{"id":1250,"date":"2017-02-17T23:57:10","date_gmt":"2017-02-18T04:57:10","guid":{"rendered":"https:\/\/www.roshreview.com\/?p=1250"},"modified":"2017-02-17T23:57:10","modified_gmt":"2017-02-18T04:57:10","slug":"ep-18-training-exam-review-part-3-3-obgyn-pediatrics-procedural-renal-pulmonary-toxicology-trauma","status":"publish","type":"post","link":"https:\/\/www.roshreview.com\/blog\/ep-18-training-exam-review-part-3-3-obgyn-pediatrics-procedural-renal-pulmonary-toxicology-trauma\/","title":{"rendered":"Podcast Ep 18: In-Training Exam Review (3 of 3) OB\/GYN &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_18_Roshcast_Emergency_Board_Review.mp3\"><\/audio><\/figure>\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\"><p>Believe you can and you\u2019re halfway there. <\/p><cite>\u2013Theodore Roosevelt<\/cite><\/blockquote>\n\n\n\n<h6 class=\"wp-block-heading\">Welcome back to Episode 18! This is the last and final rapid review before the In-Training Exam! Remember to pause the podcast as you go through the review and quiz yourself. Let\u2019s get started with Ob\/GYN.<\/h6>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p><strong><u>OB\/GYN Emergencies<\/u><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>The most common cause of <strong>maternal mortality during delivery<\/strong> is maternal hemorrhage. <strong>Maternal hemorrhage<\/strong> can be caused by <strong>uterine atony<\/strong>, <strong>genital trauma<\/strong> or <strong>retained products<\/strong>. <strong>Uterine atony<\/strong> is treated with <strong>oxytocin<\/strong> or <strong>uterine massage<\/strong>. <strong>Genital trauma<\/strong> is treated with <strong>pressure or ligation<\/strong>. <strong>Retained products<\/strong> require <strong>removal of the products<\/strong> to control the hemorrhage.<\/li><li><strong>Vaginal candidiasis<\/strong> is treated with <strong>fluconazole or clotrimazole<\/strong>. <strong>Bacterial vaginosis<\/strong> is treated with <strong>metronidazole<\/strong>, twice daily for 7 days. Lastly, <strong>trichomoniasis<\/strong> is treated with a <strong>single dose of metronidazole<\/strong>.<\/li><li><strong>PID<\/strong> is typically caused by <strong>gonorrhea<\/strong>, chlamydia, or both. It is treated with <strong>ceftriaxone 250 mg IM once and doxycycline 100 mg PO BID x 14<\/strong> days if the patient can tolerate PO. <strong>Cervicitis<\/strong> is treated with <strong>ceftriaxone 250 mg IM<\/strong> and <strong>azithromycin 1g PO<\/strong>.<\/li><li><strong>Fitz-Hugh-Curtis syndrome <\/strong>is a <strong>perihepatitis<\/strong> associated <strong>with PID<\/strong>. It is a difficult diagnosis to make, but suspect it in <strong>sexually active woman<\/strong> with <strong>right upper quadrant pain<\/strong>.<\/li><\/ul>\n\n\n\n<p><strong><u>Pediatric Emergencies<\/u><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Suspect <strong>epiglottitis<\/strong> in those who were <strong>incompletely vaccinated<\/strong>. The first priority is <strong>airway management<\/strong>, which ideally involves <strong>intubation in an operating room<\/strong>. The second priority is antibiotics. <strong>Ampicillin-sulbactam<\/strong> or <strong>ceftriaxone<\/strong> are often used.<\/li><li><strong>Pertussis<\/strong> has three stages: the <strong>catarrhal stage<\/strong>, the <strong>paroxysmal stage<\/strong>, and the <strong>convalescent stage<\/strong>. Treatment is with a <strong>macrolide<\/strong>.<\/li><li>There are five common congenital <strong>cyanotic heart defects<\/strong>, which can be remembered by the numbers 1\u20135. One is for <strong>Truncus Arteriosus<\/strong>, in which two vessels join to make one. Two is for <strong>Transposition of the Great Vessels<\/strong> in which the two great vessels are switched. Three is for<strong> Tricuspid Atresia<\/strong>. Remember three for TRIcuspid. Four is for the four defects of<strong> Tetralogy of Fallot<\/strong>. Lastly, five is for the five words of <strong>Total Anomalous Pulmonary Vascular Return.