CRACKCast & Physicians as Humans on CanadiEM

This episode of CRACKCast covers Rosen's Chapter 187, The Immunocompromised Patient. This chapter covers the unique population of immunocompromised patients, including management of febrile neutropenia, as well as common infections seen in these patients and how to treat them.

Core Questions

1. List 4 factors altering pharmacokinetics in the elderly (ADME)
2. List 6 factors contributing to adverse events from medications in the elderly
   1. Beers List
3. Which 8 meds are most responsible for adverse events in the elderly?
4. List 5 harmful drug interactions in the elderly
5. What are top 10 STOPP criteria?

This episode of CRACKCast covers Rosen's chapter 183, approach to the geriatric patient. Our geriatric patients can often mask serious diagnoses with vague presentations and multiple co-morbidities.

This episode of CRACKCast covers Rosen's Chapter 181, Labor and Delivery. This chapter covers the high risk realm of ED deliveries, including potential complications such as PROM, malpresentation and umbilical cord emergencies.

This episode of CRACKCast covers Rosen's Chapter 179, Drug Therapy in Pregnancy. There is a lot of fear and anxiety often present within pharmacologic therapy in pregnancy, but having informed, shared decision making with patients can lead to safer outcomes and adherence when treating.

This episode of CRACKCast covers Rosen's Chapter 178, Co-Morbid Medical Emergencies during Pregnancy. This chapter covers many complicated issues that arise during the care of pregnant patients already suffering from concomitant medical illness, and how to manage these conditions balancing risks to both mother and fetus.

This episode of CRACKCast covers Rosen's Chapter 177, Acute Complications of Pregnancy. This chapter covers many acute issues that arise during the unique physiologic state that is pregnancy, from first trimester bleeding to diagnostic challenges and management of other conditions during pregnancy.

Core questions

1. What are the indications for orthopedic surgery for clavicle fracture?
2. List 5 Xray features of supracondylar fracture
3. Describe the Gartland Classification for Extension-type supracondylar fractures
4. List specific complications of a supracondylar fracture.
5. Describe the sequence of ossification around the elbow.
6. What is Baumann's Angle? (shownotes)
   1. Monteggia fracture-dislocation
   2. Toddler's fracture
   3. Nursemaid's elbow.
7. Describe the radiographic findings and management of:
8. Describe the Ortolani and Barlow maneuvers. (shownotes)
9. List 3 physical exam findings consistent with DDH.
10. List 10 causes of hip pain in children
11. Provide a differential diagnosis of limp in the toddler, school-aged child and adolescent.
12. How would you differentiate between transient synovitis and septic arthritis in a child with hip pain?
13. What is the most common location for septic arthritis in a child?
14. What is the prognosis for transient synovitis?
15. What is the most common cause of septic arthritis?
    1. Age
    2. 2 months – 5 yrs
    3. 5 yrs – 12 yrs
    4. > 12 yrs
    5. Prosthetic joint
    6. Sickle cell disease
    7. Immunocompromised
16. What are the important pathogens of septic arthritis in the following groups:
17. Describe three mechanisms for the development of septic arthritis in children.
18. Regarding synovial fluid analysis, which tests should be ordered. How are the results interpreted?
19. Describe the management of a child with septic arthritis? What the indications for operative debridement?
20. What are the potential complications of septic arthritis?
21. Describe the pathophysiology of Legg-Perthes disease; how does slipped capital femoral epiphysis (SCFE) occur?
22. Describe the common clinical presentation of SCFE + LCPD
23. Describe 2 radiographic findings consistent with SCFE + LCPD
24. How is SCFE classified? How is this classification used to determine management? (shownotes)
25. What is the risk of bilateral SCFE? (shownotes)
26. What are the potential complications of SCFE? (shownotes)
27. What is a juvenile Tilleaux fracture? How does it occur?
28. What is a triplanar fracture?
29. List seven red flags for pediatric back pain.
30. What is spondylolysis? What is spondylolisthesis? How is it managed?
31. List 4 common apophyseal injuries in children.

