Podcast Ep 13: Shoulder Dislocations, GERD, Burns, Ethanol Abuse, & More

January 18, 2017

You must do the things you think you cannot do.
-Eleanor Roosevelt

Welcome back to lucky Episode 13! We will start with a cardiology review based on teaching points from prior episodes. Then, we will take you through some new topics from orthopedics to burns.

  • Hypertension is the most common finding in acute aortic dissection.
  • Fusion beats are a QRS complex with hybrid morphology of a sinus beat and an intraventricular beat resulting from impulses from two different locations activating the ventricle. One of the impulses is typically ventricular and the other is typically supraventricular.
  • Nitrate therapy works by reducing both the preload and afterload by dilating veins, coronary arteries, and systemic arteries. It works by relaxing vascular smooth muscles.
  • There are five cyanotic congenital heart lesions. Remember the 5 T’s and the 1-5 mnemonic: one for truncus arteriosus, two for transposition of the great vessels, three for tricuspid atresia, four for Tetrology of Fallot, and 5 for total anomalous pulmonary vascular return (TAPVR).

Now onto this week’s podcast

Question 1

Which of the following is the most common complication associated with an anterior shoulder dislocation?

A. Axillary nerve injury

B. Bankart lesion

C. Greater tuberosity fracture

D. Hill-Sachs defect

Teaching image

Question 2

A 35-year-old woman presents for evaluation of chest pain. The patient describes a burning pain that begins in the subxiphoid area and radiates up into her neck. Occasionally she has a bitter taste in her mouth. Her electrocardiogram and chest radiograph are normal. Which of the following is most likely to help her symptoms?

A. Avoidance of fatty foods

B. Calcium channel blocker therapy

C. Eradication of H. pylori

D. Head of bed elevation while sleeping

Teaching image

Question 3

You diagnose a 43-year-old patient with alcohol withdrawal. Lab studies reveal a hemoglobin of 8 g/dL and an MCV of 115. Which of the following is the most common cause of these findings

A. Chronic alcohol abuse

B. Pyridoxine deficiency

C. Thiamine deficiency

D. Vitamin B12 deficiency

Teaching image

Question 4

A 36-year-old woman with multiple sclerosis presents with progressive monocular vision loss over the preceding several hours. Which of the following exam findings would be expected?

A. Afferent pupillary defect

B. Diplopia on upward gaze

C. Hazy cornea

D. Sharp disc margins

Teaching image

Question 5

Which of the following statements is true regarding giant cell arteritis?

A. Aortic involvement can lead to valvular disease and dissection

B. Corticosteroid therapy should be initiated only when biopsy confirms the disease

C. Histologic findings of inflammation are irreversible

D. It is associated with sudden, painful binocular vision loss

Teaching image

Question 6

Which of the following describes a burn that causes pressure and discomfort, extends into the dermis, and may have thick-walled blisters or be leathery white?

A. First-degree burn

B. Second-degree deep partial-thickness burn

C. Second-degree superficial partial-thickness burn

D. Third-degree burn

Teaching image

  • The Hill-Sachs defect is the most common complication of anterior shoulder dislocations, occurring in 40% of cases.
  • The Hill-Sachs defect is a depression fracture of the posterolateral surface of the humeral head, not to be confused with a Bankart lesion, which is a fracture of the anterior aspect of the inferior glenoid rim.
  • The axillary nerve function can be tested by arm abduction and sensation over the deltoid muscle.
  • Initial treatment for GERD should begin with lifestyle and behavior modifications such as weight loss and head of the bed elevation. Empiric medical therapy can be started with a trial of PPIs.
  • Untreated GERD can lead to Barrett Esophagus, which increases the risk for esophageal neoplasm.
  • In chronic alcohol abuse, you may see macrocytic anemia and pancytopenia due to the bone marrow suppressive effects of ethanol.
  • Pyridoxine deficiency leads to a sideroblastic, microcytic anemia. It is seen in children and in patients on isoniazid.
  • Vitamin B12 deficiency usually occurs secondary to absorptive problems rather than poor dietary intake. Vitamin B12 deficiency causes a megaloblastic anemia and pancytopenia.
  • The progressive monocular vision loss seen in MS causes an afferent pupillary defect also known as a Marcus Gunn pupil.
  • Temporal arteritis commonly presents with unilateral temporal headache, jaw claudication, tender temporal artery, sudden painless monocular vision loss, and an ESR between 50–100.
  • Up to 50% of patients with temporal arteritis have polymyalgia rheumatica.
  • Temporal arteritis should be treated with immediate steroids, long before biopsy confirms the diagnosis.
  • In giant cell arteritis, aortic involvement can lead to valvular disease and dissection.
  • First-degree burns affect the epidermis, have a superficial thickness, and are characterized by pain, redness, and mild swelling.
  • Superficial partial-thickness burns affect the papillary region of the dermis. They cause pain, blisters, splotchy skin, and severe swelling.
  • Deep partial-thickness burns affect the reticular region of the dermis and are white, leathery, and relatively painless.
  • Full-thickness burns affect the hypodermis and are charred, insensate, and may form eschars.
  • Fourth-degree burns affect the deeper tissues like the subcutaneous fat, muscles, and bone.

That finishes off lucky Episode 13. We hope you enjoyed this week’s episode. Keep the feedback coming to Roshcast@roshreview.com, so we can tailor this podcast help it fit your learning habits. We will be skipping one week, so Jeff can enjoy his honeymoon!

Until next time,
Jeff and Nachi

P.S. If you missed last week’s episode including penile lesions, listen here.

By Nachi Gupta, M.D., Ph.D., and Megha Rajpal, M.D.

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