Guest pac4hire Posted September 29, 2005 Share Posted September 29, 2005 wind POD1-2 wound POD 3-5 walking POD 4-8 veins POD 7-10 wonder drugs POD 8-10 Quote Link to comment Share on other sites More sharing options...
ajnelson Posted September 29, 2005 Share Posted September 29, 2005 You got it! Good job :) Quote Link to comment Share on other sites More sharing options...
Guest pac4hire Posted September 30, 2005 Share Posted September 30, 2005 my turn... what are three things that must be further investigated in any male over 50 or the two things in a female that presents with a direct or indirect inguinal hernia. what is that patho that would cause the hernia? Quote Link to comment Share on other sites More sharing options...
JenGintheED Posted November 3, 2005 Share Posted November 3, 2005 Hey, no one answered Sean's pimping yet... any takers? I got this yesterday from an IM doc who thinks the vital functions of life are breathing, eating, sleeping & pimping :p "One of my patients was admitted last night. She's 81 and has a PMH of epilepsy. Family called 911 because she was slow to come out the ictal period. In the ED her vitals are wnl, temp 39.4, obtunded but maintaining her airway. 1. What are the top three things on your differential? 2. What do you need to look for on PE?" Enjoy! Quote Link to comment Share on other sites More sharing options...
ajnelson Posted November 4, 2005 Share Posted November 4, 2005 Hey, no one answered Sean's pimping yet... any takers? I have to say - hernia's are not a strong point of mine, so I would love to hear the answer to this one! I got this yesterday from an IM doc who thinks the vital functions of life are breathing, eating, sleeping & pimping :p "One of my patients was admitted last night. She's 81 and has a PMH of epilepsy. Family called 911 because she was slow to come out the ictal period. In the ED her vitals are wnl, temp 39.4, obtunded but maintaining her airway. 1. What are the top three things on your differential? 2. What do you need to look for on PE?" Enjoy! Not sure if top 3 - but definately would be in my DDx: seizure, hypoglycemia, stroke PE: would want to do a full neuro exam looking for any deficits: would look for symmetry between right & left side of body, look for decreased strength, check CN's, gaits, and would also want to check a fingerstick Quote Link to comment Share on other sites More sharing options...
JenGintheED Posted November 4, 2005 Share Posted November 4, 2005 According to this doc, sz & hypoglycemia should be low on the list... stroke a possibility he was fishing for, but what would be the source of the emboli? Go back to the ED presentation. Hint: I shouldn't say "vs wnl" if the temp is 39.4, huh? Quote Link to comment Share on other sites More sharing options...
ajnelson Posted November 4, 2005 Share Posted November 4, 2005 septic emboli? I guess I was just focusing on the 'grogginess' & the amount of time to come out of it... Quote Link to comment Share on other sites More sharing options...
andersenpa Posted November 4, 2005 Share Posted November 4, 2005 fever and mental status changes, i'm thinking meningitis...but the source? fevers could also be neurogenic, but one must obviously r/o infectious focus. 1. sepsis - pan Cx 2. CVA - CT head 3. fever + AMS + old lady = showering veggies? echo? don't know enough hx; although i'm sure your pimp would say i have all i need, right?...... Quote Link to comment Share on other sites More sharing options...
JenGintheED Posted November 4, 2005 Share Posted November 4, 2005 Good job! His top three: 1. meningitis 2. septic emboli from endocarditis 3. bacteremia His teaching point: Just like "everything that wheezes is not asthma", "everything that seizes is not a sz d/o". Any fever in a LOL, or any change in sz pattern in a LOL, needs to be investigated. This lady was going to be discharged home w/epilepsy as dx... admitted only because she had strange bruises and protective services was 3 hours away. Ended up she had a bacteremia, not worked up until the internist was called to admit her! :eek: On PE, he was looking for Kernig & Brudzinski for meningitis; Janeway lesions, Osler lesions & splinter hemmorhages for endocarditis. Pretty cool... I like pimping that I may use one day! Quote Link to comment Share on other sites More sharing options...
ajnelson Posted November 8, 2005 Share Posted November 8, 2005 This is kind of an easy one - but something I hadn't thought about until I had to do it: What can you have a child do to make them Valsalva? Quote Link to comment Share on other sites More sharing options...