<\/strong><\/li><li><strong>The three common acyanotic<\/strong> heart lesions <strong>are atrial septal defects<\/strong>,<strong> patent ductus arteriosus<\/strong>, and <strong>ventricular septal defects<\/strong>. Symptomatic children with such lesions typically present with <strong>congestive heart failure by 6 months of life<\/strong>.<\/li><li><strong>Acrocyanosis<\/strong> is a <strong>transient blue discoloration<\/strong> of the hands and feet, which can occur when a newborn is cold. Typically, the <strong>pulse oximetry reading is normal<\/strong>.<\/li><\/ul>\n\n\n\n<p><strong><u>Procedural Emergencies<\/u><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>The <strong>emergence reaction<\/strong> from <strong>ketamine<\/strong> is the most <strong>common adverse effect<\/strong>. The most <strong>serious adverse<\/strong> <strong>reaction<\/strong> is <strong>laryngospasm<\/strong>. The laryngospasm can be treated with <strong>bag valve mask ventilation<\/strong>. Ketamine can also be used for analgesia in lieu of opiates at a dose of 0.1\u20130.3 mg\/kg.<\/li><\/ul>\n\n\n\n<p><strong><u>Renal Emergencies<\/u><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Hematuria<\/strong> with <strong>hearing loss<\/strong> is associated with <strong>Alport syndrome<\/strong>. <strong>Hematuria<\/strong> and <strong>hemoptysis<\/strong> is associated with <strong>Goodpasture\u2019s syndrome<\/strong>.<\/li><li><strong>Winter\u2019s formula<\/strong> (pCO2 = 1.5HCO<sub>3<\/sub><sup>&#8211;<\/sup> + 8 +\/-2) is a formula to determine if there is appropriate <strong>respiratory compensation<\/strong> in a <strong>metabolic acidosis.<\/strong><\/li><li><strong>MUDPILES<\/strong> mnemonic can be used to remember the causes of an <strong>anion gap metabolic acidosis<\/strong>: <strong>Methanol<\/strong>, <strong>Uremia<\/strong>, <strong>DKA<\/strong>, <strong>Propylene glycol<\/strong>, <strong>Iron<\/strong> or <strong>INH<\/strong>, <strong>Lactic acidosis<\/strong>, <strong>Ethylene glycol<\/strong>, and <strong>Salicylates<\/strong>.<\/li><li>The <strong>HARDASS<\/strong> mnemonic can be used to remember the causes of a <strong>non-anion gap metabolic<\/strong> <strong>acidosis<\/strong>: <strong>Hyperalimentation<\/strong>, <strong>Addison\u2019s disease<\/strong>, <strong>RTA<\/strong>, <strong>Diarrhea<\/strong>, <strong>Acetazolamide<\/strong>, <strong>Spironolactone<\/strong>, and <strong>Saline infusion<\/strong>.<\/li><\/ul>\n\n\n\n<p><strong><u>Pulmonary Emergencies<\/u><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>A <strong>ventilation perfusion scan (V\/Q)<\/strong> has the <strong>highest sensitivity<\/strong> for excluding <strong>pulmonary embolism.<\/strong><\/li><li>With <strong>pulmonary embolisms<\/strong>, the most common finding is sinus tachycardia. Do not forget about the classic S1Q3T3 pattern.<\/li><li>The common cause of <strong>SVC syndrome<\/strong> is <strong>malignancy<\/strong>. The four most common malignancies are <strong>bronchogenic carcinoma<\/strong>, <strong>small cell lung cancer<\/strong>, <strong>squamous cell lung cancer<\/strong>, and <strong>lymphoma<\/strong>.<\/li><li>In <strong>drowning victims<\/strong>, a <strong>4 to 6 hour observation period<\/strong> is typically sufficient before discharge with <strong>normal vitals and a normal exam<\/strong>. Any <strong>oxygen requirement<\/strong> or <strong>pulmonary finding <\/strong>on exam requires <strong>admission<\/strong>.