.roshreview.com/wp-content/uploads/Ep45-DeWinter.png" rel="nofollow" target="_blank">Teaching Image</a>Question 6A 25-year-old man presents the emergency department with knee pain. This morning he slipped on the ice and felt a pop in his knee. On physical exam his left knee appears to have a moderate effusion with limited range of motion and medial joint line tenderness. An X-ray of the left knee is performed. A pedunculated, bony exostosis with well-defined margins is seen along the distal lateral femur on the AP view of the knee. What is the most likely diagnosis of the incidental bone lesion?A. Aneurysmal bone cystB. OsteochondromaC. Osteoid osteomaD. Osteosarcoma<a href="https://www.roshreview.com/wp-content/uploads/Ep45-Osteosarcoma.png" rel="nofollow" target="_blank">Teaching Image</a><a href="Ep45-Osteoid-Osteoma" rel="nofollow" target="_blank">Teaching Image</a><a href="Ep45-Osteochondroma" rel="nofollow" target="_blank">Teaching Image</a><ul><li>Intubated patients with ARDS should be started on low tidal volumes of 6–8 cc/kg of ideal body weight, and the PEEP and FiO2 should be titrated up together.</li><li>The PaO2 to FiO2 ratio in patients with ARDS is &lt; 300. The lower the ratio, the worse the disease process.</li><li>There are three classes of dental fractures: <ul><li>Ellis Class I involves injury to the enamel alone and is treated by smoothing any rough edges.</li><li>Ellis Class II involves injury to the dentin and enamel. This is treated by covering exposed dentin with calcium hydroxide.</li><li>Ellis Class III involves the pulp along with the dentin and enamel. These usually require antibiotics and immediate dental consult. </li></ul></li><li>ST segment elevation in aVR greater than 1 mm or greater than the ST segment elevation in V1 is most concerning for occlusion of the left main coronary artery.</li><li>Dressler syndrome is pericarditis occuring one week to several months after an MI.</li><li>A left ventricular aneurysm is a complication of a large anterior wall MI. EKG shows ST segment elevations in the anterior leads.</li><li>De Winter ECG patterns presents with tall, prominent symmetric T waves in the precordial leads with upsloping ST segment depression greater than 1mm at the J point and ST segment elevation may be seen in aVR</li><li>De Winter EKG is a STEMI equivalent and represents acute LAD occlusion.</li><li>Aneurysmal bone cyst, osteochondroma, and osteoid osteoma are benign bone lesions.</li><li>Osteosarcoma is a malignant bone lesion seen on X-ray as a lytic lesion, a blastic lesion, or a heavily ossified mass.</li></ul>That wraps up RoshCast Episode 45! Be sure to also check out the rest of the <a href="https://www.roshreview.com/blog/" rel="noreferrer noopener nofollow" target="_blank">Rosh Review Blog </a>for questions from prior episodes, related images and tables, as well as bonus teaching points. There are also tons of other great free resources to help prepare you for the boards and the wards. Don’t forget to follow us on twitter <a href="https://twitter.com/roshcast?lang=en" rel="nofollow" target="_blank">@RoshCast</a> and <a href="https://twitter.com/roshreview?lang=en" rel="nofollow" target="_blank">@RoshReview</a>. And you can always email us at <a href="mailto:roshcast@roshreview.com">RoshCast@RoshReview.com</a> with any feedback, corrections, or suggestions. You can also help us pick questions by identifying ones you would like us to review. Write “RoshCast” in the submit feedback box as you go through the question bank. Lastly, if you have a minute, make sure to rate us and leave comments on <a href="https://itunes.apple.com/us/podcast/roshcast/id1156487141?mt=2" rel="noreferrer noopener nofollow" target="_blank">iTunes</a> to help spread the word about RoshCast. We’re also launching on Google Play in the near future.Megha and NachiThe post <a href="https://www.roshreview.com/blog/podcast-ep-45-ards-dental-fractures-stemis-pericarditis-bone-lesions/" rel="nofollow" target="_blank">Podcast Ep 45: ARDS, Dental Fractures, STEMIs, Pericarditis, &amp; More</a> appeared first on <a href="https://www.roshreview.com/blog" rel="nofollow" target="_blank">RoshReview.com</a>.

Ep 45 Roshcast Emergency Board Review

By failing to prepare, you are preparing to fail.–Benjamin FranklinWelcome back to RoshCast for Episode 44! We are back to an every other week schedule covering core content. Let’s start out with a rapid review of neonatal conjunctivitis.The three dangerous causes of neonatal conjunctivitis that you need to consider in the ED are gonorrhea, chlamydia, and herpes.Gonorrhea is the most aggressive bacteria associated with neonatal conjunctivitis. It presents in the first week of life with purulent drainage and ulcerations, and it can disseminate to cause gonococcal sepsis. Culture the drainage for confirmation, and treat the baby with cefotaxime.Chlamydia neonatal conjunctivitis, which presents in the first month of life, can disseminate into the lungs. Treat with oral erythromycin.The third and least dangerous cause of neonatal conjunctivitis is herpetic. In this case you may see vesicles in the eye. Treat this with IV acyclovir.Now onto this week’s podcastQuestion 1A 21-year-old man presents after he was bitten by a spider. He has a picture of the spider on his phone (shown above). Which of the following is a potential complication of a bite by this spider?A. Abdominal rigidityB. Autonomic instabilityC. Coagulation abnormalitiesD. PancreatitisTeaching ImageQuestion 2A 66-year-old man with hypertension and hyperlipidemia presents after an episode of severe chest pain while walking to work. He is currently asymptomatic. His vitals are T 36.27°C, HR 76/min, BP 143/85 mm Hg, RR 18/min, and oxygen saturation 99%. A 12-lead ECG is performed as seen above. Which of the following is the most appropriate next step in management?A. Give 325 mg of aspirin, and activate the cardiac catheterization labB. Give 325 mg of aspirin, and admit for serial troponin testing and stress testC. Give 325 mg of aspirin, and discharge home with cardiology follow-up in 24–48 hoursD. Send d-dimer, and consider CT pulmonary angiogram if elevatedTeaching ImageQuestion 3A 17-year-old boy from New Jersey presents with a 3-day history of rash and a 1-day history of facial droop. He also complains of a headache. The images above represent the physical examination findings. In addition you note mild nuchal rigidity. A noncontrast head CT is performed and is normal. Which of the following is the next best step for this patient?A. Acyclovir and corticosteroidsB. Lumbar punctureC. MRI brainD. Serologic testing for Lyme disease Teaching ImageQuestion 4A 52-year-old man presents with decreased sensation in the upper extremities and chronic neck pain. He states that the loss of sensation has been progressive for months. On physical examination, he has decreased sensation to pain over the upper back, shoulders, and arms with intact proprioception and light touch. What disorder does this patient exhibit?A. Anterior cord syndromeB. Brown-Sequard syndromeC. Central cord syndromeD. SyringomyeliaTeaching ImageQuestion 5What is the most frequently seen oculomotor sign in patients with Wernicke encephalopathy?A. Lateral nystagmusB. Lateral rectus palsyC. MiosisD. PtosisTeaching ImageQuestion 6A patient with metastatic breast cancer presents with weakness and nausea. An ECG is shown above. What electrolyte abnormality is likely in this patient?A. HypercalcemiaB. HypernatremiaC. HypocalcemiaD. HyponatremiaTeaching ImageBrown recluse spiders have violin-shaped markings on their back. The toxin here can lead to hematologic abnormalities. There is no antivenin available in the US.Black widow spiders, on the other hand, have a red hourglass shape on their ventral surface and their toxin causes autonomic instability and abdominal wall rigidity. There is an antivenin available, but it’s only used in severe cases.Wellen’s syndrome type A demonstrates biphasic T waves in V1–V3 and type B demonstrates deeply inverted T waves in V1–V3.  It is highly specific for a critical stenosis of the LAD. Activate the catheterization lab!There are three stages of Lyme disease: Early Lyme manifests with the classic erythema migrans rash.The second stage is acute disseminated infection which results in neurologic, cardiac, arthritic, and ophthalmic manifestations.The third is late Lyme disease, which presents with worse neurologic manifestations and chronic Lyme arthritis. The most common location of syringomyelia is the cervical spine. Patients present with a cape-like distribution of loss of pain and temperature sensation in the upper extremities with preservation of light touch and proprioception.Anterior cord syndrome is characterized by loss of motor function below the lesion and preservation of position, touch, and vibration sensation.Brown-Sequard syndrome presents with ipsilateral motor function loss and contralateral pain and temperature sensation loss.Central cord syndrome presents with bilateral motor paresis and sensory impairment.The most frequently seen oculomotor sign in Wernicke encephalopathy is lateral nystagmus.Diagnosis of Wernicke encephalopathy requires two out of four of the following criteria: dietary deficiencies, oculomotor dysfunction, cerebellar dysfunction, and altered mental status.Hypercalcemia can cause QT shortening, while hypocalcemia can cause QT prolongation.Malignancy is the most common inpatient cause of hypercalcemia while primary hyperparathyroidism is the most common outpatient cause.That wraps up RoshCast Episode 44! Be sure to also check out the rest of the Rosh Review Blog for questions from prior episodes, related images and tables, as well as bonus teaching points. There are also tons of other great free resources to help prepare you for the boards and the wards. Don’t forget to follow us on twitter @RoshCast and @RoshReview. And you can always email us at RoshCast@RoshReview.com with any feedback, corrections, or suggestions. You can also help us pick questions by identifying ones you would like us to review. Write “RoshCast” in the submit feedback box as you go through the question bank. Lastly, if you have a minute, make sure to rate us and leave comments on iTunes to help spread the word about RoshCast. We’re launching on Google Play in the near future also.Megha and NachiThe post Podcast Ep 44: Spider Bites, Biphasic T Waves, Lyme Disease, Syringomyelia, Wernicke Encephalopathy, Electrolyte Abnormalities appeared first on RoshReview.com.

<blockquote>By failing to prepare, you are preparing to fail.–Benjamin Franklin</blockquote><h6>Welcome back to RoshCast for Episode 44! We are back to an every other week schedule covering core content. Let’s start out with a rapid review of neonatal conjunctivitis.</h6><ul><li>The three dangerous causes of neonatal conjunctivitis that you need to consider in the ED are gonorrhea, chlamydia, and herpes.</li><li>Gonorrhea is the most aggressive bacteria associated with neonatal conjunctivitis. It presents in the first week of life with purulent drainage and ulcerations, and it can disseminate to cause gonococcal sepsis. Culture the drainage for confirmation, and treat the baby with cefotaxime.</li><li>Chlamydia neonatal conjunctivitis, which presents in the first month of life, can disseminate into the lungs. Treat with oral erythromycin.</li><li>The third and least dangerous cause of neonatal conjunctivitis is herpetic. In this case you may see vesicles in the eye. Treat this with IV acyclovir.</li></ul>Now onto this week’s podcastQuestion 1A 21-year-old man presents after he was bitten by a spider. He has a picture of the spider on his phone (shown above). Which of the following is a potential complication of a bite by this spider?A. Abdominal rigidityB. Autonomic instabilityC. Coagulation abnormalitiesD. Pancreatitis<a href="https://www.roshreview.com/wp-content/uploads/Ep44-Black-Widow-Brown-Recluse.jpg" rel="nofollow" target="_blank">Teaching Image</a>Question 2A 66-year-old man with hypertension and hyperlipidemia presents after an episode of severe chest pain while walking to work. He is currently asymptomatic. His vitals are T 36.27°C, HR 76/min, BP 143/85 mm Hg, RR 18/min, and oxygen saturation 99%. A 12-lead ECG is performed as seen above. Which of the following is the most appropriate next step in management?A. Give 325 mg of aspirin, and activate the cardiac catheterization labB. Give 325 mg of aspirin, and admit for serial troponin testing and stress testC. Give 325 mg of aspirin, and discharge home with cardiology follow-up in 24–48 hoursD. Send d-dimer, and consider CT pulmonary angiogram if elevated<a href="https://www.roshreview.com/wp-content/uploads/Ep44-Wellens-Syndrome.png" rel="nofollow" target="_blank">Teaching Image</a>Question 3A 17-year-old boy from New Jersey presents with a 3-day history of rash and a 1-day history of facial droop. He also complains of a headache. The images above represent the physical examination findings. In addition you note mild nuchal rigidity. A noncontrast head CT is performed and is normal. Which of the following is the next best step for this patient?A. Acyclovir and corticosteroidsB. Lumbar punctureC. MRI brainD. Serologic testing for Lyme disease <a href="https://www.roshreview.com/wp-content/uploads/Ep44-3-Stages-of-Lyme-Disease.png" rel="nofollow" target="_blank">Teaching Image</a>Question 4A 52-year-old man presents with decreased sensation in the upper extremities and chronic neck pain. He states that the loss of sensation has been progressive for months. On physical examination, he has decreased sensation to pain over the upper back, shoulders, and arms with intact proprioception and light touch. What disorder does this patient exhibit?A. Anterior cord syndromeB. Brown-Sequard syndromeC. Central cord syndromeD. Syringomyelia<a href="https://www.roshreview.com/wp-content/uploads/Ep44-Syrinomyelia.jpg" rel="nofollow" target="_blank">Teaching Image</a>Question 5What is the most frequently seen oculomotor sign in patients with Wernicke encephalopathy?A. Lateral nystagmusB. Lateral rectus palsyC. MiosisD. Ptosis<a href="https://www.roshreview.com/wp-content/uploads/Ep44-Wernicke-Syndrome.png" rel="nofollow" target="_blank">Teaching Image</a>Question 6A patient with metastatic breast cancer presents with weakness and nausea. An ECG is shown above. What electrolyte abnormality is likely in this patient?A. HypercalcemiaB. HypernatremiaC. HypocalcemiaD. Hyponatremia<a href="https://www.roshreview.com/wp-content/uploads/Ep44-Hypercalcemia.jpg" rel="nofollow" target="_blank">Teaching Image</a><ul><li>Brown recluse spiders have violin-shaped markings on their back. The toxin here can lead to hematologic abnormalities. There is no antivenin available in the US.</li><li>Black widow spiders, on the other hand, have a red hourglass shape on their ventral surface and their toxin causes autonomic instability and abdominal wall rigidity. There is an antivenin available, but it’s only used in severe cases.</li><li>Wellen’s syndrome type A demonstrates biphasic T waves in V1–V3 and type B demonstrates deeply inverted T waves in V1–V3.  It is highly specific for a critical stenosis of the LAD. Activate the catheterization lab!</li><li>There are three stages of Lyme disease: <ul><li>Early Lyme manifests with the classic erythema migrans rash.</li><li>The second stage is acute disseminated infection which results in neurologic, cardiac, arthritic, and ophthalmic manifestations.</li><li>The third is late Lyme disease, which presents with worse neurologic manifestations and chronic Lyme arthritis. </li></ul></li><li>The most common location of syringomyelia is the cervical spine. Patients present with a cape-like distribution of loss of pain and temperature sensation in the upper extremities with preservation of light touch and proprioception.</li><li>Anterior cord syndrome is characterized by loss of motor function below the lesion and preservation of position, touch, and vibration sensation.</li><li>Brown-Sequard syndrome presents with ipsilateral motor function loss and contralateral pain and temperature sensation loss.</li><li>Central cord syndrome presents with bilateral motor paresis and sensory impairment.</li><li>The most frequently seen oculomotor sign in Wernicke encephalopathy is lateral nystagmus.</li><li>Diagnosis of Wernicke encephalopathy requires two out of four of the following criteria: dietary deficiencies, oculomotor dysfunction, cerebellar dysfunction, and altered mental status.</li><li>Hypercalcemia can cause QT shortening, while hypocalcemia can cause QT prolongation.</li><li>Malignancy is the most common inpatient cause of hypercalcemia while primary hyperparathyroidism is the most common outpatient cause.</li></ul>That wraps up RoshCast Episode 44! Be sure to also check out the rest of the <a href="https://www.roshreview.com/blog/" rel="noreferrer noopener nofollow" target="_blank">Rosh Review Blog </a>for questions from prior episodes, related images and tables, as well as bonus teaching points. There are also tons of other great free resources to help prepare you for the boards and the wards. Don’t forget to follow us on twitter <a href="https://twitter.com/roshcast?lang=en" rel="nofollow" target="_blank">@RoshCast</a> and <a href="https://twitter.com/roshreview?lang=en" rel="nofollow" target="_blank">@RoshReview</a>. And you can always email us at <a href="mailto:roshcast@roshreview.com">RoshCast@RoshReview.com</a> with any feedback, corrections, or suggestions. You can also help us pick questions by identifying ones you would like us to review. Write “RoshCast” in the submit feedback box as you go through the question bank. Lastly, if you have a minute, make sure to rate us and leave comments on <a href="https://itunes.apple.com/us/podcast/roshcast/id1156487141?mt=2" rel="noreferrer noopener nofollow" target="_blank">iTunes</a> to help spread the word about RoshCast. We’re launching on Google Play in the near future also.Megha and NachiThe post <a href="https://www.roshreview.com/blog/podcast-ep-43-pulmonary-embolism-colchicine-facial-paralysis-cervical-spine-injuries-blast-injuries-traumatic-iritis-2/" rel="nofollow" target="_blank">Podcast Ep 44: Spider Bites, Biphasic T Waves, Lyme Disease, Syringomyelia, Wernicke Encephalopathy, Electrolyte Abnormalities</a> appeared first on <a href="https://www.roshreview.com/blog" rel="nofollow" target="_blank">RoshReview.com</a>.

Ep 44 Roshcast Emergency Board Review

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Emergency Medicine Board Review

“As to diseases, make a habit of two things — to help, or at least, to do no harm.”   ― HippocratesWelcome back to episode 6!Last week’s episode included a new intro Rapid Review…let us know what you think of it. Should we continue it? Keep sending your thoughts to feedback@roshreview.com. This podcast is fluid, and we are open to making changes that would best suit our listeners’ learning styles.Let’s get started.Prophylaxis for Neisseria meningitidis should be offered to household members, school contacts in the prior 7 days, and those with direct exposure to the patient. The preferred antibiotic regimen is rifampin BID for two days.The most common cause of a bilateral Bell’s palsy is Lyme disease.The most common cause of maternal mortality during delivery is maternal hemorrhage, which can be caused by uterine atony, genital trauma, retained products, or, DIC.The most serious adverse reaction to ketamine is laryngospasm, which is treated with bag-valve-mask ventilation. Tthe most common adverse reaction is an emergence reaction.Now to this week’s podcast.Question 1Which of the following antidotes is paired with the correct poisoning?A. Bupivacaine – IntralipidB. Hydrofluoric acid – Sodium bicarbonateC. Lorazepam – FomepizoleD. Metformin – OctreotideTeaching imageQuestion 2A 3-year-old girl presents to the ED with altered mental status. She was in her usual state of health until one day prior to presentation when she developed abdominal pain, vomiting, and bloody diarrhea after she was found with a bottle of vitamins from the family’s medicine cabinet. She transiently improved for a few hours then became increasingly lethargic. On arrival, she responds only to painful stimulus. Her blood pressure is 65/40 mm Hg and her heart rate is 160 beats per minute. She appears profoundly dehydrated. Her arterial blood gas demonstrates a metabolic acidosis. What is the most definitive therapy for this patient?A. Activated charcoalB. DeferoxamineC. Sodium bicarbonateD. Whole-bowel irrigationTeaching imageQuestion 3You are the physician for a patient who is diagnosed with pancreatic adenocarcinoma. The oncologist makes a note of a positive Trousseau’s syndrome in the documentation. Which of the following is she referring to?A. Nontender palpable gallbladderB. Palpable left supraclavicular lymph nodeC. Popliteal pain with abrupt ankle dorsiflexionD. Tender migratory thrombophlebitisTeaching imageQuestion 4:A 27-year-old woman presents with a painful rash on both of her legs. What is the most common cause of this condition?A. AllergyB. Drug hypersensitivity reactionC. Herpes virusD. Streptococcal infectionQuestion 5A 15-year-old G1P0 woman at 23 weeks presents with sharp, left lower quadrant abdominal pain for 1 hour. She has had an ultrasound confirming the presence of a single intrauterine pregnancy. The pain is severe and associated with nausea. Pelvic examination reveals tenderness of the left adnexa. The patient’s urinalysis is unremarkable. What test should be ordered to diagnose the patient?A. Abdominal X-rayB. CT scan of the abdomen and pelvisC. Pelvic ultrasoundD. White blood cell countTeaching imageQuestion 6Which of the following statements is true regarding the diagnosis of Epstein-Barr virus infection?A. Guillain-Barre syndrome is a possible complicationB. Neutrophilia predominatesC. Splenomegaly occurs in 10% of patientsD. The virus is transmitted via respiratory dropletsBupivacaine toxicity is treated with intralipid.Hydrofluoric acid is treated with calcium gluconate, either topically or intra-arterially.Benzodiazepine overdoses should be treated with flumazenil but use caution in those who use them chronically as reversal may precipitate seizures.Iron overdoses occur with ingestions of greater than 40 mg/kg. They should be treated with deferoxamine. For less significant overdoses, GI decontamination may be attempted. Charcoal is of no use here, as it does not bind Iron.The 5 stages of iron toxicity are GI irritation, recovery, shock and metabolic acidosis, fulminant hepatic failure, and bowel obstruction leading to scarring.Trousseau’s syndrome, a migratory thrombophlebitis, is associated with pancreatic cancer.Erythema nodosum is an inflammatory condition characterized by tender red-violet nodules under the skin. The most common cause is infection. Drugs can also cause erythema nodosum, with OCPs being the most common culprit.Erythema nodosum is treated with NSAIDs. Potassium iodine can be used in severe cases.Ovarian torsion is difficult to diagnose. It is commonly seen in women of childbearing age and more commonly occurs on the right, especially in ovaries with large cysts. Laparoscopy is the only way to definitively rule out the condition.EBV infection can lead to many neurologic complications such as encephalitis, meningitis, and Guillain-Barre Syndrome.EBV infection is associated with a profound lymphocytic predominance, with atypical lymphocytes seen on the peripheral smear.Splenomegaly is a common sequela of EBV infection, so remember to tell athletes to abstain from contact sports for up to 4 weeks after infection.That concludes episode 6. We’ll keep new episodes coming throughout the holiday season so make sure to set your favorite podcast player to download them automatically. Also, don’t forget to write a short review for Roshcast on iTunes when you have a minute.If you’d like to start at episode 1 to hear more of our educational pearls, just follow this link back to Roshcast.Until next time,Jeff and NachiP.S. Dr. Rosh recently published an article to help residents preparing for the upcoming emergency medicine In-training Exam…you may find it useful to learn How to Increase Your Emergency Medicine In-Training Exam Score by 10 Points. The post Podcast Ep 6: Bupivacaine Toxicity, Iron Overdose, &amp; More appeared first on RoshReview.com.

<blockquote>“As to diseases, make a habit of two things — to help, or at least, to do no harm.”   ― Hippocrates</blockquote><h6>Welcome back to episode 6! Last week’s episode included a new intro Rapid Review…let us know what you think of it. Should we continue it? Keep sending your thoughts to <a href="mailto:feedback@roshreview.com">feedback@roshreview.com</a>. This podcast is fluid, and we are open to making changes that would best suit our listeners’ learning styles.</h6>Let’s get started.<ul><li>Prophylaxis for Neisseria meningitidis should be offered to household members, school contacts in the prior 7 days, and those with direct exposure to the patient. The preferred antibiotic regimen is rifampin BID for two days.</li><li>The most common cause of a bilateral Bell’s palsy is Lyme disease.</li><li>The most common cause of maternal mortality during delivery is maternal hemorrhage, which can be caused by uterine atony, genital trauma, retained products, or, DIC.</li><li>The most serious adverse reaction to ketamine is laryngospasm, which is treated with bag-valve-mask ventilation. Tthe most common adverse reaction is an emergence reaction.</li></ul>Now to this week’s podcast.Question 1Which of the following antidotes is paired with the correct poisoning?A. Bupivacaine – IntralipidB. Hydrofluoric acid – Sodium bicarbonateC. Lorazepam – FomepizoleD. Metformin – Octreotide<a href="https://www.roshreview.com/wp-content/uploads/Table-Antidotes-and-toxins.png" rel="nofollow" target="_blank">Teaching image</a>Question 2A 3-year-old girl presents to the ED with altered mental status. She was in her usual state of health until one day prior to presentation when she developed abdominal pain, vomiting, and bloody diarrhea after she was found with a bottle of vitamins from the family’s medicine cabinet. She transiently improved for a few hours then became increasingly lethargic. On arrival, she responds only to painful stimulus. Her blood pressure is 65/40 mm Hg and her heart rate is 160 beats per minute. She appears profoundly dehydrated. Her arterial blood gas demonstrates a metabolic acidosis. What is the most definitive therapy for this patient?A. Activated charcoalB. DeferoxamineC. Sodium bicarbonateD. Whole-bowel irrigation<a href="https://www.roshreview.com/wp-content/uploads/Table-Stages-of-iron-toxicity.png" rel="nofollow" target="_blank">Teaching image</a>Question 3You are the physician for a patient who is diagnosed with pancreatic adenocarcinoma. The oncologist makes a note of a positive Trousseau’s syndrome in the documentation. Which of the following is she referring to?A. Nontender palpable gallbladderB. Palpable left supraclavicular lymph nodeC. Popliteal pain with abrupt ankle dorsiflexionD. Tender migratory thrombophlebitis<a href="https://www.roshreview.com/wp-content/uploads/Image-Trousseaus-Syndrome-migratory-thrombophlebitis.jpg" rel="nofollow" target="_blank">Teaching image</a>Question 4:A 27-year-old woman presents with a <a href="https://www.roshreview.com/wp-content/uploads/Image-Erythema-nodosum-for-Question.png" rel="nofollow" target="_blank">painful rash on both of her legs</a>. What is the most common cause of this condition?A. AllergyB. Drug hypersensitivity reactionC. Herpes virusD. Streptococcal infectionQuestion 5A 15-year-old G1P0 woman at 23 weeks presents with sharp, left lower quadrant abdominal pain for 1 hour. She has had an ultrasound confirming the presence of a single intrauterine pregnancy. The pain is severe and associated with nausea. Pelvic examination reveals tenderness of the left adnexa. The patient’s urinalysis is unremarkable. What test should be ordered to diagnose the patient?A. Abdominal X-rayB. CT scan of the abdomen and pelvisC. Pelvic ultrasoundD. White blood cell count<a href="https://www.roshreview.com/wp-content/uploads/Image-Ovarian-torsion-torsed-ovary.png" rel="nofollow" target="_blank">Teaching image</a>Question 6Which of the following statements is true regarding the diagnosis of Epstein-Barr virus infection?A. Guillain-Barre syndrome is a possible complicationB. Neutrophilia predominatesC. Splenomegaly occurs in 10% of patientsD. The virus is transmitted via respiratory droplets<ul><li>Bupivacaine toxicity is treated with intralipid.</li><li>Hydrofluoric acid is treated with calcium gluconate, either topically or intra-arterially.</li><li>Benzodiazepine overdoses should be treated with flumazenil but use caution in those who use them chronically as reversal may precipitate seizures.</li><li>Iron overdoses occur with ingestions of greater than 40 mg/kg. They should be treated with deferoxamine. For less significant overdoses, GI decontamination may be attempted. Charcoal is of no use here, as it does not bind Iron.</li><li>The 5 stages of iron toxicity are GI irritation, recovery, shock and metabolic acidosis, fulminant hepatic failure, and bowel obstruction leading to scarring.</li><li>Trousseau’s syndrome, a migratory thrombophlebitis, is associated with pancreatic cancer.</li><li>Erythema nodosum is an inflammatory condition characterized by tender red-violet nodules under the skin. The most common cause is infection. Drugs can also cause erythema nodosum, with OCPs being the most common culprit.</li><li>Erythema nodosum is treated with NSAIDs. Potassium iodine can be used in severe cases.</li><li>Ovarian torsion is difficult to diagnose. It is commonly seen in women of childbearing age and more commonly occurs on the right, especially in ovaries with large cysts. Laparoscopy is the only way to definitively rule out the condition.</li><li>EBV infection can lead to many neurologic complications such as encephalitis, meningitis, and Guillain-Barre Syndrome.</li><li>EBV infection is associated with a profound lymphocytic predominance, with atypical lymphocytes seen on the peripheral smear.</li><li>Splenomegaly is a common sequela of EBV infection, so remember to tell athletes to abstain from contact sports for up to 4 weeks after infection.</li></ul>That concludes episode 6. We’ll keep new episodes coming throughout the holiday season so make sure to set your favorite podcast player to download them automatically. Also, don’t forget to write a short review for <a href="https://itunes.apple.com/us/podcast/rosh-review/id1156487141?mt=2" rel="noreferrer noopener nofollow" target="_blank">Roshcast on iTunes</a> when you have a minute.If you’d like to start at episode 1 to hear more of our educational pearls, just follow this link back to <a href="https://www.roshreview.com/category/blog/podcasts/" rel="noreferrer noopener nofollow" target="_blank">Roshcast</a>.Until next time, Jeff and NachiP.S. Dr. Rosh recently published an article to help residents preparing for the upcoming emergency medicine In-training Exam…you may find it useful to learn <a href="https://www.roshreview.com/blog/study-strategies/how-to-increase-your-emergency-medicine-board-exam-score-by-10-points/" rel="noreferrer noopener nofollow" target="_blank">How to Increase Your Emergency Medicine In-Training Exam Score by 10 Points</a>. The post <a href="https://www.roshreview.com/blog/episode-6-bupivacaine-toxicity-iron-overdose-pancreatic-cancer-erythema-nodosum-ovarian-torsion-ebv-infectionand-much/" rel="nofollow" target="_blank">Podcast Ep 6: Bupivacaine Toxicity, Iron Overdose, &amp; More</a> appeared first on <a href="https://www.roshreview.com/blog" rel="nofollow" target="_blank">RoshReview.com</a>.

Ep 6 Roshcast Emergency Board Review

There are two ways of spreading light: to be the candle or the mirror that reflects it.-Edith WhartonWelcome back to Episode 26! Remember to listen for a trauma ring tone and if you hear one send us the time via email or tweet us @Roshcast with the time you hear it. This week, we start out with a brief ultrasound review and then get into some ophthalmology, ID, and toxicology. We will discuss a challenging cyanide toxicity question thanks to a suggestion from one of our listeners. Hope you enjoy it!Lung sliding on bedside ultrasound is a normal finding. Absence of lung sliding is indicative of a pneumothorax.A lines are a normal finding on lung ultrasound. They are horizontal lines that are reflections of the pleura. B lines are concerning for pulmonary edema and appear as “vertical headlights” throughout the thorax.Any pregnant patient with lower abdominal pain or vaginal bleeding who doesn’t already have a confirmed intrauterine pregnancy requires a pelvic ultrasound to rule out an ectopic pregnancy.Now onto this week’s podcast.Question 1A 72-year-old man complains of decreased painless vision in his left eye associated with flashing lights and floaters. Visual acuity in the left eye is 20/200 and in the right eye is 20/30. Which of the following is the most likely diagnosis?A. Acute angle-closure glaucoma B. Optic neuritisC. Retinal detachmentD. Temporal arteritisTeaching ImageQuestion 2What is the most common causative organism of meningitis in a 1-week-old child?A. Group B streptococciB. Haemophilus influenzaeC. Listeria monocytogenesD. Staphylococcus aureusTeaching ImageQuestion 3A 17-year-old man presents to the ED 30 minutes after intentionally ingesting an unknown amount of drain cleaner. The active ingredient is sodium hydroxide; the pH of the product is 13. Upon arrival, the patient is afebrile, heart rate is 120 beats per minute, blood pressure 130/70 mm Hg, respirations 22 breaths per minute, and oxygen saturation 97% on room air. He appears uncomfortable and reports chest discomfort. There are superficial burns of the oral mucosa and inflammation in the posterior oropharynx, but he is in no respiratory distress. Which of the following is true regarding this patient’s care?A. Activated charcoal should be administered because the patient presented within an hour of ingestionB. Dilution with milk or water may be performedC. Gastric lavage should be performed to prevent systemic toxicityD. He should be kept NPO in preparation for endoscopyE. Induction of vomiting with ipecac may be attemptedTeaching ImageQuestion 4A 45-year-old man is rescued from a house fire. He was unresponsive at the scene and was intubated by paramedics. Upon arrival, he is afebrile, tachycardic to 130 with a blood pressure of 90/60. His arterial blood gas is significant for a pH of 7.16, a carboxyhemoglobin level of 20%, and a lactate level of 11.5 mmol/L. What is the most appropriate treatment for potential cyanide toxicity in this patient.A. Administer hydroxocobalamin as a 5 g IV infusionB. Administer sodium bicarbonate to correct the acidosisC. Administer the cyanide antidote kit (amyl nitrate, sodium nitrite, sodium thiosulfate)D. Arrange for the patient to receive immediate hyperbaric oxygen therapyE. Hyperventilate the patient and maintain FiO2 at 100%Question 5An 85-year-old man presents via ambulance after a reported fall. He is non-verbal, bed-bound, and incontinent of urine and stool at baseline. He requires round-the-clock care, which is primarily provided by his daughter, a retired nurse. There are also several grandchildren that assist with his care on a daily basis. The EMS team is concerned for elder abuse and alerts you of their concerns on arrival to the ED. Which of the following factors is associated with a greater likelihood of underlying elder abuse?A. Daughter’s occupationB. History of incontinenceC. Male sexD. Support by the grandchildrenTeaching ImageQuestion 6Which of the following is true regarding the characteristic rash of chickenpox?A. Lesions appear over 2–4 weeks with multiple stages present at onceB. Lesions appear over 2–4 weeks with one stage present at a time C. Lesions appear over days and fade by the third dayD. Lesions appear over days with multiple stages present at onceTeaching ImageRetinal detachment is associated with painless monocular vision loss with floaters and flashing lights. The retina appears as a dull and gray. Retinal detachment is treated surgically or with laser therapy. Consult ophthalmology immediately.Acute angle closure glaucoma classically presents with painful monocular vision loss. The pupil would be fixed and mid-dilated with a hazy cornea and perilimbic injection.Optic neuritis is characterized by central vision loss with preserved peripheral vision. Patents may also report pain with eye movement and reduced color vision.Temporal arteritis is a vasculitis that causes monocular vision loss and is associated with unilateral headaches and polymyalgia rheumatica.In neonates, 75% of cases of meningitis are caused by Group B strep. Other causes include E. coli, Listeria, and other gram-negative bacilli. Treatment is with cefotaxime and ampicillin or gentamycin and ampicillinIn infants, bacterial causes of meningitis additionally include S. pneumoniae, N. meningitidis, and H. influenzae. Treat this age group with vancomycin, ampicillin, and cefotaxime or ceftriaxone.In children 3 months to 18 years, the three most common causes of bacterial meningitis are S. pneumoniae, N. meningitidis, and H. influenzae. Treatment is with either ceftriaxone and vancomycin or cefotaxime and vancomycin.In adults 18 to 50 years old, S. pneumoniae and N. meningitidis, are the most common pathogens. Treat them with ceftriaxone and vancomycin.In those over 50, in addition to S. pneumoniae and N. meningitidis, gram-negative bacilli and Listeria are also more common cause of bacterial meningitis, so ampicillin must be added to the ceftriaxone and vancomycin.After an alkali ingestion, early endoscopy is critical as it determines the extent of the injury and helps guide management, disposition, and follow up decisions. All patients should be kept NPO following their ingestion.Cyanide toxicity can be treated by giving either hydroxocobalamin or with the traditional kit which includes a combination of amyl nitrite, sodium nitrite, and sodium thiosulfate.For fire victims who also have elevated carboxyhemoglobin levels, cyanide poisoning should be treated with hydroxocobalamin.In the traditional cyanide overdose kit, the nitrites cause a methemoglobinemia, regenerating the mitochondria, while the thiosulfate aids in excretion.Elder abuse can come in any form: physical, sexual, emotional, neglect, abandonment, and even financial, failure to recognize it can lead to significant morbidity and mortality.The lesions of chickenpox appear over days with multiple stages present at once. They first appear at the hairline and spread caudally.Chickenpox is caused by the varicella-zoster virus, or human herpesvirus type 3. Treatment is supportive with antipyretics, antipruritics, and analgesia.There are two vaccines for chickenpox – both are live attenuated vaccines and are recommended for all immunocompetent infants over the age of 1 and in all non-infected immunocompetent adults.That wraps up Episode 26. As always, feel free to submit questions for us to review. Don’t forget to listen for the trauma phone ring tone in the coming weeks for a chance to win a Rosh Review Subscription. Remember to tweet us @Roshcast or email us at roshcast@roshreview.com the exact time you hear the ring to win the prize.Until next time,Jeff and NachiThe post Podcast Ep 26: Retinal Detachment, Meningitis, Chicken Pox &amp; More appeared first on RoshReview.com.

