{"id":1061,"date":"2016-12-13T22:06:49","date_gmt":"2016-12-14T03:06:49","guid":{"rendered":"https:\/\/www.roshreview.com\/?p=1061"},"modified":"2016-12-13T22:06:49","modified_gmt":"2016-12-14T03:06:49","slug":"ep-9-pneumonia-endocarditis-colchicine-toxicity-herpes-zoster-lung-ultrasound","status":"publish","type":"post","link":"https:\/\/www.roshreview.com\/blog\/ep-9-pneumonia-endocarditis-colchicine-toxicity-herpes-zoster-lung-ultrasound\/","title":{"rendered":"Podcast Ep 9: Pneumonia, Endocarditis, Colchicine Toxicity, Herpes Zoster, &amp; More"},"content":{"rendered":"\n<figure class=\"wp-block-audio\"><audio controls src=\"https:\/\/media.blubrry.com\/thereveal\/s\/media.blubrry.com\/roshcast\/s\/content.blubrry.com\/roshcast\/Ep_9_Emergency_Medicine_Board_Review.mp3\"><\/audio><\/figure>\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\"><p><span>We\u2019re sitting on a train oblivious to the fact that it\u2019s moving at 80 miles per hour, but anyone sitting outside the train watches it&nbsp;whiz right by! This is the value of learning to&nbsp;see the world through the eyes of others. &nbsp; -Andy Grove<\/span><\/p><\/blockquote>\n\n\n\n<h6 class=\"wp-block-heading\">Welcome back to episode 9! This week we review many high yield associations such as organisms and valvular endocarditis. The episodes are short and sweet, so you can even listen twice! We will start this week\u2019s episode off with a Rapid Review of the previous week\u2019s highlights. Be sure to listen to last week\u2019s episode if you missed it.<\/h6>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><img loading=\"lazy\" decoding=\"async\" width=\"201\" height=\"74\" src=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/RapidReview-2-e1475624722961.png\" alt=\"\" class=\"wp-image-818\" \/><\/figure><\/div>\n\n\n\n<ul class=\"wp-block-list\"><li>Hematuria without RBCs on urine microscopy would be seen in rhabdomyolysis<\/li><li><strong>Hematuria<\/strong> and <strong>hearing loss<\/strong> is associated with <strong>Alport syndrome.<\/strong><\/li><li><strong>Hematuria<\/strong> with <strong>hemoptysis<\/strong> is associated with <strong>Goodpasture syndrome.<\/strong><\/li><li>Be cognizant of the increased incidence of <strong>hematuria<\/strong> caused by <strong>schistosomiasis<\/strong> in <strong>recent immigrants<\/strong> to the United States.<\/li><li><strong>VP shunt obstruction<\/strong> occurs more frequently <strong>proximally<\/strong> than distally due to either <strong>choroid plexus obstruction<\/strong> or <strong>increased protein<\/strong> within the CSF.<\/li><li><em><strong>Eikenella<\/strong><\/em> is a common contaminant of <strong>fight bites<\/strong>. Treatment is typically with <strong>amoxicillin-clavulanate.<\/strong><\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Now onto this week\u2019s podcast<\/strong><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Question 1<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 45-year-old man, with a long history of alcohol abuse, presents to the ED complaining of fever and cough for three days. Which of the following organisms is the most common cause of pneumonia in this population?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A. Group A <em>Streptococcus<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">B<em>. Klebsiella pneumoniae<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">C.<em> Legionella pneumophilia<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">D.<em> Streptococcus pneumoniae<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Table-Common-Bacterial-causes-of-pneumonia.png\">Teaching image<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Question 2<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 45-year-old man with a history of alcohol abuse presents with numbness and weakness of the left hand. He states he slept on a bench last night and awoke this morning with the symptoms. Physical examination reveals decreased sensation over the first, second, and third digits and a wrist drop. What management is indicated?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A. CT of the cervical spine<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">B. MRI of the brain<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">C. Noncontrast CT scan of the head<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">D. Wrist splint and follow up with neurology<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Image-Wrist-drop-radial-nerve-palsy.png\">Teaching image&nbsp;<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Question 3<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Which of the following is true regarding infective endocarditis?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A. Janeway lesions are tender erythematous macules<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">B. Surgery is indicated for fungal endocarditis<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">C. The mitral valve is most commonly involved in intravenous drug abusers<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">D. The presence of fever is one of the major Duke criteria for the diagnosis of endocarditis<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Image-Endocarditis-olser-nodes-roth-spots-janeway-lesions.pages.png\">Teaching image<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Question 4<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 75-year-old man with dementia presents to the ED with severe vomiting and diarrhea. He is admitted to the hospital for renal failure and dehydration. An infectious workup is initiated because he has a leukocytosis. The following day, he develops pancytopenia, renal failure, and acute respiratory distress syndrome. He is transferred to the intensive care unit where he has a cardiac arrest and expires. When the family arrives, they report the patient was in his usual state of health until three days ago, when he suffered a gout flare and began to take excessive amounts of a new medication to control the pain. Ingestion of what medication could account for this patient\u2019s presentation and clinical course?