{"id":1168,"date":"2017-01-18T23:59:48","date_gmt":"2017-01-19T04:59:48","guid":{"rendered":"https:\/\/www.roshreview.com\/?p=1168"},"modified":"2023-12-14T00:55:52","modified_gmt":"2023-12-14T00:55:52","slug":"ep-13-shoulder-dislocations-gerd-ethanol-abuse-multiple-sclerosis-temporal-arteritis-burns","status":"publish","type":"post","link":"https:\/\/www.roshreview.com\/blog\/ep-13-shoulder-dislocations-gerd-ethanol-abuse-multiple-sclerosis-temporal-arteritis-burns\/","title":{"rendered":"Podcast Ep 13: Shoulder Dislocations, GERD, Burns, Ethanol Abuse, &amp; More"},"content":{"rendered":"\n<figure class=\"wp-block-audio\"><audio controls src=\"https:\/\/media.blubrry.com\/roshcast\/content.blubrry.com\/roshcast\/Ep_13_Roshcast_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\">\n<p>You must do the things you think you cannot do.<br>-Eleanor Roosevelt<\/p>\n<\/blockquote>\n\n\n\n<h6 class=\"wp-block-heading\">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.<\/h6>\n\n\n\n<hr class=\"wp-block-separator has-css-opacity\"\/>\n\n\n<div class=\"wp-block-image\">\n<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>\n<\/div>\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Hypertension<\/strong> is the most common finding in <strong>acute aortic dissection<\/strong>.<\/li>\n\n\n\n<li><strong>Fusion beats<\/strong> are a <strong>QRS complex with hybrid morphology<\/strong> of a sinus beat and an intraventricular beat resulting from impulses from <strong>two different locations<\/strong> activating the ventricle. One of the impulses is typically <strong>ventricular<\/strong> and the other is typically <strong>supraventricular<\/strong>.<\/li>\n\n\n\n<li><strong>Nitrate therapy<\/strong> works by <strong>reducing both the preload and afterload<\/strong> by dilating veins, coronary arteries, and systemic arteries. It works by relaxing vascular smooth muscles.<\/li>\n\n\n\n<li>There are <strong>five cyanotic congenital heart lesions<\/strong>. Remember the 5 T\u2019s and the 1-5 mnemonic: one for <strong>truncus arteriosus<\/strong>, two for <strong>transposition of the great vessels<\/strong>, three for <strong>tricuspid atresia<\/strong>, four for <strong>Tetrology of Fallot<\/strong>, and 5 for <strong>total anomalous pulmonary vascular return<\/strong> (TAPVR).<\/li>\n<\/ul>\n\n\n\n<p><strong>Now onto this week\u2019s podcast<\/strong><\/p>\n\n\n\n<hr class=\"wp-block-separator has-css-opacity\"\/>\n\n\n\n<p><strong>Question 1<\/strong><\/p>\n\n\n\n<p>Which of the following is the most common complication associated with an anterior shoulder dislocation?<\/p>\n\n\n\n<p>A. Axillary nerve injury<\/p>\n\n\n\n<p>B. Bankart lesion<\/p>\n\n\n\n<p>C. Greater tuberosity fracture<\/p>\n\n\n\n<p>D. Hill-Sachs defect<\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Image-Hill-Sachs-deformity-lesion-and-bankart-lesion-anterior-shoulder-dislocation.png\">Teaching image<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator has-css-opacity\"\/>\n\n\n\n<p><strong>Question 2<\/strong><\/p>\n\n\n\n<p>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?<\/p>\n\n\n\n<p>A. Avoidance of fatty foods<\/p>\n\n\n\n<p>B. Calcium channel blocker therapy<\/p>\n\n\n\n<p>C. Eradication of <em>H. pylori<\/em><\/p>\n\n\n\n<p>D. Head of bed elevation while sleeping<\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Image-GERD-Gastroesophageal-Reflux.png\">Teaching image<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator has-css-opacity\"\/>\n\n\n\n<p><strong>Question 3<\/strong><\/p>\n\n\n\n<p>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<\/p>\n\n\n\n<p>A. Chronic alcohol abuse<\/p>\n\n\n\n<p>B. Pyridoxine deficiency<\/p>\n\n\n\n<p>C. Thiamine deficiency<\/p>\n\n\n\n<p>D. Vitamin B12 deficiency<\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Image-Megaloblastic-Anemia.png\">Teaching image<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator has-css-opacity\"\/>\n\n\n\n<p><strong>Question 4<\/strong><\/p>\n\n\n\n<p>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?