<blockquote>There are two ways of spreading light: to be the candle or the mirror that reflects it.-Edith Wharton</blockquote><h6>Welcome back to Episode 26! Remember to listen for a trauma ring tone and if you hear one send us the time via email or tweet us <a href="https://twitter.com/Roshcast?lang=en" rel="nofollow" target="_blank">@Roshcast</a> with the time you hear it. This week, we start out with a brief ultrasound review and then get into some ophthalmology, ID, and toxicology. We will discuss a challenging cyanide toxicity question thanks to a suggestion from one of our listeners. Hope you enjoy it!</h6><ul><li>Lung sliding on bedside ultrasound is a normal finding. Absence of lung sliding is indicative of a pneumothorax.</li><li>A lines are a normal finding on lung ultrasound. They are horizontal lines that are reflections of the pleura. B lines are concerning for pulmonary edema and appear as “vertical headlights” throughout the thorax.</li><li>Any pregnant patient with lower abdominal pain or vaginal bleeding who doesn’t already have a confirmed intrauterine pregnancy requires a pelvic ultrasound to rule out an ectopic pregnancy.</li></ul>Now onto this week’s podcast.Question 1A 72-year-old man complains of decreased painless vision in his left eye associated with flashing lights and floaters. Visual acuity in the left eye is 20/200 and in the right eye is 20/30. Which of the following is the most likely diagnosis?A. Acute angle-closure glaucoma B. Optic neuritisC. Retinal detachmentD. Temporal arteritis<a href="https://www.roshreview.com/wp-content/uploads/Ep26-retinal_detachment.png" rel="nofollow" target="_blank">Teaching Image</a>Question 2What is the most common causative organism of meningitis in a 1-week-old child?A. Group B streptococciB. Haemophilus influenzaeC. Listeria monocytogenesD. Staphylococcus aureus<a href="https://www.roshreview.com/wp-content/uploads/Ep26-meningitis_treatment_and_bacteria.png" rel="nofollow" target="_blank">Teaching Image</a>Question 3A 17-year-old man presents to the ED 30 minutes after intentionally ingesting an unknown amount of drain cleaner. The active ingredient is sodium hydroxide; the pH of the product is 13. Upon arrival, the patient is afebrile, heart rate is 120 beats per minute, blood pressure 130/70 mm Hg, respirations 22 breaths per minute, and oxygen saturation 97% on room air. He appears uncomfortable and reports chest discomfort. There are superficial burns of the oral mucosa and inflammation in the posterior oropharynx, but he is in no respiratory distress. Which of the following is true regarding this patient’s care?A. Activated charcoal should be administered because the patient presented within an hour of ingestionB. Dilution with milk or water may be performedC. Gastric lavage should be performed to prevent systemic toxicityD. He should be kept NPO in preparation for endoscopyE. Induction of vomiting with ipecac may be attempted<a href="https://www.roshreview.com/wp-content/uploads/Ep26-caustic-ingestion.png" rel="nofollow" target="_blank">Teaching Image</a>Question 4A 45-year-old man is rescued from a house fire. He was unresponsive at the scene and was intubated by paramedics. Upon arrival, he is afebrile, tachycardic to 130 with a blood pressure of 90/60. His arterial blood gas is significant for a pH of 7.16, a carboxyhemoglobin level of 20%, and a lactate level of 11.5 mmol/L. What is the most appropriate treatment for potential cyanide toxicity in this patient.A. Administer hydroxocobalamin as a 5 g IV infusionB. Administer sodium bicarbonate to correct the acidosisC. Administer the cyanide antidote kit (amyl nitrate, sodium nitrite, sodium thiosulfate)D. Arrange for the patient to receive immediate hyperbaric oxygen therapyE. Hyperventilate the patient and maintain FiO2 at 100%Question 5An 85-year-old man presents via ambulance after a reported fall. He is non-verbal, bed-bound, and incontinent of urine and stool at baseline. He requires round-the-clock care, which is primarily provided by his daughter, a retired nurse. There are also several grandchildren that assist with his care on a daily basis. The EMS team is concerned for elder abuse and alerts you of their concerns on arrival to the ED. Which of the following factors is associated with a greater likelihood of underlying elder abuse?A. Daughter’s occupationB. History of incontinenceC. Male sexD. Support by the grandchildren<a href="https://www.roshreview.com/wp-content/uploads/Ep26-types_of_elder_abuse_risk_factors.png" rel="nofollow" target="_blank">Teaching Image</a>Question 6Which of the following is true regarding the characteristic rash of chickenpox?A. Lesions appear over 2–4 weeks with multiple stages present at onceB. Lesions appear over 2–4 weeks with one stage present at a time C. Lesions appear over days and fade by the third dayD. Lesions appear over days with multiple stages present at once<a href="https://www.roshreview.com/wp-content/uploads/Ep26-chickenpox_varicella.png" rel="nofollow" target="_blank">Teaching Image</a><ul><li>Retinal detachment is associated with painless monocular vision loss with floaters and flashing lights. The retina appears as a dull and gray. Retinal detachment is treated surgically or with laser therapy. Consult ophthalmology immediately.</li><li>Acute angle closure glaucoma classically presents with painful monocular vision loss. The pupil would be fixed and mid-dilated with a hazy cornea and perilimbic injection.</li><li>Optic neuritis is characterized by central vision loss with preserved peripheral vision. Patents may also report pain with eye movement and reduced color vision.</li><li>Temporal arteritis is a vasculitis that causes monocular vision loss and is associated with unilateral headaches and polymyalgia rheumatica.</li><li>In neonates, 75% of cases of meningitis are caused by Group B strep. Other causes include E. coli, Listeria, and other gram-negative bacilli. Treatment is with cefotaxime and ampicillin or gentamycin and ampicillin</li><li>In infants, bacterial causes of meningitis additionally include S. pneumoniae, N. meningitidis, and H. influenzae. Treat this age group with vancomycin, ampicillin, and cefotaxime or ceftriaxone.</li><li>In children 3 months to 18 years, the three most common causes of bacterial meningitis are S. pneumoniae, N. meningitidis, and H. influenzae. Treatment is with either ceftriaxone and vancomycin or cefotaxime and vancomycin.</li><li>In adults 18 to 50 years old, S. pneumoniae and N. meningitidis, are the most common pathogens. Treat them with ceftriaxone and vancomycin.</li><li>In those over 50, in addition to S. pneumoniae and N. meningitidis, gram-negative bacilli and Listeria are also more common cause of bacterial meningitis, so ampicillin must be added to the ceftriaxone and vancomycin.</li><li>After an alkali ingestion, early endoscopy is critical as it determines the extent of the injury and helps guide management, disposition, and follow up decisions. All patients should be kept NPO following their ingestion.</li><li>Cyanide toxicity can be treated by giving either hydroxocobalamin or with the traditional kit which includes a combination of amyl nitrite, sodium nitrite, and sodium thiosulfate.</li><li>For fire victims who also have elevated carboxyhemoglobin levels, cyanide poisoning should be treated with hydroxocobalamin.</li><li>In the traditional cyanide overdose kit, the nitrites cause a methemoglobinemia, regenerating the mitochondria, while the thiosulfate aids in excretion.</li><li>Elder abuse can come in any form: physical, sexual, emotional, neglect, abandonment, and even financial, failure to recognize it can lead to significant morbidity and mortality.</li><li>The lesions of chickenpox appear over days with multiple stages present at once. They first appear at the hairline and spread caudally.</li><li>Chickenpox is caused by the varicella-zoster virus, or human herpesvirus type 3. Treatment is supportive with antipyretics, antipruritics, and analgesia.</li><li>There are two vaccines for chickenpox – both are live attenuated vaccines and are recommended for all immunocompetent infants over the age of 1 and in all non-infected immunocompetent adults.</li></ul>That wraps up Episode 26. As always, feel free to submit questions for us to review. Don’t forget to listen for the trauma phone ring tone in the coming weeks for a chance to win a Rosh Review Subscription. Remember to tweet us <a href="https://twitter.com/Roshcast?lang=en" rel="nofollow" target="_blank">@Roshcast</a> or email us at <a href="mailto:roshcast@roshreview.com">roshcast@roshreview.com</a> the exact time you hear the ring to win the prize.Until next time, Jeff and NachiThe post <a href="https://www.roshreview.com/blog/ep-26-retinal-detachment-meningitis-caustic-ingestions-cyanide-toxicity-elder-abuse-chicken-pox/" rel="nofollow" target="_blank">Podcast Ep 26: Retinal Detachment, Meningitis, Chicken Pox &amp; More</a> appeared first on <a href="https://www.roshreview.com/blog" rel="nofollow" target="_blank">RoshReview.com</a>.

Ep 26 Roshcast Emergency Board Review

I wish to do something great and wonderful, but I must start by doing the little things like they were great and wonderful.   -Albert EinsteinWelcome back to another episode of Roshcast. This is Episode 7 and we’ll be talking about Rh immunoglobulin, dystonic reactions, chemical-induced corneal burns, medication-induced hypoglycemia, vaginal candidiasis, ocular trauma, and much more. The In-Training exam is 92 days away. By consistently studying a little every week and identifying your weaknesses, you can increase your emergency medicine in-training exam score by 10 points.Bupivacaine toxicity is treated with intralipid.Hydrofluoric acid exposure is treated with calcium gluconate (topically or intra-arterially).Benzodiazepine overdoses can be treated with flumazenil. However, be careful in chronic users so as to no precipitate a withdrawal seizure.An iron ingestion of greater than 40 mg/kg typically requires chelation. Treatment should be with deferoxamine as charcoal does not bind iron and is therefore of no use.Trousseau’s sign is associated with pancreatic cancer. It is a migratory thrombophlebitis.Erythema nodosum is a tender, reddish-violet nodule deep under the skin. They can be caused by infections, typically strep, or drugs, with OCPs being the most commonly implicated drugs.In a patient with an EBV infection, treatment with either ampicillin or amoxicillin may result in a morbilliform rash.Some general housekeeping:You can find our previous episodes here in case you missed them.Please send us feedback so we can continue to make small improvements to the show. Remember to leave your comments below to any questions you have on the content and our discussion.Now to this week’s podcastQuestion 1A 22-year old woman presents with vaginal bleeding. She should be approximately 10 weeks pregnant based on a previous ultrasound, which confirmed an intrauterine pregnancy. On today’s bedside ultrasound, no intrauterine pregnancy is visualized. Her blood type is A negative and the father’s blood type is unknown. Which of the following is true regarding the administration of Rh immunoglobulin?A. A test dose is administered first because of the risk of an anaphylactoid reactionB. Rh immunoglobulin 300 micrograms is indicatedC. Rh immunoglobulin is not indicatedD. She can delay Rh immunoglobulin for up to 72 hoursTeaching imageQuestion 2A 22-year-old man presents to the ED with clonus of his neck to the right. Which of the following drugs is he most likely taking?A. BenztropineB. CocaineC. HaloperidolD. ZiprasidoneTeaching image Teaching videoQuestion 3A patient presents after a chemical splash to the eye. What management is immediately indicated?A. High volume irrigationB. Pupil dilation and slit lamp examinationC. Referral to ophthalmologyD. Topical antibiotics and ophthalmology consultationTeaching imageQuestion 4Which of the following medications most commonly leads to recurrent episodes of hypoglycemia?A. Glargine insulinB. GlimepirideC. MetforminD. PioglitazoneTeaching imageQuestion 5A 34-year-old woman presents complaining of dysuria and vaginal itching. Your speculum exam reveals a vaginal vault filled with a thick, curdy white discharge. Which of the following statements is correct regarding this diagnosis?A. A fishy odor is present when vaginal discharge is mixed with potassium hydroxideB. Metronidazole is the recommended treatmentC. Multiple petechiae are often seen on the vaginal wallD. The pH of the discharge is less than 4.5E. Vaginal discharge is often foul smellingTeaching imageQuestion 6An 18-year-old softball player is struck in the face with a softball. The CT shows a fracture of the inferior orbital floor. She has numbness over the anteromedial cheek and upper lip. Which of the following nerves is likely to be affected?A. Anterior superior alveolar nerveB. Inferior orbital nerveC. Supratrochlear nerveD. Zygomatic branch of the facial nerveTeaching imageRh immunoglobulin administration can be delayed up to 72 hours. The correct dose is 50 mcg for those less than 12 weeks gestation and 300 mcg for those 12 weeks and over.Haloperidol and other typical antipsychotics can cause a dystonic reaction. The treatment is either benztropine or diphenhydramine. They can both be given IV or IM, with IV being the preferred route.A chemical splash to the eye should be immediately treated with high volume irrigation. The eye should be irrigated copiously or to a target pH of 7.0-7.2. Alkali burns typically cause more damage than acidic burns due to their characteristic liquefactive necrosis.Sulfonylurea oral anti-hyperglycemics can cause recurrent episodes of hypoglycemia.In factitious hypoglycemia, blood work would typically show a low c peptide but high insulin levels due to the exogenous administration of insulin.Vaginal candidiasis is characterized by a thick, white, odorless vaginal discharge. It is treated with fluconazole or clotrimazole. The pH of the discharge is typically less than 4.5.A fishy-smelling vaginal odor is classic for bacterial vaginosis which is treated with metronidazole. Metronidazole is also the treatment for trichomonas.The inferior orbital nerve runs through the inferior orbital floor. It innervates the anteromedial face.The post Podcast Ep 7: Hypoglycemia, Vaginal Candidiasis, Corneal Burns, &amp; More appeared first on RoshReview.com.

<blockquote>I wish to do something great and wonderful, but I must start by doing the little things like they were great and wonderful.   -Albert Einstein</blockquote><h6>Welcome back to another episode of Roshcast. This is Episode 7 and we’ll be talking about Rh immunoglobulin, dystonic reactions, chemical-induced corneal burns, medication-induced hypoglycemia, vaginal candidiasis, ocular trauma, and much more. </h6>The In-Training exam is 92 days away. By consistently studying a little every week and identifying your weaknesses, you can <a href="https://www.roshreview.com/blog/study-strategies/how-to-increase-your-emergency-medicine-board-exam-score-by-10-points/" rel="noreferrer noopener nofollow" target="_blank">increase your emergency medicine in-training exam score by 10 points</a>.<ul><li>Bupivacaine toxicity is treated with intralipid.</li><li>Hydrofluoric acid exposure is treated with calcium gluconate (topically or intra-arterially).</li><li>Benzodiazepine overdoses can be treated with flumazenil. However, be careful in chronic users so as to no precipitate a withdrawal seizure.</li><li>An iron ingestion of greater than 40 mg/kg typically requires chelation. Treatment should be with deferoxamine as charcoal does not bind iron and is therefore of no use.</li><li>Trousseau’s sign is associated with pancreatic cancer. It is a migratory thrombophlebitis.</li><li>Erythema nodosum is a tender, reddish-violet nodule deep under the skin. They can be caused by infections, typically strep, or drugs, with OCPs being the most commonly implicated drugs.</li><li>In a patient with an EBV infection, treatment with either ampicillin or amoxicillin may result in a morbilliform rash.</li></ul>Some general housekeeping:You can find our<a href="https://www.roshreview.com/blog/" rel="noreferrer noopener nofollow" target="_blank"> previous episodes</a> here in case you missed them.Please <a href="mailto:feedback@roshreview.com" rel="noreferrer noopener">send us feedback</a> so we can continue to make small improvements to the show. Remember to <a href="#comments" rel="noreferrer noopener nofollow" target="_blank">leave your comments</a> below to any questions you have on the content and our discussion.Now to this week’s podcastQuestion 1A 22-year old woman presents with vaginal bleeding. She should be approximately 10 weeks pregnant based on a previous ultrasound, which confirmed an intrauterine pregnancy. On today’s bedside ultrasound, no intrauterine pregnancy is visualized. Her blood type is A negative and the father’s blood type is unknown. Which of the following is true regarding the administration of Rh immunoglobulin?A. A test dose is administered first because of the risk of an anaphylactoid reactionB. Rh immunoglobulin 300 micrograms is indicatedC. Rh immunoglobulin is not indicatedD. She can delay Rh immunoglobulin for up to 72 hours<a href="https://www.roshreview.com/wp-content/uploads/Image-Rh-isoimmunization-Rh-negative-Rh-positive.png" rel="noreferrer noopener nofollow" target="_blank">Teaching image</a>Question 2A 22-year-old man presents to the ED with clonus of his neck to the right. Which of the following drugs is he most likely taking?A. BenztropineB. CocaineC. HaloperidolD. Ziprasidone<a href="https://www.roshreview.com/wp-content/uploads/Image-Acute-dystonic-reaction-dystonia.jpg" rel="noreferrer noopener nofollow" target="_blank">Teaching image </a><a href="https://www.roshreview.com/wp-content/uploads/Acute-Dystonia.m4v" rel="noreferrer noopener nofollow" target="_blank">Teaching video</a>Question 3A patient presents after a chemical splash to the eye. What management is immediately indicated?A. High volume irrigationB. Pupil dilation and slit lamp examinationC. Referral to ophthalmologyD. Topical antibiotics and ophthalmology consultation<a href="https://www.roshreview.com/wp-content/uploads/Image-Eye-irrigation-chemical-eye-burn-morgan-lens.png" rel="noreferrer noopener nofollow" target="_blank">Teaching image</a>Question 4Which of the following medications most commonly leads to recurrent episodes of hypoglycemia?A. Glargine insulinB. GlimepirideC. MetforminD. Pioglitazone<a href="https://www.roshreview.com/wp-content/uploads/Table-Diabetes-type-2-Medication-Classes.jpg" rel="noreferrer noopener nofollow" target="_blank">Teaching image</a>Question 5A 34-year-old woman presents complaining of dysuria and vaginal itching. Your speculum exam reveals a vaginal vault filled with a thick, curdy white discharge. Which of the following statements is correct regarding this diagnosis?A. A fishy odor is present when vaginal discharge is mixed with potassium hydroxideB. Metronidazole is the recommended treatmentC. Multiple petechiae are often seen on the vaginal wallD. The pH of the discharge is less than 4.5E. Vaginal discharge is often foul smelling<a href="https://www.roshreview.com/wp-content/uploads/Image-Bacterial-vaginosis-Trichomoniasis-Candidiasis-Vaginal-discharge.jpg" rel="noreferrer noopener nofollow" target="_blank">Teaching image</a>Question 6An 18-year-old softball player is struck in the face with a softball. The CT shows a fracture of the inferior orbital floor. She has numbness over the anteromedial cheek and upper lip. Which of the following nerves is likely to be affected?A. Anterior superior alveolar nerveB. Inferior orbital nerveC. Supratrochlear nerveD. Zygomatic branch of the facial nerve<a href="https://www.roshreview.com/wp-content/uploads/Image-Blow-out-fracture-inferior-rectus-entrapment-inferior-orbital-wall-fracture.png" rel="noreferrer noopener nofollow" target="_blank">Teaching image</a><ul><li><a href="/tag/rh-immunoglobulin/" rel="noreferrer noopener nofollow" target="_blank">Rh immunoglobulin</a> administration can be delayed up to 72 hours. The correct dose is 50 mcg for those less than 12 weeks gestation and 300 mcg for those 12 weeks and over.</li><li>Haloperidol and other typical antipsychotics can cause a <a href="/tag/dystonic-reaction/" rel="noreferrer noopener nofollow" target="_blank">dystonic reaction</a>. The treatment is either <a href="/tag/benztropine/" rel="noreferrer noopener nofollow" target="_blank">benztropine</a> or <a href="/tag/diphenhydramine/" rel="noreferrer noopener nofollow" target="_blank">diphenhydramine</a>. They can both be given IV or IM, with IV being the preferred route.</li><li>A chemical splash to the eye should be immediately treated with high volume irrigation. The eye should be irrigated copiously or to a target pH of 7.0-7.2. Alkali burns typically cause more damage than acidic burns due to their characteristic liquefactive necrosis.</li><li><a href="/tag/sulfonylurea/" rel="noreferrer noopener nofollow" target="_blank">Sulfonylurea</a> oral anti-hyperglycemics can cause recurrent episodes of <a href="/tag/hypoglycemia/" rel="noreferrer noopener nofollow" target="_blank">hypoglycemia</a>.</li><li>In <a href="/tag/factitious-hypoglycemia/" rel="noreferrer noopener nofollow" target="_blank">factitious hypoglycemia</a>, blood work would typically show a <a href="/tag/low-c-peptide/" rel="noreferrer noopener nofollow" target="_blank">low c peptide</a> but high insulin levels due to the exogenous administration of insulin.</li><li><a href="/tag/vaginal-candidiasis/" rel="noreferrer noopener nofollow" target="_blank">Vaginal candidiasis</a> is characterized by a thick, white, odorless vaginal discharge. It is treated with fluconazole or clotrimazole. The pH of the discharge is typically less than 4.5.</li><li>A fishy-smelling vaginal odor is classic for <a href="/tag/bacterial-vaginosis/" rel="noreferrer noopener nofollow" target="_blank">bacterial vaginosis</a> which is treated with metronidazole. Metronidazole is also the treatment for trichomonas.</li><li>The<a href="/tag/inferior-orbital-nerve/" rel="noreferrer noopener nofollow" target="_blank"> inferior orbital nerve</a> runs through the <a href="/tag/inferior-orbital-floor/" rel="noreferrer noopener nofollow" target="_blank">inferior orbital floor</a>. It innervates the anteromedial face.</li></ul>The post <a href="https://www.roshreview.com/blog/ep-7-rh-immunoglobulin-dystonic-reactions-corneal-burns-hypoglycemia-vaginal-candidiasis-ocular-trauma/" rel="nofollow" target="_blank">Podcast Ep 7: Hypoglycemia, Vaginal Candidiasis, Corneal Burns, &amp; More</a> appeared first on <a href="https://www.roshreview.com/blog" rel="nofollow" target="_blank">RoshReview.com</a>.

Ep 7 Roshcast Emergency Board Review

In the end the great truth will have been learned, that the quest is greater than what is sought, the effort finer than the prize, or rather that the effort is the prize, the victory cheap and hollow were it not for the rigor of the game.  -Justice Benjamin CardozoWelcome back to episode 8! With Thanksgiving behind us, let’s keep up the momentum, as the In-Training Exam is right around the corner. Here is a sneak peek into the category breakdown established by ABEM for the ITE.Roshcast episodes are 10–15 minutes long so you can focus on a few topics at a time without feeling overwhelmed. The short duration of each episode also allows you to go back and review episodes you may have missed or want to reinforce.We begin each episode with a quick Rapid Review of the previous week’s highlights. Rh immunoglobulin administration can be delayed up to 72 hours. The correct dose is 50 mcg for those less than 12 weeks gestation and 300 mcg for those 12 weeks and over.Haloperidol and other typical antipsychotics can cause a dystonic reaction. The treatment is either benztropine or diphenhydramine. 50% of reactions occurring within 48 hours of administration and 90% occur within 5 days.The target pH for eye irrigation should be between 7.0–7.2, but do not delay irrigation to confirm a staring pH.Sulfonylureas commonly cause recurrent hypoglycemia as they stimulate the islet beta cells to secrete more insulin, increase the sensitivity of peripheral tissues to insulin, and have a prolonged half-life.Now to this week’s podcastQuestion 1Which of the following patients requires emergent consultation with an orthopedic specialist?A. A 36-year-old woman with a femur fracture and distal cyanosisB.  58-year-old man with extension-based chronic low back pain and leg numbnessC.  75-year-old ambulatory woman with a tibial osteosarcomaD. An 18-year-old man with a reduced sacral ala fracture and BP 130/86Question 2A 12-year-old boy presents to the ED with headache, vomiting, and lethargy for two days. He had a ventriculoperitoneal shunt placed for hydrocephalus one year ago. What is the most likely cause of his shunt malfunction?A. Abdominal pseudocyst formationB. Choroid plexus obstructionC. LoculationD. Mechanical failureE. Slit ventricle syndromeTeaching imageQuestion 3A 25-year-old man presents to the emergency department after being in an altercation at a music concert. On exam, you note the findings seen above. Which of the following organisms is of most concern?A. Capnocytophaga canimorsusB. Cercopithecine herpesvirusC. Eikenella corrodensD. Pasteurella multocidaTeaching imageQuestion 4Which of these children with hematuria needs admission to the hospital?A. A 10-year-old boy with recent sore throat treated with amoxicillin, tea-colored urine, and normal urine output; UA shows microscopic hematuria and proteinuria; blood tests are normalB. A 12-year-old girl with lower abdominal pain, dysuria, urgency, frequency, and pink urine; UA shows microscopic hematuria, &gt; 50 WBCs/hpf, + leukocyte esterase, + nitrites; urine pregnancy test is negativeC. A 6-year-old boy with nausea, vomiting, bloody diarrhea, and decreased urine output; UA shows microscopic hematuria and hyaline casts; blood tests show a high WBC count, low hemoglobin, and low plateletsD. An 8-year-old girl with diffuse mild edema, tea-colored urine, and normal urine output; UA shows microscopic hematuria and proteinuria; blood tests show a normal WBC count, hemoglobin, and platelets but low proteinTeaching imageQuestion 5Which of the following is a cyanotic heart lesion?A. Atrial septal defectB. Patent ductus arteriosusC. Tricuspid atresiaD. Ventricular septal defectTeaching imageQuestion 6A 68-year-old man presents to the ED after a fall down 12 stairs. His only medication is warfarin, which he takes for atrial fibrillation. On physical exam, you note a large parietal scalp hematoma. His noncontrast computed tomography scan of the head is shown above. His INR is 4.5. Which of the following is the most appropriate treatment?A. CryoprecipitateB. Fresh frozen plasmaC. Packed red blood cellsD. PlateletsTeaching imageEmergent orthopedics consultation is needed for any fracture with neurovascular compromise, suspected compartment syndrome, all open fractures, and all displaced unstable fractures and irreducible fractures.VP shunt obstruction occurs proximally more frequently than distally.Proximal VP shunt obstruction occurs due to choroid plexus obstruction or increased protein within the CSF.Distal VP shunt obstruction occurs due to abdominal pseudocyst formation, which typically presents with abdominal pain due to the large size of the cyst.With respect to VP shunt malfunction, slit ventricle syndrome occurs when the ventricles are over drained and they collapse, obstructing the proximal shunt orifice. With the reaccumulation of fluid, the obstruction is relieved. Patients typically present with cyclical symptoms.In treating patients with fight bites, we are concerned for Eikenella contamination. In fight bites overlying the metacarpal, a hand surgery consultation is necessary.In human bites, amoxicillin-clavulanate is typically the first-line antibiotic of choice. For established infections, IV antibiotics such as ampicillin-sulbactam, cefoxitin, or piperacillin-tazobactam may be used.For a child with mild to moderate edema, with a normal blood pressure and no respiratory symptoms, the child can typically be discharged home with outpatient nephrology follow up. The treatment is typically corticosteroids.Hematuria with hearing loss is associated with Alport syndrome. Hematuria and hemoptysis is associated with Goodpasture’s syndrome.There are five important cyanotic congenital heart lesions to remember. Remember the numbers 1 to 5. One is for truncus arteriosus, in which two vessels join to make one. Two is for transposition of the great vessels in which the two great vessels are switched. Three is for tricuspid atresia. Remember three for TRIcuspid. Four is for the four defects of tetralogy of Fallot. Lastly, five is for the five letters of total anomalous pulmonary vascular return.Atrial septal defects, patent ductus arteriosus, and ventricular septal defects are all acyanotic heart lesions, or lesions with left to right shunt. Symptomatic children with such lesions typically present with congestive heart failure by 6 months of life.For any patient on warfarin with a life-threatening bleed, FFP, PCC, or recombinant factory, 7a should be given.For a patient on aspirin with a life-threatening bleed, DDAVP should be given in addition to platelets.Until next time,Jeff and NachiP.S. If you like Nachi and Jeff’s content, remember to check out Rosh Review’s emergency medicine qbank with thousands of high yield questions, explanations, images, audio, and video teaching files.The post Podcast Ep 8: Pneumonia, Herpes Zoster, Lung Ultrasound &amp; More appeared first on RoshReview.com.

<blockquote>In the end the great truth will have been learned, that the quest is greater than what is sought, the effort finer than the prize, or rather that the effort is the prize, the victory cheap and hollow were it not for the rigor of the game.  -Justice Benjamin Cardozo</blockquote><h6>Welcome back to episode 8! With Thanksgiving behind us, let’s keep up the momentum, as the In-Training Exam is right around the corner. Here is a sneak peek into the category breakdown <a href="https://www.roshreview.com/wp-content/uploads/IGITE-The-Wheel-of-Categories.png" rel="noreferrer noopener nofollow" target="_blank">established by ABEM</a> for the ITE.</h6><a href="https://www.roshreview.com/category/blog/podcasts/" rel="noreferrer noopener nofollow" target="_blank">Roshcast</a> episodes are 10–15 minutes long so you can focus on a few topics at a time without feeling overwhelmed. The short duration of each episode also allows you to go back and review episodes you may have missed or want to reinforce.We begin each episode with a quick Rapid Review of the previous week’s highlights. <ul><li>Rh immunoglobulin administration can be delayed up to 72 hours. The correct dose is 50 mcg for those less than 12 weeks gestation and 300 mcg for those 12 weeks and over.</li><li>Haloperidol and other typical antipsychotics can cause a dystonic reaction. The treatment is either benztropine or diphenhydramine. 50% of reactions occurring within 48 hours of administration and 90% occur within 5 days.</li><li>The target pH for eye irrigation should be between 7.0–7.2, but do not delay irrigation to confirm a staring pH.</li><li>Sulfonylureas commonly cause recurrent hypoglycemia as they stimulate the islet beta cells to secrete more insulin, increase the sensitivity of peripheral tissues to insulin, and have a prolonged half-life.</li></ul>Now to this week’s podcastQuestion 1Which of the following patients requires emergent consultation with an orthopedic specialist?A. A 36-year-old woman with a femur fracture and distal cyanosisB.  58-year-old man with extension-based chronic low back pain and leg numbnessC.  75-year-old ambulatory woman with a tibial osteosarcomaD. An 18-year-old man with a reduced sacral ala fracture and BP 130/86Question 2A 12-year-old boy presents to the ED with headache, vomiting, and lethargy for two days. He had a ventriculoperitoneal shunt placed for hydrocephalus one year ago. What is the most likely cause of his shunt malfunction?A. Abdominal pseudocyst formationB. Choroid plexus obstructionC. LoculationD. Mechanical failureE. Slit ventricle syndrome<a href="https://www.roshreview.com/wp-content/uploads/Image-VP-ventriculoperitoneal-shunt.png" rel="nofollow" target="_blank">Teaching image</a>Question 3A 25-year-old man presents to the emergency department after being in an altercation at a music concert. On exam, you note the findings seen above. Which of the following organisms is of most concern?A. Capnocytophaga canimorsusB. Cercopithecine herpesvirusC. Eikenella corrodensD. Pasteurella multocida<a href="https://www.roshreview.com/wp-content/uploads/Image-Fight-Bite-Human-Bite.png" rel="nofollow" target="_blank">Teaching image</a>Question 4Which of these children with hematuria needs admission to the hospital?A. A 10-year-old boy with recent sore throat treated with amoxicillin, tea-colored urine, and normal urine output; UA shows microscopic hematuria and proteinuria; blood tests are normalB. A 12-year-old girl with lower abdominal pain, dysuria, urgency, frequency, and pink urine; UA shows microscopic hematuria, &gt; 50 WBCs/hpf, + leukocyte esterase, + nitrites; urine pregnancy test is negativeC. A 6-year-old boy with nausea, vomiting, bloody diarrhea, and decreased urine output; UA shows microscopic hematuria and hyaline casts; blood tests show a high WBC count, low hemoglobin, and low plateletsD. An 8-year-old girl with diffuse mild edema, tea-colored urine, and normal urine output; UA shows microscopic hematuria and proteinuria; blood tests show a normal WBC count, hemoglobin, and platelets but low protein<a href="https://www.roshreview.com/wp-content/uploads/Image-Hemolytic-Uremic-Syndrome-HUS.pages.png" rel="nofollow" target="_blank">Teaching image</a>Question 5Which of the following is a cyanotic heart lesion?A. Atrial septal defectB. Patent ductus arteriosusC. Tricuspid atresiaD. Ventricular septal defect<a href="https://www.roshreview.com/wp-content/uploads/Table-Congenital-heart-disease.jpg" rel="nofollow" target="_blank">Teaching image</a>Question 6A 68-year-old man presents to the ED after a fall down 12 stairs. His only medication is warfarin, which he takes for atrial fibrillation. On physical exam, you note a large parietal scalp hematoma. His noncontrast computed tomography scan of the head is shown above. His INR is 4.5. Which of the following is the most appropriate treatment?A. CryoprecipitateB. Fresh frozen plasmaC. Packed red blood cellsD. Platelets<a href="https://www.roshreview.com/wp-content/uploads/Table-Warfarin-reversal-PCC-vitamin-K-factor-VII-FFP-prothrombin-complex-concentrate.png" rel="nofollow" target="_blank">Teaching image</a><ul><li><a href="/tag/emergent-orthopedics-consultation/" rel="noreferrer noopener nofollow" target="_blank">Emergent orthopedics consultation</a> is needed for any fracture with <a href="/tag/neurovascular-compromise/" rel="noreferrer noopener nofollow" target="_blank">neurovascular compromise</a>, suspected compartment syndrome, all open fractures, and all displaced unstable fractures and irreducible fractures.</li><li><a href="/tag/vp-shunt-obstruction/" rel="noreferrer noopener nofollow" target="_blank">VP shunt obstruction</a> occurs proximally more frequently than distally.</li><li><a href="/tag/proximal-vp-shunt-obstruction/" rel="noreferrer noopener nofollow" target="_blank">Proximal VP shunt obstruction</a> occurs due to <a href="/tag/choroid-plexus-obstruction" rel="noreferrer noopener nofollow" target="_blank">choroid plexus obstruction</a> or increased protein within the CSF.</li><li><a href="/tag/distal-vo-shunt-obstruction/" rel="noreferrer noopener nofollow" target="_blank">Distal VP shunt obstruction</a> occurs due to <a href="/tag/abdominal-pseudocyst-formation" rel="noreferrer noopener nofollow" target="_blank">abdominal pseudocyst formation</a>, which typically presents with abdominal pain due to the large size of the cyst.</li><li>With respect to VP shunt malfunction, <a href="/tag/slit-ventricle-syndrome/" rel="noreferrer noopener nofollow" target="_blank">slit ventricle syndrome</a> occurs when the ventricles are over drained and they collapse, obstructing the proximal shunt orifice. With the reaccumulation of fluid, the obstruction is relieved. Patients typically present with cyclical symptoms.</li><li>In treating patients with <a href="/tag/fight-bites/" rel="noreferrer noopener nofollow" target="_blank">fight bites</a>, we are concerned for <a href="/tag/eikenella" rel="noreferrer noopener nofollow" target="_blank">Eikenella</a><a href="/tag/eikenella" rel="noreferrer noopener nofollow" target="_blank"> </a>contamination. In fight bites overlying the metacarpal, a hand surgery consultation is necessary.</li><li>In <a href="/tag/human-bites/" rel="noreferrer noopener nofollow" target="_blank">human bites</a>, <a href="/tag/amoxicillin-clavulanate" rel="noreferrer noopener nofollow" target="_blank">amoxicillin-clavulanate</a> is typically the first-line antibiotic of choice. For established infections, IV antibiotics such as ampicillin-sulbactam, cefoxitin, or piperacillin-tazobactam may be used.</li><li>For a child with mild to moderate edema, with a normal blood pressure and no respiratory symptoms, the child can typically be discharged home with outpatient nephrology follow up. The treatment is typically <a href="/tag/corticosteroids/" rel="noreferrer noopener nofollow" target="_blank">corticosteroids</a>.</li><li><a href="/tag/hematuria/" rel="noreferrer noopener nofollow" target="_blank">Hematuria</a> with <a href="/tag/hearing-loss/" rel="noreferrer noopener nofollow" target="_blank">hearing loss</a> is associated with <a href="/tag/alport-syndrome/" rel="noreferrer noopener nofollow" target="_blank">Alport syndrome</a>. Hematuria and hemoptysis is associated with Goodpasture’s syndrome.</li><li>There are five important <a href="/tag/cyanotic-congenital-heart-lesions" rel="noreferrer noopener nofollow" target="_blank">cyanotic congenital heart lesions</a> to remember. Remember the numbers 1 to 5. One is for <a href="/tag/truncus-arteriosus/" rel="noreferrer noopener nofollow" target="_blank">truncus arteriosus</a>, in which two vessels join to make one. Two is for <a href="/tag/transposition-of-the-great-vessels" rel="noreferrer noopener nofollow" target="_blank">transposition of the great vessels</a> in which the two great vessels are switched. Three is for <a href="/tag/tricuspid-atresia/" rel="noreferrer noopener nofollow" target="_blank">tricuspid atresia</a>. Remember three for TRIcuspid. Four is for the four defects of <a href="/tag/tetralogy-of-fallot" rel="noreferrer noopener nofollow" target="_blank">tetralogy of Fallot</a>. Lastly, five is for the five letters of <a href="/tag/total-anomalous-pulmonary-vascular-return/" rel="noreferrer noopener nofollow" target="_blank">total anomalous pulmonary vascular return</a>.</li><li><a href="/tag/atrial-septal-defects/" rel="noreferrer noopener nofollow" target="_blank">Atrial septal defects</a>, <a href="/tag/patent-ductus-arteriosus/" rel="noreferrer noopener nofollow" target="_blank">patent ductus arteriosus</a>, and <a href="/tag/ventricular-septal-defects/" rel="noreferrer noopener nofollow" target="_blank">ventricular septal defects</a> are all <a href="/tag/acyanotic-heart-lesions" rel="noreferrer noopener nofollow" target="_blank">acyanotic</a><a href="/tag/acyanotic-heart-lesions" rel="noreferrer noopener nofollow" target="_blank"> </a><a href="/tag/acyanotic-heart-lesions" rel="noreferrer noopener nofollow" target="_blank">heart lesions</a>, or lesions with left to right shunt. Symptomatic children with such lesions typically present with congestive heart failure by 6 months of life.</li><li>For any patient on <a href="/tag/warfarin/" rel="noreferrer noopener nofollow" target="_blank">warfarin</a> with a life-threatening bleed, FFP, PCC, or recombinant factory, 7a should be given.</li><li>For a patient on <a href="/tag/aspirin/" rel="noreferrer noopener nofollow" target="_blank">aspirin</a><a href="/tag/aspirin/" rel="noreferrer noopener nofollow" target="_blank"> </a>with a life-threatening bleed, <a href="/tag/ddvap/" rel="noreferrer noopener nofollow" target="_blank">DDAVP</a> should be given in addition to <a href="/tag/platelets/" rel="noreferrer noopener nofollow" target="_blank">platelets</a>.</li></ul>Until next time, Jeff and NachiP.S. If you like Nachi and Jeff’s content, remember to check out <a href="https://www.roshreview.com/specialties/emergency-medicine/" rel="noreferrer noopener nofollow" target="_blank">Rosh Review’s emergency medicine qbank</a> with thousands of high yield questions, explanations, images, audio, and video teaching files.The post <a href="https://www.roshreview.com/blog/ep8-fractures-vp-shunts-fight-bites-hemolytic-uremic-syndrome-cyanotic-heart-lesions-anticoagulation-much/" rel="nofollow" target="_blank">Podcast Ep 8: Pneumonia, Herpes Zoster, Lung Ultrasound &amp; More</a> appeared first on <a href="https://www.roshreview.com/blog" rel="nofollow" target="_blank">RoshReview.com</a>.