Wisecracks:

1. List 6 specific xray findings / fractures consistent with non-accidental injury (shownotes)
2. What is a corner / bucket handle fracture?
3. What are the investigations in a complete skeletal survey (shownotes)
4. List 4 conditions with similar presentation to child abuse (shownotes)
5. List causes of pathologic fractures in children.
6. What is the utility of blood culture, ESR and CRP in a child with suspected septic arthritis of the hip?
7. What the mechanism of a lateral elbow condyle fracture and how are they managed? (shownotes)
8. What is the mechanism of a medial elbow condyle fracture and how are they managed? (shownotes)

What is the most common pediatric fracture?

This episode of CRACKCast covers Chapter 174 in Rosen's 9th Edition. Today, we will go over common topics in paediatric neurology and emergency medicine that will help you on your next shift! Knowledge of neurologic disorders is essential for any practitioner of emergency medicine, so strap in for a high-yield post.

Core Questions

1. List ten causes of provoked (acutely symptomatic) seizures.
2. List four episodic disorders that may mimic seizures in neonates and four in non-neonates.
   • How does it differ if you are unable to obtain IV or IO access?
3. Give an approach to acute seizure control in a 9-month-old and in a 5-year-old.
4. What is the definition of status epilepticus?
5. List 6 medical treatments for status epilepticus.
6. What is the definition of a simple febrile seizure?
7. Describe the management of febrile seizure.
   • Which patients should have outpatient imaging and neurology follow-up?
   • Which children with seizure should be admitted to hospital?
8. List 5 reasons for CT Head after seizure and describe management after the 1st peds seizure.
9. List 10 differential diagnoses for headache in peds.
10. List 8 indications for radiologic imaging in patients with headache.
11. With regards to presentation and management, how are migraines different in children?
12. Describe the criteria which define migraine headache (review).
13. List 10 causes of pediatric ataxia.
14. Describe an approach to the pediatric patient with ataxia.
15. List 5 central and 5 peripheral causes of vertigo. Which is the more common cause of vertigo in children?
16. List 8 risk factors for pediatric stroke.

Wisecracks

1. Describe each of the following:
2. • Infantile Spasms
   • Absence Epilepsy
   • Benign Rolandic Epilepsy of Childhood
   • Lennox-Gastaut Syndrome
3. What is the most common cause of status epilepticus in children? In adults?
4. List five side effects of therapeutic dilantin use.
5. When is LP indicated in children with febrile seizures?
6. Give causes of acute, acute recurrent, chronic progressive and chronic non-progressive headaches.
7. Describe the presentation of infantile botulism.

This episode of CRACKCast covers Rosen's Chapter 173, Genitourinary and Renal Tract Disorders. Torsion, phimosis, UTIs, stones, and priapism are some of the high-yield topics covered here.

Core questions:

1. List a DDx for priapism and describe treatment.

2. Describe the management of a paraphimosis.

3. Describe the management of a phimosis.

4. What is the pathophysiology of balanoposthitis? What is the most common bug in balanoposthitis?

5. How is balanoposthitis managed?

6. Describe the diagnosis and management of pediatric epididymitis and orchitis.

7. Describe the diagnosis and management of testicular torsion.

8. List common bacteria in peds UTI and describe treatment in patients

9. List 6 ddx renal mass – how should these be imaged first?

10. Give a differential diagnosis of proteinuria in children.

11. What is the most common cause of proteinuria in children?

12. Provide a differential diagnosis of acute renal failure in children. What is the most common causes?

13. Describe the clinical presentation of glomerulonephritis in a child.

14. Define hypertension in a child.

15. List causes of hypertension in a child.

16. List 2 medical treatments for acute HTN crisis in children.

17. What are the two types of HUS? What are the typical presenting features?

18. Describe the management of HUS and HSP in kids.

Wisecracks:

1. List three complications of circumcision.

2. Describe approaches to penile entrapment and tourniquet states.

3. Which side is a varicocele concerning and why?

4. Other than cystitis and pyelonephritis, list 6 other causes of pediatric dysuria

5. List 10 ddx for hematuria in peds.

6. List 5 false indicators of hematuria.

7. List 6 causes of nephrotic syndrome in peds.

8. List 5 complications of acute renal failure in children.

9. How does E. coli cause HUS? Which strain of E. coli is the concerning one?