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A. Acetaminophen<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">B. Colchicine<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">C. Indomethacin<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">D. Oxycodone<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">E. Prednisone<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Image-Colchicine-Toxicity.png\">Teaching image&nbsp;<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Question 5<\/strong><\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><img loading=\"lazy\" decoding=\"async\" width=\"300\" height=\"236\" src=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Image-Varicella-Zoster3-Shingles-1-300x236.jpg\" alt=\"\" class=\"wp-image-1067\" srcset=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/sites\/2\/Image-Varicella-Zoster3-Shingles-1-300x236.jpg 300w, https:\/\/www.roshreview.com\/wp-content\/uploads\/sites\/2\/Image-Varicella-Zoster3-Shingles-1.jpg 448w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/figure><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">A 55-year-old man presents with right-sided chest pain and a rash for 4 days as seen above. What management should be initiated?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A. Diphenhydramine<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">B. Pain control<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">C. Topical antibiotics<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">D. Topical corticosteroids<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Image-Varicella-Zoster-Shingles.jpg\">Teaching image<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Question 6<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">What ultrasound finding is consistent with a pneumothorax?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A. A lines<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">B. Absence of lung sliding<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">C. B lines<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">D. Presence of lung sliding<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">&nbsp;<a>Video &#8211; Lung sliding, pneumothorax<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><img loading=\"lazy\" decoding=\"async\" width=\"201\" height=\"74\" src=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/RapidReview-2-e1475624722961.png\" alt=\"\" class=\"wp-image-818\" \/><\/figure><\/div>\n\n\n\n<ul class=\"wp-block-list\"><li><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/streptococcus-pneumoniae\" target=\"_blank\">Streptococcus pneumoniae<\/a><\/strong>&nbsp;is classically associated with <strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/rusty-colored-sputum\" target=\"_blank\">rusty colored sputum<\/a><\/strong>. <strong><em><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/klebsiella-pneumoniae\" target=\"_blank\">Klebsiella pneumoniae<\/a><\/em><\/strong> is associated with <strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/currant-jelly-sputum\" target=\"_blank\">currant jelly sputum<\/a>.<\/strong><\/li><li>The most common cause of&nbsp;<strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/pneumonia-in-alcoholics\" target=\"_blank\">pneumonia in alcoholics<\/a><\/strong> is <strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/streptococcus-pneumoniae\" target=\"_blank\"><em>Streptococcus pneumoniae<\/em><\/a>.<\/strong><\/li><li><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/radial-nerve-palsy%20\" target=\"_blank\">Radial nerve palsy<\/a><\/strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/radial-nerve-palsy%20\" target=\"_blank\"> <\/a>presents with&nbsp;<strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/wrist-drop\" target=\"_blank\">wrist drop<\/a><\/strong> and decreased sensation over the first through third fingers. Treatment is supportive with a <strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/wrist-splint\" target=\"_blank\">wrist splint<\/a>.<\/strong><\/li><li>The mnemonic FROM JANE can be used to help remember many of the findings associated with bacterial endocarditis. Fever, Roth spots, Osler nodes, Murmur, Janeway lesions, Anemia, Nail-bed hemorrhages, Emboli.<\/li><li><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/tricuspid-endocarditis\" target=\"_blank\">Tricuspid endocarditis<\/a><\/strong> is frequently seen in <strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/iv-drug-abusers\" target=\"_blank\">IV drug users<\/a><\/strong>. Tricuspid endocarditis is also frequently caused by <strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/staphylococcus-aureus\" target=\"_blank\"><em>Staphylococcus aureus<\/em><\/a><\/strong>.<\/li><li><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/native-valve-endocarditis\" target=\"_blank\">Native valve endocarditis<\/a>&nbsp;<\/strong>is most commonly seen in the <strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/mitral\" target=\"_blank\">mitral <\/a>&gt; <a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/aortic-valves\" target=\"_blank\">aortic valves<\/a><\/strong>.