Ep 8 Roshcast Emergency Board Review

We are what we repeatedly do. Excellence, then, is not an act, but a habit. –AristotleWelcome back to RoshCast for Episode 41! As we get closer and closer to the in-training, now would be a great time to go back and listen to old episodes to brush up on some of the core EM knowledge that you may not come across regularly on shift. Let’s get started with a rapid review and our regular mixed content of questions, answers, and high-yield review.Staph aureus is the most common bacterial cause of septic arthritis in adults.In a patient with splenic dysfunction, the strep species are more likely to cause septic arthritis.Septic arthritis classically presents with fever, monoarticular joint pain, and a decreased range of motion.Joint aspirates with a white count &gt; 50,000 with more than 75% PMNs are indicative of septic arthritis.Now onto this week’s podcastQuestion 1 Which of the following hematological disorders is characterized by intermittent venous and arterial thrombosis, splenomegaly, and abnormal proliferation of all three myeloid cell lines?A. Aplastic anemiaB. Chronic myelogenous leukemiaC. Disseminated intravascular coagulopathyD. Polycythemia veraTeaching Image Question 2Which of the following pairs are matched correctly?A. Elevated direct bilirubin – Gilbert’s syndromeB. Elevated indirect bilirubin – CholestasisC. Elevated transaminases with ALT/AST ratio &gt; 2:1 – Alcoholic hepatitisD. Elevated transaminases with AST and ALT &gt; 10,000 IU/L – Ischemic hepatitisTeaching Image Question 3Which of the following conditions can result in refractory hypokalemia that is not correctable by the administration of potassium?A. HypermagnesemiaB. HypernatremiaC. HypomagnesemiaD. HyponatremiaTeaching ImageQuestion 4A 29-year-old man is brought to the ED for a gunshot wound to the right chest. He is diagnosed with a right-sided hemopneumothorax. A tube thoracostomy is subsequently performed with immediate drainage of 250 cc of blood. The nurse connects the chest tube to a commercial suction device, and a chest radiograph is performed that confirms proper placement. You note an absence of respiratory fluctuation of the fluid level in the drainage tube. A repeat chest X-ray shows the right-sided hemothorax remains. Which of the following is true regarding this finding?A. An air leak is presentB. The lung is still collapsedC. There is a blockage of the drainage tubeD. This is an expected findingQuestion 5Which of the following is true regarding Ranson’s criteria?A. A score of 0–3 on admission constitutes a high-risk populationB. Glucose &gt; 200 mg/dL on admission is associated with a higher mortality rateC. Hematocrit &lt; 35% at 48 hours is predictive of mortalityD. WBC &lt; 10,000 is associated with a higher mortality rateTeaching Image Question 6The Emergency Medical Treatment and Active Labor Law of 1986, or EMTALA, requires hospitals to provide which of the following?A. Care to all patients B. Interpreters for all patients in a timely mannerC. Screening exam, competent ED physicians and appropriate stabilizationD. Screening exam, stabilization process, appropriate transfer processQuestion 7A 58-year-old man with a history of cirrhosis presents with abdominal pain and fever. His abdomen is tender to palpation with guarding. You are concerned about spontaneous bacterial peritonitis. You perform a paracentesis and send the ascitic fluid for analysis. Which of the following is most consistent with a diagnosis of spontaneous bacterial peritonitis?A. Low ascitic fluid glucose concentration B. Polymorphonuclear neutrophil count &lt; 250 cells/mm3C. Serum-ascites albumin gradient &lt; 1.1 g/dLD. White blood cell count &lt; 1,000 cells/mm3Teaching Image Polycythemia vera is a chronic myeloproliferative disorder marked by increased red blood cell production but can involve all three cell lines.Polycythemia vera presents with pruritus, especially after bathing, headaches, bleeding, engorged retinal veins, splenomegaly, and gout. Treatment is with serial phlebotomy or with myelosuppressive agents.Gilbert’s syndrome is associated with an elevated indirect bilirubin. Alcoholic hepatitis is associated with an AST to ALT ratio of roughly 2:1.In ischemic hepatitis, you would expect elevated transaminases over 10,000.Hypomagnesemia can result in refractory hypokalemia not correctable by the administration of potassium.Hypomagnesemia can lead to a prolonged QT, a widened QRS as well as atrial and ventricular dysrhythmias.With respect to chest tubes, an air leak occurs when there is persistent air inside the pleural space.An absence of respiratory fluctuation or a decrease in drainage of a chest tube implies that the system is blocked or the lung is fully expanded.Ranson’s criteria is a scoring system designed to predict mortality from acute pancreatitis. EMTALA, enacted in 1986, is a section of the Consolidated Omnibus Labor Act. It governs how physicians triage, register, examine, workup, treat and/or stabilize, discharge or transfer, utilize resources, and involve medical staff expertise when caring for patients who present to the ED.Spontaneous bacterial peritonitis is diagnosed with an elevated ascitic fluid PMN cell count over 250 and a positive ascitic fluid bacterial culture, all in the absence of a secondary cause of peritonitis like a bowel perforation. SBP is also associated low ascitic glucose concentrations. It’s treated with a third-generation cephalosporin.That wraps up RoshCast Episode 41! Don’t forget to follow us on twitter @RoshCast and @RoshReview. We can also be reached by email at RoshCast@RoshReview.com and are open to any feedback, corrections or suggestions. You can also help us pick questions by identifying ones you would like us to review. To do so, write “Roshcast” in the submit feedback box as you go through the question bank. And finally, if you have a minute, make sure to rate us and leave comments on iTunes to help spread the word about Roshcast.Until next time,Jeff and NachiThe post Podcast Ep 41: Polycythemia Vera, Ischemic Hepatitis &amp; More appeared first on RoshReview.com.

<blockquote>We are what we repeatedly do. Excellence, then, is not an act, but a habit. –Aristotle</blockquote><h6>Welcome back to RoshCast for Episode 41! As we get closer and closer to the in-training, now would be a great time to go back and listen to old episodes to brush up on some of the core EM knowledge that you may not come across regularly on shift. Let’s get started with a rapid review and our regular mixed content of questions, answers, and high-yield review.</h6><ul><li>Staph aureus is the most common bacterial cause of septic arthritis in adults.</li><li>In a patient with splenic dysfunction, the strep species are more likely to cause septic arthritis.</li><li>Septic arthritis classically presents with fever, monoarticular joint pain, and a decreased range of motion.</li><li>Joint aspirates with a white count &gt; 50,000 with more than 75% PMNs are indicative of septic arthritis.</li></ul>Now onto this week’s podcastQuestion 1 Which of the following hematological disorders is characterized by intermittent venous and arterial thrombosis, splenomegaly, and abnormal proliferation of all three myeloid cell lines?A. Aplastic anemiaB. Chronic myelogenous leukemiaC. Disseminated intravascular coagulopathyD. Polycythemia vera<a href="https://www.roshreview.com/wp-content/uploads/Ep41_-_polycythemia_vera.jpg" rel="nofollow" target="_blank">Teaching Image </a>Question 2Which of the following pairs are matched correctly?A. Elevated direct bilirubin – Gilbert’s syndromeB. Elevated indirect bilirubin – CholestasisC. Elevated transaminases with ALT/AST ratio &gt; 2:1 – Alcoholic hepatitisD. Elevated transaminases with AST and ALT &gt; 10,000 IU/L – Ischemic hepatitis<a href="https://www.roshreview.com/wp-content/uploads/Ep40_-_ast_alt_alkaline_phosphatase_transaminases_liver_function_tests.png" rel="nofollow" target="_blank">Teaching Image </a>Question 3Which of the following conditions can result in refractory hypokalemia that is not correctable by the administration of potassium?A. HypermagnesemiaB. HypernatremiaC. HypomagnesemiaD. Hyponatremia<a href="https://www.roshreview.com/wp-content/uploads/Ep41_-_hypomagnesemia_magnesium.png" rel="nofollow" target="_blank">Teaching Image</a>Question 4A 29-year-old man is brought to the ED for a gunshot wound to the right chest. He is diagnosed with a right-sided hemopneumothorax. A tube thoracostomy is subsequently performed with immediate drainage of 250 cc of blood. The nurse connects the chest tube to a commercial suction device, and a chest radiograph is performed that confirms proper placement. You note an absence of respiratory fluctuation of the fluid level in the drainage tube. A repeat chest X-ray shows the right-sided hemothorax remains. Which of the following is true regarding this finding?A. An air leak is presentB. The lung is still collapsedC. There is a blockage of the drainage tubeD. This is an expected findingQuestion 5Which of the following is true regarding Ranson’s criteria?A. A score of 0–3 on admission constitutes a high-risk populationB. Glucose &gt; 200 mg/dL on admission is associated with a higher mortality rateC. Hematocrit &lt; 35% at 48 hours is predictive of mortalityD. WBC &lt; 10,000 is associated with a higher mortality rate<a href="https://www.roshreview.com/wp-content/uploads/Ep41_-_acute_pancreatitis_ranson_s_criteria.png" rel="nofollow" target="_blank">Teaching Image </a>Question 6The Emergency Medical Treatment and Active Labor Law of 1986, or EMTALA, requires hospitals to provide which of the following?A. Care to all patients B. Interpreters for all patients in a timely mannerC. Screening exam, competent ED physicians and appropriate stabilizationD. Screening exam, stabilization process, appropriate transfer processQuestion 7A 58-year-old man with a history of cirrhosis presents with abdominal pain and fever. His abdomen is tender to palpation with guarding. You are concerned about spontaneous bacterial peritonitis. You perform a paracentesis and send the ascitic fluid for analysis. Which of the following is most consistent with a diagnosis of spontaneous bacterial peritonitis?A. Low ascitic fluid glucose concentration B. Polymorphonuclear neutrophil count &lt; 250 cells/mm3C. Serum-ascites albumin gradient &lt; 1.1 g/dLD. White blood cell count &lt; 1,000 cells/mm3<a href="https://www.roshreview.com/wp-content/uploads/Ep41_-_spontaneous_bacterial_peritonitis_sbp.png" rel="nofollow" target="_blank">Teaching Image </a><ul><li>Polycythemia vera is a chronic myeloproliferative disorder marked by increased red blood cell production but can involve all three cell lines.</li><li>Polycythemia vera presents with pruritus, especially after bathing, headaches, bleeding, engorged retinal veins, splenomegaly, and gout. Treatment is with serial phlebotomy or with myelosuppressive agents.</li><li>Gilbert’s syndrome is associated with an elevated indirect bilirubin.</li><li> Alcoholic hepatitis is associated with an AST to ALT ratio of roughly 2:1.</li><li>In ischemic hepatitis, you would expect elevated transaminases over 10,000.</li><li>Hypomagnesemia can result in refractory hypokalemia not correctable by the administration of potassium.</li><li>Hypomagnesemia can lead to a prolonged QT, a widened QRS as well as atrial and ventricular dysrhythmias.</li><li>With respect to chest tubes, an air leak occurs when there is persistent air inside the pleural space.</li><li>An absence of respiratory fluctuation or a decrease in drainage of a chest tube implies that the system is blocked or the lung is fully expanded.</li><li>Ranson’s criteria is a scoring system designed to predict mortality from acute pancreatitis. </li><li>EMTALA, enacted in 1986, is a section of the Consolidated Omnibus Labor Act. It governs how physicians triage, register, examine, workup, treat and/or stabilize, discharge or transfer, utilize resources, and involve medical staff expertise when caring for patients who present to the ED.</li><li>Spontaneous bacterial peritonitis is diagnosed with an elevated ascitic fluid PMN cell count over 250 and a positive ascitic fluid bacterial culture, all in the absence of a secondary cause of peritonitis like a bowel perforation. SBP is also associated low ascitic glucose concentrations. It’s treated with a third-generation cephalosporin.</li></ul>That wraps up RoshCast Episode 41! Don’t forget to follow us on twitter <a href="https://twitter.com/roshcast?lang=en" rel="nofollow" target="_blank">@RoshCast</a> and <a href="https://twitter.com/roshreview?lang=en" rel="nofollow" target="_blank">@RoshReview</a>. We can also be reached by email at <a href="mailto:roshcast@roshreview.com">RoshCast@RoshReview.com</a> and are open to any feedback, corrections or suggestions. You can also help us pick questions by identifying ones you would like us to review. To do so, write “Roshcast” in the submit feedback box as you go through the question bank. And finally, if you have a minute, make sure to rate us and leave comments on <a href="https://itunes.apple.com/us/podcast/roshcast/id1156487141?mt=2" rel="noreferrer noopener nofollow" target="_blank">iTunes</a> to help spread the word about Roshcast.Until next time, Jeff and NachiThe post <a href="https://www.roshreview.com/blog/ep-41-polycythemia-vera-ischemic-hepatitis-hypomagnesemia-chest-tubes-ransons-criteria-emtala-sbp/" rel="nofollow" target="_blank">Podcast Ep 41: Polycythemia Vera, Ischemic Hepatitis &amp; More</a> appeared first on <a href="https://www.roshreview.com/blog" rel="nofollow" target="_blank">RoshReview.com</a>.

Ep 41 Roshcast Emergency Board Review

“The person who creates structure the soonest, is the person who is most comfortable in residency the soonest.”  -Adam Rosh, MDWelcome back to RoshCast episode number 39! As we mentioned at the end of episode 38, this won’t be a regular old RoshCast. Instead of our regularly scheduled content, we put together an interview with Dr. Adam Rosh – the namesake of the Rosh Review, former program director, and most importantly an emergency physician who has dedicated the last 20 years of his life to education. While this episode will not contain our usual board review content, it will include tactical advice on preparing for and taking your board exam.This episode provides a gold mine of actionable information, tools, strategies, and tactics that you can use not only for your upcoming Shelf exam, In-Training exam, or ABEM Certification exam, but any high stakes endeavor. Some of the topics Dr. Rosh talked about include:The biggest studying challenges going from medical school to residencyThe best advice Dr. Rosh received when he was an internA system to 10X your medical knowledge during residencyHow to implement a study strategy called “layering” to build deep medical knowledgeHow a “notebook system” made all the difference in the world to building confidence as a residentAn opportunity to aggregate Post-it Pearls A system to capture mistakes to improve clinical practiceHow studying material like the leads of an ECG looking at the heart can lead to improved understanding Using interleaving to improve preparation for the actual examWhat do you do if you answered all of the questions in the Qbank?How forgetting leads to improved recallAvoiding the illusion of knowingChoosing the right study materialMaking sure you prevent people from stealing your timeThe importance of exercise or simply taking a break to go for a walk to improve recallUpcoming releases within Rosh Review And much more…Items referenced during the interviewFlip notebookHow to Increase Your Emergency Medicine Board Exam Score by 10 PointsAn Emergency Medicine Resident’s Clinical ExperienceThat’s wraps up RoshCast Episode 39. Don’t forget to follow us on Twitter @RoshCast and @RoshReview. We can also be reached by email at RoshCast@RoshReview.com and are open to any feedback, corrections or suggestions. You can also help us pick questions by identifying ones you would like us to review. To do so, write “RoshCast” in the submit feedback box as you go through the question bank. And finally, if you have a minute, make sure to rate us and leave comments on iTunes to help spread the word about RoshCast.And let us know if you’d like us to do a Part 2 with Dr. Rosh. Until next time,Jeff and NachiThe post Podcast Ep 39: Special Episode! Listen to an Interview with Dr. Rosh appeared first on RoshReview.com.

<blockquote>“The person who creates structure the soonest, is the person who is most comfortable in residency the soonest.”  -Adam Rosh, MD</blockquote>Welcome back to RoshCast episode number 39! As we mentioned at the end of episode 38, this won’t be a regular old RoshCast. Instead of our regularly scheduled content, we put together an interview with Dr. Adam Rosh – the namesake of the Rosh Review, former program director, and most importantly an emergency physician who has dedicated the last 20 years of his life to education. While this episode will not contain our usual board review content, it will include tactical advice on preparing for and taking your board exam.This episode provides a gold mine of actionable information, tools, strategies, and tactics that you can use not only for your upcoming Shelf exam, In-Training exam, or ABEM Certification exam, but any high stakes endeavor. Some of the topics Dr. Rosh talked about include:<ul><li>The biggest studying challenges going from medical school to residency</li><li>The best advice Dr. Rosh received when he was an intern</li><li>A system to 10X your medical knowledge during residency</li><li>How to implement a study strategy called “layering” to build deep medical knowledge</li><li>How a “notebook system” made all the difference in the world to building confidence as a resident</li><li>An opportunity to aggregate Post-it Pearls </li><li>A system to capture mistakes to improve clinical practice</li><li>How studying material like the leads of an ECG looking at the heart can lead to improved understanding </li><li>Using interleaving to improve preparation for the actual exam</li><li>What do you do if you answered all of the questions in the Qbank?</li><li>How forgetting leads to improved recall</li><li>Avoiding the illusion of knowing</li><li>Choosing the right study material</li><li>Making sure you prevent people from stealing your time</li><li>The importance of exercise or simply taking a break to go for a walk to improve recall</li><li>Upcoming releases within Rosh Review </li><li>And much more…</li></ul>Items referenced during the interview<a href="https://www.amazon.com/Staples-Bound-Memo-Books-Pack/dp/B00WKZ3Y88/ref=pd_bxgy_229_img_3?_encoding=UTF8&amp;psc=1&amp;refRID=QBCS3VCC3KK0CN27X9DA" rel="noreferrer noopener nofollow" target="_blank">Flip notebook</a><a href="https://www.roshreview.com/blog/study-strategies/how-to-increase-your-emergency-medicine-board-exam-score-by-10-points/" rel="noreferrer noopener nofollow" target="_blank">How to Increase Your Emergency Medicine Board Exam Score by 10 Points</a><a href="https://www.dropbox.com/s/gyyshk2qh7w8gwv/CORD%20Poster-ROSH.pdf?dl=0" rel="noreferrer noopener nofollow" target="_blank">An Emergency Medicine Resident’s Clinical Experience</a><a href="https://www.dropbox.com/s/gyyshk2qh7w8gwv/CORD%20Poster-ROSH.pdf?dl=0" rel="nofollow" target="_blank"></a>That’s wraps up RoshCast Episode 39. Don’t forget to follow us on Twitter <a href="https://twitter.com/roshcast?lang=en" rel="nofollow" target="_blank">@RoshCast</a> and <a href="https://twitter.com/roshreview?lang=en" rel="nofollow" target="_blank">@RoshReview</a>. We can also be reached by email at <a href="mailto:roshcast@roshreview.com">RoshCast@RoshReview.com</a> and are open to any feedback, corrections or suggestions. You can also help us pick questions by identifying ones you would like us to review. To do so, write “RoshCast” in the submit feedback box as you go through the question bank. And finally, if you have a minute, make sure to rate us and leave comments on <a href="https://itunes.apple.com/us/podcast/roshcast/id1156487141?mt=2" rel="noreferrer noopener nofollow" target="_blank">iTunes</a> to help spread the word about RoshCast.And let us know if you’d like us to do a Part 2 with Dr. Rosh. Until next time, Jeff and NachiThe post <a href="https://www.roshreview.com/blog/ep-39-special-episode-interview-dr-adam-rosh-board-review-strategies-study-tactics-flip-notebook-changed-life/" rel="nofollow" target="_blank">Podcast Ep 39: Special Episode! Listen to an Interview with Dr. Rosh</a> appeared first on <a href="https://www.roshreview.com/blog" rel="nofollow" target="_blank">RoshReview.com</a>.

Ep 39 Roshcast Emergency Board Review

People who are crazy enough to think they can change the world, are the ones who do.-Rob SiltanenWelcome back to Roshcast Episode 33! This episode marks an incredible milestone for Roshcast. Exactly 365 days ago, Roshcast was born (Apgars 7 and 9). It is wild to look back and think about how much we have covered – hundreds of questions, thousands of pearls, dozens of test-taking strategies, regular tweets, etc. We couldn’t be more excited about where Roshcast has been or where it is going. In honor of hitting one year, we are doing another trauma ring tone competition. During episodes 34 to 38, listen for a trauma ring tone, and tweet the exact time to us or e-mail the time to us. A few weeks ago, we also launched a new partnership with the EM Clerkship podcast as a core EM corollary for selected topics. This week, we are doing another crossover episode, in which we return to cardiac arrhythmias — specifically, bradycardia. Let’s get the episode started with a rapid review of some essential vitamins, which were recently covered on the Rosh Blog.The fat-soluble vitamins are A, D, E, and K.Vitamin D deficiency can lead to rickets in children and osteomalacia in adults. Vitamin D deficiency is classical seen in the elderly, those with insufficient sun exposure, malnutrition, malabsorption, breastfeeding infants, and those who take anticonvulsants.Vitamin E deficiency can present with areflexia, peripheral neuropathy, gait abnormalities, ophthalmoplegia, and decreased proprioception.Vitamin A deficiency is associated with night blindness, xerosis (dryness of the skin, mucous membranes, and conjunctiva), as well as Bitot’s spots (white patches on the conjunctiva).Now onto this week’s podcastQuestion 1A 66-year-old woman presents with generalized weakness and dyspnea on exertion for 2 weeks. Vital signs are BP 80/45, HR 40, RR 16, and pulse oximetry 97% on room air. Her ECG is shown above. There are no other ST-segment abnormalities. Which of the following is the most appropriate next step in management?A. Administer aspirin, heparin and admit for acute coronary syndromeB. Cardiac catheterization laboratory activationC. Observation and arrange for follow up with cardiologyD. Place a transcutaneous pacemakerTeaching ImageQuestion 2A patient has the above ECG shown above. Which of the following findings is likely to be present on exam?A. A harsh crescendo-decrescendo systolic murmurB. A swollen and tender right lower legC. Decreased core body temperatureD. Elevated jugular venous distensionTeaching ImageQuestion 3Which of the following organisms is associated with pneumonia and bullous myringitis?A. Bordetella pertussisB. Haemophilus influenzaeC. Streptococcus bovisD. Streptococcus pneumoniaeTeaching ImageQuestion 4A 52-year-old man presents from his primary care physician’s office for evaluation of an abnormal electrocardiogram. His ECG is seen above. He has no symptoms. What is the appropriate intervention?A. Measurement of cardiac enzymesB. No interventionC. Telemetry observationD. Transcutaneous pacer pad placementTeaching ImageQuestion 5A Segond fracture, seen in the X-ray above, is pathognomonic for what ligamentous injury?A. Anterior cruciate ligament (ACL)B. Lateral collateral ligament (LCL)C. Medial collateral ligament (MCL)D. Posterior cruciate Ligament (PCL)Teaching ImageQuestion 6An infant with episodes of cyanosis and respiratory difficulty is diagnosed with Tetralogy of Fallot. Which of the following defects would you expect to see on echocardiographic examination?A. Aorta-pulmonary artery transpositionB. Atrial septal defectC. Left ventricular hypertrophyD. Overriding aortaQuestion 7A 50-year-old woman presents to the ED with minor chest pain. She lifted some heavy groceries from the car yesterday. She has a history of hypertension that is controlled with metoprolol. In the ED, her vital signs are BP 120/80, HR 68, RR 14, and oxygen saturation 99% on room air. Her rhythm strip is seen above. Which of the following is the represented rhythm?A. First-degree heart blockB. Third-degree heart blockC. Type I second-degree heart blockD. Type II second-degree heart blockTeaching ImageSecond-degree type 1 block may be related to increased vagal tone or medications that block the AV node.Second-degree type 2 block and complete heart block require a pacemaker.  If symptomatic or hemodynamically unstable, patients with such high degree AV block require immediate transcutaneous or transvenous pacing until a permanent pacer can be implanted.Medications that block the AV node include adenosine, beta-blockers, calcium channel blockers, and digoxin.Osborn waves, also known as late delta waves or J waves, are positive deflections of the J point that are characteristic of hypothermia and are usually only seen at temperatures below 32° Celsius.Concurrent bullous myringitis and pneumonia is associated with Streptococcus pneumoniae.  Treating the pneumonia will also treat the otalgia.A Segond fracture is pathognomonic for ACL injury.To test for ACL injury, perform either the Lachman or the anterior drawer test.  The Lachman test is more sensitive.Remember the PROVe mnemonic for the cardiac defects seen in Tetralogy of Fallot (ToF): Pulmonary stenosis, RV hypertrophy, Overriding aorta, and VSD.  That wraps up Episode 33, marking one full year of Roshcast. We will be at ACEP at the end of the month and hope to see many of you there. Definitely swing by the Rosh Review booth (1442) to say hi and give us some feedback or any suggestions you might have to improve the podcast! Don’t forget to follow us on Twitter @Roshcast and @Roshreview. We can also be reached by email at roshcast@roshreview.com. Remember that you can help us pick questions by identifying ones you would like us to review. To do so, write “Roshcast” in the submit feedback box as you go through the question bank. And finally, if you have a minute, make sure to rate us and leave comments on iTunes to help spread the word about Roshcast.Until next time,Jeff and NachiThe post Podcast Ep 33: Heart Block, Hypothermia, Bullous Myringitis, &amp; More appeared first on RoshReview.com.

<blockquote>People who are crazy enough to think they can change the world, are the ones who do.-Rob Siltanen</blockquote><h6>Welcome back to Roshcast Episode 33! This episode marks an incredible milestone for Roshcast. Exactly 365 days ago, Roshcast was born (Apgars 7 and 9). It is wild to look back and think about how much we have covered – hundreds of questions, thousands of pearls, dozens of test-taking strategies, regular tweets, etc. </h6>We couldn’t be more excited about where Roshcast has been or where it is going. In honor of hitting one year, we are doing another trauma ring tone competition. During episodes 34 to 38, listen for a trauma ring tone, and <a href="twitter.com/roshcast" rel="noreferrer noopener nofollow" target="_blank">tweet</a> the exact time to us or <a href="mailto:roshcast@roshreview.com">e-mail</a> the time to us. A few weeks ago, we also launched a new partnership with the <a href="http://emclerkship.com/" rel="noreferrer noopener nofollow" target="_blank">EM Clerkship podcast</a> as a core EM corollary for selected topics. This week, we are doing another crossover episode, in which we return to cardiac arrhythmias — specifically, bradycardia. Let’s get the episode started with a rapid review of some essential vitamins, which were <a href="https://www.roshreview.com/blog/rapid-review/rapid-review-vitamin-deficiencies/" rel="noreferrer noopener nofollow" target="_blank">recently covered</a> on the Rosh Blog.<ul><li>The fat-soluble vitamins are A, D, E, and K.</li><li>Vitamin D deficiency can lead to rickets in children and osteomalacia in adults. Vitamin D deficiency is classical seen in the elderly, those with insufficient sun exposure, malnutrition, malabsorption, breastfeeding infants, and those who take anticonvulsants.</li><li>Vitamin E deficiency can present with areflexia, peripheral neuropathy, gait abnormalities, ophthalmoplegia, and decreased proprioception.</li><li>Vitamin A deficiency is associated with night blindness, xerosis (dryness of the skin, mucous membranes, and conjunctiva), as well as Bitot’s spots (white patches on the conjunctiva).</li></ul>Now onto this week’s podcastQuestion 1A 66-year-old woman presents with generalized weakness and dyspnea on exertion for 2 weeks. Vital signs are BP 80/45, HR 40, RR 16, and pulse oximetry 97% on room air. Her ECG is shown above. There are no other ST-segment abnormalities. Which of the following is the most appropriate next step in management?A. Administer aspirin, heparin and admit for acute coronary syndromeB. Cardiac catheterization laboratory activationC. Observation and arrange for follow up with cardiologyD. Place a transcutaneous pacemaker<a href="https://www.roshreview.com/wp-content/uploads/Ep33-Mobitz-2.jpg" rel="nofollow" target="_blank">Teaching Image</a>Question 2A patient has the above ECG shown above. Which of the following findings is likely to be present on exam?A. A harsh crescendo-decrescendo systolic murmurB. A swollen and tender right lower legC. Decreased core body temperatureD. Elevated jugular venous distension<a href="https://www.roshreview.com/wp-content/uploads/Ep33-Osborn-Wave.png" rel="nofollow" target="_blank">Teaching Image</a>Question 3Which of the following organisms is associated with pneumonia and bullous myringitis?A. Bordetella pertussisB. Haemophilus influenzaeC. Streptococcus bovisD. Streptococcus pneumoniae<a href="https://www.roshreview.com/wp-content/uploads/Ep33-Bullous-Myringitis.png" rel="nofollow" target="_blank">Teaching Image</a>Question 4A 52-year-old man presents from his primary care physician’s office for evaluation of an abnormal electrocardiogram. His ECG is seen above. He has no symptoms. What is the appropriate intervention?A. Measurement of cardiac enzymesB. No interventionC. Telemetry observationD. Transcutaneous pacer pad placement<a href="https://www.roshreview.com/wp-content/uploads/Ep33-Mobitz-1.png" rel="nofollow" target="_blank">Teaching Image</a>Question 5A Segond fracture, seen in the X-ray above, is pathognomonic for what ligamentous injury?A. Anterior cruciate ligament (ACL)B. Lateral collateral ligament (LCL)C. Medial collateral ligament (MCL)D. Posterior cruciate Ligament (PCL)<a href="https://www.roshreview.com/wp-content/uploads/Ep33-Segond-Fracture.jpg" rel="nofollow" target="_blank">Teaching Image</a>Question 6An infant with episodes of cyanosis and respiratory difficulty is diagnosed with Tetralogy of Fallot. Which of the following defects would you expect to see on echocardiographic examination?A. Aorta-pulmonary artery transpositionB. Atrial septal defectC. Left ventricular hypertrophyD. Overriding aortaQuestion 7A 50-year-old woman presents to the ED with minor chest pain. She lifted some heavy groceries from the car yesterday. She has a history of hypertension that is controlled with metoprolol. In the ED, her vital signs are BP 120/80, HR 68, RR 14, and oxygen saturation 99% on room air. Her rhythm strip is seen above. Which of the following is the represented rhythm?A. First-degree heart blockB. Third-degree heart blockC. Type I second-degree heart blockD. Type II second-degree heart block<a href="https://www.roshreview.com/wp-content/uploads/Ep33-All-Heart-Blocks.jpg" rel="nofollow" target="_blank">Teaching Image</a><ul><li>Second-degree type 1 block may be related to increased vagal tone or medications that block the AV node.</li><li>Second-degree type 2 block and complete heart block require a pacemaker.  If symptomatic or hemodynamically unstable, patients with such high degree AV block require immediate transcutaneous or transvenous pacing until a permanent pacer can be implanted.</li><li>Medications that block the AV node include adenosine, beta-blockers, calcium channel blockers, and digoxin.</li><li>Osborn waves, also known as late delta waves or J waves, are positive deflections of the J point that are characteristic of hypothermia and are usually only seen at temperatures below 32° Celsius.</li><li>Concurrent bullous myringitis and pneumonia is associated with Streptococcus pneumoniae.  Treating the pneumonia will also treat the otalgia.</li><li>A Segond fracture is pathognomonic for ACL injury.</li><li>To test for ACL injury, perform either the Lachman or the anterior drawer test.  The Lachman test is more sensitive.</li><li>Remember the PROVe mnemonic for the cardiac defects seen in Tetralogy of Fallot (ToF): Pulmonary stenosis, RV hypertrophy, Overriding aorta, and VSD.  </li></ul>That wraps up Episode 33, marking one full year of Roshcast. We will be at ACEP at the end of the month and hope to see many of you there. Definitely swing by the <a href="http://s36.a2zinc.net/clients/ACEP/ACEP17/Public/eventmap.aspx?MapID=20&amp;MapItBoothID=112633&amp;MapItBooth=1442" rel="noreferrer noopener nofollow" target="_blank">Rosh Review booth (1442)</a> to say hi and give us some feedback or any suggestions you might have to improve the podcast! Don’t forget to follow us on Twitter <a href="https://twitter.com/roshcast?lang=en" rel="nofollow" target="_blank">@Roshcast</a> and <a href="https://twitter.com/roshreview?lang=en" rel="nofollow" target="_blank">@Roshreview</a>. We can also be reached by email at <a href="mailto:roshcast@roshreview.com">roshcast@roshreview.com</a>. Remember that you can help us pick questions by identifying ones you would like us to review. To do so, write “Roshcast” in the submit feedback box as you go through the question bank. And finally, if you have a minute, make sure to rate us and leave comments on <a href="https://itunes.apple.com/us/podcast/roshcast/id1156487141?mt=2" rel="noreferrer noopener nofollow" target="_blank">iTunes</a> to help spread the word about Roshcast.Until next time, Jeff and NachiThe post <a href="https://www.roshreview.com/blog/ep-33-heart-block-hypothermia-bullous-myringitis-segond-fractures-tetralogy-fallot/" rel="nofollow" target="_blank">Podcast Ep 33: Heart Block, Hypothermia, Bullous Myringitis, &amp; More</a> appeared first on <a href="https://www.roshreview.com/blog" rel="nofollow" target="_blank">RoshReview.com</a>.

