{"id":1714,"date":"2017-08-03T17:16:31","date_gmt":"2017-08-03T21:16:31","guid":{"rendered":"https:\/\/www.roshreview.com\/?p=1714"},"modified":"2017-08-03T17:16:31","modified_gmt":"2017-08-03T21:16:31","slug":"ep-29-personality-disorders-neonatal-resuscitation-post-concussive-syndrome-abdominal-trauma-conjunctivitis-flexor-tenosynovitis","status":"publish","type":"post","link":"https:\/\/www.roshreview.com\/blog\/ep-29-personality-disorders-neonatal-resuscitation-post-concussive-syndrome-abdominal-trauma-conjunctivitis-flexor-tenosynovitis\/","title":{"rendered":"Podcast Ep 29: Personality Disorders, Neonatal Resuscitation &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_29_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>Success is the sum of small efforts, repeated day in and day out.<\/p><cite>-Robert J. Collier<\/cite><\/blockquote>\n\n\n\n<h6 class=\"wp-block-heading\">Welcome back to Episode 29! This week we are starting out with a bit of psychiatry before swinging over to the Pediatric ER for a quick neonatal resuscitation. We may even stop by the trauma bay to see what is happening there and give you a chance to win a prize. We\u2019ve said enough already. Let\u2019s get warmed up with a rapid review. This week, we are trying something new \u2013 we will be reviewing some of the <a href=\"https:\/\/www.roshreview.com\/blog\/rapid-review\/rapid-review-hypothyroidism\/\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\">recent<\/a> <a rel=\"noreferrer noopener\" aria-label=\"Rapid (opens in a new tab)\" href=\"https:\/\/www.roshreview.com\/blog\/rapid-review\/rapid-review-acanthosis-nigricans\/\" target=\"_blank\">Rapid<\/a> <a rel=\"noreferrer noopener\" aria-label=\"Reviews (opens in a new tab)\" href=\"https:\/\/www.roshreview.com\/blog\/rapid-review\/rapid-review-cushings-syndrome\/\" target=\"_blank\">Reviews<\/a> that Yehuda has been uploading to the blog. Make sure to check them out going forward too!<\/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>With primary hypothyroidism, you would expect a high TSH and a low T4. On physical, you may see periorbital edema, dry skin, and coarse brittle hair. &nbsp;Patients often complain of weakness, fatigue, facial swelling, constipation, cold intolerance, and weight gain.<\/li><li>With acanthosis nigricans, you would expect thickened, velvety, darkly pigmented plaques on the neck or axillae. &nbsp;<\/li><li>Cushing\u2019s syndrome most commonly caused by hypercortisolism from an ACTH-secreting pituitary tumor. Cushing\u2019s syndrome is diagnosed by a 24h urine cortisol and serum ACTH levels.<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Now onto this week&#8217;s 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\">You are working in the ED when the police bring in a 26-year-old man who was involved in a bar fight. The patient is well known to staff as he frequently seeks treatment in the ED for injuries related to fights and alcohol abuse. He has been caught smoking cigarettes in the ED bathroom, has urinated on the floor, and been known to steal food trays and other patients&#8217; belongings. As you enter his examination room, you overhear him giving the registration clerk a false identity. Which of the following personality disorders best fits with this patient\u2019s behavior?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A. Antisocial<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">B. Borderline<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">C. Paranoid<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">D. Schizoid<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep29-Personality-Disorders.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 2<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A term pregnant patient presents to the ED in active labor and delivery. There is no meconium seen, but the baby has a weak cry and poor tone initially. After clearing the airway, drying the baby vigorously, and providing warmth, the poor tone persists. On exam, the heart rate is 85 and the newborn appears apneic. Which of the following is the most appropriate next step?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A. Administer atropine<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">B. Administer epinephrine<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">C. Begin chest compressions<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">D. Provide positive-pressure ventilations<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep29-Newborn-Resuscitation.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 3<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 13-year-old boy with no past medical history presents with a headache 3 days after a closed head injury. The patient states that he stood up from kneeling and hit the top of his head on a wood cabinet. There was no loss of consciousness or seizure activity. In addition to the headache, he complains of difficulty concentrating at school and dizziness. His physical examination is unremarkable. What management is indicated?