Emergency Medicine Jeopardy

1
Emergency Medicine Jeopardy

• Dr. Kelly Kasteel

2
Rashes Bones Whats in a Name Hodge- Podge Handy Tips
100 100 100 100 100
200 200 200 200 200
300 300 300 300 300
400 400 400 400 400
500 500 500 500 500
Finish
3
Rashes Bones Whats in a Name Hodge- Podge Handy Tips
100 100 100 100 100
200 200 200 200 200
300 300 300 300 300
400 400 400 400 400
500 500 500 500 500
4
Rashes 100

• A 24 year old male presents with an itchy rash to
  his arms

5
Rashes 100

• Questions?

6
Rashes 100

• Allergic contact dermatitis
• Toxicodendron species (poison ivy)

7
Poison Ivy

• Susceptible individuals
• Type IV allergic reaction
• Urushiol containing compounds (also mango skin,
  unroasted cashew nutshells)

8
Poison Ivy

• Treatment?
• Decontamination
• Symptomatic
• Steroids?

9
Rashes 200

• A 34 year old female presents with lesions to her
  legs

10
Rashes 200

• Questions?

11
Rashes 200

• Erythema nodosum
• Painful nodules most commonly to shins
• Prodromal flu-like symptoms /- arthralgias

12
Causes of Erythema Nodosum?

• Infectious
• Strep
• Staph
• TB
• Fungal (coccidiomycosis)
• Drugs
• OCP
• Sulfonamides

• Pregnancy
• Hodgkins, NHL
• Sarcoid
• IBD
• Behcets

13
Treatment?

• Symptomatic
• NSAIDS
• Colchicine
• Potassium iodide (mechanism unknown)
• Underlying cause

14
Rashes 300

• What can cause the following skin changes?

15
Rashes 300
16
Rashes 300

• Nikolskys sign
• Causes?
• Erythema multiforme major (SJS)
• Staph scalded skin syndrome (SSSS)
• Toxic Epidermal Necrolysis (TEN)
• Toxic Shock Syndrome
• Bullous pemphigus
• Burns

17
Rashes 300

• Treatment?
• Burn unit
• Fluid resuscitation
• Infection potential

18
Rash 400

• A 28 year old male presents with a non-pruritic
  rash to his torso that over time spreads to his
  extremities

19
Rash 400

• Questions?

20
Kaposis Sarcoma

• Cause HHV-8
• Initial presentation cutaneous
• Tumour cells --gt spindle cells
• Can spread to mucous membranes, internal organs
• AIDS defining illness

21
Rashes 500

• A 48 year old gentleman presents with a painful
  red face

22
Rashes 500

• Questions?

23
How to differentiate cellulitis from erysipelas?

• Cellulitis
• More indiscreet margins

• Erysipelas
• Sharply demarcated borders
• Fiery red, indurated
• Lymphatic involvement
• St. Anthonys Fire

24
Cause of erysipelas?

• Group A Strep

25
Bones 100

• A 17 year old female involved in an MVC complains
  of neck pain

26
Bones 100
27
Bones 100

• Clay shovelers fracture
• Mechanism?
• Forced hyperflexion
• Stable or unstable?
• Stable
• Treatment?
• Symptomatic

28
Bones 200

• Two patients injured their thumbs

29
Patient 1
30
Patient 2
31
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

32
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

33
Bones 300
34
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

35
Bones 400

• A 12 year old boy injured his leg after sliding
  into base during a ball game

36
Bones 400
37
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

38
Bones 500

• A 25 year old female fell onto her knee

39
Bones 500
40
Bones 500
41
Bones 500

• Patellar fracture
• Treatment?