Ep 33 Roshcast Emergency Board Review

The secret of change is to focus all of your energy, not on fighting the old, but on building the new. –SocratesWelcome back to RoshCast for Episode 42! With the in-training exam around the corner, go back and power through old episodes during commutes to pick up as many points as possible. Good luck!Patent ductus arteriosus (or PDA) closes, the neonate will present in heart failure and shock.Turner’s syndrome is associated with coarctation. Turner’s is also associated with webbed neck, short stature, and low-set ears.Individuals with Turner’s syndrome are missing an X chromosome as well, making it a 45,XO chromosomal condition.A blood pressure differential between the arms and legs—specifically, the pressure in the arms is higher than the legs. Depending on the specific anatomy, you might even note a difference in the pressures between both arms.Classic EKG and chest X-ray findings associated with coarctation of the aorta include left ventricular hypertrophy and rib notching, respectively.Now onto this week’s podcastQuestion 1 Which of the following is typically seen in Korsakoff syndrome?A. Cerebellar dysfunctionB. Long-term memory impairmentC. OphthalmoplegiaD. Recent memory impairmentTeaching Image Question 2Which of the following is the most common physical exam finding in an abdominal aortic aneurysm?A. Abdominal bruitB. Diminished femoral pulsesC. Duodenal obstructionD. Pulsatile abdominal massTeaching ImageQuestion 3A 24-year-old woman at full term presents with rupture of membranes and contractions. Sterile exam reveals a crowning infant with a visible cord. After elevating the fetal head, what management is indicated? A. Clamp and cut cord and proceed with deliveryB. Continue with standard deliveryC. Emergent cesarean section D. Intravenous tocolyticsTeaching Image Question 4You suspect a 35-year-old man has epiglottitis with impending airway compromise. Which of the following is the best method for confirming the diagnosis?A. Computed tomography of the neckB. Frontal cervical soft tissue radiograph C. Indirect laryngoscopyD. Lateral cervical soft tissue radiographTeaching ImageQuestion 5A 21-year-old man presents with a stab wound to the right chest. His vitals are HR 157/min, BP 81/43 mm Hg, RR 28/min, and oxygen saturation 91%. The patient is intubated, and packed red blood cells are started. Physical examination reveals a bleeding wound to the right chest, a midline trachea, and decreased breath sounds on auscultation of the right hemithorax. Which of the following should be performed next?A. Application of a pelvic binderB. Placement of a right thoracostomy tubeC. Right chest thoracotomyD. Transfer to operating roomTeaching Image Question 6A 65-year-old man with a history of hypertension presents with left-sided weakness beginning two hours prior to arrival. Vitals are BP 155/85 mm Hg, HR 102/min, RR 12/min, oxygen saturation 100% on RA. His CT scan is shown above. Which of the following therapies is appropriate?A. Antihypertensives to lower mean arterial pressure by 25%B. Head of bed at 30°C. Neurosurgical evacuationD. Prophylactic antiepileptic drugsTeaching ImageKorsakoff syndrome is a chronic neurologic disease caused by thiamine deficiency that typically presents with impairment of recent memory formation. Patients may also exhibit apathy and confabulation.Wernicke’s encephalopathy often presents with ophthalmoplegia, nystagmus, ataxia, and mental status changes. Wernicke’s encephalopathy and Korsakoff syndrome or often seen simultaneously.Treat both Wenicke and Korsakoff syndromes with thiamine and magnesium.The most common physical exam finding in AAA is a pulsatile mass. At a diameter of 5 cm, the risk of rupture increases markedly. Diagnosis is made by ultrasound or CT scan.For umbilical cord prolapse during delivery, plan for an emergent C-section. If C-section is not possible, attempt manual replacement of the cord into the uterus, followed by rapid vaginal delivery.Epiglottitis classically presents with rapid onset of fever and dysphagia, often with drooling, anxiety, stridor, and a muffled voice.The best method for confirming the diagnosis of epiglottitis is via indirect laryngoscopy, which can be done with a nasopharyngoscope. However, be careful as manipulation can lead to laryngospasm and airway obstruction. Make sure a surgical airway kit is available at the bedside.The classic finding on lateral neck X-ray in those with epiglottitis is a thumbprint sign.An ED thoracotomy would be indicated in a patient who loses vitals in route to the hospital or in the ED.  For intracranial hemorrages, treatment is first supportive with airway protection and maintenance of adequate perfusion. Elevate the head of the bed to 30 degrees and maintain normothermia, normocarbia, and euglycemia. Current data do not support the use of antiepileptics.That wraps up RoshCast Episode 42! Be sure to also check out RoshCast blog for questions from this episode and prior episodes, related images and tables, as well as bonus teaching points. There are also tons of other great free resources there to help prepare you for the boards and the wards. Don’t forget to follow us on twitter @RoshCast and @RoshReview. And you can always email us at RoshCast@RoshReview.com with any feedback, corrections, or suggestions. You can also help us pick questions by identifying ones you would like us to review. Write “RoshCast” in the submit feedback box as you go through the question bank. Lastly, if you have a minute, make sure to rate us and leave comments on iTunes to help spread the word about RoshCast.Good luck on the in-training exam next week!Jeff and NachiThe post Podcast Ep 42: Korsakoff Syndrome, AAA, Prolapsed Umbilical Cord appeared first on RoshReview.com.

<blockquote>The secret of change is to focus all of your energy, not on fighting the old, but on building the new. –Socrates</blockquote><h6>Welcome back to RoshCast for Episode 42! With the in-training exam around the corner, go back and power through old episodes during commutes to pick up as many points as possible. Good luck!</h6><ul><li>Patent ductus arteriosus (or PDA) closes, the neonate will present in heart failure and shock.</li><li>Turner’s syndrome is associated with coarctation. Turner’s is also associated with webbed neck, short stature, and low-set ears.</li><li>Individuals with Turner’s syndrome are missing an X chromosome as well, making it a 45,XO chromosomal condition.</li><li>A blood pressure differential between the arms and legs—specifically, the pressure in the arms is higher than the legs. Depending on the specific anatomy, you might even note a difference in the pressures between both arms.</li><li>Classic EKG and chest X-ray findings associated with coarctation of the aorta include left ventricular hypertrophy and rib notching, respectively.</li></ul>Now onto this week’s podcastQuestion 1 Which of the following is typically seen in Korsakoff syndrome?A. Cerebellar dysfunctionB. Long-term memory impairmentC. OphthalmoplegiaD. Recent memory impairment<a href="https://www.roshreview.com/wp-content/uploads/Ep42-Wernicke-Korsakoff.png" rel="nofollow" target="_blank">Teaching Image</a> Question 2Which of the following is the most common physical exam finding in an abdominal aortic aneurysm?A. Abdominal bruitB. Diminished femoral pulsesC. Duodenal obstructionD. Pulsatile abdominal mass<a href="https://www.roshreview.com/wp-content/uploads/Ep42-AAA.jpg" rel="nofollow" target="_blank">Teaching Image</a>Question 3A 24-year-old woman at full term presents with rupture of membranes and contractions. Sterile exam reveals a crowning infant with a visible cord. After elevating the fetal head, what management is indicated? A. Clamp and cut cord and proceed with deliveryB. Continue with standard deliveryC. Emergent cesarean section D. Intravenous tocolytics<a href="https://www.roshreview.com/wp-content/uploads/Ep42-Umbilical-Cord-Prolapse.jpg" rel="nofollow" target="_blank">Teaching Image </a>Question 4You suspect a 35-year-old man has epiglottitis with impending airway compromise. Which of the following is the best method for confirming the diagnosis?A. Computed tomography of the neckB. Frontal cervical soft tissue radiograph C. Indirect laryngoscopyD. Lateral cervical soft tissue radiograph<a href="https://www.roshreview.com/wp-content/uploads/Ep41-Epiglottitis.png" rel="nofollow" target="_blank">Teaching Image</a>Question 5A 21-year-old man presents with a stab wound to the right chest. His vitals are HR 157/min, BP 81/43 mm Hg, RR 28/min, and oxygen saturation 91%. The patient is intubated, and packed red blood cells are started. Physical examination reveals a bleeding wound to the right chest, a midline trachea, and decreased breath sounds on auscultation of the right hemithorax. Which of the following should be performed next?A. Application of a pelvic binderB. Placement of a right thoracostomy tubeC. Right chest thoracotomyD. Transfer to operating room<a href="https://www.roshreview.com/wp-content/uploads/Ep42-Traumatic-Hemothorax.png" rel="nofollow" target="_blank">Teaching Image </a>Question 6A 65-year-old man with a history of hypertension presents with left-sided weakness beginning two hours prior to arrival. Vitals are BP 155/85 mm Hg, HR 102/min, RR 12/min, oxygen saturation 100% on RA. His CT scan is shown above. Which of the following therapies is appropriate?A. Antihypertensives to lower mean arterial pressure by 25%B. Head of bed at 30°C. Neurosurgical evacuationD. Prophylactic antiepileptic drugs<a href="https://www.roshreview.com/wp-content/uploads/Ep42-Intraparenchymal-Hemorrhage.jpg" rel="nofollow" target="_blank">Teaching Image</a><ul><li>Korsakoff syndrome is a chronic neurologic disease caused by thiamine deficiency that typically presents with impairment of recent memory formation. Patients may also exhibit apathy and confabulation.</li><li>Wernicke’s encephalopathy often presents with ophthalmoplegia, nystagmus, ataxia, and mental status changes. Wernicke’s encephalopathy and Korsakoff syndrome or often seen simultaneously.</li><li>Treat both Wenicke and Korsakoff syndromes with thiamine and magnesium.</li><li>The most common physical exam finding in AAA is a pulsatile mass. At a diameter of 5 cm, the risk of rupture increases markedly. Diagnosis is made by ultrasound or CT scan.</li><li>For umbilical cord prolapse during delivery, plan for an emergent C-section. If C-section is not possible, attempt manual replacement of the cord into the uterus, followed by rapid vaginal delivery.</li><li>Epiglottitis classically presents with rapid onset of fever and dysphagia, often with drooling, anxiety, stridor, and a muffled voice.</li><li>The best method for confirming the diagnosis of epiglottitis is via indirect laryngoscopy, which can be done with a nasopharyngoscope. However, be careful as manipulation can lead to laryngospasm and airway obstruction. Make sure a surgical airway kit is available at the bedside.</li><li>The classic finding on lateral neck X-ray in those with epiglottitis is a thumbprint sign.</li><li>An ED thoracotomy would be indicated in a patient who loses vitals in route to the hospital or in the ED.  </li><li>For intracranial hemorrages, treatment is first supportive with airway protection and maintenance of adequate perfusion. Elevate the head of the bed to 30 degrees and maintain normothermia, normocarbia, and euglycemia. Current data do not support the use of antiepileptics.</li></ul>That wraps up RoshCast Episode 42! Be sure to also check out <a href="https://www.roshreview.com/blog/" rel="noreferrer noopener nofollow" target="_blank">RoshCast blog </a>for questions from this episode and prior episodes, related images and tables, as well as bonus teaching points. There are also tons of other great free resources there to help prepare you for the boards and the wards. Don’t forget to follow us on twitter <a href="https://twitter.com/roshcast?lang=en" rel="nofollow" target="_blank">@RoshCast</a> and <a href="https://twitter.com/roshreview?lang=en" rel="nofollow" target="_blank">@RoshReview</a>. And you can always email us at <a href="mailto:roshcast@roshreview.com">RoshCast@RoshReview.com</a> with any feedback, corrections, or suggestions. You can also help us pick questions by identifying ones you would like us to review. Write “RoshCast” in the submit feedback box as you go through the question bank. Lastly, if you have a minute, make sure to rate us and leave comments on <a href="https://itunes.apple.com/us/podcast/roshcast/id1156487141?mt=2" rel="noreferrer noopener nofollow" target="_blank">iTunes</a> to help spread the word about RoshCast.Good luck on the in-training exam next week! Jeff and NachiThe post <a href="https://www.roshreview.com/blog/ep-42-korsakoff-syndrome-aaa-prolapsed-umbilical-cord-epiglottitis-thoracostomy-intracerebral-hemorrhage/" rel="nofollow" target="_blank">Podcast Ep 42: Korsakoff Syndrome, AAA, Prolapsed Umbilical Cord</a> appeared first on <a href="https://www.roshreview.com/blog" rel="nofollow" target="_blank">RoshReview.com</a>.

Ep 42 Roshcast Emergency Board Review

What we think, we become-BuddhaWelcome back to Episode 16! With the In-training Exam next week, we are doing things a little different this week. Instead of covering new material before the exam, we are launching three episodes, back to back, reviewing the most high-yield points that we have covered so far, organized by topic. We think this extra layer of spaced repetition will help you gain a few extra points during your test. We have set it up in a quiz format, so you can pause the podcast as you go along.Now onto this week’s podcastAbdominal EmergenciesSmall bowel obstructions are caused most commonly by postoperative adhesions followed by malignancy.  Large bowel obstructions are caused most commonly by malignancy followed by volvulus.Reynolds’ pentad for acute cholangitis consists of fever, right upper quadrant pain, jaundice, altered mental status, and hypotension.The initial treatment for GERD should always begin with lifestyle and behavior modifications including weight loss, head of bed elevation, and avoiding eating prior to sleeping. If lifestyle modifications are not providing adequate relief, PPIs are the empiric treatment of choice for GERD.Untreated GERD can lead to Barrett Esophagus, which increases the risk for esophageal neoplasm.Cardiovascular EmergenciesNitrates reduce both the preload and the afterload by dilating vascular smooth muscles. Avoid nitrates in inferior MIs and in those on phosphodiesterase inhibitors.The most common finding in an acute aortic dissection is hypertension.Capture beats are normal narrow supraventricular beats within a run of wide complex beats. Fusion beats occur when impulses from two different locations activate the ventricle. One impulse is typically ventricular and the other is supraventricular, resulting in a QRS complex with hybrid morphology of a sinus beat and an intraventricular beat.For hemodynamically stable patients, AVNRT can be treated with beta-blockers, calcium channel blockers, or, less commonly, digoxin. Unstable or refractory cases require cardioversion.The mnemonic FROM JANE (Fever, Roth’s spots, Osler’s nodes, Murmur, Janeway lesions, Anemia, Nail-bed hemorrhages, and Emboli), can be used to remember the findings associated with bacterial endocarditis.In IV drug users with endocarditis, the tricuspid valve is most commonly affected and Staph aureus is the most common bacteria isolated.In native valve endocarditis, the mitral valve is most commonly infected followed by the aortic valve.Strep bovis endocarditis is associated with colon cancer (remember: cancer in the colon, bovis in the blood).In cardiac arrest, AED use, early bystander CPR, amiodarone for shock-resistant ventricular tachycardia or ventricular fibrillation, therapeutic hypothermia, and cardiac catheterization for ventricular dysrhythmias, even in EKGs that do not meet STEMI criteria, have all been shown to improve outcomes.MAP = CO x SVR + CVP. Its’ more easily estimated by the formula MAP = ⅓SBP + ⅔DBP.The right coronary artery occlusion supplies the AV node in the majority of patients. Acute occlusion can lead to heart black.The six P’s of acute arterial occlusion are paresthesias, paralysis, pallor, pulselessness, poikilothermia, and pain out of proportion to exam. Paralysis and paresthesias require emergent surgical intervention.Acute arterial embolisms should be managed by embolectomy, whereas in situ thromboses may respond to anticoagulation.Left ventricular thrombus formation after an MI is the most common source of an arterial embolus.Cutaneous EmergenciesEscharotomies are performed along the medial and lateral aspects of both the upper and lower extremities.The Parkland formula = 4 x percentage burned x weight (in kg). Give the first half of the fluid over the first 8 hours and the second half of the fluid over the next 16 hours.Staph scalded skin syndrome is caused by an exotoxin. These patients will have a positive Nikolsky’s sign. Rupturing the bullae will not spread the toxin, as it is spread via the blood stream.Trousseau’s syndrome is a migratory thrombophlebitis associated with pancreatic cancer.Erythema nodosum is an inflammatory condition characterized by tender red-violet nodules under the skin. The most common cause is an infection but drugs can also cause erythema nodosum, with OCPs being the most common culprit. The treatment is NSAIDs for mild to moderate cases. Potassium iodine can be used in severe cases.Endocrine EmergenciesSulfonylurea anti-hyperglycemia can cause recurrent episodes of hypoglycemia.In factitious hypoglycemia, C-peptide should be low and insulin levels should be high due to exogenous administration of insulin.Environmental EmergenciesScorpion stings cause local redness and edema with a heightened sensitivity to touch in the area. You can also have numbness and weakness in the affected area. Systemic symptoms include fasciculations, disconjugate gaze, temperature reversal, and pancreatitis.Black widow spiders are found throughout the entire United States. They can be identified by the hourglass on their abdomen. In contrast, brown recluse spiders are found in the Midwest.Black widow spider bites cause a local papule with a halo. Severe systemic symptoms include a peritonitic abdomen, muscle fasciculations, and diaphoresis. Brown recluse spider bites cause a papule that later blisters and may necrose. Systemic symptoms include renal failure, pulmonary edema, and shockPit viper snakebites cause local swelling and oozing from the wound. Severe envenomation can lead to a DIC-like coagulopathy and hemorrhagic bullae.Frostbite should be treated with immersion in a warm water bath at 37 to 39 degrees Celsius. Water at a higher temperature will warm no faster and cause increased pain and potentially tissue damage.So, that’s it for part 1. Stay tuned for the remaining two parts. Was this review helpful? Do you want us to change anything? Send us your thoughts at roshcast@roshreview.com.Until next time,Jeff and NachiP.S. If you missed Episode 15, including arterial emboli, listen here.The post Podcast Ep 16: In-Training Exam Review, Abdominal, Cardiovascular &amp; More appeared first on RoshReview.com.

<blockquote>What we think, we become-Buddha</blockquote><h6>Welcome back to Episode 16! With the In-training Exam next week, we are doing things a little different this week. Instead of covering new material before the exam, we are launching three episodes, back to back, reviewing the most high-yield points that we have covered so far, organized by topic. We think this extra layer of spaced repetition will help you gain a few extra points during your test. We have set it up in a quiz format, so you can pause the podcast as you go along.</h6>Now onto this week’s podcastAbdominal Emergencies<ul><li>Small bowel obstructions are caused most commonly by postoperative adhesions followed by malignancy.  </li><li>Large bowel obstructions are caused most commonly by malignancy followed by volvulus.</li><li>Reynolds’ pentad for acute cholangitis consists of fever, right upper quadrant pain, jaundice, altered mental status, and hypotension.</li><li>The initial treatment for GERD should always begin with lifestyle and behavior modifications including weight loss, head of bed elevation, and avoiding eating prior to sleeping. If lifestyle modifications are not providing adequate relief, PPIs are the empiric treatment of choice for GERD.</li><li>Untreated GERD can lead to Barrett Esophagus, which increases the risk for esophageal neoplasm.</li></ul>Cardiovascular Emergencies<ul><li>Nitrates reduce both the preload and the afterload by dilating vascular smooth muscles. Avoid nitrates in inferior MIs and in those on phosphodiesterase inhibitors.</li><li>The most common finding in an acute aortic dissection is hypertension.</li><li>Capture beats are normal narrow supraventricular beats within a run of wide complex beats. Fusion beats occur when impulses from two different locations activate the ventricle. One impulse is typically ventricular and the other is supraventricular, resulting in a QRS complex with hybrid morphology of a sinus beat and an intraventricular beat.</li><li>For hemodynamically stable patients, AVNRT can be treated with beta-blockers, calcium channel blockers, or, less commonly, digoxin. Unstable or refractory cases require cardioversion.</li><li>The mnemonic FROM JANE (Fever, Roth’s spots, Osler’s nodes, Murmur, Janeway lesions, Anemia, Nail-bed hemorrhages, and Emboli), can be used to remember the findings associated with bacterial endocarditis.</li><li>In IV drug users with endocarditis, the tricuspid valve is most commonly affected and Staph aureus is the most common bacteria isolated.</li><li>In native valve endocarditis, the mitral valve is most commonly infected followed by the aortic valve.</li><li>Strep bovis endocarditis is associated with colon cancer (remember: cancer in the colon, bovis in the blood).</li><li>In cardiac arrest, AED use, early bystander CPR, amiodarone for shock-resistant ventricular tachycardia or ventricular fibrillation, therapeutic hypothermia, and cardiac catheterization for ventricular dysrhythmias, even in EKGs that do not meet STEMI criteria, have all been shown to improve outcomes.</li><li>MAP = CO x SVR + CVP. Its’ more easily estimated by the formula MAP = ⅓SBP + ⅔DBP.</li><li>The right coronary artery occlusion supplies the AV node in the majority of patients. Acute occlusion can lead to heart black.</li><li>The six P’s of acute arterial occlusion are paresthesias, paralysis, pallor, pulselessness, poikilothermia, and pain out of proportion to exam. Paralysis and paresthesias require emergent surgical intervention.</li><li>Acute arterial embolisms should be managed by embolectomy, whereas in situ thromboses may respond to anticoagulation.</li><li>Left ventricular thrombus formation after an MI is the most common source of an arterial embolus.</li></ul>Cutaneous Emergencies<ul><li>Escharotomies are performed along the medial and lateral aspects of both the upper and lower extremities.</li><li>The Parkland formula = 4 x percentage burned x weight (in kg). Give the first half of the fluid over the first 8 hours and the second half of the fluid over the next 16 hours.</li><li>Staph scalded skin syndrome is caused by an exotoxin. These patients will have a positive Nikolsky’s sign. Rupturing the bullae will not spread the toxin, as it is spread via the blood stream.</li><li>Trousseau’s syndrome is a migratory thrombophlebitis associated with pancreatic cancer.</li><li>Erythema nodosum is an inflammatory condition characterized by tender red-violet nodules under the skin. The most common cause is an infection but drugs can also cause erythema nodosum, with OCPs being the most common culprit. The treatment is NSAIDs for mild to moderate cases. Potassium iodine can be used in severe cases.</li></ul>Endocrine Emergencies<ul><li>Sulfonylurea anti-hyperglycemia can cause recurrent episodes of hypoglycemia.</li><li>In factitious hypoglycemia, C-peptide should be low and insulin levels should be high due to exogenous administration of insulin.</li></ul>Environmental Emergencies<ul><li>Scorpion stings cause local redness and edema with a heightened sensitivity to touch in the area. You can also have numbness and weakness in the affected area. Systemic symptoms include fasciculations, disconjugate gaze, temperature reversal, and pancreatitis.</li><li>Black widow spiders are found throughout the entire United States. They can be identified by the hourglass on their abdomen. In contrast, brown recluse spiders are found in the Midwest.</li><li>Black widow spider bites cause a local papule with a halo. Severe systemic symptoms include a peritonitic abdomen, muscle fasciculations, and diaphoresis. Brown recluse spider bites cause a papule that later blisters and may necrose. Systemic symptoms include renal failure, pulmonary edema, and shock</li><li>Pit viper snakebites cause local swelling and oozing from the wound. Severe envenomation can lead to a DIC-like coagulopathy and hemorrhagic bullae.</li><li>Frostbite should be treated with immersion in a warm water bath at 37 to 39 degrees Celsius. Water at a higher temperature will warm no faster and cause increased pain and potentially tissue damage.</li></ul>So, that’s it for part 1. Stay tuned for the remaining two parts. Was this review helpful? Do you want us to change anything? Send us your thoughts at <a href="mailto:roshcast@roshreview.com">roshcast@roshreview.com</a>.Until next time, Jeff and NachiP.S. If you missed Episode 15, including arterial emboli, <a href="https://www.roshreview.com/podcasts/ep-15-erythema-multiforme-pneumothorax-heart-block-brain-natriuretic-peptide-angioedema-arterial-emboli-airway-obstructionand/" rel="noreferrer noopener nofollow" target="_blank">listen here</a>.The post <a href="https://www.roshreview.com/blog/ep-16-training-exam-review-part-1-3-abdominal-cardiovascular-cutaneous-endocrine-environmental-emergencies/" rel="nofollow" target="_blank">Podcast Ep 16: In-Training Exam Review, Abdominal, Cardiovascular &amp; More</a> appeared first on <a href="https://www.roshreview.com/blog" rel="nofollow" target="_blank">RoshReview.com</a>.

Ep 16 Roshcast Emergency Board Review

Dreams and dedication are a powerful combination.-William LonggoodWelcome back to Roshcast for Episode 40! After a quick detour last week to talk with Dr. Rosh, we are back at it with our regular routine. But before we get going, if you have any thoughts or feedback on last week’s episode, or even if you have any unanswered questions, make sure you send them our way to RoshCast@RoshReview.com, so that we can get them answered either individually by email or on another special episode. This week, we are going to cover a few pediatric respiratory questions to parallel the EM Clerkship podcast’s most recent episode in addition to some bread and butter emergency medicine. Before we begin, let’s get warmed up with a rapid review covering environmental emergencies, since these are things we see less frequently in our day to do practice but ALWAYS appear on the in-training exam. Pit viper bites cause local swelling and oozing from the wound. Severe envenomations can lead to a DIC like coagulopathy and hemorrhagic bullae.Brown recluse spider bites cause a papule that later blisters and may necrose. Systemic symptoms include renal failure, pulmonary edema, and shock.Black widow spider bites cause a local papule with a halo. Severe systemic symptoms include a peritonitic abdomen, muscle fasciculations, and diaphoresis. Remember that you can identify a black widow spider by the red hourglass on their abdomen.Frostbite should be treated with immersion in a warm water bath set at 37-39 degrees Celsius.Now onto this week’s podcastQuestion 1 Let’s get right into with a pediatric respiratory question: A 3-year-old girl presents to the ED with 1 hour of a barking cough and inspiratory stridor at rest. On exam, she has mild retractions but is not hypoxic. Which of the following interventions has been shown to reduce hospital length of stay in moderate to severe croup?A. DexamethasoneB. HelioxC. Humidified airD. Racemic epinephrineTeaching Image Question 2A 33-year-old woman presents with intermittent, intense shooting pain to the left side of the face. She states that the pain begins near her ear and radiates to her chin. The pain is often brought on by chewing and brushing her teeth. Which of the following managements is most likely indicated?A. CarbamazepineB. Dental X-raysC. Mandible CT scanD. PrednisoneTeaching ImageQuestion 3Which of the following cervical spine fractures is considered stable?A. Bilateral facet dislocationB. Flexion teardrop fractureC. Jefferson fractureD. Type I odontoid fractureTeaching Image Question 4You are working in a busy pediatric ED in December. During your shift, you evaluate and treat four children with moderate croup by administering oral dexamethasone and aerosolized epinephrine. You re-evaluate each child two hours after the initial racemic epinephrine treatment. Which of the following children can most safely be discharged home?A. A 1-year-old boy with persistent stridor at restB. A 2-year-old uninsured boy with clinical improvement, but no primary care physicianC. A 3-month-old girl with a history of tracheomalacia who has clinical improvementD. A 4-year-old girl with retractions that have since resolvedTeaching ImageQuestion 5A 10-year-old boy presents with increased lethargy and vomiting. Mom states the patient has had three days of cough, rhinorrhea, sore throat, and fever. The nanny has been giving the patient an appropriate dose of over-the-counter cold medicine. The physical exam is remarkable for lethargy, mild icterus, and hepatomegaly. Laboratory results are remarkable for markedly elevated AST and ALT. Which medication is most likely responsible for this patient’s presentation?A. AcetaminophenB. AspirinC. GuaifenesinD. IbuprofenTeaching Image Question 6A 52-year-old man with a history of renal failure status post-transplant presents with shortness of breath. He has had a non-productive cough with fevers for the last 3 days. His only medication is mycophenolate mofetil. With ambulation, he desaturates to 85% on room air and his resting saturation is 90%. Physical examination is notable for diffuse bilateral crackles. His chest X-ray is shown above. Which of the following is the most appropriate drug to administer next?A. Anaerobic antibiotic coverageB. Beta-agonistC. Loop diureticD. Oral corticosteroidTeaching Image Question 7A 6-month-old girl born at 35 weeks gestation and previously well presents to the ED with wheezing and increased work of breathing. Mom reports that her daughter has had a low-grade fever, rhinorrhea, and cough for the past 3 days. In the ED, the patient’s vital signs are T 38.3ºC, HR 150/min, RR 72/min, and a pulse oximetry of 90% on room air. On exam, she is wheezing, using accessory muscles, and having subcostal retractions. An albuterol nebulizer treatment was given but no improvement was seen. Which of the following is the most appropriate next step in management?A. Administer 1 mg/kg of oral dexamethasoneB. Administer another albuterol nebulizer treatment because the patient continues to be wheezingC. Administer high-dose inhaled corticosteroidsD. Admit to the hospital and provide supportive careTeaching Image Dexamethasone is the first-line treatment for croup. It reduces hospital length of stay in moderate to severe case of croup.The Westley Croup Severity Score incorporates level of consciousness, cyanosis, stridor, air entry, and retractions to help guide management, which ranges from supportive care, to nebulized epinephrine, to ICU admission and intubation.In children with croup, chest X-ray may show the classic steeple sign.Trigeminal neuralgia presents with paroxysms of lancinating pain, typically in the V2 and V3 dermatomes. Treatment is with carbamazepine.Bilateral facet dislocations, flexion teardrop fractures, Jefferson fractures, and type 2 and type 3 odontoid fractures are all unstable cervical spine fractures.A flexion teardrop fracture is a fracture of the anterior inferior portion of the vertebral body, which disrupts the anterior and posterior ligamentous structures.A Jefferson fracture is a burst fracture.A type 1 odontoid fracture is an avulsion of the tip of the odontoid. A type 2 odontoid fracture, which is the most common, is a fracture at the base of the dens. A type 3 odontoid fracture is a fracture at the junction of the odontoid and the body of C2.Reye syndrome presents with a rapidly progressive, non-inflammatory encephalopathy associated with altered mental status, cerebral edema, and hepatic dysfunction. Patients typically present with respiratory or a GI prodrome followed by an encephalopathic picture.  Reye syndrome is caused by salicylate usage in the setting of a viral illness. Influenza and chickenpox are commonly implicated viruses.PJP pneumonia presents with bilateral perihilar infiltrates in a classic batwing appearance. Immunocompromised patients are at risk.PJP pneumonia is ideally treated with trimethoprim-sulfamethoxazole. In sulfa allergic patients, consider primaquine-clindamycin or atovaquone for mild to moderate disease or pentamidine for severe disease.Bronchiolitis should be treated with supportive care. In first-time wheezers, evidence suggests that there is no role for oral steroids or beta-agonists.That wraps up RoshCast Episode 40! Be sure to also check out the blog for questions from this episode and prior episodes, related images and tables, as well as bonus teaching points. There are also tons of other great free resources there to help prepare you for the boards and the wards. Don’t forget to follow us on Twitter @RoshCast and @RoshReview. You can always email us at RoshCast@RoshReview.com with any feedback, corrections or suggestions. You can also help us pick questions by identifying ones you would like us to review. Write “RoshCast” in the submit feedback box as you go through the question bank. Lastly, if you have a minute, make sure to rate us and leave comments on iTunes to help spread the word about RoshCast. We’ll be back soon with more high quality review.Until next time, Jeff and Nachi The post Podcast Ep 40: Croup, Trigeminal Neuralgia, PJP Pneumonia, &amp; More appeared first on RoshReview.com.

<blockquote>Dreams and dedication are a powerful combination.-William Longgood</blockquote><h6>Welcome back to Roshcast for Episode 40! After a quick detour last week to talk with Dr. Rosh, we are back at it with our regular routine. But before we get going, if you have any thoughts or feedback on last week’s episode, or even if you have any unanswered questions, make sure you send them our way to <a href="mailto:roshcast@roshreview.com">RoshCast@RoshReview.com</a>, so that we can get them answered either individually by email or on another special episode. </h6>This week, we are going to cover a few pediatric respiratory questions to parallel the EM Clerkship podcast’s most recent episode in addition to some bread and butter emergency medicine. Before we begin, let’s get warmed up with a rapid review covering environmental emergencies, since these are things we see less frequently in our day to do practice but ALWAYS appear on the in-training exam. <ul><li>Pit viper bites cause local swelling and oozing from the wound. Severe envenomations can lead to a DIC like coagulopathy and hemorrhagic bullae.</li><li>Brown recluse spider bites cause a papule that later blisters and may necrose. Systemic symptoms include renal failure, pulmonary edema, and shock.</li><li>Black widow spider bites cause a local papule with a halo. Severe systemic symptoms include a peritonitic abdomen, muscle fasciculations, and diaphoresis. Remember that you can identify a black widow spider by the red hourglass on their abdomen.</li><li>Frostbite should be treated with immersion in a warm water bath set at 37-39 degrees Celsius.</li></ul>Now onto this week’s podcastQuestion 1 Let’s get right into with a pediatric respiratory question: A 3-year-old girl presents to the ED with 1 hour of a barking cough and inspiratory stridor at rest. On exam, she has mild retractions but is not hypoxic. Which of the following interventions has been shown to reduce hospital length of stay in moderate to severe croup?A. DexamethasoneB. HelioxC. Humidified airD. Racemic epinephrine<a href="https://www.roshreview.com/wp-content/uploads/Ep40_-_westley_croup_severity_score.png" rel="nofollow" target="_blank">Teaching Image </a>Question 2A 33-year-old woman presents with intermittent, intense shooting pain to the left side of the face. She states that the pain begins near her ear and radiates to her chin. The pain is often brought on by chewing and brushing her teeth. Which of the following managements is most likely indicated?A. CarbamazepineB. Dental X-raysC. Mandible CT scanD. Prednisone<a href="https://www.roshreview.com/wp-content/uploads/Ep40_-_trigeminal_neuralgia.png" rel="nofollow" target="_blank">Teaching Image</a>Question 3Which of the following cervical spine fractures is considered stable?A. Bilateral facet dislocationB. Flexion teardrop fractureC. Jefferson fractureD. Type I odontoid fracture<a href="https://www.roshreview.com/wp-content/uploads/Ep40_-_odontoid_fracture.png" rel="nofollow" target="_blank">Teaching Image </a>Question 4You are working in a busy pediatric ED in December. During your shift, you evaluate and treat four children with moderate croup by administering oral dexamethasone and aerosolized epinephrine. You re-evaluate each child two hours after the initial racemic epinephrine treatment. Which of the following children can most safely be discharged home?A. A 1-year-old boy with persistent stridor at restB. A 2-year-old uninsured boy with clinical improvement, but no primary care physicianC. A 3-month-old girl with a history of tracheomalacia who has clinical improvementD. A 4-year-old girl with retractions that have since resolved<a href="https://www.roshreview.com/wp-content/uploads/Ep40_-_classification_of_croup.jpg" rel="nofollow" target="_blank">Teaching Image</a>Question 5A 10-year-old boy presents with increased lethargy and vomiting. Mom states the patient has had three days of cough, rhinorrhea, sore throat, and fever. The nanny has been giving the patient an appropriate dose of over-the-counter cold medicine. The physical exam is remarkable for lethargy, mild icterus, and hepatomegaly. Laboratory results are remarkable for markedly elevated AST and ALT. Which medication is most likely responsible for this patient’s presentation?A. AcetaminophenB. AspirinC. GuaifenesinD. Ibuprofen<a href="https://www.roshreview.com/wp-content/uploads/Ep40_-_reye_syndrome.png" rel="nofollow" target="_blank">Teaching Image </a>Question 6A 52-year-old man with a history of renal failure status post-transplant presents with shortness of breath. He has had a non-productive cough with fevers for the last 3 days. His only medication is mycophenolate mofetil. With ambulation, he desaturates to 85% on room air and his resting saturation is 90%. Physical examination is notable for diffuse bilateral crackles. His chest X-ray is shown above. Which of the following is the most appropriate drug to administer next?A. Anaerobic antibiotic coverageB. Beta-agonistC. Loop diureticD. Oral corticosteroid<a href="https://www.roshreview.com/wp-content/uploads/Ep40_-_pcp_pneumonia_pneumocystis_pneumocystis_jiroveci_pneumonia.png" rel="nofollow" target="_blank">Teaching Image </a>Question 7A 6-month-old girl born at 35 weeks gestation and previously well presents to the ED with wheezing and increased work of breathing. Mom reports that her daughter has had a low-grade fever, rhinorrhea, and cough for the past 3 days. In the ED, the patient’s vital signs are T 38.3ºC, HR 150/min, RR 72/min, and a pulse oximetry of 90% on room air. On exam, she is wheezing, using accessory muscles, and having subcostal retractions. An albuterol nebulizer treatment was given but no improvement was seen. Which of the following is the most appropriate next step in management?A. Administer 1 mg/kg of oral dexamethasoneB. Administer another albuterol nebulizer treatment because the patient continues to be wheezingC. Administer high-dose inhaled corticosteroidsD. Admit to the hospital and provide supportive care<a href="https://www.roshreview.com/wp-content/uploads/Ep40_-_bronchiolitis_rsv.png" rel="nofollow" target="_blank">Teaching Image </a><ul><li>Dexamethasone is the first-line treatment for croup. It reduces hospital length of stay in moderate to severe case of croup.</li><li>The <a href="https://www.mdcalc.com/westley-croup-score" rel="noreferrer noopener nofollow" target="_blank">Westley Croup Severity Score</a> incorporates level of consciousness, cyanosis, stridor, air entry, and retractions to help guide management, which ranges from supportive care, to nebulized epinephrine, to ICU admission and intubation.</li><li>In children with croup, chest X-ray may show the classic steeple sign.</li><li>Trigeminal neuralgia presents with paroxysms of lancinating pain, typically in the V2 and V3 dermatomes. Treatment is with carbamazepine.</li><li>Bilateral facet dislocations, flexion teardrop fractures, Jefferson fractures, and type 2 and type 3 odontoid fractures are all unstable cervical spine fractures.</li><li>A flexion teardrop fracture is a fracture of the anterior inferior portion of the vertebral body, which disrupts the anterior and posterior ligamentous structures.</li><li>A Jefferson fracture is a burst fracture.</li><li>A type 1 odontoid fracture is an avulsion of the tip of the odontoid. A type 2 odontoid fracture, which is the most common, is a fracture at the base of the dens. A type 3 odontoid fracture is a fracture at the junction of the odontoid and the body of C2.</li><li>Reye syndrome presents with a rapidly progressive, non-inflammatory encephalopathy associated with altered mental status, cerebral edema, and hepatic dysfunction. Patients typically present with respiratory or a GI prodrome followed by an encephalopathic picture.  </li><li>Reye syndrome is caused by salicylate usage in the setting of a viral illness. Influenza and chickenpox are commonly implicated viruses.</li><li>PJP pneumonia presents with bilateral perihilar infiltrates in a classic batwing appearance. Immunocompromised patients are at risk.</li><li>PJP pneumonia is ideally treated with trimethoprim-sulfamethoxazole. In sulfa allergic patients, consider primaquine-clindamycin or atovaquone for mild to moderate disease or pentamidine for severe disease.</li><li>Bronchiolitis should be treated with supportive care. In first-time wheezers, evidence suggests that there is no role for oral steroids or beta-agonists.</li></ul>That wraps up RoshCast Episode 40! Be sure to also check out the <a href="https://www.roshreview.com/blog/" rel="noreferrer noopener nofollow" target="_blank">blog</a> for questions from this episode and prior episodes, related images and tables, as well as bonus teaching points. There are also tons of other great free resources there to help prepare you for the boards and the wards. Don’t forget to follow us on Twitter <a href="https://twitter.com/roshcast?lang=en" rel="nofollow" target="_blank">@RoshCast</a> and <a href="https://twitter.com/roshreview?lang=en" rel="nofollow" target="_blank">@RoshReview</a>. You can always email us at <a href="mailto:roshcast@roshreview.com">RoshCast@RoshReview.com</a> with any feedback, corrections or suggestions. You can also help us pick questions by identifying ones you would like us to review. Write “RoshCast” in the submit feedback box as you go through the question bank. Lastly, if you have a minute, make sure to rate us and leave comments on <a href="https://itunes.apple.com/us/podcast/roshcast/id1156487141?mt=2" rel="noreferrer noopener nofollow" target="_blank">iTunes</a> to help spread the word about RoshCast. We’ll be back soon with more high quality review.Until next time,  Jeff and Nachi The post <a href="https://www.roshreview.com/blog/ep-40-croup-trigeminal-neuralgia-odontoid-fractures-reyes-syndrome-pjp-pneumonia-bronchiolitis/" rel="nofollow" target="_blank">Podcast Ep 40: Croup, Trigeminal Neuralgia, PJP Pneumonia, &amp; More</a> appeared first on <a href="https://www.roshreview.com/blog" rel="nofollow" target="_blank">RoshReview.com</a>.

