CRACKCast & Physicians as Humans on CanadiEM

This episode of CRACKCast covers Rosen's Chapter 95, Large Intestine. This chapter covers a number of pathologies affecting the large colon, including their associated risk factors & complications.

1. List features that are typical for IBS.

(Describe the Rome IV criteria and list 4 medications used to treat irritable bowel syndrome - show notes)

1. What is the pathophysiology of diverticular disease?

1. List clinical presentations of diverticular disease.

1. How is diverticular disease managed in the ED? Which patients should be admitted to hospital? List 3 complications.

1. List the types and potential causes of large bowel obstruction.

1. What are the four types of GI volvulus? What are the risk factors for developing each type?

1. List the extra-intestinal manifestations of IBD.

1. What are the pathologic and clinical differences between UC and Crohn's?

1. List 4 categories of medical therapy for IBD and give one example for each.

1. Describe the radiologic features of toxic megacolon.

1. What the potential causes of toxic megacolon?

1. Which conditions are associated with the development of colonic ischemia? List 4 precipitants of ischemic colitis in the elderly and 3 in young patients

1. List 4 ddx for colitis

1. Differentiate between acute and chronic radiation proctocolitis in pathophys and clinical presentation

Wisecracks:

1) What is Ogilvie's Syndrome? List 3 RFs

2) Compare AXR findings in SBO with LBO

3) What is the difference between each Cecal and Sigmoid volvulus on AXR? How is management different?

4) List 3 Perianal complications and 6 Extra-intestinal manifestations of Crohn's disease.

5) How does adult intussusception differ from peds

This episode covers Chapter 94 of Rosen's Emergency Medicine 8th edition (look at chapter 84 for the 9th edition). Have you ever seen gastroenteritis? If you haven't, its probably because you aren't in emergency medicine yet... but once you are... you will. Listen to this post to get ready for the brown winter.

1. Describe a general approach or investigation and management for suspected infectious diarrhea in the following groups:
   1. Non-bloody diarrhea
   2. Bloody Diarrhea
2. What are the 4 most common causes of infectious diarrhea? List 4 pathogens that a special test needs to be requested to diagnose in addition to stool C+S, O+P.
3. Describe common infectious patterns and risk factors for each of the following
   1. Campylobacter
   2. Salmonella
   3. Shigella
   4. Yersinia
   5. Vibrio parahaemolyticus
   6. Enterohemorrhagic E. coli
4. List 6 causes of bloody diarrhea and 5 features of illness that suggest invasive E.coli
5. List causes of toxin-induced bacterial enteritis: 4 performed toxins, 4 in-which toxins are produced after colonization. For each, describe typical source and pattern of illness
6. List 5 RFs for C. diff. What are 2 therapy options?
7. List the 2 most common causes of viral gastroenteritis. Differentiate the two based on patient population and course of illness
8. List 4 protozoal causes of gastroenteritis. For each, describe the clinical presentation
9. List 6 causes of diarrhea in AIDS. Describe an appropriate initial work-up. What additional steps may be required?
10. What is food poisoning?
11. Describe an approach to the management of travelers' diarrhea. What are 5 common causes. Which if the most common?

This podcast covers Chapter 93 of Rosen's 8th Edition Emergency Medicine (or Chapter 83 if you've got the new-shiny 9th edition).

All hail to the appendix. The pluto of our organs.

1. List 8 ddx for appendicitis
2. List 5 causes of acute appendiceal obstruction and describe the pathophysiology of appendicitis including pain location
3. List 5 PEX findings in appendicitis. Describe how the presentation of appendicitis is different in peds, pregnant women, and elderly.
4. List 2 advantages and disadvantages each for CT and US in the diagnosis of appendicitis. What is the sensitivity/specificity of ↑WBC
5. Describe a clinical pathway for the diagnosis and management of appendicitis.
6. When are antibiotics indicated?

Wisecracks:

1) Which patient groups present atypically

2) Describe the Alvarado Score and the Ped for Appendicitis

3) What are U/S findings of appendicitis?

This episode of CRACKCast covers Rosen's Chapter 92 for the 8th Edition (Chapter 82 9th Edition), Small Intestine. This chapter covers the various pathologies, diagnoses and treatments of the Small Intestine.