<\/li><li><strong><em><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/streptococcus-bovis-endocarditis\" target=\"_blank\">Streptococcus bovis<\/a><\/em><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/streptococcus-bovis-endocarditis\" target=\"_blank\"> endocarditis<\/a><\/strong> is associated with <strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/gi-malignancy\" target=\"_blank\">GI malignancy<\/a><\/strong>.<\/li><li>Symptomatic&nbsp;<strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/colchicine-overdoses\" target=\"_blank\">colchicine overdoses<\/a><\/strong> must be admitted because of an elevated risk of <strong>sudden cardiac<\/strong> Complications include <strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/renal-failure\" target=\"_blank\">renal failure<\/a><\/strong>, <strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/rhabdomyolysis\" target=\"_blank\">rhabdomyolysis<\/a>, <a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/bone-marrow-suppression\" target=\"_blank\">bone marrow suppression<\/a><\/strong>, and <strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/ards\" target=\"_blank\">ARDS<\/a>.<\/strong><\/li><li><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/herpes-zoster\" target=\"_blank\">Herpes zoster<\/a><\/strong> is treated with multimodal analgesic based <strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/pain-management\" target=\"_blank\">pain management<\/a><\/strong> along with&nbsp;<strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/oral-acyclovir\" target=\"_blank\">oral acyclovir<\/a> and <a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/prednisone\" target=\"_blank\">prednisone<\/a><\/strong>.<\/li><li><strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/absence-of-lung-sliding%20\" target=\"_blank\">Absence of lung sliding<\/a><\/strong><a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/tag\/absence-of-lung-sliding%20\" target=\"_blank\"> <\/a>is indicative of a <strong><a href=\"\/tag\/pneumothorax\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\">pneumothorax<\/a><\/strong>. A lines are horizontal lines that are the normal reflection of the pleura. B lines are vertical \u201cheadlights\u201d that are indicative of pulmonary edema.<\/li><\/ul>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p class=\"wp-block-paragraph\">Hope you enjoyed this week\u2019s episode. Let us know how to make this better by sending feedback to <a href=\"mailto:Roshcast@roshreview.com\">Roshcast@roshreview.com<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Here is last week&#8217;s emergency medicine board review podcast where Jeff and review&nbsp;fight bites, VP shunts, cyanotic heart lesions, hemolytic uremic syndrome, and much more<\/p>\n\n\n\n<figure class=\"wp-block-audio\"><audio controls src=\"https:\/\/media.blubrry.com\/roshcast\/content.blubrry.com\/roshcast\/Ep8_Roshcast_Emergency_Medicine_Board_Review.mp3\"><\/audio><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Until next time,<br>Jeff and Nachi<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">P.S. If you&#8217;re looking for thousands of more high-quality <a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"\/specialties\/emergency-medicine\/\" target=\"_blank\">emergency medicine board review questions<\/a>, please visit <a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"https:\/\/www.roshreview.com\/specialties\/emergency-medicine\/\" target=\"_blank\">Rosh Review<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Welcome back to episode 9! This week we review many high yield associations such as organisms and valvular endocarditis. The episodes are short and sweet, so you can even listen twice! We will start this week\u2019s episode off with a Rapid Review of the previous week\u2019s highlights. Be sure to listen to last week\u2019s episode if you missed it.<\/p>\n","protected":false},"author":11,"featured_media":1070,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"inline_featured_image":false,"footnotes":""},"categories":[2025,1999],"tags":[2060,2177,2185,2282,2411,2412,2467,2714,2793,2911,2930,2989,3041,3090,3166,3193,3327,3328,3330,3368,3432,3451,3469,3498,3575,3583,3584,3683,3697,3784,3785],"coauthors":[],"class_list":["post-1061","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-emergency-medicine","category-podcast","tag-absence-of-lung-sliding","tag-aortic-valves","tag-ards","tag-bone-marrow-suppression","tag-colchicine-overdoses","tag-colchicine-toxicity","tag-currant-jelly-sputum","tag-gi-malignancy","tag-herpes-zoster","tag-iv-drug-users","tag-klebsiella-pneumoniae","tag-lung-sliding","tag-mitral","tag-native-valve-endocarditis","tag-oral-acyclovir","tag-pain-management","tag-pneumonia","tag-pneumonia-in-alcoholics","tag-pneumothorax","tag-prednisone","tag-radial-nerve-palsy","tag-renal-failure","tag-rhabdomyolysis","tag-rusty-colored-sputum","tag-staphylococcus-aureus","tag-streptococcus-bovis-endocarditis","tag-streptococcus-pneumoniae","tag-tricuspid-endocarditis","tag-ultrasound","tag-wrist-drop","tag-wrist-splint"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v21.7 (Yoast SEO v26.6) - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Podcast Ep 8: Pneumonia, Herpes Zoster, Endocarditis &amp; more - RoshReview.com<\/title>\n<meta name=\"description\" content=\"Welcome to RoshCast (Ep. 9), the first question and answer style emergency medicine podcast. 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