Ep 40 Roshcast Emergency Board Review

Success is the sum of small efforts, repeated day in and day out.-Robert J. CollierWelcome back to Episode 29! This week we are starting out with a bit of psychiatry before swinging over to the Pediatric ER for a quick neonatal resuscitation. We may even stop by the trauma bay to see what is happening there and give you a chance to win a prize. We’ve said enough already. Let’s get warmed up with a rapid review. This week, we are trying something new – we will be reviewing some of the recent Rapid Reviews that Yehuda has been uploading to the blog. Make sure to check them out going forward too!With primary hypothyroidism, you would expect a high TSH and a low T4. On physical, you may see periorbital edema, dry skin, and coarse brittle hair.  Patients often complain of weakness, fatigue, facial swelling, constipation, cold intolerance, and weight gain.With acanthosis nigricans, you would expect thickened, velvety, darkly pigmented plaques on the neck or axillae.  Cushing’s syndrome most commonly caused by hypercortisolism from an ACTH-secreting pituitary tumor. Cushing’s syndrome is diagnosed by a 24h urine cortisol and serum ACTH levels.Now onto this week’s podcast.Question 1You are working in the ED when the police bring in a 26-year-old man who was involved in a bar fight. The patient is well known to staff as he frequently seeks treatment in the ED for injuries related to fights and alcohol abuse. He has been caught smoking cigarettes in the ED bathroom, has urinated on the floor, and been known to steal food trays and other patients’ belongings. As you enter his examination room, you overhear him giving the registration clerk a false identity. Which of the following personality disorders best fits with this patient’s behavior?A. AntisocialB. BorderlineC. ParanoidD. SchizoidTeaching ImageQuestion 2A term pregnant patient presents to the ED in active labor and delivery. There is no meconium seen, but the baby has a weak cry and poor tone initially. After clearing the airway, drying the baby vigorously, and providing warmth, the poor tone persists. On exam, the heart rate is 85 and the newborn appears apneic. Which of the following is the most appropriate next step?A. Administer atropineB. Administer epinephrineC. Begin chest compressionsD. Provide positive-pressure ventilationsTeaching ImageQuestion 3A 13-year-old boy with no past medical history presents with a headache 3 days after a closed head injury. The patient states that he stood up from kneeling and hit the top of his head on a wood cabinet. There was no loss of consciousness or seizure activity. In addition to the headache, he complains of difficulty concentrating at school and dizziness. His physical examination is unremarkable. What management is indicated?A. CT scan of the head with contrastB. CT scan of the head without contrastC. MRI of the brainD. Neurology referralTeaching ImageQuestion 4Which of the following organs is the most commonly injured in adult blunt abdominal trauma?A. BladderB. IntestineC. LiverD. SpleenTeaching ImageQuestion 5An 18-year-old man presents with red eyes. He has been sick with upper respiratory symptoms for two days. Examination is notable for bilateral conjunctival injection with scant discharge. He has rhinorrhea and sounds congested. He has a palpable preauricular lymph node on the left. Which of the following is the most likely cause of his red eyes?A. AdenovirusB. RhinovirusC. Staphylococcus aureusD. Streptococcus pneumoniaeTeaching ImageQuestion 6A 19-year-old man presents with pain in his index finger. Which of the following is suggestive of flexor tenosynovitis?A. Delayed capillary refillB. Holding the finger fully extendedC. Pain on passive extensionD. Swelling localized to the volar aspect of the fingerTeaching ImageThose with antisocial personality disorder often display a blatant disregard for others, violate societal norms, and lack a remorse for their actions.  They are of often aggressive, irritable, and impulsive.Borderline personality disorder is a cluster B personality disorder and is characterized by self-destructive, impulsive behavior. They often have erratic emotions and may come off as being overly sexual and are frequently in crisis.Paranoid personality disorder is a cluster A personality disorder.  Paranoid patients are often cold, humorless, and suspicious.Schizoid personality disorder is also a cluster A personality disorder.  Schizoid patients are often loners with few friends who are indifferent to praise and criticism.In a neonatal resuscitation, the first step is to warm, dry, and stimulate the neonate and clear the airway if necessary.  If there is no response to these measures, begin positive pressure ventilation at a rate of 40–60 breaths per minute.Bradycardia in a newborn is often a sign of hypoxia.In a child over 2 with a GCS less than or equal to 14 or if are there signs of a basilar skull fracture or signs of AMS, there is a 4.3% chance of a clinically important traumatic brain injury. These children require head imaging.Postconcussive syndrome may present with many nonspecific symptoms, including headache, dizziness, confusion, amnesia, difficulty concentrating, and blurry vision without a focal neurologic finding.All patients with postconcussive syndrome should be referred to a neurologist for functional testing and tracking of symptom resolution.  Caution patients about returning to contact sports too soon to prevent a second impact.The most commonly injured organ in adult blunt abdominal trauma is the spleen. The liver is the second most commonly injured organ.Splenic lacerations are graded 1-5.  Most can be managed non-operatively.  Hemodynamic instability warrants an exploratory laparotomy.Conjunctivitis most commonly presents with redness, foreign body sensation, drainage, swelling of the lid, and even crusting in the morning. Treatment is supportive with compresses and artificial tears.The most common cause of conjunctivitis is a viral infection, with adenovirus being the most common virus.There are four cardinal signs of acute flexor tenosynovitis: 1) tenderness along the course of the flexor tendon 2) fusiform or symmetrical swelling of the finger 3) pain with passive range of motion 4) a flexed posture of the finger.Flexor tenosynovitis is most commonly caused by penetrating trauma and direct inoculation of the actual sheath, but direct spread from other areas of the hand occur as well.  Flexor tenosynovitis is a surgical emergency and requires antibiotics and hand surgery consultation.So that wraps up Episode 29. From neonatal resuscitation to personality disorders with a brief stop in the trauma bay, we have covered quite a bit. Hope you all enjoyed. Don’t forget to email us or tweet us if you caught the time of the trauma ring tone to win the prize.Until next time,Jeff and NachiThe post Podcast Ep 29: Personality Disorders, Neonatal Resuscitation &amp; More appeared first on RoshReview.com.

<blockquote>Success is the sum of small efforts, repeated day in and day out.-Robert J. Collier</blockquote><h6>Welcome back to Episode 29! This week we are starting out with a bit of psychiatry before swinging over to the Pediatric ER for a quick neonatal resuscitation. We may even stop by the trauma bay to see what is happening there and give you a chance to win a prize. We’ve said enough already. Let’s get warmed up with a rapid review. This week, we are trying something new – we will be reviewing some of the <a href="https://www.roshreview.com/blog/rapid-review/rapid-review-hypothyroidism/" rel="noreferrer noopener nofollow" target="_blank">recent</a> <a href="https://www.roshreview.com/blog/rapid-review/rapid-review-acanthosis-nigricans/" rel="noreferrer noopener nofollow" target="_blank">Rapid</a> <a href="https://www.roshreview.com/blog/rapid-review/rapid-review-cushings-syndrome/" rel="noreferrer noopener nofollow" target="_blank">Reviews</a> that Yehuda has been uploading to the blog. Make sure to check them out going forward too!</h6><ul><li>With primary hypothyroidism, you would expect a high TSH and a low T4. On physical, you may see periorbital edema, dry skin, and coarse brittle hair.  Patients often complain of weakness, fatigue, facial swelling, constipation, cold intolerance, and weight gain.</li><li>With acanthosis nigricans, you would expect thickened, velvety, darkly pigmented plaques on the neck or axillae.  </li><li>Cushing’s syndrome most commonly caused by hypercortisolism from an ACTH-secreting pituitary tumor. Cushing’s syndrome is diagnosed by a 24h urine cortisol and serum ACTH levels.</li></ul>Now onto this week’s podcast.Question 1You are working in the ED when the police bring in a 26-year-old man who was involved in a bar fight. The patient is well known to staff as he frequently seeks treatment in the ED for injuries related to fights and alcohol abuse. He has been caught smoking cigarettes in the ED bathroom, has urinated on the floor, and been known to steal food trays and other patients’ belongings. As you enter his examination room, you overhear him giving the registration clerk a false identity. Which of the following personality disorders best fits with this patient’s behavior?A. AntisocialB. BorderlineC. ParanoidD. Schizoid<a href="https://www.roshreview.com/wp-content/uploads/Ep29-Personality-Disorders.jpg" rel="nofollow" target="_blank">Teaching Image</a>Question 2A term pregnant patient presents to the ED in active labor and delivery. There is no meconium seen, but the baby has a weak cry and poor tone initially. After clearing the airway, drying the baby vigorously, and providing warmth, the poor tone persists. On exam, the heart rate is 85 and the newborn appears apneic. Which of the following is the most appropriate next step?A. Administer atropineB. Administer epinephrineC. Begin chest compressionsD. Provide positive-pressure ventilations<a href="https://www.roshreview.com/wp-content/uploads/Ep29-Newborn-Resuscitation.png" rel="nofollow" target="_blank">Teaching Image</a>Question 3A 13-year-old boy with no past medical history presents with a headache 3 days after a closed head injury. The patient states that he stood up from kneeling and hit the top of his head on a wood cabinet. There was no loss of consciousness or seizure activity. In addition to the headache, he complains of difficulty concentrating at school and dizziness. His physical examination is unremarkable. What management is indicated?A. CT scan of the head with contrastB. CT scan of the head without contrastC. MRI of the brainD. Neurology referral<a href="https://www.roshreview.com/wp-content/uploads/Ep29-Postconcussive-Syndrome.png" rel="nofollow" target="_blank">Teaching Image</a>Question 4Which of the following organs is the most commonly injured in adult blunt abdominal trauma?A. BladderB. IntestineC. LiverD. Spleen<a href="https://www.roshreview.com/wp-content/uploads/Ep29-Splenic-Laceration.png" rel="nofollow" target="_blank">Teaching Image</a>Question 5An 18-year-old man presents with red eyes. He has been sick with upper respiratory symptoms for two days. Examination is notable for bilateral conjunctival injection with scant discharge. He has rhinorrhea and sounds congested. He has a palpable preauricular lymph node on the left. Which of the following is the most likely cause of his red eyes?A. AdenovirusB. RhinovirusC. Staphylococcus aureusD. Streptococcus pneumoniae<a href="https://www.roshreview.com/wp-content/uploads/Ep29-Conjunctivitis.png" rel="nofollow" target="_blank">Teaching Image</a>Question 6A 19-year-old man presents with pain in his index finger. Which of the following is suggestive of flexor tenosynovitis?A. Delayed capillary refillB. Holding the finger fully extendedC. Pain on passive extensionD. Swelling localized to the volar aspect of the finger<a href="https://www.roshreview.com/wp-content/uploads/Ep29-Kanavels-Criteria.png" rel="nofollow" target="_blank">Teaching Image</a><ul><li>Those with antisocial personality disorder often display a blatant disregard for others, violate societal norms, and lack a remorse for their actions.  They are of often aggressive, irritable, and impulsive.</li><li>Borderline personality disorder is a cluster B personality disorder and is characterized by self-destructive, impulsive behavior. They often have erratic emotions and may come off as being overly sexual and are frequently in crisis.</li><li>Paranoid personality disorder is a cluster A personality disorder.  Paranoid patients are often cold, humorless, and suspicious.</li><li>Schizoid personality disorder is also a cluster A personality disorder.  Schizoid patients are often loners with few friends who are indifferent to praise and criticism.</li><li>In a neonatal resuscitation, the first step is to warm, dry, and stimulate the neonate and clear the airway if necessary.  If there is no response to these measures, begin positive pressure ventilation at a rate of 40–60 breaths per minute.</li><li>Bradycardia in a newborn is often a sign of hypoxia.</li><li>In a child over 2 with a GCS less than or equal to 14 or if are there signs of a basilar skull fracture or signs of AMS, there is a 4.3% chance of a clinically important traumatic brain injury. These children require head imaging.</li><li>Postconcussive syndrome may present with many nonspecific symptoms, including headache, dizziness, confusion, amnesia, difficulty concentrating, and blurry vision without a focal neurologic finding.</li><li>All patients with postconcussive syndrome should be referred to a neurologist for functional testing and tracking of symptom resolution.  Caution patients about returning to contact sports too soon to prevent a second impact.</li><li>The most commonly injured organ in adult blunt abdominal trauma is the spleen. The liver is the second most commonly injured organ.</li><li>Splenic lacerations are graded 1-5.  Most can be managed non-operatively.  Hemodynamic instability warrants an exploratory laparotomy.</li><li>Conjunctivitis most commonly presents with redness, foreign body sensation, drainage, swelling of the lid, and even crusting in the morning. Treatment is supportive with compresses and artificial tears.</li><li>The most common cause of conjunctivitis is a viral infection, with adenovirus being the most common virus.</li><li>There are four cardinal signs of acute flexor tenosynovitis: 1) tenderness along the course of the flexor tendon 2) fusiform or symmetrical swelling of the finger 3) pain with passive range of motion 4) a flexed posture of the finger.</li><li>Flexor tenosynovitis is most commonly caused by penetrating trauma and direct inoculation of the actual sheath, but direct spread from other areas of the hand occur as well.  </li><li>Flexor tenosynovitis is a surgical emergency and requires antibiotics and hand surgery consultation.</li></ul>So that wraps up Episode 29. From neonatal resuscitation to personality disorders with a brief stop in the trauma bay, we have covered quite a bit. Hope you all enjoyed. Don’t forget to <a href="mailto:roshcast@roshreview.com">email us</a> or <a href="http://www.twitter.com/roshcast" rel="noreferrer noopener nofollow" target="_blank">tweet us</a> if you caught the time of the trauma ring tone to win the prize.Until next time, Jeff and NachiThe post <a href="https://www.roshreview.com/blog/ep-29-personality-disorders-neonatal-resuscitation-post-concussive-syndrome-abdominal-trauma-conjunctivitis-flexor-tenosynovitis/" rel="nofollow" target="_blank">Podcast Ep 29: Personality Disorders, Neonatal Resuscitation &amp; More</a> appeared first on <a href="https://www.roshreview.com/blog" rel="nofollow" target="_blank">RoshReview.com</a>.

Ep 29 Roshcast Emergency Board Review

Only I can change my life. No one can do it for me.-Carol BurnettWelcome back to Episode 30! First, we must congratulate Sean for winning the trauma ring tone challenge by being the first to respond after the episode release. An honorable mention goes out to Nich and Dhinakar. Stay tuned for future contests and prizes!Today’s episode also marks the launch of a new partnership with the EM Clerkship podcast. Going forward, we are going to occasionally focus episodes on a specific topic—a topic that was recently covered by EM Clerkship. We will cover a few questions on that specific area and fill in the rest of the episode with the usual random assortment.  You can listen to the podcasts in either order.  Either start with Roshcast to see where you stand and then head over to EM clerkship for more detail—or alternatively, start with EM clerkship to learn the nuts and bolts, and then head back here to test yourself. Any time we do these joint releases, we will plan to match our mid-week release with their release a few days earlier on Sunday. Hopefully you enjoy our new collaboration!Enough announcement. Let’s get going with the rapid review! To diagnose Kawasaki disease, you must have a fever for five or more days and four of the following five criteria: bilateral bulbar conjunctival injection, oral mucous membrane changes, peripheral extremity changes, polymorphous rash, and cervical lymphadenopathy.  Kawasaki disease is treated with IVIG and aspirin.  Ocular findings associated with Wernicke’s encephalopathy include nystagmus, lateral rectus palsy, and conjugate gaze palsies.  When treating Wernicke encephalopathy, you should replace thiamine before repleting their glucose. Now onto this week’s podcast.Question 1You are caring for a 60 kg patient who has been seizing for 30 minutes. You have already administered 4 mg of IV lorazepam and 1200 mg of phenytoin without termination of seizure activity. Which of the following should most likely be your next step?A. Administer another bolus of IV phenytoinB. Administer IV fosphenytoin C. Administer IV pentobarbital D. Administer IV sodium bicarbonateTeaching ImageQuestion 2A 33-year-old man presents with a seizure lasting for 5 minutes. EMS administered 2 mg of lorazepam with cessation of seizure activity. On presentation, the patient is confused. The patient’s medication list includes metoprolol and isoniazid. During the evaluation, he has another seizure lasting for 10 minutes and then a third seizure lasting for another 10 minutes. What adjunctive therapy should be given?A. Folic acidB. PhenobarbitalC. PyridoxineD. Sodium bicarbonateTeaching ImageQuestion 3A 75-year-old nursing home patient presents with abdominal distension. Vital signs are normal and the patient is “nontoxic” appearing. An abdominal X-ray is obtained. What management is indicated?A. Endoscopic detorsionB. Intravenous antibioticsC. Observation and reassessmentD. Surgical resectionQuestion 4A 26-year-old woman with a history of dysmenorrhea and depression presents to the ED after having a seizure witnessed by her husband. He reports finding her on the bedroom floor with an empty pill bottle. Which of the following non-steroidal anti-inflammatory (NSAIDs) medications did she most likely ingest?A. CelecoxibB. IbuprofenC. Mefenamic acidD. RofecoxibQuestion 5An 8-month-old child presents to the emergency department having generalized tonic-clonic seizure activity. Her mother reports that she is bottle-fed and has been diluting her formula secondary to financial strains. Her serum sodium is found to be 120 mEq/L. She weighs 8 kgs. She is actively seizing. What is the most appropriate dose of 3% hypertonic saline to administer the patient?A. 16 mL of 3% hypertonic saline B. 4 mL of 3% hypertonic saline C. 64 mL of 3% hypertonic saline D. 80 mL of 3% hypertonic salineQuestion 6A full-term 3-week-old girl is brought in by her parents who report that she has been “acting funny” for 2 hours. They noticed that she has been moving her lips nonstop. She was a full-term, normal, spontaneous vaginal delivery and has been feeding well with adequate wet diapers since hospital discharge. She is afebrile and vital signs are normal. The anterior fontanelle is flat, and red reflexes are present. Heart, lung, and abdominal exams are normal. Her neurologic exam is positive for root, suck, and Moro reflexes, upgoing Babinski reflexes, and rhythmic lip-smacking movements. What is the most appropriate next step to take with this baby?A. Administer phenobarbitalB. Initiate EEG monitoringC. Perform a CT scan of the brainD. Provide reassurance that this is normal behaviorTeaching ImageStatus epilepticus is defined as 2 or more continuous seizures without full recovery or continuous seizure activity for greater than 5 minutes.Benzodiazepines are the first-line agents for status epilepticus.  Midazolam has the fastest onset, but lorazepam has a longer half-life.Second-line agents for status epilepticus include phenytoin, fosphenytoin, valproic acid, phenobarbital, or levetiracetam. Fosphenytoin is preferred as it can be given more quickly.Third-line agents for status epilepticus include pentobarbital and propofol along with likely intubation.All seizing patients need to have their blood glucose checked.In patients on INH having seizures, pyridoxine should be administered.For sigmoid volvulus, the treatment of choice is endoscopic detorsion, typically a flexible sigmoidoscopy.On a barium enema of a patient with sigmoid volvulus, the classic finding is a bird’s beak appearance.Mefenamic acid is an NSAID given for menstrual pain. Overdose can cause seizures 2–7 hours after ingestion.  Treatment is with benzodiazepines.For seizures related to hyponatremia, 3% hypertonic saline at 2 mL/kg should be given with a max of 100 mL over 10–60 minutes.Neonatal seizures are more likely to be focal than tonic-clonic.  Look for signs like lip smacking, eye deviation, staring, rhythmic blinking, and bicycling movements.Phenobarbital is the drug of choice for neonatal seizures.First neonatal seizures require a full septic workup. Empiric antibiotics should be given.That wraps up Episode 30. Don’t forget to follow us on Twitter at @Roshcast and @RoshReview. We can also be reached by email at roshcast@roshreview.com. Send over any feedback, corrections, or suggestions. You can also help us pick questions for the podcast by identifying ones you would like us to review. To do so, write “Roshcast” in the submit feedback box as you go through the question bank. And finally, if you have a minute, make sure to rate us and leave comments on iTunes to help spread the word about Roshcast.Until next time,Jeff and NachiThe post Podcast Ep 30: Status Epilepticus, Isoniazid Toxicity, Hyponatrem appeared first on RoshReview.com.

<blockquote>Only I can change my life. No one can do it for me.-Carol Burnett</blockquote><h6>Welcome back to Episode 30! First, we must congratulate Sean for winning the trauma ring tone challenge by being the first to respond after the episode release. An honorable mention goes out to Nich and Dhinakar. Stay tuned for future contests and prizes!</h6>Today’s episode also marks the launch of a new partnership with the <a href="http://emclerkship.com/" rel="noreferrer noopener nofollow" target="_blank">EM Clerkship podcast</a>. Going forward, we are going to occasionally focus episodes on a specific topic—a topic that was recently covered by EM Clerkship. We will cover a few questions on that specific area and fill in the rest of the episode with the usual random assortment.  You can listen to the podcasts in either order.  Either start with Roshcast to see where you stand and then head over to EM clerkship for more detail—or alternatively, start with EM clerkship to learn the nuts and bolts, and then head back here to test yourself. Any time we do these joint releases, we will plan to match our mid-week release with their release a few days earlier on Sunday. Hopefully you enjoy our new collaboration!Enough announcement. Let’s get going with the rapid review!<ul><li> To diagnose Kawasaki disease, you must have a fever for five or more days and four of the following five criteria: bilateral bulbar conjunctival injection, oral mucous membrane changes, peripheral extremity changes, polymorphous rash, and cervical lymphadenopathy. </li><li> Kawasaki disease is treated with IVIG and aspirin. </li><li> Ocular findings associated with Wernicke’s encephalopathy include nystagmus, lateral rectus palsy, and conjugate gaze palsies. </li><li> When treating Wernicke encephalopathy, you should replace thiamine before repleting their glucose. </li></ul>Now onto this week’s podcast.Question 1You are caring for a 60 kg patient who has been seizing for 30 minutes. You have already administered 4 mg of IV lorazepam and 1200 mg of phenytoin without termination of seizure activity. Which of the following should most likely be your next step?A. Administer another bolus of IV phenytoinB. Administer IV fosphenytoin C. Administer IV pentobarbital D. Administer IV sodium bicarbonate<a href="https://www.roshreview.com/wp-content/uploads/2017/08/ep30-medications-for-status-epilepticus.png" rel="nofollow" target="_blank">Teaching Image</a>Question 2A 33-year-old man presents with a seizure lasting for 5 minutes. EMS administered 2 mg of lorazepam with cessation of seizure activity. On presentation, the patient is confused. The patient’s medication list includes metoprolol and isoniazid. During the evaluation, he has another seizure lasting for 10 minutes and then a third seizure lasting for another 10 minutes. What adjunctive therapy should be given?A. Folic acidB. PhenobarbitalC. PyridoxineD. Sodium bicarbonate<a href="https://www.roshreview.com/wp-content/uploads/2017/08/ep30-inh-toxicity.jpg" rel="nofollow" target="_blank">Teaching Image</a>Question 3A 75-year-old nursing home patient presents with abdominal distension. Vital signs are normal and the patient is “nontoxic” appearing. An abdominal X-ray is obtained. What management is indicated?A. Endoscopic detorsionB. Intravenous antibioticsC. Observation and reassessmentD. Surgical resectionQuestion 4A 26-year-old woman with a history of dysmenorrhea and depression presents to the ED after having a seizure witnessed by her husband. He reports finding her on the bedroom floor with an empty pill bottle. Which of the following non-steroidal anti-inflammatory (NSAIDs) medications did she most likely ingest?A. CelecoxibB. IbuprofenC. Mefenamic acidD. RofecoxibQuestion 5An 8-month-old child presents to the emergency department having generalized tonic-clonic seizure activity. Her mother reports that she is bottle-fed and has been diluting her formula secondary to financial strains. Her serum sodium is found to be 120 mEq/L. She weighs 8 kgs. She is actively seizing. What is the most appropriate dose of 3% hypertonic saline to administer the patient?A. 16 mL of 3% hypertonic saline B. 4 mL of 3% hypertonic saline C. 64 mL of 3% hypertonic saline D. 80 mL of 3% hypertonic salineQuestion 6A full-term 3-week-old girl is brought in by her parents who report that she has been “acting funny” for 2 hours. They noticed that she has been moving her lips nonstop. She was a full-term, normal, spontaneous vaginal delivery and has been feeding well with adequate wet diapers since hospital discharge. She is afebrile and vital signs are normal. The anterior fontanelle is flat, and red reflexes are present. Heart, lung, and abdominal exams are normal. Her neurologic exam is positive for root, suck, and Moro reflexes, upgoing Babinski reflexes, and rhythmic lip-smacking movements. What is the most appropriate next step to take with this baby?A. Administer phenobarbitalB. Initiate EEG monitoringC. Perform a CT scan of the brainD. Provide reassurance that this is normal behavior<a href="https://www.roshreview.com/wp-content/uploads/2017/08/ep30-neonatal-seizures.png" rel="nofollow" target="_blank">Teaching Image</a><ul><li>Status epilepticus is defined as 2 or more continuous seizures without full recovery or continuous seizure activity for greater than 5 minutes.</li><li>Benzodiazepines are the first-line agents for status epilepticus.  Midazolam has the fastest onset, but lorazepam has a longer half-life.</li><li>Second-line agents for status epilepticus include phenytoin, fosphenytoin, valproic acid, phenobarbital, or levetiracetam. Fosphenytoin is preferred as it can be given more quickly.</li><li>Third-line agents for status epilepticus include pentobarbital and propofol along with likely intubation.</li><li>All seizing patients need to have their blood glucose checked.</li><li>In patients on INH having seizures, pyridoxine should be administered.</li><li>For sigmoid volvulus, the treatment of choice is endoscopic detorsion, typically a flexible sigmoidoscopy.</li><li>On a barium enema of a patient with sigmoid volvulus, the classic finding is a bird’s beak appearance.</li><li>Mefenamic acid is an NSAID given for menstrual pain. Overdose can cause seizures 2–7 hours after ingestion.  Treatment is with benzodiazepines.</li><li>For seizures related to hyponatremia, 3% hypertonic saline at 2 mL/kg should be given with a max of 100 mL over 10–60 minutes.</li><li>Neonatal seizures are more likely to be focal than tonic-clonic.  Look for signs like lip smacking, eye deviation, staring, rhythmic blinking, and bicycling movements.</li><li>Phenobarbital is the drug of choice for neonatal seizures.</li><li>First neonatal seizures require a full septic workup. Empiric antibiotics should be given.</li></ul>That wraps up Episode 30. Don’t forget to follow us on Twitter at <a href="http://twitter.com/roshcast" rel="nofollow" target="_blank">@Roshcast</a> and <a href="http://twitter.com/roshreview" rel="nofollow" target="_blank">@RoshReview</a>. We can also be reached by email at <a href="mailto:roshcast@roshreview.com">roshcast@roshreview.com</a>. Send over any feedback, corrections, or suggestions. You can also help us pick questions for the podcast by identifying ones you would like us to review. To do so, write “Roshcast” in the submit feedback box as you go through the question bank. And finally, if you have a minute, make sure to rate us and leave comments on iTunes to help spread the word about Roshcast.Until next time, Jeff and NachiThe post <a href="https://www.roshreview.com/blog/ep-30-status-epilepticus-isoniazid-toxicity-sigmoid-volvulus-nsaid-overdose-hyponatremia-neonatal-seizures/" rel="nofollow" target="_blank">Podcast Ep 30: Status Epilepticus, Isoniazid Toxicity, Hyponatrem</a> appeared first on <a href="https://www.roshreview.com/blog" rel="nofollow" target="_blank">RoshReview.com</a>.

Ep 30 Roshcast Emergency Board Review

The only journey is the one within.-Rainer Maria RilkeWelcome back to Episode 31! We are continuing our collaborative effort with the EM Clerkship podcast, focusing this week on tachydysrhythmias in addition to a mixture of random topics. We start the episode off with another rapid review of a few of the recent blog posts by Yehuda Wolf.In a gravid female, the uterus will be palpable at the umbilicus at around 20 weeks. At 12 weeks, the fundal height will be around the pubic symphysis. Lastly, at 36 weeks the fundus will be at the xiphoid process.Patients with polycystic ovarian syndrome are often obese and complain of hirsutism, irregular menses, acne, and sleep disordered breathing. You might also notice acanthosis nigricans and fatty liver disease.Management for PCOS is typically done in an outpatient setting, but a common regimen could include OCPs, metformin, and lifestyle modification.Now onto this week’s podcastQuestion 1A 58-year old man is brought to the ED for chest pain that started 30 minutes prior to arrival while he was jogging in the park. Initially, the patient’s cardiac monitor shows sinus tachycardia with a rate of 120 beats per minute. However, while you are interviewing the patient in the resuscitation bay, he suddenly becomes pale, pulseless, and the below rhythm is seen on the cardiac monitor. Which of the following is the definitive next step to manage this rhythm?A. Chest compressionsB. DefibrillationC. EpinephrineD. Synchronized cardioversionTeaching ImageQuestion 2Which of the following treatments is contraindicated in a young person who has Wolff-Parkinson-White (WPW) syndrome with atrial fibrillation?A. AdenosineB. lbutilideC. ProcainamideD. Synchronized cardioversionTeaching ImageQuestion 3In a patient with traumatic brain injury, which of the following secondary insults should be given the highest priority for correcting in the ED?A. HypercarbiaB. HyperpyrexiaC. HypotensionD. HypothermiaQuestion 4A 45-year-old man with a history of opioid abuse presents to the ED with new onset syncope. While you are evaluating the patient, he becomes unresponsive and you note the rhythm below on the monitor. Which of the following medications is the most likely cause of this presentation?A. Buprenorphine/naloxoneB. FentanylC. KetorolacD. MethadoneTeaching ImageQuestion 5An 84-year-old man presents from a nursing home. The patient is lethargic and unable to provide any history. The transfer record reports a new cough and chills. His vital signs are T 102°F, BP 88/42, HR 118, RR 22, and oxygen saturation 95% on room air. In addition to an intravenous normal saline bolus of 30 cc/kg, which of the following is the most appropriate empiric treatment?A. Cefepime, vancomycin, and azithromycinB. Ceftriaxone and azithromycinC. Ceftriaxone, vancomycin, and azithromycinD. Ciprofloxacin and metronidazoleTeaching ImageQuestion 6What is the most likely underlying chronic medical problem in the patient with the following ECG?A. CardiomyopathyB. COPDC. HyperthyroidismD. Mitral stenosisTeaching ImageIn a witnessed cardiac arrest for a patient in ventricular fibrillation, immediate defibrillation should be performed.In an unwitnessed cardiac arrest with an unknown downtime, regardless of rhythm, chest compressions should be initiated immediately.The defibrillating dose for a biphasic defibrillator is 200 J, whereas 360 J are required with a monophasic defibrillator.  Biphasic defibrillators are preferred as they cause less cardiac damage and have higher first shock success.In atrial fibrillation with WPW, avoid AV nodal blocking agents, like amiodarone, beta-blockers, calcium channel blockers, and digoxin.For an unstable patient in atrial fibrillation with WPW, synchronized cardioversion should be performed.In patients with traumatic brain injury, hypoxia and hypotension are associated with worse outcomes.Torsades de Pointes is often caused by drugs that prolong the QT. Other risk factors for Torsades de Pointes include female gender, hypokalemia, hypomagnesemia, structural heart disease, stroke, brain injury, and bradyarrhythmias.Torsades de Pointes should be treated with magnesium if the patient is stable.  In an unstable patient, synchronized cardioversion or overdrive pacing should be performed.There are four criteria to think of for healthcare-associated pneumonia: Infection occurring within 90 days of a 2-day or longer hospitalization.Resident from a nursing home or long-term care facility.Infection within 30 days of receiving IV antibacterial therapy, chemo, or wound care.A patient on hemodialysis. HCAP should be treated with three drugs: one covering gram negatives including Pseudomonas, one for MRSA coverage, and lastly a third for atypical coverage.Always draw blood cultures before giving antibiotics when treating suspected sepsis and start a 30 cc/kg bolus assuming they do not have contraindications.Multifocal atrial tachycardia is often associated with COPD.That wraps up Episode 31. Do not forget to follow us on Twitter @Roshcast and @Roshreview. We can also be reached by email at roshcast@roshreview.com. We are open to any feedback, corrections, or suggestions. You can also help us pick questions by identifying ones you would like us to review. To do so, write “Roshcast” in the submit feedback box as you go through the question bank. And finally, if you have a minute, make sure to rate us and leave comments on iTunes to help spread the word about Roshcast.Until next time,Jeff and NachiThe post Podcast Ep 31: Ventricular Fibrillation, Traumatic Brain Injury, &amp; More appeared first on RoshReview.com.