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A. CT scan of the head with contrast<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">B. CT scan of the head without contrast<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">C. MRI of the brain<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">D. Neurology referral<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep29-Postconcussive-Syndrome.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\">Which of the following organs is the most commonly injured in adult blunt abdominal trauma?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A. Bladder<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">B. Intestine<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">C. Liver<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">D. Spleen<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep29-Splenic-Laceration.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 5<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">An 18-year-old man presents with red eyes. He has been sick with upper respiratory symptoms for two days. Examination is notable for bilateral conjunctival injection with scant discharge. He has rhinorrhea and sounds congested. He has a palpable preauricular lymph node on the left. Which of the following is the most likely cause of his red eyes?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A. Adenovirus<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">B. Rhinovirus<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">C. <em>Staphylococcus aureus<\/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\/Ep29-Conjunctivitis.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 6<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 19-year-old man presents with pain in his index finger. Which of the following is suggestive of flexor tenosynovitis?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A. Delayed capillary refill<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">B. Holding the finger fully extended<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">C. Pain on passive extension<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">D. Swelling localized to the volar aspect of the finger<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep29-Kanavels-Criteria.png\">Teaching Image<\/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>Those with <strong>antisocial personality disorder<\/strong> often display a <strong>blatant disregard for others<\/strong>, <strong>violate societal norms<\/strong>, and <strong>lack a remorse for their actions<\/strong>. &nbsp;They are of often <strong>aggressive<\/strong>, <strong>irritable<\/strong>, and <strong>impulsive<\/strong>.<\/li><li><strong>Borderline personality disorder<\/strong> is a <strong>cluster B<\/strong> personality disorder and is characterized by <strong>self-destructive<\/strong>, <strong>impulsive<\/strong> behavior. They often have <strong>erratic emotions<\/strong> and may come off as being <strong>overly sexual<\/strong> and are <strong>frequently in crisis<\/strong>.<\/li><li><strong>Paranoid personality disorder<\/strong> is a <strong>cluster A<\/strong> personality disorder. &nbsp;Paranoid patients are often <strong>cold<\/strong>, <strong>humorless<\/strong>, and <strong>suspicious<\/strong>.<\/li><li><strong>Schizoid personality disorder<\/strong> is also a <strong>cluster A<\/strong> personality disorder. &nbsp;Schizoid patients are often <strong>loners<\/strong> with <strong>few<\/strong> <strong>friends<\/strong> who are indifferent to praise and criticism.<\/li><li>In a <strong>neonatal resuscitation<\/strong>, the first step&nbsp;is to <strong>warm<\/strong>, <strong>dry<\/strong>, and <strong>stimulate<\/strong> the neonate and <strong>clear the airway<\/strong> if necessary. &nbsp;<strong>If there is no response<\/strong> to these measures, <strong>begin positive pressure ventilation<\/strong> at a rate of<strong> 40\u201360 breaths per minute<\/strong>.<\/li><li><strong>Bradycardia<\/strong> in a <strong>newborn<\/strong> is often a sign of <strong>hypoxia<\/strong>.<\/li><li>In a <strong>child over 2<\/strong> with a <strong>GCS less than or equal to 14<\/strong> <strong>or if are there signs of a basilar skull fracture or signs of AMS<\/strong>, there is a <strong>4.3% chance of a clinically important traumatic brain injury<\/strong>. These children require <strong>head imaging<\/strong>.<\/li><li><strong>Postconcussive syndrome<\/strong> may present with many <strong>nonspecific symptoms<\/strong>, including <strong>headache<\/strong>, <strong>dizziness<\/strong>, <strong>confusion<\/strong>, <strong>amnesia<\/strong>, <strong>difficulty concentrating<\/strong>, and <strong>blurry vision<\/strong> without a focal neurologic finding.<\/li><li>All patients with <strong>postconcussive syndrome<\/strong> should be <strong>referred to a neurologist<\/strong> for functional testing and tracking of symptom resolution. &nbsp;<strong>Caution patients about returning to contact sports<\/strong> too soon to prevent a second impact.<\/li><li>The <strong>most commonly<\/strong> <strong>injured<\/strong> organ in <strong>adult blunt abdominal trauma<\/strong> is the <strong>spleen<\/strong>. The <strong>liver<\/strong> is the <strong>second<\/strong> most commonly injured organ.