Ep 1 Roshcast Emergency Board Review

Creativity is an infinite resource. The more you spend the more you have.  -Maya Angelou

Welcome to Rosh Review’s podcast corollary. Many of you may be thinking – what is a podcast corollary? Great question. We are making the time-tested questions of Rosh Review audible. Not only will we review the questions and answers, but we will also take the questions “One Step Further™” and review the most important points from each topic. At the end of each episode, we will rapid-fire review the pearls from the episode to drive home key concepts. Before we begin, though, introductions are in order.

Who We Are

Nachi Gupta, MD PHD

* Prior to medicine, Nachi studied math and statistics. A lot of it! He worked in missile defense, as an economist at a hedge fund, and on predicting the winners of sporting events.

* Nachi is currently a PGY3 Emergency Medicine resident at The Mount Sinai Hospital, Icahn School of Medicine in NYC

* EM Passions include: mathematical modeling and applications to medicine, critical care, medical education

* Other interests: comedy, traveling, cooking, bass guitar, audio recording, financial modeling, poker, entrepreneurship, wine, NYC

Jeffrey Nusbaum, MD

* Jeff is a former firefighter and EMT and plans to pursue an EMS fellowship as he searches for any possible way to ride a fire truck

* Jeff is currently a PGY3 Emergency Medicine resident at The Mount Sinai Hospital, Icahn School of Medicine in NYC

* EM Passions include: EMS (obvi), critical care, medical education

* Other interests include: the outdoors, grilling, weekend trips with family friends, and NYC street meat carts

Now that that’s out of the way, let’s get to Roshcast: Emergency Medicine Board Review. 

Question 1 

A 2-year-old girl presents to the ED reluctant to move her left arm. The patient’s father states he grabbed his daughter by her wrist to pull her up from the floor. On exam, there is no swelling or deformity. Which of the following maneuvers should be attempted to correct the injury?

A. Elbow flexion followed by pronation

B. Hypersupination of the forearm

C. Pronation followed by elbow flexion

D. Supination followed by elbow flexion

Teaching card to supplement answer

Question 2 

A 63-year-old man is brought to the ED by paramedics secondary to aphasia that began 30 minutes prior to arrival. The man is unable to give any history and has never been to your hospital. His vital signs are T 37°C, BP 180/98, HR 90, and RR 20. His exam is unremarkable except for profound expressive aphasia. Capillary blood glucose is 124 mg/dL. His ECG shows normal sinus rhythm with normal ST segments and T waves. CT scan of the head is normal. Sixty minutes after arriving to the ED, the patient’s aphasia resolves. Which of the following is the most appropriate diagnosis, treatment, and disposition for this patient?

A. Hypertensive emergency; start IV antihypertensive therapy and admit to the medical intensive care unit

B. Stroke; administer tissue plasminogen activator; admit to stroke unit

C. Transient ischemic attack; administer aspirin and dipyridamole; admit to stroke unit

D. Transient ischemic attack; administer low molecular weight heparin and warfarin; discharge home with close neurology follow up

E. Transient ischemic attack; start heparin infusion; admit to stroke...