1. List types of mechanical bowel obstruction.
2. What are potential etiologies of mechanical bowel obstruction?
3. List causes of functional small bowel obstruction.
4. List 5 lab tests useful in the dx of SBO. What findings are expected on AXR? On CT?
5. Describe the acute management of SBO.
6. What are the potential complications of a small bowel obstruction?
7. List the 4 primary types of mesenteric ischemia. For each describe 4 associated factors/etiologies.
8. Describe the classic presentation of acute mesenteric ischemia?
9. How is mesenteric ischemia diagnosed? List 4 lab abnormalities expected in acute mesenteric ischemia. List 5 findings on AXR.
10. What is the management approach for the different types of mesenteric ischemia?

Wisecracks:

1.What is an adynamic ileus? List at least 5 causes. 2.Which patients with SBO should receive antibiotics? 3.What are the 3 arteries supplying the GI tract? Which most common culprit in acute 4.mesenteric ischemia?

This episode covers Chapter 91 of Rosen's Emergency Medicine 8th edition (or Chapter 81 of the 9th edition).

1. List 10 ddx for pancreatitis
2. List 10 causes of pancreatitis. Which are most common in adults? Which one is most common in pediatrics?
3. Describe 6 management priorities in acute pancreatitis.
4. What are the early, late and chronic complications of pancreatitis?
5. Describe Ranson's criteria and Atlanta criteria
6. List causes of chronic pancreatitis. What is the best diagnostic tool? What 4 findings can be seen?
7. Describe the management of chronic pancreatitis (6 priorities)?
8. What is the 5 year survival of pancreatic cancer? Describe typical clinical findings. How is it diagnosed? What is the management?

Wisecracks:

1. Specifically list 10 drug causes.
2. List 5 causes of false-positive amylase elevation.
3. List 4 peripancreatic/local complications of pancreatitis that may be visualized on CT

This episode covers Chapter 80 of Rosen's Emergency Medicine 9th edition. (Yes the new edition). Building on previous episodes (see fever, Jaundice and abdo pain), today we take a look at all things right upper quadrant badness.

1) List 8 ddx for hepatitis

2) Complete the following table for Hepatitis A, B & C: Transmission, Risk Factors, Carrier State, Acute Infection, Previous Infection, Chronic Infection, Prev Vaccine, Transmission Risk, Vaccine.

(show notes: What is hepatitis E? Where is it commonly found (geographically)? What is the significance of hepatitis D?)

3) Describe the post-exposure prophylaxis for exposure to HepA, HepB, HepC

4) Compare the expected lab work in acute viral hepatitis vs EtOH hepatitis

5) What liver diseases are associated with alcohol abuse? What non-hepatic conditions are associated with alcohol abuse? Describe the management of EtOH hepatitis

6) List 6 stigmata of chronic liver dz and list 3 complications

7) How is are chronic cirrhosis and ascites managed in the ER?

8) Describe a grading scale for hepatic encephalopathy and list 5 management considerations

9) Describe the ER diagnosis and management of SBP.

10) List 3 types of drug-induced liver disease.

11) What are two types of hepatic abscesses? How are they diagnosed and treated?

12) What is budd-chiari syndrome? How is it managed?

13) What is primary sclerosing cholangitis (PSC)? What is primary biliary cirrhosis? What is PSC associated with?

14) List 6 RFs for Cholelithiasis

15) Describe the clinical presentation of cholecystitis. List Lab, Xray (3) and US (4) findings

16) List 4 patients that get acalculous cholecystitis

17) List 4 considerations in the management of acute cholecystitis. When is surgery performed early?

18) What is the classic presentation of ascending cholangitis? What two clinical eponyms are described? How is ascending cholangitis managed?

Wisecracks:

1.. Which conditions are associated with transaminases in the 10000s?

1. How do you approach a patient with a needlestick injury? What is the risk of transmission following a needlestick?
2. What are underlying causes of hepatic encephalopathy in patients with known liver disease?
3. What are the typical investigations performed on ascites fluid? What is the SAAG and how is it interpreted?
4. What is the significance of a calcified gallbladder?

This episode covers Chapter 89 of Rosen's Emergency 8th edition (or chapter 79 of 9th edition). Great review of some old concepts already presented, add a few spritzers of new stuff.

• List the the types of dysphagia. What is an ED approach to this condition?

• What are 4 areas of narrowing in the esophagus that FBs get stuck?

• List 8 causes of esophageal obstruction & List 3 therapies for a food bolus.

• What are the indications for removal of an esophageal foreign body?

• What are the indications for removal of a gastric foreign body?