<blockquote>The only journey is the one within.-Rainer Maria Rilke</blockquote>Welcome back to Episode 31! We are continuing our collaborative effort with the <a href="http://emclerkship.com/" rel="noreferrer noopener nofollow" target="_blank">EM Clerkship podcast</a>, focusing this week on tachydysrhythmias in addition to a mixture of random topics. We start the episode off with another rapid review of a few of the recent <a href="https://www.roshreview.com/blog/rapid-review/rapid-review-polycystic-ovarian-syndrome/" rel="noreferrer noopener nofollow" target="_blank">blog</a> <a href="https://www.roshreview.com/blog/rapid-review/rapid-review-fundal-height/" rel="noreferrer noopener nofollow" target="_blank">posts</a> by <a href="https://www.roshreview.com/author/yehudawolf/" rel="noreferrer noopener nofollow" target="_blank">Yehuda Wolf</a>.<ul><li>In a gravid female, the uterus will be palpable at the umbilicus at around 20 weeks. At 12 weeks, the fundal height will be around the pubic symphysis. Lastly, at 36 weeks the fundus will be at the xiphoid process.</li><li>Patients with polycystic ovarian syndrome are often obese and complain of hirsutism, irregular menses, acne, and sleep disordered breathing. You might also notice acanthosis nigricans and fatty liver disease.</li><li>Management for PCOS is typically done in an outpatient setting, but a common regimen could include OCPs, metformin, and lifestyle modification.</li></ul>Now onto this week’s podcastQuestion 1A 58-year old man is brought to the ED for chest pain that started 30 minutes prior to arrival while he was jogging in the park. Initially, the patient’s cardiac monitor shows sinus tachycardia with a rate of 120 beats per minute. However, while you are interviewing the patient in the resuscitation bay, he suddenly becomes pale, pulseless, and the below rhythm is seen on the cardiac monitor. Which of the following is the definitive next step to manage this rhythm?A. Chest compressionsB. DefibrillationC. EpinephrineD. Synchronized cardioversion<a href="https://www.roshreview.com/wp-content/uploads/Ep31-ECG-Vfib.jpg" rel="nofollow" target="_blank">Teaching Image</a>Question 2Which of the following treatments is contraindicated in a young person who has Wolff-Parkinson-White (WPW) syndrome with atrial fibrillation?A. AdenosineB. lbutilideC. ProcainamideD. Synchronized cardioversion<a href="https://www.roshreview.com/wp-content/uploads/Ep31-WPW.png" rel="nofollow" target="_blank">Teaching Image</a>Question 3In a patient with traumatic brain injury, which of the following secondary insults should be given the highest priority for correcting in the ED?A. HypercarbiaB. HyperpyrexiaC. HypotensionD. HypothermiaQuestion 4A 45-year-old man with a history of opioid abuse presents to the ED with new onset syncope. While you are evaluating the patient, he becomes unresponsive and you note the rhythm below on the monitor. Which of the following medications is the most likely cause of this presentation?A. Buprenorphine/naloxoneB. FentanylC. KetorolacD. Methadone<a href="https://www.roshreview.com/wp-content/uploads/Ep31-Torsades-De-Pointes2.jpg" rel="nofollow" target="_blank">Teaching Image</a>Question 5An 84-year-old man presents from a nursing home. The patient is lethargic and unable to provide any history. The transfer record reports a new cough and chills. His vital signs are T 102°F, BP 88/42, HR 118, RR 22, and oxygen saturation 95% on room air. In addition to an intravenous normal saline bolus of 30 cc/kg, which of the following is the most appropriate empiric treatment?A. Cefepime, vancomycin, and azithromycinB. Ceftriaxone and azithromycinC. Ceftriaxone, vancomycin, and azithromycinD. Ciprofloxacin and metronidazole<a href="https://www.roshreview.com/wp-content/uploads/Ep31-HCAP-Treatment.png" rel="nofollow" target="_blank">Teaching Image</a>Question 6What is the most likely underlying chronic medical problem in the patient with the following ECG?A. CardiomyopathyB. COPDC. HyperthyroidismD. Mitral stenosis<a href="https://www.roshreview.com/wp-content/uploads/Ep31-Multifocal-Atrial-Tachycardia.png" rel="nofollow" target="_blank">Teaching Image</a><ul><li>In a witnessed cardiac arrest for a patient in ventricular fibrillation, immediate defibrillation should be performed.</li><li>In an unwitnessed cardiac arrest with an unknown downtime, regardless of rhythm, chest compressions should be initiated immediately.</li><li>The defibrillating dose for a biphasic defibrillator is 200 J, whereas 360 J are required with a monophasic defibrillator.  Biphasic defibrillators are preferred as they cause less cardiac damage and have higher first shock success.</li><li>In atrial fibrillation with WPW, avoid AV nodal blocking agents, like amiodarone, beta-blockers, calcium channel blockers, and digoxin.</li><li>For an unstable patient in atrial fibrillation with WPW, synchronized cardioversion should be performed.</li><li>In patients with traumatic brain injury, hypoxia and hypotension are associated with worse outcomes.</li><li>Torsades de Pointes is often caused by drugs that prolong the QT. Other risk factors for Torsades de Pointes include female gender, hypokalemia, hypomagnesemia, structural heart disease, stroke, brain injury, and bradyarrhythmias.</li><li>Torsades de Pointes should be treated with magnesium if the patient is stable.  In an unstable patient, synchronized cardioversion or overdrive pacing should be performed.</li><li>There are four criteria to think of for healthcare-associated pneumonia: <ul><li>Infection occurring within 90 days of a 2-day or longer hospitalization.</li><li>Resident from a nursing home or long-term care facility.</li><li>Infection within 30 days of receiving IV antibacterial therapy, chemo, or wound care.</li><li>A patient on hemodialysis. </li></ul></li><li>HCAP should be treated with three drugs: one covering gram negatives including Pseudomonas, one for MRSA coverage, and lastly a third for atypical coverage.</li><li>Always draw blood cultures before giving antibiotics when treating suspected sepsis and start a 30 cc/kg bolus assuming they do not have contraindications.</li><li>Multifocal atrial tachycardia is often associated with COPD.</li></ul>That wraps up Episode 31. Do not forget to follow us on Twitter <a href="twitter.com/roshcast" rel="nofollow" target="_blank">@Roshcast</a> and <a href="twitter.com/roshreview" rel="nofollow" target="_blank">@Roshreview</a>. We can also be reached by email at <a href="mailto:roshcast@roshreview.com">roshcast@roshreview.com</a>. We are open to any feedback, corrections, or suggestions. You can also help us pick questions by identifying ones you would like us to review. To do so, write “Roshcast” in the submit feedback box as you go through the question bank. And finally, if you have a minute, make sure to rate us and leave comments on <a href="https://itunes.apple.com/us/podcast/roshcast/id1156487141?mt=2" rel="noreferrer noopener nofollow" target="_blank">iTunes</a> to help spread the word about Roshcast.Until next time, Jeff and NachiThe post <a href="https://www.roshreview.com/blog/ep-31-ventricular-fibrillation-wolff-parkinson-white-syndrome-traumatic-brain-injury-torsades-de-pointes-healthcare-associated-pneumonia-multifocal-atrial-tachycardia/" rel="nofollow" target="_blank">Podcast Ep 31: Ventricular Fibrillation, Traumatic Brain Injury, &amp; More</a> appeared first on <a href="https://www.roshreview.com/blog" rel="nofollow" target="_blank">RoshReview.com</a>.

Ep 31 Roshcast Emergency Board Review

It is during our darkest moments that we must focus to see the light.-AristotleWelcome back to Episode 27 and a big welcome to all the new interns who are only about 1 week into residency! We hope you find Roshcast to be easy to listen to and helpful in your education. As we have said from the outset, we want this to be as high-yield as possible to not only improve your in-training scores but also improve your care at the bedside. We are open to any suggestions, so please reach out.Let’s get warmed up with a rapid review – this week, we are going over some HIV-related illnesses.Toxoplasmosis is rarely seen with CD4 &gt; 200. Be concerned in those with CD4 &lt; 100.Toxoplasmosis is transmitted through cat feces. It is treated with pyrimethamine, sulfadiazine, and folinic acid.The classic X-ray finding for PJP pneumonia is diffuse interstitial infiltrates in a “bat wing” appearance.In PJP pneumonia, if the PaO2 is less than 70 or the A-a gradient is greater than 36, treat with steroids in addition to trimethoprim-sulfamethoxazole.Now onto this week’s podcastQuestion 1A 67-year-old man with hypertension and end-stage renal disease presents after an incomplete dialysis session secondary to shortness of breath. His vital signs are BP 110/95, HR 65, RR 22, T 37.3°C, and oxygen saturation 99% on 2L NC. You obtain the ECG shown above, which shows a widened QRS, almost resembling a sine wave. Which of the following is the most appropriate next step in this patient’s management?A. Calcium gluconate B. Cardiology consultationC. DefibrillationD. Transcutaneous pacingTeaching ImageQuestion 2EMS calls notifying you that there is a mass casualty situation. There was an explosion at a construction site and they will be bringing 20 ambulatory, asymptomatic patients to your emergency department. After checking airway, breathing and circulation, what test, if normal, would allow you to rapidly discharge patients?A. Abdominal ultrasound B. Ophthalmoscope evaluation of the eye C. Otoscope evaluation of tympanic membranesD. Oxygen saturationQuestion 3A 42-year-old woman with sickle cell anemia presents to the ED complaining of unilateral knee pain. You are worried she might have septic arthritis. Which of the following organisms is most likely to be responsible?A. Pasturella multocidaB. Pseudomonas aeruginosaC. Salmonella spp.D. Staphylococcus aureusTeaching ImageQuestion 4In which of the following spondyloarthropathies is uveitis the most common extra-articular manifestation?A. Ankylosing spondylitisB. Fibromyalgia C. Psoriatic arthritisD. Reactive arthritisQuestion 5At which location is the pediatric airway the narrowest?A. CricoidB. EpiglottisC. PharynxD. Vocal cordsTeaching ImageQuestion 6A 29-year-old man presents to the ED with partial-thickness burns to his entire back and right arm. The patient weights 70 kg. Based on the Parkland formula, how much crystalloid solution is required in the first 24 hours?A. 1,260 mLB. 10,080 mLC. 5,040 mLD. 7,560 mLTeaching ImageEKG changes seen in patients with hyperkalemia include peaked T waves, QRS widening, dropped P waves, and bradycardia.Temporizing measures for managing hyperkalemia include calcium, insulin and glucose, sodium bicarbonate, and albuterol.Furosemide and dialysis can be used to permanently remove potassium from the body.For blast injuries, make sure to examine the tympanic membranes. They are damaged at lower pressures than other parts of the body.Primary blast injuries occur from blast overpressure. Secondary blast injuries are caused by flying debris. Tertiary blast injuries are caused by victims being thrown. And lastly, quaternary blast injuries are caused by environmental hazards caused by the explosion.The most common cause of septic arthritis is Staphylococcus aureus in adults and children over 2, except for sexually active younger adults, in which case Neisseria gonorrhoeae is more common.On joint aspirate of a septic joint, the white blood cell count is typically greater than 50,000 and the aspirate appears purulent.  Remember that if clinical suspicion is high, start antibiotics, consult an orthopedist early, and defer to the gram stain and culture for definitive diagnosis.The most common extra-articular manifestation of ankylosing spondylitis is uveitis.  The narrowest part of the pediatric airway is the cricoid.As compared to the adult airway, the pediatric airway has a proportionally smaller larynx, which is more anterior, the epiglottis is longer and narrower, the tongue is proportionally larger, the neck is typically shorter, and the adenoids are often larger.The pediatric endotracheal tube should be placed to a depth of 3 x the endotracheal tube size.The parkland formula can be calculated by the formula 4 x % TBSA burned x weight (kg).  Give the first half in the first 8 hours and the second half over the next 16 hours.Although, the parkland formula is a good guide, fluid resuscitation in burns should ultimately be guided by vital signs and urine output.  In children, target 1–2 mL/kg/hr, and in adults, target 30 mL/hr.That wraps up Episode 27. From blast injuries to hyperkalemia, we have covered the entire spectrum of emergency medicine this week. Hope you enjoyed. Do not forget to listen for the trauma phone ring tone in the coming weeks for a chance to win a Rosh Review Subscription. Remember to tweet @Roshcast or email Roshcast@roshreview.com the exact time when you hear the ring to win the prize.Until next time,Jeff and NachiThe post Podcast Ep 27: Hyperkalemia, Blast Injuries &amp; More appeared first on RoshReview.com.

<blockquote>It is during our darkest moments that we must focus to see the light.-Aristotle</blockquote><h6>Welcome back to Episode 27 and a big welcome to all the new interns who are only about 1 week into residency! We hope you find Roshcast to be easy to listen to and helpful in your education. As we have said from the outset, we want this to be as high-yield as possible to not only improve your in-training scores but also improve your care at the bedside. We are open to any suggestions, so please reach out.</h6>Let’s get warmed up with a rapid review – this week, we are going over some HIV-related illnesses.<ul><li>Toxoplasmosis is rarely seen with CD4 &gt; 200. Be concerned in those with CD4 &lt; 100.</li><li>Toxoplasmosis is transmitted through cat feces. It is treated with pyrimethamine, sulfadiazine, and folinic acid.</li><li>The classic X-ray finding for PJP pneumonia is diffuse interstitial infiltrates in a “bat wing” appearance.</li><li>In PJP pneumonia, if the PaO2 is less than 70 or the A-a gradient is greater than 36, treat with steroids in addition to trimethoprim-sulfamethoxazole.</li></ul>Now onto this week’s podcastQuestion 1A 67-year-old man with hypertension and end-stage renal disease presents after an incomplete dialysis session secondary to shortness of breath. His vital signs are BP 110/95, HR 65, RR 22, T 37.3°C, and oxygen saturation 99% on 2L NC. You obtain the ECG shown above, which shows a widened QRS, almost resembling a sine wave. Which of the following is the most appropriate next step in this patient’s management?A. Calcium gluconate B. Cardiology consultationC. DefibrillationD. Transcutaneous pacing<a href="https://www.roshreview.com/wp-content/uploads/Ep27-ECG-Changes-Hyperkalemia.jpg" rel="nofollow" target="_blank">Teaching Image</a>Question 2EMS calls notifying you that there is a mass casualty situation. There was an explosion at a construction site and they will be bringing 20 ambulatory, asymptomatic patients to your emergency department. After checking airway, breathing and circulation, what test, if normal, would allow you to rapidly discharge patients?A. Abdominal ultrasound B. Ophthalmoscope evaluation of the eye C. Otoscope evaluation of tympanic membranesD. Oxygen saturationQuestion 3A 42-year-old woman with sickle cell anemia presents to the ED complaining of unilateral knee pain. You are worried she might have septic arthritis. Which of the following organisms is most likely to be responsible?A. Pasturella multocidaB. Pseudomonas aeruginosaC. Salmonella spp.D. Staphylococcus aureus<a href="https://www.roshreview.com/wp-content/uploads/Ep27-Septic-Arthritis.png" rel="nofollow" target="_blank">Teaching Image</a>Question 4In which of the following spondyloarthropathies is uveitis the most common extra-articular manifestation?A. Ankylosing spondylitisB. Fibromyalgia C. Psoriatic arthritisD. Reactive arthritisQuestion 5At which location is the pediatric airway the narrowest?A. CricoidB. EpiglottisC. PharynxD. Vocal cords<a href="https://www.roshreview.com/wp-content/uploads/Ep27-Pediatric-Airway.png" rel="nofollow" target="_blank">Teaching Image</a>Question 6A 29-year-old man presents to the ED with partial-thickness burns to his entire back and right arm. The patient weights 70 kg. Based on the Parkland formula, how much crystalloid solution is required in the first 24 hours?A. 1,260 mLB. 10,080 mLC. 5,040 mLD. 7,560 mL<a href="https://www.roshreview.com/wp-content/uploads/Ep27-Parkland-Formula.png" rel="nofollow" target="_blank">Teaching Image</a><ul><li>EKG changes seen in patients with hyperkalemia include peaked T waves, QRS widening, dropped P waves, and bradycardia.</li><li>Temporizing measures for managing hyperkalemia include calcium, insulin and glucose, sodium bicarbonate, and albuterol.</li><li>Furosemide and dialysis can be used to permanently remove potassium from the body.</li><li>For blast injuries, make sure to examine the tympanic membranes. They are damaged at lower pressures than other parts of the body.</li><li>Primary blast injuries occur from blast overpressure. Secondary blast injuries are caused by flying debris. Tertiary blast injuries are caused by victims being thrown. And lastly, quaternary blast injuries are caused by environmental hazards caused by the explosion.</li><li>The most common cause of septic arthritis is Staphylococcus aureus in adults and children over 2, except for sexually active younger adults, in which case Neisseria gonorrhoeae is more common.</li><li>On joint aspirate of a septic joint, the white blood cell count is typically greater than 50,000 and the aspirate appears purulent.  Remember that if clinical suspicion is high, start antibiotics, consult an orthopedist early, and defer to the gram stain and culture for definitive diagnosis.</li><li>The most common extra-articular manifestation of ankylosing spondylitis is uveitis.  </li><li>The narrowest part of the pediatric airway is the cricoid.</li><li>As compared to the adult airway, the pediatric airway has a proportionally smaller larynx, which is more anterior, the epiglottis is longer and narrower, the tongue is proportionally larger, the neck is typically shorter, and the adenoids are often larger.</li><li>The pediatric endotracheal tube should be placed to a depth of 3 x the endotracheal tube size.</li><li>The parkland formula can be calculated by the formula 4 x % TBSA burned x weight (kg).  Give the first half in the first 8 hours and the second half over the next 16 hours.</li><li>Although, the parkland formula is a good guide, fluid resuscitation in burns should ultimately be guided by vital signs and urine output.  In children, target 1–2 mL/kg/hr, and in adults, target 30 mL/hr.</li></ul>That wraps up Episode 27. From blast injuries to hyperkalemia, we have covered the entire spectrum of emergency medicine this week. Hope you enjoyed. Do not forget to listen for the trauma phone ring tone in the coming weeks for a chance to win a Rosh Review Subscription. Remember to tweet <a href="https://twitter.com/roshcast" rel="nofollow" target="_blank">@Roshcast</a> or email <a href="mailto:Roshcast@roshreview.com)">Roshcast@roshreview.com</a> the exact time when you hear the ring to win the prize.Until next time, Jeff and NachiThe post <a href="https://www.roshreview.com/blog/ep-27-hyperkalemia-blast-injuries-septic-arthritis-ankylosing-spondylitis-pediatric-airway-burn-resuscitation/" rel="nofollow" target="_blank">Podcast Ep 27: Hyperkalemia, Blast Injuries &amp; More</a> appeared first on <a href="https://www.roshreview.com/blog" rel="nofollow" target="_blank">RoshReview.com</a>.

Ep 27 Roshcast Emergency Board Review

Fear is the great extinguisher of dreams… Conversely, it can be your best mentor and source of motivation. –Paula AmatoWelcome back to episode 10! This week we review some key ophthalmologic findings with excellent teaching images for you to see. We also hit the lung, the joints, the extremities, and even spend time on scorpions, snakes, and spiders. We begin each episode with a rapid review of the previous week’s highlights then dive into the Q&amp;A and wrap up with another rapid review of the covered content. Let’s get started.The most common cause of pneumonia in an alcoholic is Streptococcus pneumoniae.Radial nerve palsy is a peripheral nerve lesion caused by compression of the radial nerve in the axilla. The most common findings are wrist drop and hand numbness over the first to third digits. It is managed conservatively with a wrist splint.IV drug abusers are at risk for tricuspid endocarditis. The most commonly implicated organism is staph aureus.Colchicine overdoses cause severe GI distress, bone marrow suppression, rhabdomyolysis, renal failure, metabolic acidosis, and even ARDS.The mainstay of treatment for herpes zoster is pain control. Acyclovir may be prescribed within the first 72 hours of onset of the lesions.Now onto this week’s podcastQuestion 1A 43-year-old man is currently undergoing palliative radiation therapy for pancreatic cancer. He presents to the emergency department with a 4-day history of gradually worsening left lower extremity pain. Pain is localized to the calf and made worse with ambulation. Exam shows mild edema of the left calf without erythema or warmth. Which of the following is the most likely diagnosis?A. CellulitisB. Deep venous thrombosisC. Peripheral artery diseaseD. Superficial thrombophlebitisTeaching imageQuestion 2 A 25-year-old man presents to the ED with right eye pain, tearing, and photophobia. After instilling fluorescein into the affected eye, you see the above on slit lamp exam. Which of the following is the most likely prognosis of this condition?A. Complete resolution within 24–72 hoursB. Corneal erosion and perforationC. Diminished unilateral visual acuityD. Recurrent lesions with viral reactivationTeaching imageQuestion 3In which setting is allopurinol contraindicated for the treatment of gout?A. Acute attack of goutB. Alcoholic patientC. Hyperuricemia greater than 8.0D. In combination with colchicineTeaching imageQuestion 4 A 52-year-old man presents with a red right eye that is associated with severe pain and blurred vision. On exam, there is some cloudiness to the cornea. Pupils are 5 mm OD and 3 mm OS. Which of the following is the most likely diagnosis?A. Acute glaucomaB. ConjunctivitisC. IritisD. KeratitisTeaching image 1Teaching image 2Question 5Heightened sensitivity to touch in the area of the sting, along with local numbness and weakness, is associated with which of the following animals?A. Black widow spider B. Brown recluse spider C. Pit viperD. ScorpionTeaching imageQuestion 6What is the most common symptom seen in acute bronchitis?A. Chest painB. CoughC. FeverD. SputumDVTs typically present with non-specific symptoms including unilateral limb swelling, pain, redness, warm, or even distended collateral veins.Predisposing risk factors for DVT include malignancy, immobilization, recent surgery, obesity, smoking, oral contraceptives, recreational drugs, and hypercoagulable states.Corneal abrasions typically resolve within 24-72 hours. They are most commonly caused by ocular trauma or an ocular foreign body. Corneal abrasions are treated with a topical antibiotic such as erythromycin or ciprofloxacin. Tetanus vaccination should be given to patients who are not up to date.Allopurinol is contraindicated in an acute presentation of gout. The first-line therapy is NSAIDs.Negatively birefringent crystals are seen in gout and positively birefringent crystals are seen in pseudogout. Gout is typically seen in the first metatarsophalangeal joint, whereas pseudogout most commonly affects the larger joints like the knees and ankles.Acute glaucoma often classical presents as a red, painful eye with blurry vision and asymmetric pupils.Acute angle-closure glaucoma is caused by closure of the anterior chamber. Treatment should begin with topical beta-blockers, carbonic anhydrase inhibitors, steroids, and miotics.Scorpion stings produce local redness and edema with a heightened sensitivity to touch in the area of the sting with numbness and weakness of the affected area. Systemic symptoms include fasciculations, disconjugate gaze, temperature reversal, and pancreatitis.Black widow spider bites cause a local papule with a halo. Severe systemic symptoms include a peritonitic abdomen, muscle fasciculation’s, and diaphoresis. Black widow spiders have a red hourglass on their abdomen and can be found throughout the entire United States.Brown recluse spiders are found in the Midwest. They cause a papule that later blisters and may necrose. Systemic symptoms include renal failure, pulmonary edema, and shock.Pit viper snakebites cause local swelling and oozing from the wound. Severe envenomations can lead to a DIC-like coagulopathy and hemorrhagic bullae.The most common symptom of acute bronchitis is a cough. The most common cause is a viral illness that should be treated with supportive care.Need to beef up on your colchicine toxicity knowledge? Check out last week’s episodeDon’t forget that the high-yield questions, explanations, and images can be found in the Rosh Review Emergency Medicine Qbank. We will be taking some time off over the holidays, but be ready to go with us in 2017, since the in-service exam will only be a few weeks away.Happy Holidays from the Roshcast team as well as everybody from Rosh Review!Jeff, Nachi, and AdamThe post Podcast Ep 10: Gout, Glaucoma, Bronchitis, Spider Bites, &amp; More appeared first on RoshReview.com.

<blockquote>Fear is the great extinguisher of dreams… Conversely, it can be your best mentor and source of motivation. –Paula Amato</blockquote><h6>Welcome back to episode 10! This week we review some key ophthalmologic findings with excellent teaching images for you to see. We also hit the lung, the joints, the extremities, and even spend time on scorpions, snakes, and spiders. </h6>We begin each episode with a rapid review of the previous week’s highlights then dive into the Q&amp;A and wrap up with another rapid review of the covered content. Let’s get started.<ul><li>The most common cause of pneumonia in an alcoholic is Streptococcus pneumoniae.</li><li>Radial nerve palsy is a peripheral nerve lesion caused by compression of the radial nerve in the axilla. The most common findings are wrist drop and hand numbness over the first to third digits. It is managed conservatively with a wrist splint.</li><li>IV drug abusers are at risk for tricuspid endocarditis. The most commonly implicated organism is staph aureus.</li><li>Colchicine overdoses cause severe GI distress, bone marrow suppression, rhabdomyolysis, renal failure, metabolic acidosis, and even ARDS.</li><li>The mainstay of treatment for herpes zoster is pain control. Acyclovir may be prescribed within the first 72 hours of onset of the lesions.</li></ul>Now onto this week’s podcastQuestion 1A 43-year-old man is currently undergoing palliative radiation therapy for pancreatic cancer. He presents to the emergency department with a 4-day history of gradually worsening left lower extremity pain. Pain is localized to the calf and made worse with ambulation. Exam shows mild edema of the left calf without erythema or warmth. Which of the following is the most likely diagnosis?A. CellulitisB. Deep venous thrombosisC. Peripheral artery diseaseD. Superficial thrombophlebitis<a href="https://www.roshreview.com/wp-content/uploads/Image-Deep-Vein-thrombosis-and-DVT-risk-factors.jpg" rel="nofollow" target="_blank">Teaching image</a>Question 2 A 25-year-old man presents to the ED with right eye pain, tearing, and photophobia. After instilling fluorescein into the affected eye, you see the above on slit lamp exam. Which of the following is the most likely prognosis of this condition?A. Complete resolution within 24–72 hoursB. Corneal erosion and perforationC. Diminished unilateral visual acuityD. Recurrent lesions with viral reactivation<a href="https://www.roshreview.com/wp-content/uploads/Image-Corneal-abrasion-fluorescein-uptake.png" rel="nofollow" target="_blank">Teaching image</a>Question 3In which setting is allopurinol contraindicated for the treatment of gout?A. Acute attack of goutB. Alcoholic patientC. Hyperuricemia greater than 8.0D. In combination with colchicine<a href="https://www.roshreview.com/wp-content/uploads/Table-Treatment-of-Gout-Allopurinol-Probenecid.png" rel="nofollow" target="_blank">Teaching image</a>Question 4 A 52-year-old man presents with a red right eye that is associated with severe pain and blurred vision. On exam, there is some cloudiness to the cornea. Pupils are 5 mm OD and 3 mm OS. Which of the following is the most likely diagnosis?A. Acute glaucomaB. ConjunctivitisC. IritisD. Keratitis<a href="https://www.roshreview.com/wp-content/uploads/Image-Development-and-Treatment-of-Acute-Angle-Glaucoma.jpg" rel="nofollow" target="_blank">Teaching image 1</a><a href="https://www.roshreview.com/wp-content/uploads/Image-Open-and-closed-angle-glaucoma.png" rel="nofollow" target="_blank">Teaching image 2</a>Question 5Heightened sensitivity to touch in the area of the sting, along with local numbness and weakness, is associated with which of the following animals?A. Black widow spider B. Brown recluse spider C. Pit viperD. Scorpion<a href="https://www.roshreview.com/wp-content/uploads/Table-Scorpion-sting-spider-bite-snake-bite.jpg" rel="nofollow" target="_blank">Teaching image</a>Question 6What is the most common symptom seen in acute bronchitis?A. Chest painB. CoughC. FeverD. Sputum<ul><li><a href="/tag/dvts" rel="noreferrer noopener nofollow" target="_blank">DVTs</a> typically present with non-specific symptoms including unilateral limb swelling, pain, redness, warm, or even distended collateral veins.</li><li>Predisposing <a href="/tag/risk-factors-for-dvt" rel="noreferrer noopener nofollow" target="_blank">risk factors for DVT</a> include malignancy, immobilization, recent surgery, obesity, smoking, oral contraceptives, recreational drugs, and hypercoagulable states.</li><li><a href="/tag/corneal-abrasions" rel="noreferrer noopener nofollow" target="_blank">Corneal abrasions</a> typically resolve within 24-72 hours. They are most commonly caused by ocular trauma or an ocular foreign body. Corneal abrasions are treated with a topical antibiotic such as erythromycin or ciprofloxacin. Tetanus vaccination should be given to patients who are not up to date.</li><li><a href="/tag/allopurinol" rel="noreferrer noopener nofollow" target="_blank">Allopurinol</a> is contraindicated in an acute presentation of <a href="/tag/gout" rel="noreferrer noopener nofollow" target="_blank">gout</a>. The first-line therapy is NSAIDs.</li><li><a href="/tag/negatively-birefringent-crystals" rel="noreferrer noopener nofollow" target="_blank">Negatively birefringent crystals</a> are seen in gout and <a href="/tag/positively-birefringent-crystals" rel="noreferrer noopener nofollow" target="_blank">positively birefringent crystals</a> are seen in <a href="/tag/pseudogout" rel="noreferrer noopener nofollow" target="_blank">pseudogout</a>. Gout is typically seen in the first metatarsophalangeal joint, whereas pseudogout most commonly affects the larger joints like the knees and ankles.</li><li><a href="/tag/acute-glaucoma" rel="noreferrer noopener nofollow" target="_blank">Acute glaucoma</a> often classical presents as a red, painful eye with blurry vision and asymmetric pupils.</li><li><a href="/tag/acute-angle-closure-glaucoma" rel="noreferrer noopener nofollow" target="_blank">Acute angle-closure glaucoma</a> is caused by closure of the anterior chamber. Treatment should begin with topical beta-blockers, carbonic anhydrase inhibitors, steroids, and miotics.</li><li><a href="/tag/scorpion-stings" rel="noreferrer noopener nofollow" target="_blank">Scorpion stings</a> produce local redness and edema with a heightened sensitivity to touch in the area of the sting with numbness and weakness of the affected area. Systemic symptoms include fasciculations, disconjugate gaze, temperature reversal, and pancreatitis.</li><li><a href="/tag/black-widow-spider-bites" rel="noreferrer noopener nofollow" target="_blank">Black widow spider bites</a> cause a local papule with a halo. Severe systemic symptoms include a peritonitic abdomen, muscle fasciculation’s, and diaphoresis. Black widow spiders have a red hourglass on their abdomen and can be found throughout the entire United States.</li><li><a href="/tag/brown-recluse-spiders" rel="noreferrer noopener nofollow" target="_blank">Brown recluse spiders</a> are found in the Midwest. They cause a papule that later blisters and may necrose. Systemic symptoms include renal failure, pulmonary edema, and shock.</li><li><a href="/tag/pit-viper-snakebites" rel="noreferrer noopener nofollow" target="_blank">Pit viper snakebites</a> cause local swelling and oozing from the wound. Severe envenomations can lead to a DIC-like coagulopathy and hemorrhagic bullae.</li><li>The most common symptom of <a href="/tag/acute-bronchitis" rel="noreferrer noopener nofollow" target="_blank">acute bronchitis</a> is a <a href="/tag/cough" rel="noreferrer noopener nofollow" target="_blank">cough</a>. The most common cause is a viral illness that should be treated with supportive care.</li></ul>Need to beef up on your colchicine toxicity knowledge? Check out last week’s episodeDon’t forget that the high-yield questions, explanations, and images can be found in the <a href="https://www.roshreview.com/specialties/emergency-medicine/" rel="noreferrer noopener nofollow" target="_blank">Rosh Review Emergency Medicine Qbank</a>. We will be taking some time off over the holidays, but be ready to go with us in 2017, since the in-service exam will only be a few weeks away.Happy Holidays from the Roshcast team as well as everybody from Rosh Review!Jeff, Nachi, and AdamThe post <a href="https://www.roshreview.com/blog/ep-10-leg-swelling-corneal-abrasions-gout-glaucoma-spider-bites-bronchitis/" rel="nofollow" target="_blank">Podcast Ep 10: Gout, Glaucoma, Bronchitis, Spider Bites, &amp; More</a> appeared first on <a href="https://www.roshreview.com/blog" rel="nofollow" target="_blank">RoshReview.com</a>.