<\/li><li><strong>Hypoxemia<\/strong> can be broken down into five categories: <strong>low inspired O<sub>2<\/sub><\/strong>, <strong>shunt<\/strong>, <strong>diffusion impairment<\/strong>, <strong>hypoventilation<\/strong>, and <strong>V-Q mismatch<\/strong>.<\/li><li>With <strong>right to left shunt<\/strong>, <strong>diffusion impairment<\/strong>, and <strong>V-Q mismatches<\/strong>, the <strong>A-a gradient is increased<\/strong>. With <strong>hypoventilation<\/strong>, the <strong>A-a gradient is normal<\/strong>.<\/li><li>The <strong>hypoxemia<\/strong> of <strong>right to left shunt<\/strong> <strong>does not improve with supplemental O2<\/strong>, but with <strong>diffusion impairment<\/strong>, <strong>hypoventilation<\/strong>, and <strong>V-Q mismatches<\/strong> it would <strong>improve<\/strong>.<\/li><li><strong>COPD<\/strong> accounts for <strong>70% of the cases of secondary spontaneous pneumothoraces<\/strong>. Remember that the <strong>incidence<\/strong> is also <strong>three times greater in men than it is in women<\/strong>.<\/li><li>A <strong>BNP<\/strong> of <strong>less than 100<\/strong> essentially <strong>rules out heart failure<\/strong>, but an <strong>elevated BNP<\/strong> is <strong>not necessarily indicative of failure<\/strong>. <strong>Obesity<\/strong> can also lead to a <strong>spuriously low BNP<\/strong>.<\/li><\/ul>\n\n\n\n<p><strong><u>Toxicological Emergencies<\/u><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Emergent dialysis<\/strong> is required for an <strong>acute ingestion<\/strong> with a <strong>lithium level greater than 4 mEq\/L<\/strong> or for a <strong>chronic ingestion<\/strong> with a <strong>lithium level greater than 2.5 mEq\/L<\/strong>. <strong>Emergent dialysis<\/strong> should also be initiated if there <strong>are any neurologic findings<\/strong> secondary to the ingestion.<\/li><li>In <strong>lithium overdose<\/strong>, there are three classic findings: <strong>bradycardia<\/strong>, <strong>T wave flattening<\/strong>, and <strong>QT prolongation<\/strong>.<\/li><li>Treatment for <strong>amphetamine overdoses<\/strong> is mostly supportive. The <strong>complex tachydysrhythmias<\/strong> are treated with <strong>sodium bicarbonate<\/strong>, <strong>agitation<\/strong> is treated with <strong>benzodiazepines<\/strong>, and <strong>hyperthermia<\/strong> is treated with <strong>aggressive cooling measures<\/strong>.<\/li><li><strong>Anticholinergic toxicity<\/strong> can be remembered by the mnemonic: <strong>mad as a hatter<\/strong>, <strong>blind as a bat<\/strong>, <strong>red as a beet<\/strong>, <strong>hot as a hare<\/strong>, and <strong>dry as a bone<\/strong>. Do not confuse the <strong>anticholinergic toxicity<\/strong> with the <strong>sympathomimetic toxicity<\/strong> as they are similar, but <strong>sympathomimetic overdoses are typically associated with diaphoresis, not dryness<\/strong>.<\/li><li><strong>The cholinergic toxidrome<\/strong> is marked by <strong>salivation<\/strong>, <strong>lacrimation<\/strong>, <strong>urination<\/strong>, <strong>defecation<\/strong>, <strong>GI upset<\/strong>, and <strong>emesis<\/strong>. Remember <strong>SLUDGE<\/strong>. The most deadly symptoms can be remembered by the <strong>killer b\u2019s<\/strong>: <strong>bronchorrhea<\/strong>, <strong>bronchospasm<\/strong>, and <strong>bradycardia<\/strong>.<\/li><li>A <strong>knee X-ray<\/strong> with <strong>hyperdense lines<\/strong> at the <strong>metaphysis<\/strong> is a classic finding in <strong>lead poisoning<\/strong>. <strong>Lead poisoning<\/strong> is treated with either <strong>succimer<\/strong> or<strong> IV EDTA <\/strong>in acute overdoses.<\/li><li><strong>Bupivacaine toxicity<\/strong> is treated with <strong>intralipid<\/strong>.