42
Patellar Fracture

• Non-surgical
• Undisplaced
• Vertical
• Peripheral
• No step-off

• Surgical
• Displaced
• Horizontal

43
Whats in a Name 100

• Hearing Loss
• Tinnitus
• Vertigo

44
Whats in a Name 100

• Menieres
• disease

45
Meniere

• Prosper Meniere (1799-1862)
• French otologist

46
Whats in a Name 200

• Bobbing of head in time with arterial pulse, seen
  in aortic insufficiency

47
Whats in a Name 200

• Mussets sign

48
Musset

• Described by author Paul de Musset
• His brother Alfred suffered from aorta failure
  --gtMusset noted that when he put his finger on
  his brothers carotid his head stopped bobbing

49
Bonus Question 200

• Capillary pulsation of nailbed seen in aortic
  insufficiency
• Quinckes capillary pulse

50
Whats in a Name 300

• Fever, RUQ pain, jaundice

51
Whats in a Name 300

• Charcots triad
• Ascending cholangitis
• Combined with CNS changes and hypotension --gt
  Reynauds pentad

52
Charcots Triad

• Jean Martin Charcot, french neurologist
  (1825-1893)

53
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 ?

54
Charcot Triad I

• Nystagmus, intention tremor, staccato speech
• Suggestive of multiple sclerosis

55
Whats in a Name 400

• Clenched fist by patient to describe chest pain

56
Whats in a Name 400

• Levines sign

57
Levine

• Dr. Sam Levine
• Pioneering American cardiologist
• Served in WWI at British Military Heart Hospital
  with William Osler

58
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

59
Whats in a Name 500

• Dullness to percussion over scapula caused by
  pericardial effusion

60
Whats in a Name 500

• Ewarts sign

61
Ewart

• William Ewart (1849-1929)
• English physician trained in England and France
• Worked in a field hospital during Franco-Prussian
  War

62
Hodgepodge 100

• A child steps on a nail in sneakered feet
• Concerns?

63
Hodgepodge 100

• Sneakers pseudomonas

64
Hodgepodge 100

• Pitfalls
• Exploration of wound
• Prophylactic antibiotics

65
Hodgepodge 200

• A 23 year old female complains of pleuritic chest
  pain

66
Hodgepodge 200
67
Hodgepodge 200

• Hamptons hump LLL
• Pulmonary infarct --gt pulmonary embolism
• Usually wedge shaped in lung peripherally

68
Hodgepodge 300

• Give a differential diagnosis for a DECREASED
  anion gap

69
Hodgepodge 300

• Hyponatremia
• Low serum albumin
• Ocult neoplasm --gt multiple myeloma
• Hyperchloremic acidosis
• Lithium toxicity (sodium effect)
• Kidney disease (unmeasured cations)

70
Hodgepodge 400

• Whats wrong with the following X-ray?

71
(No Transcript)
72
Hodgepodge 400

• Gastric bubble deviated medially
• Enlarged spleen (in trauma, splenic hematoma)

73
Hodgepodge 500

• A gentleman presents with the following
• Questions?
• Differential Diagnosis?

74
Genital Ulcers

• Chancroid
• Herpes
• Syphilis
• Behcets
• Other
• Lymphogranuloma venereum (LGV)
• Granuloma inguinale (GI)
• Drug eruption
• Systemic/dermatologic

75
Chancroid

• Pathogen
• Hemophilus ducreyi
• Treatment
• Azithromycin, ceftriaxone, ciprofloxacin

76
Handy Tips 100

• A 22 year old male complains of a very sore
  throat for the last three days

77
Peritonsillar Abscess

• Tips for draining?

78
Handy Tips 200

• While minding his own business, this patient
  broke a tooth which is now very painful

79
Fractured Tooth

• Ellis I enamel
• Ellis II dentin
• Ellis III pulp

80
Treatment

• Dentist
• Analgesia
• Antibiotics
• Protective barrier Chewing gum?

81
Handy Tips 300

• How would you repair this laceration?

82
Skin Glue

• Advantages glue vs sutures
• Contraindications
• How not to get stuck to the patient
• How not to glue the kids eye shut

83
Handy tips 400

• A RN accidentally injected herself with
  epinephrine in her thumb
• The thumb is cool and pale
• How would you treat it?

84
Phentolamine

• Alpha antagonist
• Management of adrenaline induced digital ischemia
  in children after accidental injection from an
  Epipen Emerg Med J 200421387-388

85
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

86
Handy tips 500

• A 50 year old man has very painful burning
  sensation to hands after working with a rust
  remover

87
Hydrofluoric Acid Burns

• Treatment?
• Calcium Gluconate
• How to administer?
• 1 amp 10 Ca gluconate 10 cc
• Reference E-medicine

88
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

89
Questions?
90
Online Resources

• 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