Guest pac4hire Posted November 8, 2005 Share Posted November 8, 2005 try and fart! blow a balloon up, make a funny face list goes on and on Quote Link to comment Share on other sites More sharing options...
ajnelson Posted November 8, 2005 Share Posted November 8, 2005 Yep! Another good one (especially when trying to get a kid to Valsalva longer) is to have them lay down, put your hand on their belly and have them push their belly out - I've found it works really well with the young ones. Quote Link to comment Share on other sites More sharing options...
ajnelson Posted November 10, 2005 Share Posted November 10, 2005 What congenital Heart Defect is commonly associated with a wide fixed split S2? Quote Link to comment Share on other sites More sharing options...
caldje Posted November 10, 2005 Share Posted November 10, 2005 blue baby? whats the technical name... ill figure it out in a second.. lol i dunno, but that just makes sense. let me also add that we just did murmurs and I LOVE EM. they are so fun... dont ask me why. but our prof. is big on em and says its a place that many practitioners lack in skills and that we arent aloud out without knowing murmurs well... chris Tetrology of Fallot!!!!!! lol... oh.. or patent ductus arteriosus... maybe? oh well... i lose Quote Link to comment Share on other sites More sharing options...
ajnelson Posted November 10, 2005 Share Posted November 10, 2005 nope - none of those are right... I have to say, spending an entire rotation listening to murmurs has made me somewhat more comfortable - but there have been some subtle ones that I'm not sure I'd be able to catch on a well child visit. It just takes lots & lots of practice though. Quote Link to comment Share on other sites More sharing options...
JenGintheED Posted November 10, 2005 Share Posted November 10, 2005 This baby won't be blue... it's a left-to-right shift ;) {been studying for peds cardiology rotation so don't be too impressed} Quote Link to comment Share on other sites More sharing options...
Monica Posted November 10, 2005 Share Posted November 10, 2005 ASD btw Chris, LA is right about the L>R shunt being acyanotic..usually the only time this defect may be associated with cyanosis would be if the defect was large enough then it may cause CHF which then may cause the 'blue baby' presentation. There's an easy way to remember the L>R shunts: the 3 D's- VSD ASD PDA Quote Link to comment Share on other sites More sharing options...
ajnelson Posted November 10, 2005 Share Posted November 10, 2005 Good job! It's an ASD :) I've found that it's actually pretty important to remember this, because many kids with an ASD will have no other murmur. LA - studying already? You are going to take all of the fun out of the 7hrs of videos ;) Quote Link to comment Share on other sites More sharing options...
caldje Posted November 10, 2005 Share Posted November 10, 2005 thanks guys... i was at an aids clinic today and saw some very interesting stuff... so ill throw something easy out there. felt an insane amount of lymphs nodes though... what causes the increased risk of cardiac disease in most HIV+ patients? Quote Link to comment Share on other sites More sharing options...
DizzyJ Posted November 11, 2005 Share Posted November 11, 2005 Is it a possible complication to medications (antiretroviral therapies) Quote Link to comment Share on other sites More sharing options...
UGoLong Posted November 11, 2005 Share Posted November 11, 2005 Blow up his thumb (or a balloon) seems to work. Quote Link to comment Share on other sites More sharing options...
caldje Posted November 11, 2005 Share Posted November 11, 2005 Is it a possible complication to medications (antiretroviral therapies) yup. and it seems to me its an almost inevitable complication. maybe LA can refute that but everyone i saw and most of his patients have totals above 200. Also, one way he checks to see if patients are taking their meds is to look for jaundice and LFTs. chris Quote Link to comment Share on other sites More sharing options...
JenGintheED Posted November 11, 2005 Share Posted November 11, 2005 yup. and it seems to me its an almost inevitable complication. maybe LA can refute that but everyone i saw and most of his patients have totals above 200. Also, one way he checks to see if patients are taking their meds is to look for jaundice and LFTs. chris Refute? You sound like you expect me to disagree with you?? What I learned on my HIV rotation was that dyslipidemia is a part of the natural, long-term course of the disease. ART, especially the protease inhibitors, add on to the problem. But when I first saw your question, I thought you were talking about AIDS-related cardiomyopathy :p Quote Link to comment Share on other sites More sharing options...
JenGintheED Posted November 12, 2005 Share Posted November 12, 2005 On the heels of all these cardio questions, here's another good one that I got from super-pimp: What's the most reliable PE finding that differentiates between a right-sided & left-sided mumur? Quote Link to comment Share on other sites More sharing options...
merseur Posted November 12, 2005 Share Posted November 12, 2005 Guessing--->Head Bub (Sp ?) Quote Link to comment Share on other sites More sharing options...
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