{"id":1882,"date":"2017-10-25T15:50:07","date_gmt":"2017-10-25T19:50:07","guid":{"rendered":"https:\/\/www.roshreview.com\/?p=1882"},"modified":"2017-10-25T15:50:07","modified_gmt":"2017-10-25T19:50:07","slug":"ep-34-seizures-yersinia-enterocolitica-pediatric-heart-failure-appendicitis-phimosis","status":"publish","type":"post","link":"https:\/\/www.roshreview.com\/blog\/ep-34-seizures-yersinia-enterocolitica-pediatric-heart-failure-appendicitis-phimosis\/","title":{"rendered":"Podcast Ep 34: Seizures, Yersinia enterocolitica, &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_34_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>Keep your eyes on the stars and your feet on the ground.<\/p><cite>-Theodore Roosevelt<\/cite><\/blockquote>\n\n\n\n<h6 class=\"wp-block-heading\">Welcome back to Roshcast Episode 34! This week we continue our collaboration with the <a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"http:\/\/emclerkship.com\/\" target=\"_blank\">EM Clerkship podcast<\/a>, focusing on appendicitis. Don\u2019t forget that we launched another trauma ring tone contest last week, so listen up through episode 38 to win the prize. For this week\u2019s rapid review, we reviewed dysbarism in honor of the Rosh Review Core Content Winner\u2019s presentation. If you haven\u2019t seen <a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"https:\/\/www.roshreview.com\/blog\/core-content-presentation-winner\/\" target=\"_blank\">Dr. Sanders and Dr. Levin\u2019s fantastic presentation,<\/a> it\u2019s definitely worth checking out. Let\u2019s get started!<\/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=\"178\" height=\"66\" src=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/RapidReview_50.png\" alt=\"\" class=\"wp-image-1608\" \/><\/figure><\/div>\n\n\n\n<ul class=\"wp-block-list\"><li>A <strong>diver<\/strong> with an <strong>arterial gas embolism<\/strong> would classically <strong>presents within 10 minutes<\/strong> with <strong>neurologic symptoms<\/strong> that <strong>resolve<\/strong> and <strong>then recur<\/strong>.<\/li><li>Typical <strong>symptoms<\/strong> of an <strong>arterial gas embolism<\/strong> include <strong>unconsciousness<\/strong>, <strong>respiratory or cardiac arrest<\/strong>, <strong>coma<\/strong>, <strong>stupor<\/strong>, <strong>confusion<\/strong>, <strong>unilateral neurologic changes<\/strong>, <strong>visual disturbances<\/strong>, <strong>dizziness<\/strong>, or <strong>convulsions<\/strong>.<\/li><li><strong>Decompression sickness<\/strong> presents in a variety of ways. 68% of patients will present with <strong>joint pains,<\/strong> 63% will present with <strong>numb patches<\/strong> and <strong>paresthesias<\/strong>, and 41% will have <strong>constitutional symptoms<\/strong> and <strong>fatigue<\/strong>. Other less common symptoms include dizziness, weakness, itching, hearing loss, and tinnitus.<\/li><li>On scene, a diver with either an <strong>arterial gas embolism<\/strong> <strong>or<\/strong> <strong>decompression sickness<\/strong> should be treated with the <strong>standard IV fluids<\/strong>, <strong>supplemental oxygen<\/strong>, and then be <strong>placed on a monitor<\/strong>.&nbsp;<strong>Definitive treatment<\/strong> is with <strong>hyperbaric oxygen<\/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\">Which of the following is the average duration of a typical generalized tonic-clonic seizure?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A. 1\u20132 minutes<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">B. 10\u201315 seconds<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">C. 30\u201340 seconds<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">D. 4\u20135 minutes<\/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 23-year-old man presents with abdominal pain, vomiting and two loose, nonbloody stools. Physical examination reveals right lower quadrant tenderness to palpation. A CT is performed showing a normal appendix and some inflammation at the ileocecal junction. What pathogen is commonly implicated in this disorder?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A. <em>Aeromonas<\/em> species<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">B. <em>Salmonella enterica<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">C. <em>Vibrio parahaemolyticus<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">D. <em>Yersinia enterocolitica<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep34-Yersiniosis.