{"id":2248,"date":"2018-02-22T18:49:30","date_gmt":"2018-02-22T23:49:30","guid":{"rendered":"https:\/\/www.roshreview.com\/?p=2248"},"modified":"2018-02-22T18:49:30","modified_gmt":"2018-02-22T23:49:30","slug":"ep-42-korsakoff-syndrome-aaa-prolapsed-umbilical-cord-epiglottitis-thoracostomy-intracerebral-hemorrhage","status":"publish","type":"post","link":"https:\/\/www.roshreview.com\/blog\/ep-42-korsakoff-syndrome-aaa-prolapsed-umbilical-cord-epiglottitis-thoracostomy-intracerebral-hemorrhage\/","title":{"rendered":"Podcast Ep 42: Korsakoff Syndrome, AAA, Prolapsed Umbilical Cord"},"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_42_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>The secret of change is to focus all of your energy, not on fighting the old, but on building the new.&nbsp;<\/p><cite>\u2013Socrates<\/cite><\/blockquote>\n\n\n\n<h6 class=\"wp-block-heading\">Welcome back to RoshCast for Episode 42! With the in-training exam around the corner, go back and power through old episodes during commutes to pick up as many points as possible. Good luck!<\/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><span style=\"font-weight: 400\"><strong>Patent ductus arteriosus<\/strong> (or PDA) closes, the <strong>neonate<\/strong> will present in <strong>heart failure<\/strong> and <strong>shock<\/strong>.<\/span><\/li><li><strong>Turner\u2019s syndrome<\/strong> is associated with <strong>coarctation<\/strong>. Turner\u2019s is also associated with <strong>webbed neck<\/strong>, <strong>short stature<\/strong>, and <strong>low-set ears<\/strong>.<\/li><li>Individuals with Turner\u2019s syndrome are <strong>missing an X chromosome<\/strong> as well, making it a <strong>45,XO chromosomal condition<\/strong>.<\/li><li>A <strong>blood pressure differential<\/strong> between the arms and legs\u2014specifically, the pressure in the arms is higher than the legs. Depending on the specific anatomy, you might even note a difference in the pressures between both arms.<\/li><li><span style=\"font-weight: 400\">Classic <strong>EKG<\/strong> and <strong>chest X-ray<\/strong> findings associated with <strong>coarctation of the aorta<\/strong>&nbsp;<\/span>include <strong>left ventricular hypertrophy<\/strong> and <strong>rib notching<\/strong>, respectively.<\/li><\/ul>\n\n\n\n<p><span><b>Now onto this week\u2019s podcast<\/b><\/span><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p><b>Question 1 <\/b><\/p>\n\n\n\n<p><span style=\"font-weight: 400\">Which of the following is typically seen in Korsakoff syndrome?<\/span><\/p>\n\n\n\n<p><span style=\"font-weight: 400\">A. Cerebellar dysfunction<\/span><\/p>\n\n\n\n<p><span style=\"font-weight: 400\">B. Long-term memory impairment<\/span><\/p>\n\n\n\n<p><span style=\"font-weight: 400\">C. Ophthalmoplegia<\/span><\/p>\n\n\n\n<p><span style=\"font-weight: 400\">D. Recent memory impairment<\/span><\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep42-Wernicke-Korsakoff.png\">Teaching Image<\/a>&nbsp;<\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p><b>Question 2<\/b><\/p>\n\n\n\n<p><span style=\"font-weight: 400\">Which of the following is the most common physical exam finding in an abdominal aortic aneurysm?<\/span><\/p>\n\n\n\n<p><span style=\"font-weight: 400\">A. Abdominal bruit<\/span><\/p>\n\n\n\n<p><span style=\"font-weight: 400\">B. Diminished femoral pulses<\/span><\/p>\n\n\n\n<p><span style=\"font-weight: 400\">C. Duodenal obstruction<\/span><\/p>\n\n\n\n<p><span style=\"font-weight: 400\">D. Pulsatile abdominal mass<\/span><\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep42-AAA.jpg\">Teaching Image<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p><b>Question 3<\/b><\/p>\n\n\n\n<p><span style=\"font-weight: 400\">A 24-year-old woman at full term presents with rupture of membranes and contractions. Sterile exam reveals a crowning infant with a visible cord. After elevating the fetal head, what management is indicated? <\/span><\/p>\n\n\n\n<p><span style=\"font-weight: 400\">A. Clamp and cut cord and proceed with delivery<\/span><\/p>\n\n\n\n<p><span style=\"font-weight: 400\">B. Continue with standard delivery<\/span><\/p>\n\n\n\n<p><span style=\"font-weight: 400\">C. Emergent cesarean section <\/span><\/p>\n\n\n\n<p><span style=\"font-weight: 400\">D. Intravenous tocolytics<\/span><\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep42-Umbilical-Cord-Prolapse.jpg\">Teaching Image&nbsp;<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p><b>Question 4<\/b><\/p>\n\n\n\n<p><span style=\"font-weight: 400\">You suspect a 35-year-old man has epiglottitis with impending airway compromise. Which of the following is the best method for confirming the diagnosis?