<\/p>\n\n\n\n<p>A. Afferent pupillary defect<\/p>\n\n\n\n<p>B. Diplopia on upward gaze<\/p>\n\n\n\n<p>C. Hazy cornea<\/p>\n\n\n\n<p>D. Sharp disc margins<\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Image-Optic-neuritis.png\">Teaching image<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator has-css-opacity\"\/>\n\n\n\n<p><strong>Question 5<\/strong><\/p>\n\n\n\n<p>Which of the following statements is true regarding giant cell arteritis?<\/p>\n\n\n\n<p>A. Aortic involvement can lead to valvular disease and dissection<\/p>\n\n\n\n<p>B. Corticosteroid therapy should be initiated only when biopsy confirms the disease<\/p>\n\n\n\n<p>C. Histologic findings of inflammation are irreversible<\/p>\n\n\n\n<p>D. It is associated with sudden, painful binocular vision loss<\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Image-Temporal-arteritis-Giant-cell-arteritis.jpg\">Teaching image<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator has-css-opacity\"\/>\n\n\n\n<p><strong>Question 6<\/strong><\/p>\n\n\n\n<p>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?<\/p>\n\n\n\n<p>A. First-degree burn<\/p>\n\n\n\n<p>B. Second-degree deep partial-thickness burn<\/p>\n\n\n\n<p>C. Second-degree superficial partial-thickness burn<\/p>\n\n\n\n<p>D. Third-degree burn<\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Image-first-degree-second-degree-third-degree-burn.png\">Teaching image<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator has-css-opacity\"\/>\n\n\n<div class=\"wp-block-image\">\n<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>\n<\/div>\n\n\n<ul class=\"wp-block-list\">\n<li>The <strong>Hill-Sachs defect<\/strong> is the<strong> most common complication of anterior shoulder dislocations<\/strong>, occurring in 40% of cases.<\/li>\n\n\n\n<li>The\u00a0<strong>Hill-Sachs defect<\/strong> is a <strong>depression fracture of the posterolateral surface of the humeral head<\/strong>, not to be confused with a <strong>Bankart lesion<\/strong>, which is a <strong>fracture of the anterior aspect of the inferior glenoid rim.<\/strong><\/li>\n\n\n\n<li>The\u00a0<strong>axillary nerve<\/strong> function can be tested by <strong>arm abduction and sensation over the deltoid muscle<\/strong>.<\/li>\n\n\n\n<li>Initial treatment for\u00a0<strong>GERD<\/strong> should begin with<strong>\u00a0lifestyle and behavior modifications<\/strong> such as weight loss and head of the bed elevation. Empiric medical therapy can be started with a trial of PPIs.<\/li>\n\n\n\n<li><strong>Untreated GERD<\/strong>\u00a0can lead to <strong>Barrett Esophagus<\/strong>, which increases the risk for esophageal neoplasm.<\/li>\n\n\n\n<li>In <strong>chronic alcohol abuse<\/strong>, you may see\u00a0<strong>macrocytic anemia and pancytopenia<\/strong> due to the <strong>bone marrow suppressive effects<\/strong> of ethanol.<\/li>\n\n\n\n<li><strong>Pyridoxine deficiency<\/strong>\u00a0leads to a <strong>sideroblastic, microcytic anemia<\/strong>. It is seen in\u00a0<strong>children<\/strong> and in patients on<strong> isoniazid<\/strong>.<\/li>\n\n\n\n<li><strong>Vitamin B12 deficiency<\/strong> usually occurs secondary to <strong>absorptive problems<\/strong> rather than poor dietary intake. Vitamin B12 deficiency causes a <strong>megaloblastic anemia and pancytopenia<\/strong>.<\/li>\n\n\n\n<li>The progressive\u00a0<strong>monocular vision loss<\/strong> seen in\u00a0<strong>MS<\/strong> causes an <strong>afferent pupillary defect<\/strong> also known as a <strong>Marcus Gunn pupil<\/strong>.