Ep 10 Roshcast Emergency Board Review

Believe you can and you’re halfway there. –Theodore RooseveltWelcome back to Episode 18! This is the last and final rapid review before the In-Training Exam! Remember to pause the podcast as you go through the review and quiz yourself. Let’s get started with Ob/GYN.OB/GYN EmergenciesThe most common cause of maternal mortality during delivery is maternal hemorrhage. Maternal hemorrhage can be caused by uterine atony, genital trauma or retained products. Uterine atony is treated with oxytocin or uterine massage. Genital trauma is treated with pressure or ligation. Retained products require removal of the products to control the hemorrhage.Vaginal candidiasis is treated with fluconazole or clotrimazole. Bacterial vaginosis is treated with metronidazole, twice daily for 7 days. Lastly, trichomoniasis is treated with a single dose of metronidazole.PID is typically caused by gonorrhea, chlamydia, or both. It is treated with ceftriaxone 250 mg IM once and doxycycline 100 mg PO BID x 14 days if the patient can tolerate PO. Cervicitis is treated with ceftriaxone 250 mg IM and azithromycin 1g PO.Fitz-Hugh-Curtis syndrome is a perihepatitis associated with PID. It is a difficult diagnosis to make, but suspect it in sexually active woman with right upper quadrant pain.Pediatric EmergenciesSuspect epiglottitis in those who were incompletely vaccinated. The first priority is airway management, which ideally involves intubation in an operating room. The second priority is antibiotics. Ampicillin-sulbactam or ceftriaxone are often used.Pertussis has three stages: the catarrhal stage, the paroxysmal stage, and the convalescent stage. Treatment is with a macrolide.There are five common congenital cyanotic heart defects, which can be remembered by the numbers 1–5. One is for Truncus Arteriosus, in which two vessels join to make one. Two is for Transposition of the Great Vessels in which the two great vessels are switched. Three is for Tricuspid Atresia. Remember three for TRIcuspid. Four is for the four defects of Tetralogy of Fallot. Lastly, five is for the five words of Total Anomalous Pulmonary Vascular Return.The three common acyanotic heart lesions are atrial septal defects, patent ductus arteriosus, and ventricular septal defects. Symptomatic children with such lesions typically present with congestive heart failure by 6 months of life.Acrocyanosis is a transient blue discoloration of the hands and feet, which can occur when a newborn is cold. Typically, the pulse oximetry reading is normal.Procedural EmergenciesThe emergence reaction from ketamine is the most common adverse effect. The most serious adverse reaction is laryngospasm. The laryngospasm can be treated with bag valve mask ventilation. Ketamine can also be used for analgesia in lieu of opiates at a dose of 0.1–0.3 mg/kg.Renal EmergenciesHematuria with hearing loss is associated with Alport syndrome. Hematuria and hemoptysis is associated with Goodpasture’s syndrome.Winter’s formula (pCO2 = 1.5HCO3– + 8 +/-2) is a formula to determine if there is appropriate respiratory compensation in a metabolic acidosis.MUDPILES mnemonic can be used to remember the causes of an anion gap metabolic acidosis: Methanol, Uremia, DKA, Propylene glycol, Iron or INH, Lactic acidosis, Ethylene glycol, and Salicylates.The HARDASS mnemonic can be used to remember the causes of a non-anion gap metabolic acidosis: Hyperalimentation, Addison’s disease, RTA, Diarrhea, Acetazolamide, Spironolactone, and Saline infusion.Pulmonary EmergenciesA ventilation perfusion scan (V/Q) has the highest sensitivity for excluding pulmonary embolism.With pulmonary embolisms, the most common finding is sinus tachycardia. Do not forget about the classic S1Q3T3 pattern.The common cause of SVC syndrome is malignancy. The four most common malignancies are bronchogenic carcinoma, small cell lung cancer, squamous cell lung cancer, and lymphoma.In drowning victims, a 4 to 6 hour observation period is typically sufficient before discharge with normal vitals and a normal exam. Any oxygen requirement or pulmonary finding on exam requires admission.Hypoxemia can be broken down into five categories: low inspired O2, shunt, diffusion impairment, hypoventilation, and V-Q mismatch.With right to left shunt, diffusion impairment, and V-Q mismatches, the A-a gradient is increased. With hypoventilation, the A-a gradient is normal.The hypoxemia of right to left shunt does not improve with supplemental O2, but with diffusion impairment, hypoventilation, and V-Q mismatches it would improve.COPD accounts for 70% of the cases of secondary spontaneous pneumothoraces. Remember that the incidence is also three times greater in men than it is in women.A BNP of less than 100 essentially rules out heart failure, but an elevated BNP is not necessarily indicative of failure. Obesity can also lead to a spuriously low BNP.Toxicological EmergenciesEmergent dialysis is required for an acute ingestion with a lithium level greater than 4 mEq/L or for a chronic ingestion with a lithium level greater than 2.5 mEq/L. Emergent dialysis should also be initiated if there are any neurologic findings secondary to the ingestion.In lithium overdose, there are three classic findings: bradycardia, T wave flattening, and QT prolongation.Treatment for amphetamine overdoses is mostly supportive. The complex tachydysrhythmias are treated with sodium bicarbonate, agitation is treated with benzodiazepines, and hyperthermia is treated with aggressive cooling measures.Anticholinergic toxicity can be remembered by the mnemonic: mad as a hatter, blind as a bat, red as a beet, hot as a hare, and dry as a bone. Do not confuse the anticholinergic toxicity with the sympathomimetic toxicity as they are similar, but sympathomimetic overdoses are typically associated with diaphoresis, not dryness.The cholinergic toxidrome is marked by salivation, lacrimation, urination, defecation, GI upset, and emesis. Remember SLUDGE. The most deadly symptoms can be remembered by the killer b’s: bronchorrhea, bronchospasm, and bradycardia.A knee X-ray with hyperdense lines at the metaphysis is a classic finding in lead poisoning. Lead poisoning is treated with either succimer or IV EDTA in acute overdoses.Bupivacaine toxicity is treated with intralipid.Hydrofluoric acid is treated with calcium gluconate, either topically or intra-arterially.Benzodiazepine overdoses should be treated with flumazenil but use caution in those who use them chronically as reversal may precipitate seizures.Iron overdoses occur with ingestions of greater than 40 mg/kg. They should be treated with deferoxamine. For less significant overdoses, GI decontamination may be attempted. Charcoal is of no use here, as it does not bind Iron.Symptomatic colchicine overdoses must be admitted because of an elevated risk of sudden cardiac death. Other complications include renal failure, rhabdomyolysis, bone marrow suppression, and ARDS.The Amanita genus of mushrooms can be identified by dots or scales on their cap. They produce the deadly amatoxin.Amatoxin poisoning has four stages culminating in liver failure and then death. Mortality is commonly cited as 10-30%. Activated charcoal and hemoperfusion can be considered.Traumatic EmergenciesOn bedside ultrasound, the absence of lung sliding is indicative of a pneumothorax. A-lines are horizontal lines that are the normal reflection of the pleura. B-lines are vertical “headlights” that are indicative of pulmonary edema.A simple pneumothorax is one involving &lt; 10% of the hemithorax and should be treated with a non-rebreather to increase the speed of resorption. With larger pneumothoraces, a chest tube or pigtail catheter will likely be needed.The NEXUS mnemonic can be remembered by the mnemonic NSAID: Neurologic deficit, Spinal tenderness, Altered mental status, Intoxication, and Distracting injury. The NEXUS and Canadian C-spine rules are tools to rule patients out from the need for imaging in trauma. They both have nearly 100% sensitivity, but very poor specificities and therefore cannot rule in injury.Myocardial contusions are a sequela of blunt chest trauma. The most common EKG finding is sinus tachycardia. These patients require an echocardiogram. The most common course is spontaneous resorption of resolution of the symptoms. The most serious complication is delayed rupture.That wraps up part three, the last episode in our brief In-Training Exam review! We hope you enjoyed listening! We will be taking next week off for the ITE but will resume shortly thereafter with new episodes. If you have made it this far in our podcast, you clearly take your studying seriously, and we have no doubt you will do well on the exam!Good luck,Jeff and NachiP.S. In case you missed it, here is the rest of the review: Episode 16 and Episode 17.The post Podcast Ep 18: In-Training Exam Review (3 of 3) OB/GYN &amp; More appeared first on RoshReview.com.

<blockquote>Believe you can and you’re halfway there. –Theodore Roosevelt</blockquote><h6>Welcome back to Episode 18! This is the last and final rapid review before the In-Training Exam! Remember to pause the podcast as you go through the review and quiz yourself. Let’s get started with Ob/GYN.</h6>OB/GYN Emergencies<ul><li>The most common cause of maternal mortality during delivery is maternal hemorrhage. Maternal hemorrhage can be caused by uterine atony, genital trauma or retained products. Uterine atony is treated with oxytocin or uterine massage. Genital trauma is treated with pressure or ligation. Retained products require removal of the products to control the hemorrhage.</li><li>Vaginal candidiasis is treated with fluconazole or clotrimazole. Bacterial vaginosis is treated with metronidazole, twice daily for 7 days. Lastly, trichomoniasis is treated with a single dose of metronidazole.</li><li>PID is typically caused by gonorrhea, chlamydia, or both. It is treated with ceftriaxone 250 mg IM once and doxycycline 100 mg PO BID x 14 days if the patient can tolerate PO. Cervicitis is treated with ceftriaxone 250 mg IM and azithromycin 1g PO.</li><li>Fitz-Hugh-Curtis syndrome is a perihepatitis associated with PID. It is a difficult diagnosis to make, but suspect it in sexually active woman with right upper quadrant pain.</li></ul>Pediatric Emergencies<ul><li>Suspect epiglottitis in those who were incompletely vaccinated. The first priority is airway management, which ideally involves intubation in an operating room. The second priority is antibiotics. Ampicillin-sulbactam or ceftriaxone are often used.</li><li>Pertussis has three stages: the catarrhal stage, the paroxysmal stage, and the convalescent stage. Treatment is with a macrolide.</li><li>There are five common congenital cyanotic heart defects, which can be remembered by the numbers 1–5. One is for Truncus Arteriosus, in which two vessels join to make one. Two is for Transposition of the Great Vessels in which the two great vessels are switched. Three is for Tricuspid Atresia. Remember three for TRIcuspid. Four is for the four defects of Tetralogy of Fallot. Lastly, five is for the five words of Total Anomalous Pulmonary Vascular Return.</li><li>The three common acyanotic heart lesions are atrial septal defects, patent ductus arteriosus, and ventricular septal defects. Symptomatic children with such lesions typically present with congestive heart failure by 6 months of life.</li><li>Acrocyanosis is a transient blue discoloration of the hands and feet, which can occur when a newborn is cold. Typically, the pulse oximetry reading is normal.</li></ul>Procedural Emergencies<ul><li>The emergence reaction from ketamine is the most common adverse effect. The most serious adverse reaction is laryngospasm. The laryngospasm can be treated with bag valve mask ventilation. Ketamine can also be used for analgesia in lieu of opiates at a dose of 0.1–0.3 mg/kg.</li></ul>Renal Emergencies<ul><li>Hematuria with hearing loss is associated with Alport syndrome. Hematuria and hemoptysis is associated with Goodpasture’s syndrome.</li><li>Winter’s formula (pCO2 = 1.5HCO3– + 8 +/-2) is a formula to determine if there is appropriate respiratory compensation in a metabolic acidosis.</li><li>MUDPILES mnemonic can be used to remember the causes of an anion gap metabolic acidosis: Methanol, Uremia, DKA, Propylene glycol, Iron or INH, Lactic acidosis, Ethylene glycol, and Salicylates.</li><li>The HARDASS mnemonic can be used to remember the causes of a non-anion gap metabolic acidosis: Hyperalimentation, Addison’s disease, RTA, Diarrhea, Acetazolamide, Spironolactone, and Saline infusion.</li></ul>Pulmonary Emergencies<ul><li>A ventilation perfusion scan (V/Q) has the highest sensitivity for excluding pulmonary embolism.</li><li>With pulmonary embolisms, the most common finding is sinus tachycardia. Do not forget about the classic S1Q3T3 pattern.</li><li>The common cause of SVC syndrome is malignancy. The four most common malignancies are bronchogenic carcinoma, small cell lung cancer, squamous cell lung cancer, and lymphoma.</li><li>In drowning victims, a 4 to 6 hour observation period is typically sufficient before discharge with normal vitals and a normal exam. Any oxygen requirement or pulmonary finding on exam requires admission.</li><li>Hypoxemia can be broken down into five categories: low inspired O2, shunt, diffusion impairment, hypoventilation, and V-Q mismatch.</li><li>With right to left shunt, diffusion impairment, and V-Q mismatches, the A-a gradient is increased. With hypoventilation, the A-a gradient is normal.</li><li>The hypoxemia of right to left shunt does not improve with supplemental O2, but with diffusion impairment, hypoventilation, and V-Q mismatches it would improve.</li><li>COPD accounts for 70% of the cases of secondary spontaneous pneumothoraces. Remember that the incidence is also three times greater in men than it is in women.</li><li>A BNP of less than 100 essentially rules out heart failure, but an elevated BNP is not necessarily indicative of failure. Obesity can also lead to a spuriously low BNP.</li></ul>Toxicological Emergencies<ul><li>Emergent dialysis is required for an acute ingestion with a lithium level greater than 4 mEq/L or for a chronic ingestion with a lithium level greater than 2.5 mEq/L. Emergent dialysis should also be initiated if there are any neurologic findings secondary to the ingestion.</li><li>In lithium overdose, there are three classic findings: bradycardia, T wave flattening, and QT prolongation.</li><li>Treatment for amphetamine overdoses is mostly supportive. The complex tachydysrhythmias are treated with sodium bicarbonate, agitation is treated with benzodiazepines, and hyperthermia is treated with aggressive cooling measures.</li><li>Anticholinergic toxicity can be remembered by the mnemonic: mad as a hatter, blind as a bat, red as a beet, hot as a hare, and dry as a bone. Do not confuse the anticholinergic toxicity with the sympathomimetic toxicity as they are similar, but sympathomimetic overdoses are typically associated with diaphoresis, not dryness.</li><li>The cholinergic toxidrome is marked by salivation, lacrimation, urination, defecation, GI upset, and emesis. Remember SLUDGE. The most deadly symptoms can be remembered by the killer b’s: bronchorrhea, bronchospasm, and bradycardia.</li><li>A knee X-ray with hyperdense lines at the metaphysis is a classic finding in lead poisoning. Lead poisoning is treated with either succimer or IV EDTA in acute overdoses.</li><li>Bupivacaine toxicity is treated with intralipid.</li><li>Hydrofluoric acid is treated with calcium gluconate, either topically or intra-arterially.</li><li>Benzodiazepine overdoses should be treated with flumazenil but use caution in those who use them chronically as reversal may precipitate seizures.</li><li>Iron overdoses occur with ingestions of greater than 40 mg/kg. They should be treated with deferoxamine. For less significant overdoses, GI decontamination may be attempted. Charcoal is of no use here, as it does not bind Iron.</li><li>Symptomatic colchicine overdoses must be admitted because of an elevated risk of sudden cardiac death. Other complications include renal failure, rhabdomyolysis, bone marrow suppression, and ARDS.</li><li>The Amanita genus of mushrooms can be identified by dots or scales on their cap. They produce the deadly amatoxin.</li><li>Amatoxin poisoning has four stages culminating in liver failure and then death. Mortality is commonly cited as 10-30%. Activated charcoal and hemoperfusion can be considered.</li></ul>Traumatic Emergencies<ul><li>On bedside ultrasound, the absence of lung sliding is indicative of a pneumothorax. A-lines are horizontal lines that are the normal reflection of the pleura. B-lines are vertical “headlights” that are indicative of pulmonary edema.</li><li>A simple pneumothorax is one involving &lt; 10% of the hemithorax and should be treated with a non-rebreather to increase the speed of resorption. With larger pneumothoraces, a chest tube or pigtail catheter will likely be needed.</li><li>The NEXUS mnemonic can be remembered by the mnemonic NSAID: Neurologic deficit, Spinal tenderness, Altered mental status, Intoxication, and Distracting injury. The NEXUS and Canadian C-spine rules are tools to rule patients out from the need for imaging in trauma. They both have nearly 100% sensitivity, but very poor specificities and therefore cannot rule in injury.</li><li>Myocardial contusions are a sequela of blunt chest trauma. The most common EKG finding is sinus tachycardia. These patients require an echocardiogram. The most common course is spontaneous resorption of resolution of the symptoms. The most serious complication is delayed rupture.</li></ul>That wraps up part three, the last episode in our brief In-Training Exam review! We hope you enjoyed listening! We will be taking next week off for the ITE but will resume shortly thereafter with new episodes. If you have made it this far in our podcast, you clearly take your studying seriously, and we have no doubt you will do well on the exam!Good luck, Jeff and NachiP.S. In case you missed it, here is the rest of the review: <a href="https://www.roshreview.com/blog/ep-16-training-exam-review-part-1-3-abdominal-cardiovascular-cutaneous-endocrine-environmental-emergencies/" rel="noreferrer noopener nofollow" target="_blank">Episode 16</a> and <a href="https://www.roshreview.com/podcasts/ep-17-training-exam-review-part-2-3-heent-hematology-immune-system-musculoskeletal-nervous-system/" rel="noreferrer noopener nofollow" target="_blank">Episode 17</a>.The post <a href="https://www.roshreview.com/blog/ep-18-training-exam-review-part-3-3-obgyn-pediatrics-procedural-renal-pulmonary-toxicology-trauma/" rel="nofollow" target="_blank">Podcast Ep 18: In-Training Exam Review (3 of 3) OB/GYN &amp; More</a> appeared first on <a href="https://www.roshreview.com/blog" rel="nofollow" target="_blank">RoshReview.com</a>.

Ep 18 Roshcast Emergency Board Review

The most difficult thing is the decision to act, the rest is merely tenacity. The fears are paper tigers. You can do anything you decide to do. You can act to change and control your life; and the procedure, the process is its own reward.  -Amelia EarhartWelcome back to Roshcast Episode 37! This week, we’re continuing our collaboration with the EM Clerkship podcast. We’ll cover 3 EKG related questions in addition to 3 randomly generated questions. Maybe we’ll even get to a trauma question… As a reminder, listen closely for the trauma ring tone during this episode and the next episode. And e-mail us at roshcast@roshreview.com or tweet us at Roshcast the exact time of the ring tone to win a subscription. With the in-training exam right around the corner, this will certainly help get you ready for February 28th. Let’s get going with a rapid review from a recent post on the Rosh Review Blog.Supracondylar fracture is the most common type of pediatric elbow fracture. Typically caused by falling on an outstretched hand — or a FOOSH. In a posterolaterally displaced supracondylar humeral fracture, you should be concerned for the median nerve. This can be tested by asking the patient to make an “OK” sign and checking sensation at the volar tip of the index fingerFor a posteromedially displaced supracondylar fracture you should be concerned about the radial nerve. Have the patient try to make a “thumbs up” sign. And check sensation along the dorsal web space of the hand. Now onto this week’s podcastQuestion 1 A previously healthy patient who presents with leg pain is found to have a clot within the tibial vein. Which of the following treatments is most likely indicated?A. Aspirin for 6 monthsB. Heparin and warfarinC. Repeat ultrasound in 2–5 daysD. Warfarin aloneQuestion 2Which of the following is associated with a shortened PR interval? A. Brugada syndromeB. Mobitz 2° AV BlockC. Wellens syndromeD. Wolff-Parkinson-White syndromeTeaching ImageQuestion 3A 29-year-old man presents after a syncopal episode. His ECG reveals an epsilon wave, a small positive deflection buried in the end of the QRS complex. Which of the following tests will likely identify the cause of the patient’s syncope?A. Cardiac catheterizationB. Cardiac MRIC. Electrophysiology studyD. Stress testingTeaching ImageQuestion 4A 12-year-old boy is brought to the ED after being struck in the chest by a baseball during a baseball game. He collapsed immediately upon impact and has been unresponsive since. Which of the following dysrhythmias is most commonly associated with this condition?A. AsystoleB. Supraventricular tachycardia C. Ventricular fibrillationD. Ventricular tachycardiaTeaching ImageQuestion 5A 57-year-old man with hypertension presents complaining of a 6-hour history of a “floater” in the right eye. He states that he has had increasing difficulty reading as the cloudy area blocks his visual field. Additionally, he complains of decreased vision in his right eye. Which of the following represents the appropriate management?A. Administer timolol drops and emergently consult ophthalmologyB. Emergent ophthalmology consultation C. Prescribe topical antibiotics and refer to ophthalmologyD. Refer patient to ophthalmology for further assessment Teaching ImageQuestion 6A 27-year-old woman and her 25-year-old sister present with symptoms of facial flushing, headache, abdominal cramping, and diarrhea after eating in a seafood restaurant. They report that the fish they ate had a peppery taste. Which of the following is the most likely cause of their symptoms?A. AnaphylaxisB. CiguateraC. ScombroidD. Staphalococcus aureus food poisoningTeaching ImageIsolated thromboses of the calf veins can be managed by repeating an ultrasound in 2–5 days to determine the need for anticoagulation.Phlegmasia cerulean dolens is caused by extensive iliofemoral occlusion, which leads to vascular congestion and venous ischemia and a painful blue leg.Phlegmasia alba dolens is caused by a massive iliofemoral thrombosis and spasm and leads to a white leg.WPW is a congenital abnormality characterized by an abnormal accessory conduction pathway between the atria and the ventricle known as the bundle of kent. Look out for a delta wave, short PR, and widened QRS interval on EKG. The definitive treatment is ablation.Brugada syndrome is a hereditary condition characterized by a right bundle branch block-like pattern with ST elevation in leads V1 through V3.Wellens syndrome is caused by critical stenosis of the proximal LAD. On EKG you will likely see large inverted T waves or biphasic T waves in leads V2 and V3.Epsilon waves, which are small positive deflections buried in the terminal QRS complex, are characteristic of arrhythmogenic right ventricular cardiomyopathy. It is diagnosed by cardiac MRI.Arrhythmogenic right ventricular cardiomyopathy is treated with antiarrhythmics and an implantable cardiac defibrillator.Commotio cordis occurs when an object strikes the chest over the heart. It can cause sudden death. Commotio cordis is most common in children 5–15 years old, and ventricular fibrillation is the most common underlying rhythm.The commotio cordis risk window is the upstroke of the T wave in the cardiac conduction cycle.Posterior vitreous detachment can cause floaters, decreased vision, and cloudiness. Acute changes warrant emergent ophthalmology consultation.Scombroid poisoning presents with facial flushing, headache, abdominal cramping and diarrhea, palpitations, and rashes. Onset of symptoms can be anywhere from 10 minutes to 24 hours. Treatment is supportive with H1 and H2 blockers.Ciguatera toxicity is associated with muscle weakness, paresthesias, vomiting, diarrhea, and reversal of hot-cold sensation.That wraps up Roshcast Episode 37. Before we officially sign off for this week, we wanted to solicit your help for an upcoming episode. Very soon, we are bringing Adam Rosh, who is the founder of Rosh Review, onto the podcast to discuss everything from study tactics to his favorite pre-test meal. We have a couple of our own questions lined up, but we want to know what questions you have. Send us any questions for Adam to jeff@roshreview.com and we’ll try to squeeze them all in. That’s it for this week. Don’t forget to follow us on Twitter @Roshcast and @RoshReview. And you can always email us at roshcast@roshreview.com with any feedback, corrections or suggestions. You can also help us pick questions by identifying ones you would like us to review. Write “RoshCast” in the submit feedback box as you go through the question bank.  Lastly, if you have a minute, make sure to rate us and leave comments on iTunes to help spread the word about RoshCast. We’ll be back soon with more high-quality review.Until next time,Jeff and NachiThe post Podcast Ep 37: Tibial Vein Clot, PR Interval &amp; More appeared first on RoshReview.com.

<blockquote>The most difficult thing is the decision to act, the rest is merely tenacity. The fears are paper tigers. You can do anything you decide to do. You can act to change and control your life; and the procedure, the process is its own reward.  -Amelia Earhart</blockquote><h6>Welcome back to Roshcast Episode 37! This week, we’re continuing our collaboration with the <a href="http://emclerkship.com" rel="noreferrer noopener nofollow" target="_blank">EM Clerkship podcast</a>. We’ll cover 3 EKG related questions in addition to 3 randomly generated questions. Maybe we’ll even get to a trauma question… </h6>As a reminder, listen closely for the trauma ring tone during this episode and the next episode. And e-mail us at <a href="mailto:roshcast@roshreview.com">roshcast@roshreview.com</a> or tweet us at Roshcast the exact time of the ring tone to win a subscription. With the in-training exam right around the corner, this will certainly help get you ready for February 28th. Let’s get going with a rapid review from a recent <a href="https://www.roshreview.com/blog/rapid-review/rapid-review-supracondylar-fracture/" rel="noreferrer noopener nofollow" target="_blank">post</a> on the <a href="https://www.roshreview.com/blog/" rel="noreferrer noopener nofollow" target="_blank">Rosh Review Blog</a>.<ul><li>Supracondylar fracture is the most common type of pediatric elbow fracture. Typically caused by falling on an outstretched hand — or a FOOSH. </li><li>In a posterolaterally displaced supracondylar humeral fracture, you should be concerned for the median nerve. This can be tested by asking the patient to make an “OK” sign and checking sensation at the volar tip of the index finger</li><li>For a posteromedially displaced supracondylar fracture you should be concerned about the radial nerve. Have the patient try to make a “thumbs up” sign. And check sensation along the dorsal web space of the hand. </li></ul>Now onto this week’s podcastQuestion 1 A previously healthy patient who presents with leg pain is found to have a clot within the tibial vein. Which of the following treatments is most likely indicated?A. Aspirin for 6 monthsB. Heparin and warfarinC. Repeat ultrasound in 2–5 daysD. Warfarin alone Question 2Which of the following is associated with a shortened PR interval? A. Brugada syndromeB. Mobitz 2° AV BlockC. Wellens syndromeD. Wolff-Parkinson-White syndrome <a href="https://www.roshreview.com/wp-content/uploads/Ep37-Wolff-Parkinson-White.png" rel="nofollow" target="_blank">Teaching Image</a>Question 3A 29-year-old man presents after a syncopal episode. His ECG reveals an epsilon wave, a small positive deflection buried in the end of the QRS complex. Which of the following tests will likely identify the cause of the patient’s syncope?A. Cardiac catheterizationB. Cardiac MRIC. Electrophysiology studyD. Stress testing<a href="https://www.roshreview.com/wp-content/uploads/Ep37-Arrhythmogenic-Right-Ventricular-Dysplasia.jpg" rel="nofollow" target="_blank">Teaching Image</a>Question 4A 12-year-old boy is brought to the ED after being struck in the chest by a baseball during a baseball game. He collapsed immediately upon impact and has been unresponsive since. Which of the following dysrhythmias is most commonly associated with this condition?A. AsystoleB. Supraventricular tachycardia C. Ventricular fibrillationD. Ventricular tachycardia <a href="https://www.roshreview.com/wp-content/uploads/Ep37-Commotio-Cordis.jpg" rel="nofollow" target="_blank">Teaching Image</a>Question 5A 57-year-old man with hypertension presents complaining of a 6-hour history of a “floater” in the right eye. He states that he has had increasing difficulty reading as the cloudy area blocks his visual field. Additionally, he complains of decreased vision in his right eye. Which of the following represents the appropriate management?A. Administer timolol drops and emergently consult ophthalmologyB. Emergent ophthalmology consultation C. Prescribe topical antibiotics and refer to ophthalmologyD. Refer patient to ophthalmology for further assessment <a href="https://www.roshreview.com/wp-content/uploads/Ep37-Posterior-Vitreous-Detachment.png" rel="nofollow" target="_blank">Teaching Image</a>Question 6A 27-year-old woman and her 25-year-old sister present with symptoms of facial flushing, headache, abdominal cramping, and diarrhea after eating in a seafood restaurant. They report that the fish they ate had a peppery taste. Which of the following is the most likely cause of their symptoms?A. AnaphylaxisB. CiguateraC. ScombroidD. Staphalococcus aureus food poisoning<a href="https://www.roshreview.com/wp-content/uploads/Ep37-Histamine-Fish-Toxicity.png" rel="nofollow" target="_blank">Teaching Image</a><ul><li>Isolated thromboses of the calf veins can be managed by repeating an ultrasound in 2–5 days to determine the need for anticoagulation.</li><li>Phlegmasia cerulean dolens is caused by extensive iliofemoral occlusion, which leads to vascular congestion and venous ischemia and a painful blue leg.</li><li>Phlegmasia alba dolens is caused by a massive iliofemoral thrombosis and spasm and leads to a white leg.</li><li>WPW is a congenital abnormality characterized by an abnormal accessory conduction pathway between the atria and the ventricle known as the bundle of kent. Look out for a delta wave, short PR, and widened QRS interval on EKG. The definitive treatment is ablation.</li><li>Brugada syndrome is a hereditary condition characterized by a right bundle branch block-like pattern with ST elevation in leads V1 through V3.</li><li>Wellens syndrome is caused by critical stenosis of the proximal LAD. On EKG you will likely see large inverted T waves or biphasic T waves in leads V2 and V3.</li><li>Epsilon waves, which are small positive deflections buried in the terminal QRS complex, are characteristic of arrhythmogenic right ventricular cardiomyopathy. It is diagnosed by cardiac MRI.</li><li>Arrhythmogenic right ventricular cardiomyopathy is treated with antiarrhythmics and an implantable cardiac defibrillator.</li><li>Commotio cordis occurs when an object strikes the chest over the heart. It can cause sudden death. Commotio cordis is most common in children 5–15 years old, and ventricular fibrillation is the most common underlying rhythm.</li><li>The commotio cordis risk window is the upstroke of the T wave in the cardiac conduction cycle.</li><li>Posterior vitreous detachment can cause floaters, decreased vision, and cloudiness. Acute changes warrant emergent ophthalmology consultation.</li><li>Scombroid poisoning presents with facial flushing, headache, abdominal cramping and diarrhea, palpitations, and rashes. Onset of symptoms can be anywhere from 10 minutes to 24 hours. Treatment is supportive with H1 and H2 blockers.</li><li>Ciguatera toxicity is associated with muscle weakness, paresthesias, vomiting, diarrhea, and reversal of hot-cold sensation.</li></ul>That wraps up Roshcast Episode 37. Before we officially sign off for this week, we wanted to solicit your help for an upcoming episode. Very soon, we are bringing Adam Rosh, who is the founder of Rosh Review, onto the podcast to discuss everything from study tactics to his favorite pre-test meal. We have a couple of our own questions lined up, but we want to know what questions you have. Send us any questions for Adam to <a href="mailto:jeff@roshreview.com">jeff@roshreview.com</a> and we’ll try to squeeze them all in. That’s it for this week. Don’t forget to follow us on Twitter <a href="https://twitter.com/roshcast?lang=en" rel="nofollow" target="_blank">@Roshcast</a> and <a href="https://twitter.com/roshreview?lang=en" rel="nofollow" target="_blank">@RoshReview. </a>And you can always email us at <a href="mailto:roshcast@roshreview.com">roshcast@roshreview.com</a> with any feedback, corrections or suggestions. You can also help us pick questions by identifying ones you would like us to review. Write “RoshCast” in the submit feedback box as you go through the question bank.  Lastly, if you have a minute, make sure to rate us and leave comments on <a href="https://itunes.apple.com/us/podcast/roshcast/id1156487141?mt=2" rel="noreferrer noopener nofollow" target="_blank">iTunes</a> to help spread the word about RoshCast. We’ll be back soon with more high-quality review.Until next time, Jeff and NachiThe post <a href="https://www.roshreview.com/blog/ep-37-tibial-vein-clot-pr-interval-epsilon-wave-commotio-cordis-posterior-vitreous-detachment-fish-poisoning/" rel="nofollow" target="_blank">Podcast Ep 37: Tibial Vein Clot, PR Interval &amp; More</a> appeared first on <a href="https://www.roshreview.com/blog" rel="nofollow" target="_blank">RoshReview.com</a>.

Ep 37 Roshcast Emergency Board Review

Put your heart, mind, and soul into even your smallest acts. This is the secret of success.   –Swami SivanandaWelcome back to Episode 17! This is part 2 of the 3 part ITE rapid review series. In Episode 16, we covered abdominal emergencies, cardiovascular emergencies, cutaneous emergencies, endocrine emergencies, and environmental emergencies. Today we jump right in with HEENT emergencies. Let’s get started! HEENT EmergenciesThe target pH for eye irrigation after a chemical burn is 7.0–7.2. Alkali burns usually cause more damage than acidic burns due to liquefactive necrosis.Acute glaucoma classically presents with a red, painful eye, blurry vision, and asymmetric pupils. First line treatment options include beta-blockers, carbonic anhydrase inhibitors, steroids, and miotics.Corneal abrasions should be treated with topical antibiotics such as erythromycin or ciprofloxacin. Tetanus vaccination should also be updated if needed.The three most common bacterial causes of acute otitis media are Streptococcus, Haemophilus, and Moraxella. However, viral pathogens are far more common. If treating with antibiotics, the first line is typically amoxicillin.Hematologic EmergenciesAngioedema secondary to ACE-inhibitor use occurs due to a buildup of bradykinin.Hereditary angioedema is caused by a deficiency or dysfunction of the C1 esterase inhibitor. Episodes are typically precipitated by stress or trauma. Treatment is with replacement of C1 esterase inhibitor or with FFP if the inhibitor is not available.TTP is treated with plasmapheresis. If plasmapheresis cannot be performed expediently, FFP can be used as a temporizing measure.For any patient on warfarin with a life-threatening bleed, FFP, PCC, or recombinant factory VIIa should be given. For a patient on aspirin with a life-threatening bleed, DDAVP should be given in addition to platelets.Predisposing risk factors for DVT include malignancy, immobilization, recent surgery, obesity, smoking, oral contraceptives, recreational drugs, and hypercoagulable states.Chronic alcohol abuse leads to a macrocytic anemia and even pancytopenia due to ethanol’s suppressive effects on the bone marrow.Patients on long-standing isoniazid are at risk for sideroblastic anemia due to a pyridoxine deficiency.Vitamin B12 deficiency causes a megaloblastic anemia called pernicious anemia. It usually occurs secondary to absorptive problems rather than poor dietary intake.Giant Cell Arteritis commonly presents with unilateral temporal headache, jaw claudication, tender temporal artery, and even sudden painless monocular vision loss. The ESR is usually between 50-100. 50% of patients with giant cell arteritis also have polymyalgia rheumatica.Giant cell arteritis should be treated with immediate steroids, long before biopsy confirms the diagnosis.In giant cell arteritis, aortic involvement can lead to valvular disease and dissection.Both hemophilia A and B are x-linked recessive diseases. Hemophilia A is caused by decreased synthesis of factor VIII. Hemophilia B or Christmas disease is caused by decreased synthesis of factor IX. Treatment is with specific factor replacement or if unavailable, with cryoprecipitate.Immune System EmergenciesFor a new mother with mastitis, she should be advised to continue nursing from the affected breast. Dicloxacillin is the antibiotic of choice.Prophylaxis for Neisseria meningitidis should be offered to high-risk contacts, which includes household members, school contacts in the prior 7 days, and those with direct exposure to patients. The preferred antibiotic regimen for prophylaxis is two days of rifampin. Ceftriaxone and ciprofloxacin can also be used but they are slightly less effective.Fight bites are at risk for contamination with Eikenella. Amoxicillin-clavulanate is the oral antibiotic of choice. If an IV antibiotic is required, ampicillin-sulbactam, cefoxitin, or piperacillin-tazobactam can be used.Streptococcus pneumoniae is classically associated with rusty colored sputum, whereas Klebsiella pneumoniae is associated with currant jelly sputum. In alcoholics, Streptococcus pneumoniae is the most common bacterial cause of pneumonia, however the incidence of Klebsiella pneumoniae is higher in this population due to their increased risk of aspiration.There are three common painless penile lesions. They are caused by Chlamydia, Klebsiella, and Treponema pallidum. Chlamydia causes LGV, which presents as a shallow ulcer. Klebsiella causes granuloma inguinale, which presents as a beefy red ulcer and a painless papule. Treponema pallidum causes syphilis, which presents as a painless chancre.H. ducreyi causes chancroid, which typically presents with multiple painful papules that ulcerate. HSV causes genital Herpes that tends to present as tender, shallow penile lesions.Balanitis is typically caused by a candidal infection. The treatment is with topical clotrimazole.In the modified Centor score, give one point for tonsillar exudates, one point for tender anterior cervical adenopathy, one point for fever by history, one point for the absence of a cough, and one point for age less than 15. For an age over 45, you subtract one point. For a score of 0 or 1 points, treat supportively; for a score of 2 or 3 points, test and treat only if positive; and, lastly, for a score of 4 or 5 points, treat empirically. The mainstay of treatment is amoxicillin.Herpes simplex virus is the most common infection associated with erythema multiforme. Hepatitis C can also be associated with erythema multiforme, but that usually occurs in the setting of active treatment with telaprevir.  Musculoskeletal EmergenciesA nursemaid’s elbow can be reduced by either supination followed by elbow flexion or with hyperpronation.NSAIDs are the first-line therapy for gout. Although there is mixed research on this, classically allopurinol is contraindicated during an acute presentation for fear of worsening the attack.Gout is associated with negatively birefringent crystal on joint aspiration, whereas pseudogout is associated with positively birefringent crystals. Gout typically affects the first metatarsophalangeal joint, whereas pseudogout most commonly affects larger joints like the knees and ankles.The Hill-Sachs defect is the most common complication of anterior shoulder dislocations, occurring in 40% of cases. The Hill-Sachs defect is a depression fracture of the posterolateral surface of the humeral head. Do not confuse it with a Bankart lesion, which is a fracture of the anterior aspect of the inferior glenoid rim.The axillary nerve is the most commonly injured nerve in anterior shoulder dislocations. Its function can be tested by arm abduction and sensation over the deltoid muscle.Nervous System EmergenciesSevere cases of myasthenia gravis can be treated with IVIG or plasma exchange. Although not a cure, symptoms may also be decreased by cooling. The edrophonium test can be used to make the initial diagnosis.Polycystic kidney disease is associated with an increased incidence of subarachnoid hemorrhages.Lyme disease is the most common cause of a bilateral Bell’s palsy.A peripheral facial nerve palsy can be distinguished from a central one by involvement of the forehead.VP shunt obstruction occurs proximally more frequently than distally. Proximal VP shunt obstruction occurs due to choroid plexus obstruction or increased protein within the CSF. Distal VP shunt obstruction occurs due to abdominal pseudocyst formation, which typically presents with abdominal pain due to the large size of the cyst.A radial nerve palsy is treated supportively with a wrist splint.A Marcus Gunn pupil is another term for a pupil with an afferent pupillary defect.That is it for part two. We have part three ready for release tomorrow. Let us know what you think about this review by emailing us at Roshcast@roshreview.com.Until tomorrow,Jeff and NachiThe post Podcast Ep 17: In-Training Exam Review, Nervous System, &amp; More appeared first on RoshReview.com.