<\/li><li><strong>Splenic lacerations<\/strong> are <strong>graded 1-5<\/strong>. &nbsp;<strong>Most<\/strong> can be <strong>managed non-operatively<\/strong>. &nbsp;<strong>Hemodynamic instability<\/strong> warrants an <strong>exploratory laparotomy<\/strong>.<\/li><li><strong>Conjunctivitis<\/strong> most commonly presents with <strong>redness<\/strong>, <strong>foreign body sensation<\/strong>, <strong>drainage<\/strong>, <strong>swelling of the lid<\/strong>, and even <strong>crusting in the morning<\/strong>. <strong>Treatment<\/strong> is supportive with <strong>compresses<\/strong> and <strong>artificial tears<\/strong>.<\/li><li>The <strong>most common cause<\/strong> of <strong>conjunctivitis<\/strong> is a <strong>viral infection<\/strong>, with <strong>adenovirus<\/strong> being the most common virus.<\/li><li>There are <strong>four cardinal signs of acute flexor tenosynovitis<\/strong>: 1) <strong>tenderness along the course<\/strong> of the flexor tendon 2) fusiform or symmetrical<strong> swelling of the finger<\/strong> 3) <strong>pain with passive range of motion<\/strong> 4) a <strong>flexed posture of the finger<\/strong>.<\/li><li><strong>Flexor tenosynovitis<\/strong> is <strong>most commonly caused<\/strong> by <strong>penetrating trauma<\/strong> and <strong>direct inoculation<\/strong> of the actual sheath, but direct spread from other areas of the hand occur as well. &nbsp;<\/li><li><strong>Flexor tenosynovitis<\/strong> is a <strong>surgical emergency<\/strong> and requires<strong> antibiotics<\/strong> and hand surgery consultation.<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">So that wraps up Episode 29. From neonatal resuscitation to personality disorders with a brief stop in the trauma bay, we have covered quite a bit. Hope you all enjoyed. Don\u2019t forget to <a href=\"mailto:roshcast@roshreview.com\">email us<\/a> or <a href=\"http:\/\/www.twitter.com\/roshcast\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\">tweet us<\/a> if you caught the time of the trauma ring tone to win the prize.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Until next time,<br>Jeff and Nachi<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Success is the sum of small efforts, repeated day in and day out. -Robert J. Collier Welcome back to Episode 29! This week we are starting out with a bit of psychiatry before swinging over to the Pediatric ER for a quick neonatal resuscitation. We may even stop by the trauma bay to see what <a href=\"https:\/\/www.roshreview.com\/blog\/ep-29-personality-disorders-neonatal-resuscitation-post-concussive-syndrome-abdominal-trauma-conjunctivitis-flexor-tenosynovitis\/\">read more&#8230;<\/a><\/p>\n","protected":false},"author":11,"featured_media":851,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"categories":[2025,1999],"tags":[2086,2099,2136,2143,2164,2172,2193,2223,2266,2267,2284,2289,2396,2397,2426,2430,2433,2459,2513,2526,2626,2657,2668,2669,2699,2750,2757,2769,2851,2925,2976,3106,3113,3118,3161,3227,3265,3271,3343,3345,3400,3509,3561,3564,3609,3623,3677,3713],"coauthors":[],"class_list":["post-1714","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-emergency-medicine","category-podcast","tag-adenovirus","tag-aggressive","tag-amnesia","tag-ams","tag-antibiotics","tag-antisocial","tag-artificial-tears","tag-basilar-skull-fracture","tag-blunt-abdominal-trauma","tag-blurry-vision","tag-borderline","tag-bradycardia","tag-cluster-a","tag-cluster-b","tag-confusion","tag-conjunctivitis","tag-contact-sports","tag-critical-care","tag-difficulty-concentrating","tag-dizziness","tag-exploratory-laparotomy","tag-finger-swelling","tag-flexor-tendor","tag-flexor-tenosynovitis","tag-gcs","tag-hand-surgery","tag-headaches","tag-hemodynamic-instability","tag-hypoxia","tag-kanavels-criteria","tag-liver","tag-neonatal-resuscitation","tag-neurology","tag-newborn","tag-ophthalmology","tag-paranoid","tag-pediatrics","tag-penetrating-trauma","tag-positive-pressure-ventilation","tag-post-concussive-syndrome","tag-psychiatry","tag-schizoid","tag-spleen","tag-splenic-laceration","tag-surgical-emergency","tag-tbi","tag-trauma","tag-urgent-care"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.4 (Yoast SEO v28.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Podcast Ep 29: Personality Disorders, Neonatal Resuscitation &amp; More | RoshReview.com<\/title>\n<meta name=\"description\" content=\"Welcome to RoshCast (Ep. 29), the first question and answer style emergency medicine podcast. Listen and learn more.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.roshreview.com\/blog\/ep-29-personality-disorders-neonatal-resuscitation-post-concussive-syndrome-abdominal-trauma-conjunctivitis-flexor-tenosynovitis\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Podcast Ep 29: Personality Disorders, Neonatal Resuscitation &amp; More\" \/>\n<meta property=\"og:description\" content=\"Welcome to RoshCast (Ep. 29), the first question and answer style emergency medicine podcast. 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