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 9-month-old girl presents to the ED with signs of progressive dyspnea. The patient\u2019s mother reports URI symptoms that have been present for two weeks. Over the previous 24 hours, the patient has been increasingly fussy, noted to be sweaty with feeds, and has become increasingly dyspneic. Her vital signs are T 38.3\u00b0C, HR 180, RR 38, POx 93%, and BP 60\/40. On examination, you note rales at the lung bases. Her heart rhythm is irregular with an S3 gallop, and the liver is palpable 3 cm below the costal margin. Which of the following is the most appropriate therapeutic intervention?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A. Dobutamine<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">B. Immediate endotracheal intubation<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">C. Normal saline 20 ml\/kg bolus<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">D. Propranolol<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">E. Transcutaneous pacing<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep34-Myocarditis.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 statements is true regarding appendicitis?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A. An appendicolith is identified in the majority of cases of appendicitis<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">B. Leukocytosis is seen in the majority of cases<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">C. Perforation is rare in patients younger than 2 years<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">D. The presence of an appetite makes the diagnosis unlikely<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep34-Acute-Appendicitis.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 5<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Which of the following is most characteristic of phimosis?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A. Collection of dilated and tortuous veins surrounding the spermatic cord<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">B. Inability to retract foreskin over glans<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">C. Inability to return retracted foreskin over glans<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">D. Painless cyst filled with sperm<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep34-Phimosis.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\">Which of the following historical features has a high positive likelihood ratio for acute appendicitis?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A. Migration of pain from periumbilical area to the right lower quadrant<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">B. Obturator sign<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">C. Presence of pain for more than 48 hours<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">D. Vomiting before onset of pain<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep34-Acute-Appendicitis.jpg\">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=\"178\" height=\"66\" src=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/RapidReview_50.png\" alt=\"\" class=\"wp-image-1608\" \/><\/figure><\/div>\n\n\n\n<ul class=\"wp-block-list\"><li>The <strong>average duration<\/strong> of a <strong>generalized tonic-clonic seizure<\/strong> is <strong>1\u20132 minutes<\/strong>.<\/li><li><strong>Status epilepticus<\/strong> is <strong>defined<\/strong> as any <strong>seizure lasting greater than 5 minutes or 2 discrete seizures without a recovery<\/strong> to consciousness.<\/li><li>For the <strong>treatment<\/strong> of <strong>status epilepticus<\/strong>, <strong>benzodiazepines<\/strong> are the <strong>first-line<\/strong> agents. <strong>Second-line<\/strong> agents include <strong>phenytoin<\/strong>, <strong>fosphenytoin<\/strong>, <strong>valproic acid<\/strong>, <strong>phenobarbital<\/strong>, and <strong>levetiracetam<\/strong>. Pentobarbital and propofol are third-line agents.<\/li><li><em><strong>Yersinia enterocolitica<\/strong><\/em> can cause <strong>ileocecitis<\/strong> which can <strong>mimic appendicitis<\/strong>. Other symptoms include colicky abdominal pain, fever, nausea, vomiting, and diarrhea. <strong>Treatment<\/strong> is <strong>supportive<\/strong>.<\/li><li><strong>Pediatric heart failure<\/strong> is treated with <strong>dobutamine if hypotensive<\/strong> or with <strong>milrinone if normotensive or hypertensive<\/strong>.<\/li><li>Common <strong>causes<\/strong> for <strong>myocarditis<\/strong> include <strong>viruses<\/strong>, <strong>bacteria<\/strong>, <strong>parasites<\/strong>, <strong>cardiotoxins<\/strong>, <strong>systemic disorders<\/strong>, <strong>radiation<\/strong>, and <strong>hypersensitivity<\/strong>.<\/li><li>A <strong>leukocytosis<\/strong> is seen in <strong>up to 70%<\/strong> of patients with <strong>appendicitis<\/strong>.<\/li><li><strong>Appendicoliths<\/strong> are <strong>rarely identified<\/strong>, they are only seen <strong>10% of the time radiographically<\/strong>.