Transcript Document

Emergency Medicine
Jeopardy
Dr. Kelly Kasteel
What’s in Hodgea Name Podge
Handy
Tips
Rashes
Bones
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Finish
Rashes
Bones
What’s
in a
Name
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HodgePodge
Handy
Tips
Rashes $100
• A 24 year old male presents with an
itchy rash to his arms
Rashes $100
• Questions?
Rashes $100
• Allergic contact dermatitis
• Toxicodendron species (poison ivy)
Poison Ivy
• Susceptible individuals
• Type IV allergic reaction
• Urushiol containing compounds (also
mango skin, unroasted cashew
nutshells)
Poison Ivy
• Treatment?
– Decontamination
– Symptomatic
– Steroids?
Rashes $200
• A 34 year old female presents with
lesions to her legs
Rashes $200
• Questions?
Rashes $200
• Erythema nodosum
• Painful nodules most commonly to shins
• Prodromal “flu-like” symptoms +/arthralgias
Causes of Erythema
Nodosum?
• Infectious
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Strep
Staph
TB
Fungal
(coccidiomycosis)
• Drugs
– OCP
– Sulfonamides
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Pregnancy
Hodgkin’s, NHL
Sarcoid
IBD
Behcet’s
Treatment?
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Symptomatic
NSAIDS
Colchicine
Potassium iodide (mechanism
unknown)
• Underlying cause
Rashes $300
• What can cause the following skin
changes?
Rashes $300
Rashes $300
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Nikolsky’s sign
Causes?
Erythema multiforme major (SJS)
Staph scalded skin syndrome (SSSS)
Toxic Epidermal Necrolysis (TEN)
Toxic Shock Syndrome
Bullous pemphigus
Burns
Rashes $300
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Treatment?
Burn unit
Fluid resuscitation
Infection potential
Rash $400
• A 28 year old male
presents with a nonpruritic rash to his
torso that over time
spreads to his
extremities:
Rash $400
• Questions?
Kaposi’s Sarcoma
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Cause: HHV-8
Initial presentation: cutaneous
Tumour cells --> spindle cells
Can spread to mucous membranes,
internal organs
• AIDS defining illness
Rashes $500
• A 48 year old gentleman presents with a
painful red face
Rashes $500
• Questions?
How to differentiate cellulitis
from erysipelas?
• Cellulitis
• More indiscreet
margins
• Erysipelas
• Sharply demarcated
borders
• Fiery red, indurated
• Lymphatic
involvement
• “St. Anthony’s Fire”
Cause of erysipelas?
• Group A Strep
Bones $100
• A 17 year old female involved in an
MVC complains of neck pain
Bones $100
Bones $100
• Clay shoveler’s fracture
• Mechanism?
– Forced hyperflexion
• Stable or unstable?
– Stable
• Treatment?
– Symptomatic
Bones $200
• Two patients injured their thumbs:
Patient 1
Patient 2
Thumb fractures
• Rolando:
• Comminuted fracture
/ dislocation base of
1st MCP
• Usually three main
fragments: “Y”
shaped
• Less common;
poorer prognosis
• Bennett:
• Intrarticular fracture
base of 1st MCP
• Most common of all
thumb fractures
Bones $300
• A 40 year old female tripped and fell
when she stepped into a gopher hole
while running and now has pain to her
foot:
Bones $300
Bones $300
• Lisfranc injury
• Normal alignment:
• PA view:
– Medial edge of 2nd metarsal should align
with 2nd cuneiform
• Oblique view:
– Medial edge of 3rd metatarsal should align
with 3rd cuneiform
Bones $400
• A 12 year old boy injured his leg after
sliding into base during a ball game:
Bones $400
Bones $400
• Tillaux fracture
• Salter-Harris Type
III; adolescents
• Mechanism:
• External rotation
injury of the foot in a
• Anterior tibiofibular
ligament intact:
avulsion of
epiphysis
Bones $500
• A 25 year old female fell onto her knee:
Bones $500
Bones $500
Bones $500
• Patellar fracture
• Treatment?
Patellar Fracture
• Non-surgical
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Undisplaced
Vertical
Peripheral
No step-off
• Surgical
– Displaced
– Horizontal
What’s in a Name $100
• Hearing Loss
• Tinnitus
• Vertigo
What’s in a Name $100
• Meniere’s
disease
Meniere
• Prosper Meniere (1799-1862)
• French otologist
What’s in a Name $200
• Bobbing of head in time with arterial
pulse, seen in aortic insufficiency
What’s in a Name $200
• Musset’s sign
Musset
• Described by author Paul de Musset
• His brother Alfred suffered from “aorta
failure” -->Musset noted that when he
put his finger on his brother’s carotid his
head stopped bobbing
Bonus Question $200
• Capillary pulsation of nailbed seen in
aortic insufficiency
• Quincke’s capillary pulse
What’s in a Name $300
• Fever, RUQ pain, jaundice
What’s in a Name $300
• Charcot’s triad
• Ascending cholangitis
• Combined with CNS changes and
hypotension --> Reynaud’s pentad
Charcot’s Triad
• Jean Martin Charcot, french neurologist
(1825-1893)
Bonus Question $300
• Charcot is credited with two separate
“triads” of clinical signs relating to two
different diseases
• Charcot triad II = ascending cholangitis
• What is Charcot Triad I ?