<\/li>\n\n\n\n<li><strong>Temporal arteritis<\/strong> commonly presents with <strong>unilateral temporal headache<\/strong>, <strong>jaw claudication, tender temporal artery, sudden painless monocular vision loss<\/strong>, and an <strong>ESR between 50\u2013100<\/strong>.<\/li>\n\n\n\n<li>Up to 50% of patients with\u00a0<strong>temporal arteritis<\/strong> have <strong>polymyalgia rheumatica<\/strong>.<\/li>\n\n\n\n<li><strong>Temporal arteritis<\/strong> should be treated with <strong>immediate steroids<\/strong>, long before biopsy confirms the diagnosis.<\/li>\n\n\n\n<li>In <strong>giant cell arteritis<\/strong>, aortic involvement can lead to <strong>valvular disease and dissection<\/strong>.<\/li>\n\n\n\n<li><strong>First-degree burns<\/strong><a aria-label=\" (opens in a new tab)\" href=\"\/tag\/mild-swelling\" target=\"_blank\" rel=\"noreferrer noopener\">\u00a0<\/a>affect the<strong> epidermis<\/strong><a aria-label=\" (opens in a new tab)\" href=\"\/tag\/epidermis\" target=\"_blank\" rel=\"noreferrer noopener\">, <\/a>have a superficial thickness, and are characterized by <strong>pain,<\/strong><a href=\"\/tag\/mild-swelling\"><strong> <\/strong><\/a><strong>redness<\/strong><a href=\"\/tag\/mild-swelling\"><strong>, <\/strong><\/a>and<strong> mild swelling<\/strong><a aria-label=\" (opens in a new tab)\" href=\"\/tag\/mild-swelling\" target=\"_blank\" rel=\"noreferrer noopener\">.<\/a><\/li>\n\n\n\n<li><strong>Superficial partial-thickness burns<\/strong><a aria-label=\" (opens in a new tab)\" href=\"\/tag\/Superficial-partial-thickness-burn\" target=\"_blank\" rel=\"noreferrer noopener\"> <\/a>affect the <strong>papillary region of the dermis<\/strong>. They cause <strong>pain, blisters, splotchy skin, <\/strong>and<strong> severe swelling<\/strong>.<\/li>\n\n\n\n<li><strong>Deep partial-thickness burns<\/strong>\u00a0affect the\u00a0<strong>reticular region of the dermis<\/strong> and are <strong>white, leathery, <\/strong>and<strong> relatively painless<\/strong>.<\/li>\n\n\n\n<li><strong>Full-thickness burns<\/strong>\u00a0affect the\u00a0<strong>hypodermis<\/strong> and are <strong>charred, insensate, <\/strong>and may form<strong> eschars<\/strong>.<\/li>\n\n\n\n<li><strong>Fourth-degree burns<\/strong>\u00a0affect the\u00a0<strong>deeper tissues<\/strong> like the subcutaneous fat, muscles, and bone.<\/li>\n<\/ul>\n\n\n\n<p>That finishes off lucky Episode 13. We hope you enjoyed this week\u2019s episode. Keep the feedback coming to <a href=\"mailto:Roshcast@roshreview.com\">Roshcast@roshreview.com<\/a>, so we can tailor this podcast help it fit your learning habits. We will be skipping one week, so Jeff can enjoy his honeymoon!<\/p>\n\n\n\n<p>Until next time,<br>Jeff and Nachi<\/p>\n\n\n\n<p>P.S. If you missed last week\u2019s episode including penile lesions, <a href=\"https:\/\/www.roshreview.com\/podcasts\/ep-12-drownings-geriatrics-bowel-obstruction-mean-arterial-pressure-cardiac-contusion-hypoxemia-penile-lesions\/\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\">listen here<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>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.<\/p>\n","protected":false},"author":11,"featured_media":1176,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"inline_featured_image":false,"footnotes":""},"categories":[2025,1999],"tags":[2309,2622,2704,3069,3535,3630],"coauthors":[3856],"class_list":["post-1168","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-emergency-medicine","category-podcast","tag-burns","tag-ethanol-abuse","tag-gerd","tag-multiple-sclerosis","tag-shoulder-dislocation","tag-temporal-arteritis"],"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 13: Multiple Sclerosis, GERD, Burns &amp; More - RoshReview.com<\/title>\n<meta name=\"description\" content=\"Welcome to RoshCast (Ep. 13), the first question and answer style emergency medicine podcast. 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