<\/li><li><strong>33%<\/strong> of patients diagnosed with <strong>appendicitis<\/strong> <strong>do NOT report anorexia<\/strong>.<\/li><li><strong>Phimosis<\/strong> is the <strong>inability to retract the foreskin<\/strong> over the glans.<\/li><li><strong>Paraphimosis<\/strong> is the <strong>inability to return the retracted foreskin<\/strong> over the glans.<\/li><li><strong>Varicocele<\/strong> is a <strong>collection of dilated and tortuous veins surrounding the spermatic cord<\/strong>.&nbsp;They usually cause no symptoms.<\/li><li>There is a <strong>high positive likelihood ratio<\/strong> for acute <strong>appendicitis<\/strong> with <strong>migration of pain from the periumbilical area to the right lower quadrant<\/strong>.<\/li><li><strong>Obturator sign<\/strong> is the elicitation of <strong>pain with flexion and internal rotation of the right hip<\/strong> which signifies a <strong>pelvic location of the appendix<\/strong>.<\/li><li><strong>Rosving sign<\/strong> is <strong>palpation of the left lower quadrant<\/strong> causing <strong>referred pain to the right lower quadrant<\/strong>.<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">That wraps up Episode 34. We will be at ACEP next week and hope to meet many of you there. Definitely swing by the <a href=\"http:\/\/s36.a2zinc.net\/clients\/ACEP\/ACEP17\/Public\/eventmap.aspx?MapID=20&amp;MapItBoothID=112633&amp;MapItBooth=1442\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\">Rosh Review booth (1442)<\/a> to say hi and give us some feedback and suggestions!<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Don\u2019t forget to follow us on Twitter <a href=\"https:\/\/twitter.com\/roshcast?lang=en\">@Roshcast<\/a> and <a href=\"https:\/\/twitter.com\/roshreview?lang=en\">@Roshreview<\/a>. We can also be reached by email at <a href=\"mailto:roshcast@roshreview.com\">roshcast@roshreview.com<\/a> and are open to any feedback, corrections, or suggestions. You can help us pick questions by identifying ones you would like us to review. To do so, write \u201cRoshcast\u201d in the submit feedback box as you go through the question bank. And finally, if you have a minute, make sure to rate us and leave comments on <a href=\"https:\/\/itunes.apple.com\/us\/podcast\/roshcast\/id1156487141?mt=2\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\">iTunes<\/a> to help spread the word about Roshcast.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Until next time,<br>Jeff and Nachi<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Keep your eyes on the stars and your feet on the ground. -Theodore Roosevelt Welcome back to Roshcast Episode 34! This week we continue our collaboration with the EM Clerkship podcast, focusing on appendicitis. Don\u2019t forget that we launched another trauma ring tone contest last week, so listen up through episode 38 to win the <a href=\"https:\/\/www.roshreview.com\/blog\/ep-34-seizures-yersinia-enterocolitica-pediatric-heart-failure-appendicitis-phimosis\/\">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":[2154,2181,2182,2189,2233,2330,2331,2414,2485,2506,2524,2528,2652,2681,2682,2722,2829,2835,2856,2962,2963,2970,3036,3085,3091,3113,3152,3229,3230,3259,3265,3269,3291,3299,3300,3302,3433,3446,3478,3479,3490,3518,3554,3577,3607,3662,3700,3719,3730,3735,3767,3789],"coauthors":[],"class_list":["post-1882","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-emergency-medicine","category-podcast","tag-anorexia","tag-appendicitis","tag-appendicolith","tag-arterial-gas-embolism","tag-benzodiazepine","tag-cardiology","tag-cardiotoxin","tag-colicky-abdominal-pain","tag-decompression-sickness","tag-diarrhea","tag-dive-medicine","tag-dobutamine","tag-fever","tag-foreskin","tag-fosphenytoin","tag-glans","tag-hyperbaric-oxygen","tag-hypersensitivity","tag-ileocecitis","tag-leukocytosis","tag-levetiracetam","tag-likelihood-ratio","tag-milrinone","tag-myocarditis","tag-nausea","tag-neurology","tag-obturator-sign","tag-paraphimosis","tag-parasite","tag-pediatric-heart-failure","tag-pediatrics","tag-pelvis","tag-periumbilical","tag-phenobarbital","tag-phenytoin","tag-phimosis","tag-radiology","tag-referred-pain","tag-right-hip","tag-right-lower-quadrant","tag-rosvings-sign","tag-seizure","tag-spermatic-cord","tag-status-epilepticus","tag-surgery","tag-tonic-clonic-seizure","tag-unconcsciousness","tag-urology","tag-valproic-acid","tag-varicocele","tag-vomiting","tag-yersinia-enterocolitica"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.4 (Yoast SEO v28.6) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Podcast Ep 34: Seizures, Yersinia Enterocolitica &amp; More | RoshReview.com<\/title>\n<meta name=\"description\" content=\"Welcome to RoshCast (Ep. 34), the first question and answer style emergency medicine podcast. 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