• List 6 causes of esophageal perforation – where does the perforation usually happen?

• List 4 CXR findings of esophageal perforation and 3 other studies that can be performed.

• What is the ED management of a patient with esophageal perforation?

• List causes of esophagitis.

• List 10 agents or conditions associated with GERD and list 3 complications of GERD

• List 6 lifestyle modifications for someone with GERD and 3 medical therapies

• List 6 causes of gastritis and 6 ddx

• List the 2 main causes of PUD and describe the management of each.

• How are prostaglandins used the setting of GI disorders?

• What are the types of gastric volvulus? List risk factors for each. Describe the ED management.

Wisecracks:

• Differentiate between chest pain from ACS and that of an esophageal origin.

• What is the mechanism of NSAID toxicity in PUD? List 3 at risk populations and 2 methods of preventing PUD in these people.

• List 4 features of chest pain in PUD and 4 complications of PUD

• What is Borchardt's triad?

• Describe the mechanism of action of H2 blockers and PPIs

• What are the potential complications of antacid use?

This Episode covers Chapter 88 (or 78 in 9th edition) of Rosen's Emergency Medicine.

PE and DVT. Jeff Kline wrote this chapter, so you knows its a gooder!

1. List 8 DDx for DVT
2. Describe management of superficial thrombophlebitis + isolated calf thrombosis
3. How is the d-dimer test used in the diagnosis of DVT?
4. List 8 causes of an elevated D-dimer
5. What are the Wells criteria for DVT? Describe how to use this score.
6. Describe diagnostic approach of suspected DVT
7. How is a proximal lower limb DVT managed?
8. What are the common causes of upper limb DVT?
9. How are upper limb DVTs managed?
10. List 10 classic risk factors for PE
11. What are the classifications of PE?
12. List 4 ECG + 2 CXR findings consistent with PE
13. What are the Wells criteria for PE? Describe how to use this score.
14. What is the PERC rule? How is it used?
15. Which imaging tests can be used to diagnose PE? List advantages and disadvantages of each.
16. List indications for thrombolysis in PE, what is the risk of ICH?
17. What are the absolute and relative contraindications for thrombolysis
18. List markers of poor prognosis in patients with PE.

Wisecracks:

• What is phlegmasia cerulea dolens? How is it managed?

• Which patients should have an IVC filter?

• What about PE/DVT in pregnancy?

• What is the cause of hypoxia in patients with PE? What causes chest pain? What causes hypotension?

• What is Paget-Schroetter Syndrome?

This episode covers Chapter 87 of Rosen's Emergency Medicine

1. What is an atheroma and how is it formed?
2. What are the classic symptoms of arterial insufficiency?
3. Provide a differential diagnosis for chronic arterial insufficiency.
4. What is blue toe syndrome? What is its significance?
5. Differentiate between thrombotic and embolic limb ischemia based on clinical features
6. What is the management of an acutely ischemic limb?
7. List three disorders characterized by abnormal vasomotor response.
8. Describe Raynaud's disease and how it's treated?
9. What is the most common site for arterial aneurysm in the leg?
10. List four potential sites for upper extremity aneurysms, and their associated underlying causes.
11. Name three types of visceral aneurysms and their associated conditions.
12. List 6 ddx of occluded indwelling catheter + describe the management of suspected line infection.
13. What are the two types of AV fistulas used for dialysis?
14. How do you access an AV fistula?
15. List 5 complications of dialysis fistulas + treatment
16. List the 3 types of thoracic outlet syndrome. What are the typical symptoms of thoracic outlet syndrome? What is a simple bedside test for this condition?
17. List 4 anatomic abnormalities associated with thoracic outlet syndrome. Wisecracks: Describe Buerger's sign and ankle brachial index List clinical criteria for Buerger's Disease (5) What is Leriche's syndrome? List 4 types of infective aneurysms Differentiate between arterial insufficiency ulcers and venous stasis ulcers

This episode covers Chapter 86 of Rosen's Emergency Medicine. AAAs are our Great-White-Buffalo in emergency medicine. You need to know this!

1. List six presentations of an abdominal aortic aneurysm.
2. Compare Aneurysm and Pseudoaneurysm
3. List common misdiagnoses in patients with ruptured AAA
4. List three common early and delayed complications of AAA repair
5. List common delayed complications of Endovascular repair

Wisecracks:

• What to do about the intact, asymptomatic aneurysm?