Podcast Ep 8: Pneumonia, Herpes Zoster, Lung Ultrasound & More

December 6, 2016

In the end the great truth will have been learned, that the quest is greater than what is sought, the effort finer than the prize, or rather that the effort is the prize, the victory cheap and hollow were it not for the rigor of the game.  

-Justice Benjamin Cardozo
Welcome back to episode 8! With Thanksgiving behind us, let’s keep up the momentum, as the In-Training Exam is right around the corner. Here is a sneak peek into the category breakdown established by ABEM for the ITE.

Roshcast episodes are 10–15 minutes long so you can focus on a few topics at a time without feeling overwhelmed. The short duration of each episode also allows you to go back and review episodes you may have missed or want to reinforce.

We begin each episode with a quick Rapid Review of the previous week’s highlights. 

  • Rh immunoglobulin administration can be delayed up to 72 hours. The correct dose is 50 mcg for those less than 12 weeks gestation and 300 mcg for those 12 weeks and over.
  • Haloperidol and other typical antipsychotics can cause a dystonic reaction. The treatment is either benztropine or diphenhydramine. 50% of reactions occurring within 48 hours of administration and 90% occur within 5 days.
  • The target pH for eye irrigation should be between 7.0–7.2, but do not delay irrigation to confirm a staring pH.
  • Sulfonylureas commonly cause recurrent hypoglycemia as they stimulate the islet beta cells to secrete more insulin, increase the sensitivity of peripheral tissues to insulin, and have a prolonged half-life.

Now to this week’s podcast

Question 1

Which of the following patients requires emergent consultation with an orthopedic specialist?

A. A 36-year-old woman with a femur fracture and distal cyanosis

B.  58-year-old man with extension-based chronic low back pain and leg numbness

C.  75-year-old ambulatory woman with a tibial osteosarcoma

D. An 18-year-old man with a reduced sacral ala fracture and BP 130/86

Question 2

A 12-year-old boy presents to the ED with headache, vomiting, and lethargy for two days. He had a ventriculoperitoneal shunt placed for hydrocephalus one year ago. What is the most likely cause of his shunt malfunction?

A. Abdominal pseudocyst formation

B. Choroid plexus obstruction

C. Loculation

D. Mechanical failure

E. Slit ventricle syndrome

Teaching image

Question 3


A 25-year-old man presents to the emergency department after being in an altercation at a music concert. On exam, you note the findings seen above. Which of the following organisms is of most concern?

A. Capnocytophaga canimorsus

B. Cercopithecine herpesvirus

C. Eikenella corrodens

D. Pasteurella multocida

Teaching image

Question 4

Which of these children with hematuria needs admission to the hospital?

A. A 10-year-old boy with recent sore throat treated with amoxicillin, tea-colored urine, and normal urine output; UA shows microscopic hematuria and proteinuria; blood tests are normal

B. A 12-year-old girl with lower abdominal pain, dysuria, urgency, frequency, and pink urine; UA shows microscopic hematuria, > 50 WBCs/hpf, + leukocyte esterase, + nitrites; urine pregnancy test is negative

C. A 6-year-old boy with nausea, vomiting, bloody diarrhea, and decreased urine output; UA shows microscopic hematuria and hyaline casts; blood tests show a high WBC count, low hemoglobin, and low platelets

D. An 8-year-old girl with diffuse mild edema, tea-colored urine, and normal urine output; UA shows microscopic hematuria and proteinuria; blood tests show a normal WBC count, hemoglobin, and platelets but low protein

Teaching image

Question 5

Which of the following is a cyanotic heart lesion?

A. Atrial septal defect

B. Patent ductus arteriosus

C. Tricuspid atresia

D. Ventricular septal defect

Teaching image

Question 6

A 68-year-old man presents to the ED after a fall down 12 stairs. His only medication is warfarin, which he takes for atrial fibrillation. On physical exam, you note a large parietal scalp hematoma. His noncontrast computed tomography scan of the head is shown above. His INR is 4.5. Which of the following is the most appropriate treatment?

A. Cryoprecipitate

B. Fresh frozen plasma

C. Packed red blood cells

D. Platelets

Teaching image


Until next time,
Jeff and Nachi

P.S. If you like Nachi and Jeff’s content, remember to check out Rosh Review’s emergency medicine qbank with thousands of high yield questions, explanations, images, audio, and video teaching files.

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

Comments (0)