Charcot Triad I
• Nystagmus, intention tremor, staccato
speech
• Suggestive of multiple sclerosis
What’s in a Name $400
• Clenched fist by patient to describe
chest pain
What’s in a Name $400
• Levine’s sign
Levine
• Dr. Sam Levine
• Pioneering American cardiologist
• Served in WWI at British Military Heart
Hospital with William Osler
Bonus Question $400
• Name another cardiac related syndrome
which Levine is associated with
• Lown-Ganong-Levine
• Class of pre-excitation syndromes
associated with a short PR
What’s in a Name $500
• Dullness to percussion over scapula
caused by pericardial effusion
What’s in a Name $500
• Ewart’s sign
Ewart
• William Ewart (1849-1929)
• English physician trained in England
and France
• Worked in a field hospital during
Franco-Prussian War
Hodgepodge $100
• A child steps on a nail in sneakered feet
• Concerns?
Hodgepodge $100
• Sneakers = pseudomonas
Hodgepodge $100
• Pitfalls:
– Exploration of wound
– Prophylactic antibiotics
Hodgepodge $200
• A 23 year old female complains of
pleuritic chest pain
Hodgepodge $200
Hodgepodge $200
• Hampton’s hump LLL
• Pulmonary infarct --> pulmonary
embolism
• Usually wedge shaped in lung
peripherally
Hodgepodge $300
• Give a differential diagnosis for a
DECREASED anion gap
Hodgepodge $300
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Hyponatremia
Low serum albumin
Ocult neoplasm --> multiple myeloma
Hyperchloremic acidosis
Lithium toxicity (sodium effect)
Kidney disease (unmeasured cations)
Hodgepodge $400
• What’s wrong with the following X-ray?
Hodgepodge $400
• Gastric bubble deviated medially
• Enlarged spleen (in trauma, splenic
hematoma)
Hodgepodge $500
• A gentleman
presents with the
following:
• Questions?
• Differential
Diagnosis?
Genital Ulcers
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Chancroid
Herpes
Syphilis
Behcet’s
Other:
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Lymphogranuloma venereum (LGV)
Granuloma inguinale (GI)
Drug eruption
Systemic/dermatologic
Chancroid
• Pathogen:
– Hemophilus ducreyi
• Treatment:
– Azithromycin, ceftriaxone, ciprofloxacin
Handy Tips $100
• A 22 year old male
complains of a very
sore throat for the
last three days
Peritonsillar Abscess
• Tips for draining?
Handy Tips $200
• While minding his
own business, this
patient broke a tooth
which is now very
painful:
Fractured Tooth
• Ellis I: enamel
• Ellis II: dentin
• Ellis III: pulp
Treatment
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Dentist
Analgesia
Antibiotics
Protective barrier: Chewing gum?
Handy Tips $300
• How would you
repair this
laceration?
Skin Glue
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Advantages glue vs sutures
Contraindications
How not to get stuck to the patient
How not to glue the kid’s eye shut
Handy tips $400
• A RN accidentally
injected herself with
epinephrine in her
thumb
• The thumb is cool
and pale
• How would you treat
it?
Phentolamine
• Alpha antagonist
• Management of adrenaline induced digital ischemia in children
after accidental injection from an Epipen Emerg Med J
2004;21:387-388
How to use phentolamine
• Dilute 1.5 mg of phentolamine mesilate
(vials contain 10mg/cc) = 0.15 cc in 1 cc
of 2% lidocaine
• Inject subcutaneously into the site and
stop when skin becomes pink
Handy tips $500
• A 50 year old man
has very painful
burning sensation to
hands after working
with a rust remover:
Hydrofluoric Acid Burns
• Treatment?
• Calcium Gluconate
• How to administer?
• 1 amp= 10% Ca gluconate= 10 cc
• Reference: E-medicine
Calcium Gluconate
• Gel: Mix one amp
with one ounce of
surgical gel (10
packets of muco)
• Nebules: Mix one
amp with 30 cc NS
to form a 2.5%
solution
• IV Calcium: one amp
+ 5000 units heparin
diluted in 40 cc D5W;
use a Bier block
• Intra-arterial calcium:
Mix one amp with 40
cc D5W; infuse over a
4 hour period
Questions?
Online Resources
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ECGs: medstat.med.utah.edu/kw/ecg/image_index
X-rays: www.rad.washington.edu/teachingfiles.html
Eye cases: icarus.med.utoronto.ca
Trauma pics: trauma.org/imagebank
Derm pics: dermis.net
Medical pictures: www.mic.ki.se/MEDIMAGES.html
Eponyms: www.whonamedit.com
Online teaching: www.mdchoice.com