<\/li><li><strong>Hydrofluoric acid<\/strong> is treated with <strong>calcium gluconate<\/strong>, either <strong>topically<\/strong> or <strong>intra-arterially<\/strong>.<\/li><li><strong>Benzodiazepine overdoses<\/strong> should be treated with <strong>flumazenil<\/strong> but use caution in those who use them chronically as reversal may <strong>precipitate seizures<\/strong>.<\/li><li><strong>Iron overdoses<\/strong> occur with ingestions of greater than <strong>40 mg\/kg<\/strong>. They should be treated with <strong>deferoxamine<\/strong>. For less significant overdoses, <strong>GI decontamination may be attempted<\/strong>. Charcoal is of no use here, as it does not bind Iron.<\/li><li><strong>Symptomatic colchicine overdoses<\/strong> must be admitted because of an <strong>elevated risk of sudden cardiac death<\/strong>. Other complications include <strong>renal failure<\/strong>, <strong>rhabdomyolysis<\/strong>, <strong>bone marrow suppression<\/strong>, and <strong>ARDS<\/strong>.<\/li><li>The <strong>Amanita genus<\/strong> of mushrooms can be identified by <strong>dots or scales on their<\/strong> <strong>cap<\/strong>. They produce the deadly <strong>amatoxin<\/strong>.<\/li><li><strong>Amatoxin poisoning<\/strong> has <strong>four stages<\/strong> culminating in <strong>liver failure<\/strong> and then <strong>death<\/strong>. <strong>Mortality<\/strong> is commonly cited as <strong>10-30%<\/strong>. <strong>Activated charcoal<\/strong> and <strong>hemoperfusion<\/strong> can be considered.<\/li><\/ul>\n\n\n\n<p><strong><u>Traumatic Emergencies<\/u><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>On bedside<strong> ultrasound<\/strong>, the <strong>absence of lung sliding<\/strong> is indicative of a <strong>pneumothorax<\/strong>. <strong>A-lines<\/strong> are <strong>horizontal lines<\/strong> that are the normal <strong>reflection of the pleura<\/strong>. <strong>B-lines<\/strong> are <strong>vertical \u201cheadlights\u201d<\/strong> that are indicative of <strong>pulmonary edema<\/strong>.<\/li><li>A <strong>simple pneumothorax<\/strong> is one involving <strong>&lt; 10% of the hemithorax<\/strong> and should be treated with a <strong>non-rebreather<\/strong> to increase the <strong>speed of resorption<\/strong>. With larger <strong>pneumothoraces<\/strong>, a <strong>chest tube<\/strong> or <strong>pigtail catheter<\/strong> will likely be needed.<\/li><li>The <strong>NEXUS mnemonic<\/strong> can be remembered by the mnemonic <strong>NSAID<\/strong>: <strong>Neurologic deficit<\/strong>, <strong>Spinal tenderness<\/strong>, <strong>Altered mental status<\/strong>, <strong>Intoxication<\/strong>, and <strong>Distracting injury<\/strong>. The <strong>NEXUS and Canadian C-spine<\/strong> rules are tools to <strong>rule patients out <\/strong>from the need for imaging in trauma. They both have <strong>nearly 100% sensitivity<\/strong>, but very <strong>poor specificities<\/strong> and therefore cannot rule in injury.<\/li><li><strong>Myocardial contusions<\/strong> are a sequela of <strong>blunt chest trauma<\/strong>. The most <strong>common EKG finding is sinus tachycardia<\/strong>. These patients require an <strong>echocardiogram<\/strong>. The most common course is <strong>spontaneous resorption of resolution of the symptoms<\/strong>. The most <strong>serious complication<\/strong> is <strong>delayed rupture<\/strong>.<\/li><\/ul>\n\n\n\n<p>That wraps up part three, the last episode in our brief In-Training Exam review! We hope you enjoyed listening! We will be taking next week off for the ITE but will resume shortly thereafter with new episodes. If you have made it this far in our podcast, you clearly take your studying seriously, and we have no doubt you will do well on&nbsp;the exam!