<blockquote>Put your heart, mind, and soul into even your smallest acts. This is the secret of success.   –Swami Sivananda</blockquote><h6>Welcome back to Episode 17! This is part 2 of the 3 part ITE rapid review series. In <a href="https://www.roshreview.com/blog/ep-16-training-exam-review-part-1-3-abdominal-cardiovascular-cutaneous-endocrine-environmental-emergencies/" rel="noreferrer noopener nofollow" target="_blank">Episode 16</a>, we covered abdominal emergencies, cardiovascular emergencies, cutaneous emergencies, endocrine emergencies, and environmental emergencies. Today we jump right in with HEENT emergencies. Let’s get started! </h6>HEENT Emergencies<ul><li>The target pH for eye irrigation after a chemical burn is 7.0–7.2. Alkali burns usually cause more damage than acidic burns due to liquefactive necrosis.</li><li>Acute glaucoma classically presents with a red, painful eye, blurry vision, and asymmetric pupils. First line treatment options include beta-blockers, carbonic anhydrase inhibitors, steroids, and miotics.</li><li>Corneal abrasions should be treated with topical antibiotics such as erythromycin or ciprofloxacin. Tetanus vaccination should also be updated if needed.</li><li>The three most common bacterial causes of acute otitis media are Streptococcus, Haemophilus, and Moraxella. However, viral pathogens are far more common. If treating with antibiotics, the first line is typically amoxicillin.</li></ul>Hematologic Emergencies<ul><li>Angioedema secondary to ACE-inhibitor use occurs due to a buildup of bradykinin.</li><li>Hereditary angioedema is caused by a deficiency or dysfunction of the C1 esterase inhibitor. Episodes are typically precipitated by stress or trauma. Treatment is with replacement of C1 esterase inhibitor or with FFP if the inhibitor is not available.</li><li>TTP is treated with plasmapheresis. If plasmapheresis cannot be performed expediently, FFP can be used as a temporizing measure.</li><li>For any patient on warfarin with a life-threatening bleed, FFP, PCC, or recombinant factory VIIa should be given. For a patient on aspirin with a life-threatening bleed, DDAVP should be given in addition to platelets.</li><li>Predisposing risk factors for DVT include malignancy, immobilization, recent surgery, obesity, smoking, oral contraceptives, recreational drugs, and hypercoagulable states.</li><li>Chronic alcohol abuse leads to a macrocytic anemia and even pancytopenia due to ethanol’s suppressive effects on the bone marrow.</li><li>Patients on long-standing isoniazid are at risk for sideroblastic anemia due to a pyridoxine deficiency.</li><li>Vitamin B12 deficiency causes a megaloblastic anemia called pernicious anemia. It usually occurs secondary to absorptive problems rather than poor dietary intake.</li><li>Giant Cell Arteritis commonly presents with unilateral temporal headache, jaw claudication, tender temporal artery, and even sudden painless monocular vision loss. The ESR is usually between 50-100. 50% of patients with giant cell arteritis also have polymyalgia rheumatica.</li><li>Giant cell arteritis should be treated with immediate steroids, long before biopsy confirms the diagnosis.</li><li>In giant cell arteritis, aortic involvement can lead to valvular disease and dissection.</li><li>Both hemophilia A and B are x-linked recessive diseases. Hemophilia A is caused by decreased synthesis of factor VIII. Hemophilia B or Christmas disease is caused by decreased synthesis of factor IX. Treatment is with specific factor replacement or if unavailable, with cryoprecipitate.</li></ul>Immune System Emergencies<ul><li>For a new mother with mastitis, she should be advised to continue nursing from the affected breast. Dicloxacillin is the antibiotic of choice.</li><li>Prophylaxis for Neisseria meningitidis should be offered to high-risk contacts, which includes household members, school contacts in the prior 7 days, and those with direct exposure to patients. The preferred antibiotic regimen for prophylaxis is two days of rifampin. Ceftriaxone and ciprofloxacin can also be used but they are slightly less effective.</li><li>Fight bites are at risk for contamination with Eikenella. Amoxicillin-clavulanate is the oral antibiotic of choice. If an IV antibiotic is required, ampicillin-sulbactam, cefoxitin, or piperacillin-tazobactam can be used.</li><li>Streptococcus pneumoniae is classically associated with rusty colored sputum, whereas Klebsiella pneumoniae is associated with currant jelly sputum. In alcoholics, Streptococcus pneumoniae is the most common bacterial cause of pneumonia, however the incidence of Klebsiella pneumoniae is higher in this population due to their increased risk of aspiration.</li><li>There are three common painless penile lesions. They are caused by Chlamydia, Klebsiella, and Treponema pallidum. Chlamydia causes LGV, which presents as a shallow ulcer. Klebsiella causes granuloma inguinale, which presents as a beefy red ulcer and a painless papule. Treponema pallidum causes syphilis, which presents as a painless chancre.</li><li>H. ducreyi causes chancroid, which typically presents with multiple painful papules that ulcerate. HSV causes genital Herpes that tends to present as tender, shallow penile lesions.</li><li>Balanitis is typically caused by a candidal infection. The treatment is with topical clotrimazole.</li><li>In the modified Centor score, give one point for tonsillar exudates, one point for tender anterior cervical adenopathy, one point for fever by history, one point for the absence of a cough, and one point for age less than 15. For an age over 45, you subtract one point. For a score of 0 or 1 points, treat supportively; for a score of 2 or 3 points, test and treat only if positive; and, lastly, for a score of 4 or 5 points, treat empirically. The mainstay of treatment is amoxicillin.</li><li>Herpes simplex virus is the most common infection associated with erythema multiforme. Hepatitis C can also be associated with erythema multiforme, but that usually occurs in the setting of active treatment with telaprevir.  </li></ul>Musculoskeletal Emergencies<ul><li>A nursemaid’s elbow can be reduced by either supination followed by elbow flexion or with hyperpronation.</li><li>NSAIDs are the first-line therapy for gout. Although there is mixed research on this, classically allopurinol is contraindicated during an acute presentation for fear of worsening the attack.</li><li>Gout is associated with negatively birefringent crystal on joint aspiration, whereas pseudogout is associated with positively birefringent crystals. Gout typically affects the first metatarsophalangeal joint, whereas pseudogout most commonly affects larger joints like the knees and ankles.</li><li>The Hill-Sachs defect is the most common complication of anterior shoulder dislocations, occurring in 40% of cases. The Hill-Sachs defect is a depression fracture of the posterolateral surface of the humeral head. Do not confuse it with a Bankart lesion, which is a fracture of the anterior aspect of the inferior glenoid rim.</li><li>The axillary nerve is the most commonly injured nerve in anterior shoulder dislocations. Its function can be tested by arm abduction and sensation over the deltoid muscle.</li></ul>Nervous System Emergencies<ul><li>Severe cases of myasthenia gravis can be treated with IVIG or plasma exchange. Although not a cure, symptoms may also be decreased by cooling. The edrophonium test can be used to make the initial diagnosis.</li><li>Polycystic kidney disease is associated with an increased incidence of subarachnoid hemorrhages.</li><li>Lyme disease is the most common cause of a bilateral Bell’s palsy.</li><li>A peripheral facial nerve palsy can be distinguished from a central one by involvement of the forehead.</li><li>VP shunt obstruction occurs proximally more frequently than distally. Proximal VP shunt obstruction occurs due to choroid plexus obstruction or increased protein within the CSF. Distal VP shunt obstruction occurs due to abdominal pseudocyst formation, which typically presents with abdominal pain due to the large size of the cyst.</li><li>A radial nerve palsy is treated supportively with a wrist splint.</li><li>A Marcus Gunn pupil is another term for a pupil with an afferent pupillary defect.</li></ul>That is it for part two. We have part three ready for release tomorrow. Let us know what you think about this review by emailing us at <a href="mailto:Roshcast@roshreview.com">Roshcast@roshreview.com</a>.Until tomorrow, Jeff and NachiThe post <a href="https://www.roshreview.com/blog/ep-17-training-exam-review-part-2-3-heent-hematology-immune-system-musculoskeletal-nervous-system/" rel="nofollow" target="_blank">Podcast Ep 17: In-Training Exam Review, Nervous System, &amp; More</a> appeared first on <a href="https://www.roshreview.com/blog" rel="nofollow" target="_blank">RoshReview.com</a>.

Ep 17 Roshcast Emergency Board Review

Welcome back to Episode 28! We are already well into intern year. Remember it is a roller coaster, with ups and downs, but in the end, you will really appreciate just how far you have come. This week we start off with a quick ophthalmology review and then dive into the new material, covering OB/GYN, pediatric dermatology, torsades de pointes, and much more. Let’s get started.Acute angle closure glaucoma classically presents with painful monocular vision loss. The pupil would be fixed and mid-dilated with a hazy cornea and perilimbic injection.Optic neuritis is characterized by central vision loss with preserved peripheral vision. Patents may also have pain with eye movement and reduced color vision.Retinal detachment is associated with painless monocular vision loss with floaters and flashing lights. The retina can appear dull and gray. Call ophthalmology immediately for any retinal detachment.  Now onto this week’s podcast.Question 1A 27-year-old woman presents with vaginal bleeding. Her last menstrual period was eight weeks ago. On physical examination, there is a small amount of blood in the vaginal vault with an open internal cervical os. Bedside ultrasound reveals an intrauterine pregnancy with a fetal pole but no heartbeat. Which of the following is the most likely diagnosis?A. Incomplete miscarriageB. Inevitable miscarriageC. Missed abortionD. Threatened miscarriageTeaching ImageQuestion 2How does the Diagnostic and Statistical Manual (DSM-V) code personality and developmental disorders?A. Axis IB. Axis IIC. Section ID. Section IIQuestion 3A 35-year-old woman with a known history of seizure disorder is actively seizing in the ED. Which of the following is the first-line medication and route to treat her seizure?A. Intramuscular fosphenytoin B. Intravenous midazolam C. Oral lorazepamD. Rectal diazepamTeaching ImageQuestion 4Which of the following statements is true regarding airway management in children?A. Adults are more susceptible to airway obstruction than children B. Children have a lower basal oxygen consumption compared to adults which results in relative protection from hypoxia and decreased need for pre-oxygenationC. The glottic opening in children is more anterior compared to that of adultsD. The vocal cords are the narrowest portion of the airway in children compared to the cricoid ring in adultsTeaching ImageQuestion 5An 11-month old male is brought in by his mother for fever, irritability, and rash. She reports that other children at his daycare have similar symptoms. You see the following on physical exam as seen above. Which of the following is true regarding this condition?A. Intravenous steroid administration is the mainstay of therapyB. It is less common in children over 6 years of ageC. Nikolsky’s sign is negativeD. The condition is uniformly fatalTeaching ImageQuestion 6A patient with palpitations presents to the ED. Her rhythm strip is seen above. Which of the following is the most appropriate initial management?A. AmiodaroneB. CardioversionC. Magnesium sulfateD. Transvenous pacing at 60-80 bpmTeaching ImageAn incomplete abortion occurs before 20 weeks when the os is open and POC are visible either in the OS or in the vaginal canal.An inevitable miscarriage presents with an open os without passage of any products of conception.A missed abortion is a broader term that describes several conditions, in which the fetus is no longer viable, but remains intrauterine with a closed OS.A threatened abortion is defined as any vaginal bleeding during pregnancy with a confirmed intrauterine pregnancy and a closed OS.DSM-V is organized by sections. The multiaxial system of DSM-IV is gone.  In DSM-V, Section 2 covers diagnostic categories and Section 3 covers conditions that need additional research.In an actively seizing patient the first priority is airway protection – roll the patient onto the left lateral decubitus position to prevent aspiration.The first line pharmacologic management for a patient in status epilepticus is a parenteral benzodiazepine.  Midazolam has the fastest onset.Second line agents for status epilepticus includes phenytoin, fosphenytoin, valproic acid, phenobarbital, or levetiracetam.Do not forget to check a finger stick and consider INH toxicity in those in status epilepticus.The glottic opening in children is more anterior to that of adults.The narrowest portion of the pediatric airway is the cricoid cartilage.  As compared to the adult airway, in the pediatric airway, the tongue is proportionally larger and the epiglottis is longer and narrower.Staph scalded skin syndrome most commonly affects those under 2 years of age, and it rarely occurs in those over 6 years of age.Staph scalded skin syndrome is treated with IV fluids, aggressive wound management, and an anti-staphylococcal antibiotic.Torsades de pointes is associated with a prolonged QT interval, hypomagnesemia, and hypokalemia.Torsades de pointes is treated with intravenous magnesium.  That wraps up Episode 28. From psychiatry to obstetric emergencies to pediatric dermatology, we have covered the entire spectrum of emergency medicine this week. Hope you all enjoyed. Do not forget to listen for the trauma phone ring tone in the coming weeks for a chance to win a Rosh Review Subscription. Remember to tweet us @Roshcast or email us at Roshcast@roshreview.com the exact time you hear the ring to win the prize.Until next time,Jeff and NachiThe post Podcast Ep 28: Vaginal Bleeding, DSM-V, &amp; More appeared first on RoshReview.com.

<h6>Welcome back to Episode 28! We are already well into intern year. Remember it is a roller coaster, with ups and downs, but in the end, you will really appreciate just how far you have come. This week we start off with a quick ophthalmology review and then dive into the new material, covering OB/GYN, pediatric dermatology, torsades de pointes, and much more. Let’s get started.</h6><ul><li>Acute angle closure glaucoma classically presents with painful monocular vision loss. The pupil would be fixed and mid-dilated with a hazy cornea and perilimbic injection.</li><li>Optic neuritis is characterized by central vision loss with preserved peripheral vision. Patents may also have pain with eye movement and reduced color vision.</li><li>Retinal detachment is associated with painless monocular vision loss with floaters and flashing lights. The retina can appear dull and gray. Call ophthalmology immediately for any retinal detachment. <ul></ul> </li></ul>Now onto this week’s podcast.Question 1A 27-year-old woman presents with vaginal bleeding. Her last menstrual period was eight weeks ago. On physical examination, there is a small amount of blood in the vaginal vault with an open internal cervical os. Bedside ultrasound reveals an intrauterine pregnancy with a fetal pole but no heartbeat. Which of the following is the most likely diagnosis?A. Incomplete miscarriageB. Inevitable miscarriageC. Missed abortionD. Threatened miscarriage<a href="https://www.roshreview.com/wp-content/uploads/Table-Spontaneous-abortion-threatened-abortion-inevitable-abortion-incomplete-abortion-complete-abortion-septic-abortion.png" rel="nofollow" target="_blank">Teaching Image</a>Question 2How does the Diagnostic and Statistical Manual (DSM-V) code personality and developmental disorders?A. Axis IB. Axis IIC. Section ID. Section IIQuestion 3A 35-year-old woman with a known history of seizure disorder is actively seizing in the ED. Which of the following is the first-line medication and route to treat her seizure?A. Intramuscular fosphenytoin B. Intravenous midazolam C. Oral lorazepamD. Rectal diazepam<a href="https://www.roshreview.com/wp-content/uploads/Ep28-Medications-For-Status-Epilipticus.png" rel="nofollow" target="_blank">Teaching Image</a>Question 4Which of the following statements is true regarding airway management in children?A. Adults are more susceptible to airway obstruction than children B. Children have a lower basal oxygen consumption compared to adults which results in relative protection from hypoxia and decreased need for pre-oxygenationC. The glottic opening in children is more anterior compared to that of adultsD. The vocal cords are the narrowest portion of the airway in children compared to the cricoid ring in adults<a href="https://www.roshreview.com/wp-content/uploads/Ep28-Anatomical-Differences-Between-Pediatric-And-Adult-Airways.png" rel="nofollow" target="_blank">Teaching Image</a>Question 5An 11-month old male is brought in by his mother for fever, irritability, and rash. She reports that other children at his daycare have similar symptoms. You see the following on physical exam as seen above. Which of the following is true regarding this condition?A. Intravenous steroid administration is the mainstay of therapyB. It is less common in children over 6 years of ageC. Nikolsky’s sign is negativeD. The condition is uniformly fatal<a href="https://www.roshreview.com/wp-content/uploads/Image-Staphylococcal-Scalded-Skin-Syndrome-SSSS-copy-1.png" rel="nofollow" target="_blank">Teaching Image</a>Question 6A patient with palpitations presents to the ED. Her rhythm strip is seen above. Which of the following is the most appropriate initial management?A. AmiodaroneB. CardioversionC. Magnesium sulfateD. Transvenous pacing at 60-80 bpm<a href="https://www.roshreview.com/wp-content/uploads/Ep28-Torsades-de-Pointes.png" rel="nofollow" target="_blank">Teaching Image</a><ul><li>An incomplete abortion occurs before 20 weeks when the os is open and POC are visible either in the OS or in the vaginal canal.</li><li>An inevitable miscarriage presents with an open os without passage of any products of conception.</li><li>A missed abortion is a broader term that describes several conditions, in which the fetus is no longer viable, but remains intrauterine with a closed OS.</li><li>A threatened abortion is defined as any vaginal bleeding during pregnancy with a confirmed intrauterine pregnancy and a closed OS.</li><li>DSM-V is organized by sections. The multiaxial system of DSM-IV is gone.  In DSM-V, Section 2 covers diagnostic categories and Section 3 covers conditions that need additional research.</li><li>In an actively seizing patient the first priority is airway protection – roll the patient onto the left lateral decubitus position to prevent aspiration.</li><li>The first line pharmacologic management for a patient in status epilepticus is a parenteral benzodiazepine.  Midazolam has the fastest onset.</li><li>Second line agents for status epilepticus includes phenytoin, fosphenytoin, valproic acid, phenobarbital, or levetiracetam.</li><li>Do not forget to check a finger stick and consider INH toxicity in those in status epilepticus.</li><li>The glottic opening in children is more anterior to that of adults.</li><li>The narrowest portion of the pediatric airway is the cricoid cartilage.  </li><li>As compared to the adult airway, in the pediatric airway, the tongue is proportionally larger and the epiglottis is longer and narrower.</li><li>Staph scalded skin syndrome most commonly affects those under 2 years of age, and it rarely occurs in those over 6 years of age.</li><li>Staph scalded skin syndrome is treated with IV fluids, aggressive wound management, and an anti-staphylococcal antibiotic.</li><li>Torsades de pointes is associated with a prolonged QT interval, hypomagnesemia, and hypokalemia.</li><li>Torsades de pointes is treated with intravenous magnesium.  </li></ul>That wraps up Episode 28. From psychiatry to obstetric emergencies to pediatric dermatology, we have covered the entire spectrum of emergency medicine this week. Hope you all enjoyed. Do not forget to listen for the trauma phone ring tone in the coming weeks for a chance to win a Rosh Review Subscription. Remember to tweet us <a href="twitter.com/roshcast" rel="nofollow" target="_blank">@Roshcast</a> or email us at <a href="mailto:Roshcast@roshreview.com">Roshcast@roshreview.com</a> the exact time you hear the ring to win the prize.Until next time, Jeff and NachiThe post <a href="https://www.roshreview.com/blog/ep-28-vaginal-bleeding-dsm-v-statius-epilepticus-pediatric-airway-staph-scalded-skin-syndrome-torsades-de-pointes/" rel="nofollow" target="_blank">Podcast Ep 28: Vaginal Bleeding, DSM-V, &amp; More</a> appeared first on <a href="https://www.roshreview.com/blog" rel="nofollow" target="_blank">RoshReview.com</a>.

Ep 28 Roshcast Emergency Board Review

If you set your goals ridiculously high and it’s a failure, you will fail above everyone else’s success.  -James CameronWelcome back to Episode 11! Hope you all had a fantastic holiday and New Year’s break. With the In-Training Exam (ITE) just a few months away, it is time to kick the studying into high gear! We changed the brief initial Rapid Review to cover topics from all prior episodes for better spaced repetition. In this episode, we go over important mnemonics. Consider pausing the podcast briefly and quizzing yourself as you are listening. Do not forget to check out the blog for the other episodes as well as a few new Rosh Quizzes. Lastly, learn some tricks from the high-scoring test-taker Ryan Ribeira, MD.For acute lithium ingestions, a concentration of 4 mEq/L or greater requires emergent dialysis. In chronic lithium ingestions, a level of greater than 2.5 mEq/L requires emergent dialysis. Additionally, any patient with neurologic findings secondary to the ingestion requires treatment.Lead poisoning is treated with either succimer or IV EDTA. Remember the mnemonic “it sucks to eat lead.”For wide complex tachydysrhythmia in a patient presenting with an amphetamine overdose, you should administer sodium bicarbonate. Do not forget to address the agitation with benzodiazepines and the hyperthermia with cooling, which will also help control symptoms.Now onto this week’s podcastQuestion 1An 88-year-old man with Parkinson’s disease presents confused. He is using a rivastigmine patch as part of his therapy but has mistakenly put on five patches. What physical examination finding would you expect to see in this patient?A. Constipation B. Dry skinC. LacrimationD. MydriasisTeaching imageTeaching imageQuestion 2What is the most common cause of superior vena cava syndrome?A. GoiterB. Indwelling central venous catheterC. MalignancyD. ThrombosisTeaching imageQuestion 3A pH of 7.1, HCO3 of 15 and PCO2 of 30 is best described by which of the following primary acid-base disorders?A. Metabolic acidosisB. Metabolic alkalosisC. Respiratory acidosisD. Respiratory alkalosisTeaching imageQuestion 4Which of the following is true in the post-cardiac arrest patient who experiences a return of spontaneous circulation (ROSC)?A. Antiplatelet and anticoagulant therapy should be avoided in post-arrest patients B. Post arrest angioplasty or stenting of acute coronary lesions with a normal ECG has been shown to be an independent predictor of survival after cardiac arrestC. Post arrest prophylactic antiarrhythmic therapy has been shown to reduce adverse eventsD. There is no proven benefit to therapeutic hypothermiaQuestion 5A mother delivered a full-term boy in the ED about 30 minutes ago. On exam, he has cyanosis of the distal extremities, as seen above. His mucous membranes and trunk are pink, and he has +2 distal pulses. No murmurs are heard. His remaining physical exam was normal. Which of the following is most likely his pulse oximetry reading?A. 64–73%B. 74–83%C. 84–93%D. 94–100%Teaching imageQuestion 6A 53-year-old man presents to the emergency department with vomiting, diarrhea, and abdominal cramping which occurred 1 hour after eating a meal prepared from mushrooms he found growing in the forest. Which of the following most predicts a benign course of disease?A. Absence of neurologic symptomsB. Dots or scales on the cap of the mushroomC. Normal serum liver function tests on initial presentationD. Symptoms occurring within 2 hours of ingestionTeaching imageTeaching imageThe cholinergic toxidrome is marked by salivation, lacrimation, urination, defecation, GI upset, and emesis. The most deadly symptoms can be remembered by the killer “B”s: bronchorrhea, bronchospasm, and bradycardia.The anticholinergic toxidrome is marked by hyperthermia, mydriasis, dry mouth, urinary retention, and confusion.Bronchogenic carcinoma, small cell lung cancer, squamous cell lung cancer, and lymphoma are all common malignancies that can cause SVC syndrome.Dyspnea is the most common presenting symptom of SVC syndrome.In a metabolic acidosis, you can use Winters’ Formula, which dictates that the pCO2 should be 1.5 times the bicarbonate +8 +/- 2 for appropriate respiratory compensation.The mnemonic MUDPILES can be used to remember many of the common causes of anion gap metabolic acidosis: Methanol, Uremia, DKA, Propylene glycol, Iron or INH, Lactic acidosis, Ethylene glycol, and Salicylates.For the causes of non-anion gap metabolic acidosis remember HARDASS: Hyperalimentation, Addison’s disease, RTA, Diarrhea, Acetazolamide, Spironolactones, and Saline infusion.In patients with post-cardiac arrest ROSC, cardiac catheterization should be considered even in the setting of a normal EKG.In cardiac arrest, Automated External Defibrillator (AED) use, early bystander CPR, Amiodarone in shock-resistant ventricular tachycardia or ventricular fibrillation, and therapeutic hypothermia are all proven interventions to improve outcomes.Acrocyanosis is a transient blue discoloration of the hands and feet, which can occur when a newborn is cold. Typically the pulse oximetry reading is normal.Amanita mushrooms produce a deadly renal and hepatic toxin: the amatoxin.Amatoxin poisoning leads to 4 stages of symptoms culminating in liver failure. Mortality is commonly cited as 10-30%.  Activated charcoal and hemoperfusion can be considered.The Amanita genus of mushrooms can be identified by dots or scales on their cap.From Post-ROSC cardiac care to toxic mushroom ingestion, this concludes episode 11. Let us know how to make this even better by sending Please send feedback to Roshcast@roshreview.com — we want to hear your feedback to keep improving this podcast. Do not forget to check out the high-yield questions and explanations in the Rosh Review Emergency Medicine Qbank. Until next time,Jeff and NachiP.S. If you missed last week’s episode on spider bites, you can catch up here:The post Podcast Ep 11: SVC Syndrome, Metabolic Acidosis, ROSC, &amp; More appeared first on RoshReview.com.

<blockquote>If you set your goals ridiculously high and it’s a failure, you will fail above everyone else’s success.  -James Cameron</blockquote><h6>Welcome back to Episode 11! Hope you all had a fantastic holiday and New Year’s break. With the In-Training Exam (ITE) just a few months away, it is time to kick the studying into high gear! </h6>We changed the brief initial Rapid Review to cover topics from all prior episodes for better spaced repetition. In this episode, we go over important mnemonics. Consider pausing the podcast briefly and quizzing yourself as you are listening. Do not forget to check out the blog for the <a href="https://www.roshreview.com/category/podcasts/" rel="noreferrer noopener nofollow" target="_blank">other episodes</a> as well as a few new <a href="https://www.roshreview.com/tag/rosh-quiz/" rel="noreferrer noopener nofollow" target="_blank">Rosh Quizzes</a>. Lastly, learn some tricks from the <a href="https://www.roshreview.com/blog/elite-test-taker-profile-ryan-ribeira-m-d-m-p-h/" rel="noreferrer noopener nofollow" target="_blank">high-scoring test-taker</a> Ryan Ribeira, MD.<ul><li>For acute lithium ingestions, a concentration of 4 mEq/L or greater requires emergent dialysis. In chronic lithium ingestions, a level of greater than 2.5 mEq/L requires emergent dialysis. Additionally, any patient with neurologic findings secondary to the ingestion requires treatment.</li><li>Lead poisoning is treated with either succimer or IV EDTA. Remember the mnemonic “it sucks to eat lead.”</li><li>For wide complex tachydysrhythmia in a patient presenting with an amphetamine overdose, you should administer sodium bicarbonate. Do not forget to address the agitation with benzodiazepines and the hyperthermia with cooling, which will also help control symptoms.</li></ul>Now onto this week’s podcastQuestion 1An 88-year-old man with Parkinson’s disease presents confused. He is using a rivastigmine patch as part of his therapy but has mistakenly put on five patches. What physical examination finding would you expect to see in this patient?A. Constipation B. Dry skinC. LacrimationD. Mydriasis<a href="https://www.roshreview.com/wp-content/uploads/Image-Organophosphate-toxitiy-SLUDGE-DUMBELLS-CHOLINERGIC-toxicity-1.jpg" rel="noreferrer noopener nofollow" target="_blank">Teaching image</a><a href="https://www.roshreview.com/wp-content/uploads/Image-Anticholinergic-toxidrome-1.jpg" rel="noreferrer noopener nofollow" target="_blank">Teaching image</a>Question 2What is the most common cause of superior vena cava syndrome?A. GoiterB. Indwelling central venous catheterC. MalignancyD. Thrombosis<a href="https://www.roshreview.com/wp-content/uploads/Image-Superior-Vena-cava-Syndrome-SVC-syndrome.png" rel="noreferrer noopener nofollow" target="_blank">Teaching image</a>Question 3A pH of 7.1, HCO3 of 15 and PCO2 of 30 is best described by which of the following primary acid-base disorders?A. Metabolic acidosisB. Metabolic alkalosisC. Respiratory acidosisD. Respiratory alkalosis<a href="https://www.roshreview.com/wp-content/uploads/Image-Metabolic-acidosis-Winters-formula-Delta-gap.png" rel="noreferrer noopener nofollow" target="_blank">Teaching image</a>Question 4Which of the following is true in the post-cardiac arrest patient who experiences a return of spontaneous circulation (ROSC)?A. Antiplatelet and anticoagulant therapy should be avoided in post-arrest patients B. Post arrest angioplasty or stenting of acute coronary lesions with a normal ECG has been shown to be an independent predictor of survival after cardiac arrestC. Post arrest prophylactic antiarrhythmic therapy has been shown to reduce adverse eventsD. There is no proven benefit to therapeutic hypothermiaQuestion 5A mother delivered a full-term boy in the ED about 30 minutes ago. On exam, he has cyanosis of the distal extremities, as seen above. His mucous membranes and trunk are pink, and he has +2 distal pulses. No murmurs are heard. His remaining physical exam was normal. Which of the following is most likely his pulse oximetry reading?A. 64–73%B. 74–83%C. 84–93%D. 94–100%<a href="https://www.roshreview.com/wp-content/uploads/Image-Acrocyanosis2.jpg" rel="noreferrer noopener nofollow" target="_blank">Teaching image</a>Question 6A 53-year-old man presents to the emergency department with vomiting, diarrhea, and abdominal cramping which occurred 1 hour after eating a meal prepared from mushrooms he found growing in the forest. Which of the following most predicts a benign course of disease?A. Absence of neurologic symptomsB. Dots or scales on the cap of the mushroomC. Normal serum liver function tests on initial presentationD. Symptoms occurring within 2 hours of ingestion<a href="https://www.roshreview.com/wp-content/uploads/Image-Aminita-phalloides-Mushroom.jpg" rel="noreferrer noopener nofollow" target="_blank">Teaching image</a><a href="https://www.roshreview.com/wp-content/uploads/Table-Selected-mushrooms.jpg" rel="noreferrer noopener nofollow" target="_blank">Teaching image</a><ul><li>The <a href="/tag/cholinergic-toxidrome" rel="noreferrer noopener nofollow" target="_blank">cholinergic toxidrome</a> is marked by <a href="/tag/salivation" rel="noreferrer noopener nofollow" target="_blank">salivation</a>, <a href="/tag/lacrimation" rel="noreferrer noopener nofollow" target="_blank">lacrimation</a>, <a href="/tag/urination" rel="noreferrer noopener nofollow" target="_blank">urination</a>, <a href="/tag/defecation" rel="noreferrer noopener nofollow" target="_blank">defecation</a>, <a href="/tag/gi-upset" rel="noreferrer noopener nofollow" target="_blank">GI</a><a href="/tag/gi-upset" rel="noreferrer noopener nofollow" target="_blank"> </a><a href="/tag/gi-upset" rel="noreferrer noopener nofollow" target="_blank">upset</a>, and <a href="/tag/emesis" rel="noreferrer noopener nofollow" target="_blank">emesis</a>. The most deadly symptoms can be remembered by the killer “B”s: <a href="/tag/bronchorrhea" rel="noreferrer noopener nofollow" target="_blank">bronchorrhea</a>, <a href="/tag/bronchospasm" rel="noreferrer noopener nofollow" target="_blank">bronchospasm</a>, and<a href="/tag/bradycardia" rel="noreferrer noopener nofollow" target="_blank"> bradycardia</a>.</li><li>The <a href="/tag/anticholinergic-toxidrome" rel="noreferrer noopener nofollow" target="_blank">anticholinergic toxidrome</a> is marked by <a href="/tag/hyperthermia" rel="noreferrer noopener nofollow" target="_blank">hyperthermia</a>, <a href="/tag/mydriasis" rel="noreferrer noopener nofollow" target="_blank">mydriasis</a>, <a href="/tag/dry-mouth" rel="noreferrer noopener nofollow" target="_blank">dry mouth</a>, <a href="/tag/urinary-retention" rel="noreferrer noopener nofollow" target="_blank">urinary</a><a href="/tag/urinary-retention" rel="noreferrer noopener nofollow" target="_blank"> </a><a href="/tag/urinary-retention" rel="noreferrer noopener nofollow" target="_blank">retention</a>, and <a href="/tag/confusion" rel="noreferrer noopener nofollow" target="_blank">confusion</a>.</li><li>Bronchogenic carcinoma, small cell lung cancer, squamous cell lung cancer, and lymphoma are all common malignancies that can cause <a href="/tag/svc-syndrome" rel="noreferrer noopener nofollow" target="_blank">SVC syndrome</a>.</li><li><a href="/tag/dyspnea" rel="noreferrer noopener nofollow" target="_blank">Dyspnea</a> is the most common presenting symptom of <a href="/tag/svc-syndrome" rel="noreferrer noopener nofollow" target="_blank">SVC syndrome</a>.</li><li>In a <a href="/tag/metabolic-acidosis" rel="noreferrer noopener nofollow" target="_blank">metabolic acidosis</a>, you can use Winters’ Formula, which dictates that the pCO2 should be 1.5 times the bicarbonate +8 +/- 2 for appropriate respiratory compensation.</li><li>The mnemonic <a href="/tag/mudpiles" rel="noreferrer noopener nofollow" target="_blank">MUDPILES</a> can be used to remember many of the common causes of anion gap metabolic acidosis: Methanol, Uremia, DKA, Propylene glycol, Iron or INH, Lactic acidosis, Ethylene glycol, and Salicylates.</li><li>For the causes of <a href="/tag/non-anion-gap-metabolic-acidosis" rel="noreferrer noopener nofollow" target="_blank">non-anion gap metabolic acidosis</a> remember HARDASS: Hyperalimentation, Addison’s disease, RTA, Diarrhea, Acetazolamide, Spironolactones, and Saline infusion.</li><li>In patients with <a href="/tag/post-cardiac-arrest-ROSC" rel="noreferrer noopener nofollow" target="_blank">post-cardiac arrest ROSC</a>, <a href="/tag/cardiac-catheterization" rel="noreferrer noopener nofollow" target="_blank">cardiac catheterization</a> should be considered even in the setting of a normal EKG.</li><li>In <a href="/tag/cardiac-arrest" rel="noreferrer noopener nofollow" target="_blank">cardiac arrest</a>, Automated External Defibrillator (AED) use, early bystander CPR, Amiodarone in shock-resistant ventricular tachycardia or ventricular fibrillation, and therapeutic hypothermia are all proven interventions to improve outcomes.</li><li><a href="/tag/acrocyanosis%20" rel="noreferrer noopener nofollow" target="_blank">Acrocyanosis</a><a href="/tag/acrocyanosis%20" rel="noreferrer noopener nofollow" target="_blank"> </a>is a transient blue discoloration of the hands and feet, which can occur when a newborn is cold. Typically the pulse oximetry reading is normal.</li><li><a href="/tag/amanita-mushrooms" rel="noreferrer noopener nofollow" target="_blank">Amanita mushrooms</a> produce a deadly renal and hepatic toxin: the amatoxin.</li><li><a href="/tag/amatoxin-poisoning" rel="noreferrer noopener nofollow" target="_blank">Amatoxin poisoning</a> leads to 4 stages of symptoms culminating in liver failure. Mortality is commonly cited as 10-30%.  Activated charcoal and hemoperfusion can be considered.</li><li>The<a href="/tag/amanita-genus" rel="noreferrer noopener nofollow" target="_blank"> </a><a href="/tag/amanita-genus" rel="noreferrer noopener nofollow" target="_blank">Amanita genus</a> of mushrooms can be identified by dots or scales on their cap.</li></ul>From Post-ROSC cardiac care to toxic mushroom ingestion, this concludes episode 11. Let us know how to make this even better by sending Please send feedback to <a href="mailto:Roshcast@roshreview.com">Roshcast@roshreview.com</a> — we want to hear your feedback to keep improving this podcast. Do not forget to check out the high-yield questions and explanations in the <a href="https://www.roshreview.com/specialties/emergency-medicine/" rel="noreferrer noopener nofollow" target="_blank">Rosh Review Emergency Medicine Qbank</a>. Until next time, Jeff and NachiP.S. If you missed last week’s episode on spider bites, you can catch up here:The post <a href="https://www.roshreview.com/blog/ep-11-cholinergic-toxidrome-svc-syndrome-metabolic-acidosis-rosc-acrocyanosis-mushroom-poisoning/" rel="nofollow" target="_blank">Podcast Ep 11: SVC Syndrome, Metabolic Acidosis, ROSC, &amp; More</a> appeared first on <a href="https://www.roshreview.com/blog" rel="nofollow" target="_blank">RoshReview.com</a>.

Ep 11 Roshcast Emergency Board Review

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