CRACKCast & Physicians as Humans on CanadiEM

In the fourth episode of the Physicians as Humans project, I speak with Dr. Kevin Dueck, a family medicine resident at McMaster, about his decision to take parental leave during residency. Also check out his blog https://abootmedicine.wordpress.com/!

This is an ongoing project, so if you or anyone you know have a story about managing personal struggles while in medicine, please contact [email protected]. If you are unfamiliar with the project, please read this post for more information on the origin of this podcast series. The CanadiEM podcast can be added to your podcast application from the iTunes store or by entering the podcast RSS feed. If you would prefer to download it, click here. It can also be streamed above.

Thanks for listening and please refer your colleagues!

Music for Episode 04 (All songs have been modified for the project)

1. ambient by strange day. Music provided by Music for Creators under a Creative Commons Attribution 3.0 Unported— CC BY 3.0 license.
2. NOWË - Burning (Vlog No Copyright Music). Music provided by Vlog No Copyright Music. Video Link: https://youtu.be/AWv6Cr-RJaM
3. Jorm - Broken (Vlog No Copyright Music). Music provided by Vlog No Copyright Music. Video Link: https://youtu.be/sl-o3ywNTV4
4. Skander Music - Back Home (Vlog No Copyright Music). Music promoted by Vlog No Copyright Music. Video Link: https://youtu.be/uwXmBL1kQT4
5. Pressure - Riot https://youtu.be/ELksuZkgQsQ
6. Joakim Karud - Waves. Song/Free Download - https://youtu.be/xG8AWZSnFgI. Support Joakim Karud - http://smarturl.it/joakimkarud
7. LAKEY INSPIRED - In My Dreams (Vlog No Copyright Music). Music provided by Vlog No Copyright Music. Video Link: https://youtu.be/PiKks_6yC8Q

This episode of CRACKCast covers Rosen' 9th edition, Chapter 104, Factitious Disorders and Malingering.

Episode Overview

• Two categories of psychiatric illness are covered in this episode
  • Factitious Disorder
  • Malingering
• Individuals suffering from factitious disorders fabricate symptoms of illness to fulfill the sick role (primary gain)
• Individuals suffering from malingering fabricate symptoms of illness to obtain something (secondary gain)
• Despite the fact that we may suspect either factitious disorder or malingering, we must strive to objectively assess the patient for concrete evidence of disease
• If no objective evidence of disease exists in a patient, do not investigate with needless and/or harmful diagnostic modalities
  • Refer back to their primary care physician
• If you are suspecting factitious disorder by proxy, the safety of your patient should always be your first priority

Core Questions

• What is a factitious disorder and what is malingering?
• List the DSM-5 diagnostic criteria for factitious disorder imposed on self (FDIS)
• List the DSM-5 diagnostic criteria for factitious disorder imposed on another (FDIA)
• List four characteristics of malingering

This 113th episode of CRACKCast covers Rosen's 9th edition, Chapter 103, Somatoform Disorders. The diagnosis of SSD is made when there are persistent and clinically significant physical complaints that are accompanied by excessive and disproportionate health-related thoughts, feelings, and behaviours regarding these symptoms. Recent publications refer to "medically unexplained physical or somatic symptoms," rather than somatization.

This episode covers Chapter 102 of Rosen's Emergency Medicine (9th Ed.), Anxiety Disorders.

Episode Overview

• Patients who present with predominant symptoms of anxiety may be suffering from medical disorders (think cardiac, resp, endocrine, neurologic), medication effects, or substance abuse or withdrawal.
• Anxiety may accompany the onset of serious medical disease, cause significant metabolic demands, and stress a marginally compensated organ system.
• Anxiety caused by physical illness is usually suggested by the patient's physical findings but may require testing to further delineate the cause.
• Oral, intravenous, or intramuscular medication may be necessary for patients who are a significant threat to themselves or others and for anxious patients with significant medical illness.
• Limited benzodiazepine therapy may be helpful for select patients. SSRI's are the go-to long term therapy.

Core questions:

1. List 5 predictors of anxiety caused by an underlying medical issue (box)
2. List 10 organic diseases that may present with anxiety
3. Name 10 characteristics of a panic attack (box)
4. List characteristics of post-traumatic stress disorder (box)
5. Define the following:
   1. Panic attack
   2. OCD
   3. GAD
6. List ED management goals for patients with anxiety
7. List 6 non-pharmacologic therapies for anxiety

This episode of CRACKCast covers Rosen's Chapter 101 (9th Ed.), mood disorders. The podcast will focus on the diagnosis and management of common mood disturbances.

Episode Overview

• Patients with apparent mood disorders should be evaluated for medical disorders, medication effects, substance abuse or withdrawal because these conditions can mimic both depression and mania.

• Mood disorders should be suspected in patients with multiple, vague, nonspecific complaints and in patients who are frequent, heavy users of medical care.

• The differentiation of depression and dementia in elders can be difficult, but is important because depression often responds dramatically to treatment.

• Patients with mood disorders should be assessed for their suicide potential.

  Core questions:

1. List the 3 neurotransmitters implicated in depression

2. List the DSM V criteria for Major Depressive Episode (box)

3. Define Seasonal Affective disorder, Dysthymic Disorder and Cyclothymic

   disorder

4. Define Bipolar I and Bipolar II

5. List the DSM V Criteria for a Manic Episode (box)

6. List 8 general medical conditions and 8 medications that cause depression

7. Describe first line medical therapy for depression and bipolar disorder

8. List 4 criteria for hospitalization in an acute psychiatric episode

Wisecracks

1. Mnemonics for symptoms of depression and mania

This episode covers chapter 110 of Rosen's emergency medicine (100 in the 9th edition). Confused about thought disorders? We can set you thinking straight!

This episode of CRACKCast covers Rosen's Chapter 109, CNS Infections. This chapter covers a differential diagnosis for CNS infections, including necessary workup and approaches to treatment.

Are you confused by the NMJ? Good.... because we were too. This episode of CRACKCast covers Rosen's Chapter 108, Neuromuscular Disorders. These disorders have a wide range of presentations and etiologies.

This episode of CRACKCast covers Rosen's Chapter 107, Peripheral Nerve Disorders. These disorders have a wide range of presentations and etiologies. This chapter includes a comprehensive classification system to help in the ED in recognizing the various disorders.

This episode covers chapter 106 of Rosen's Emergency Medicine. Check out chapter 96 in the pretty new 9th edition. If you don't have it yet... you should. Ever wondered about how to get the spinal syndrome's straight? We've got that covered, and more of course!