<\/p>\n\n\n\n<p>Good luck,<br>Jeff and Nachi<\/p>\n\n\n\n<p>P.S. In case you missed it, here is the rest of the review: <a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"https:\/\/www.roshreview.com\/blog\/ep-16-training-exam-review-part-1-3-abdominal-cardiovascular-cutaneous-endocrine-environmental-emergencies\/\" target=\"_blank\">Episode 16<\/a> and <a href=\"https:\/\/www.roshreview.com\/podcasts\/ep-17-training-exam-review-part-2-3-heent-hematology-immune-system-musculoskeletal-nervous-system\/\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\">Episode 17<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Welcome back to Episode 18! This is the last and final rapid review before the In-Training Exam! Remember to pause the podcast as you go through the review and quiz yourself. Let\u2019s get started with Ob\/GYN.<\/p>\n","protected":false},"author":11,"featured_media":1251,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"inline_featured_image":false,"footnotes":""},"categories":[2025,1999],"tags":[2740,2866,3150,3265,3377,3410,3450,3465,3669,3677],"coauthors":[],"class_list":["post-1250","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-emergency-medicine","category-podcast","tag-gyenecology","tag-in-training-exam","tag-obstetrics","tag-pediatrics","tag-procedural","tag-pulmonary","tag-renal","tag-review","tag-toxicology","tag-trauma"],"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 18: In-Training Exam Review (3 of 3) OB\/GYN &amp; More | RoshReview.com<\/title>\n<meta name=\"description\" content=\"Welcome to RoshCast (Ep. 18), the first question and answer style emergency medicine podcast. 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Listen and learn more.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.roshreview.com\/blog\/ep-18-training-exam-review-part-3-3-obgyn-pediatrics-procedural-renal-pulmonary-toxicology-trauma\/\" \/>\n<meta property=\"og:site_name\" content=\"RoshReview.com\" \/>\n<meta property=\"article:published_time\" content=\"2017-02-18T04:57:10+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.roshreview.com\/blog\/wp-content\/uploads\/sites\/2\/Roshcast-Episode-18-Feature-Image.png\" \/>\n\t<meta property=\"og:image:width\" content=\"515\" \/>\n\t<meta property=\"og:image:height\" content=\"344\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/png\" \/>\n<meta name=\"author\" content=\"Nachi Gupta, M.D., Ph.D., and Megha Rajpal, M.D.\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Nachi Gupta, M.D., Ph.D., and Megha Rajpal, M.D.\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"7 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/www.roshreview.com\/blog\/ep-18-training-exam-review-part-3-3-obgyn-pediatrics-procedural-renal-pulmonary-toxicology-trauma\/\",\"url\":\"https:\/\/www.roshreview.com\/blog\/ep-18-training-exam-review-part-3-3-obgyn-pediatrics-procedural-renal-pulmonary-toxicology-trauma\/\",\"name\":\"Podcast Ep 18: In-Training Exam Review (3 of 3) OB\/GYN & More | RoshReview.com\",\"isPartOf\":{\"@id\":\"https:\/\/www.roshreview.com\/blog\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/www.roshreview.com\/blog\/ep-18-training-exam-review-part-3-3-obgyn-pediatrics-procedural-renal-pulmonary-toxicology-trauma\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/www.roshreview.com\/blog\/ep-18-training-exam-review-part-3-3-obgyn-pediatrics-procedural-renal-pulmonary-toxicology-trauma\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/www.roshreview.com\/wp-content\/uploads\/sites\/2\/Roshcast-Episode-18-Feature-Image.png\",\"datePublished\":\"2017-02-18T04:57:10+00:00\",\"author\":{\"@id\":\"https:\/\/www.roshreview.com\/blog\/#\/schema\/person\/a838e825547ab58f0be77d446d19338a\"},\"description\":\"Welcome to RoshCast (Ep. 18), the first question and answer style emergency medicine podcast. 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