<\/span><\/p>\n\n\n\n<p><span style=\"font-weight: 400\">A. Computed tomography of the neck<\/span><\/p>\n\n\n\n<p><span style=\"font-weight: 400\">B. Frontal cervical soft tissue radiograph <\/span><\/p>\n\n\n\n<p><span style=\"font-weight: 400\">C. Indirect laryngoscopy<\/span><\/p>\n\n\n\n<p><span style=\"font-weight: 400\">D. Lateral cervical soft tissue radiograph<\/span><\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep41-Epiglottitis.png\">Teaching Image<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p><b>Question 5<\/b><\/p>\n\n\n\n<p><span style=\"font-weight: 400\">A 21-year-old man presents with a stab wound to the right chest. His vitals are HR 157\/min, BP 81\/43 mm Hg, RR 28\/min, and oxygen saturation 91%. The patient is intubated, and packed red blood cells are started. Physical examination reveals a bleeding wound to the right chest, a midline trachea, and decreased breath sounds on auscultation of the right hemithorax. Which of the following should be performed next?<\/span><\/p>\n\n\n\n<p><span style=\"font-weight: 400\">A. Application of a pelvic binder<\/span><\/p>\n\n\n\n<p><span style=\"font-weight: 400\">B. Placement of a right thoracostomy tube<\/span><\/p>\n\n\n\n<p><span style=\"font-weight: 400\">C. Right chest thoracotomy<\/span><\/p>\n\n\n\n<p><span style=\"font-weight: 400\">D. Transfer to operating room<\/span><\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep42-Traumatic-Hemothorax.png\">Teaching Image&nbsp;<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p><b>Question 6<\/b><\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><img loading=\"lazy\" decoding=\"async\" width=\"309\" height=\"348\" src=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep42-Intraparenchymal-Hemorrhage-CT.jpg\" alt=\"\" class=\"wp-image-2256\" srcset=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/sites\/2\/Ep42-Intraparenchymal-Hemorrhage-CT.jpg 309w, https:\/\/www.roshreview.com\/wp-content\/uploads\/sites\/2\/Ep42-Intraparenchymal-Hemorrhage-CT-266x300.jpg 266w\" sizes=\"auto, (max-width: 309px) 100vw, 309px\" \/><\/figure><\/div>\n\n\n\n<p><span style=\"font-weight: 400\">A 65-year-old man with a history of hypertension presents with left-sided weakness beginning two hours prior to arrival. Vitals are BP 155\/85 mm Hg, HR 102\/min, RR 12\/min, oxygen saturation 100% on RA. His CT scan is shown above. Which of the following therapies is appropriate?<\/span><\/p>\n\n\n\n<p><span style=\"font-weight: 400\">A. Antihypertensives to lower mean arterial pressure by 25%<\/span><\/p>\n\n\n\n<p><span style=\"font-weight: 400\">B. Head of bed at 30\u00b0<\/span><\/p>\n\n\n\n<p><span style=\"font-weight: 400\">C. Neurosurgical evacuation<\/span><\/p>\n\n\n\n<p><span style=\"font-weight: 400\">D. Prophylactic antiepileptic drugs<\/span><\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep42-Intraparenchymal-Hemorrhage.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><span style=\"font-weight: 400\"><strong>Korsakoff syndrome<\/strong> is a <strong>chronic neurologic disease<\/strong> caused by <strong>thiamine deficiency<\/strong> that typically presents with <strong>impairment of recent memory formation<\/strong>. Patients may also exhibit <strong>apathy<\/strong> and <strong>confabulation<\/strong>.<\/span><\/li><li><strong>Wernicke\u2019s encephalopathy&nbsp;<\/strong>often presents with <strong>ophthalmoplegia<\/strong>, <strong>nystagmus<\/strong>, <strong>ataxia<\/strong>, and <strong>mental status changes<\/strong>. Wernicke\u2019s encephalopathy and Korsakoff syndrome or often seen simultaneously.<\/li><li>Treat both Wenicke and Korsakoff syndromes with <strong>thiamine<\/strong> and <strong>magnesium<\/strong>.<\/li><li>The most common physical exam finding in AAA is a <strong>pulsatile mass<\/strong>. At a <strong>diameter of 5 cm<\/strong>, the <strong>risk of rupture increases markedly<\/strong>. Diagnosis is made by <strong>ultrasound<\/strong> or <strong>CT scan<\/strong>.<\/li><li>For <strong>umbilical cord prolapse<\/strong> during delivery, plan for an <strong>emergent C-section<\/strong>. If C-section is not possible, attempt <strong>manual replacement of the cord<\/strong> into the uterus, followed by <strong>rapid vaginal delivery<\/strong>.<\/li><li><strong>Epiglottitis<\/strong> classically presents with <strong>rapid onset of fever<\/strong> and <strong>dysphagia<\/strong>, often with <strong>drooling<\/strong>, <strong>anxiety<\/strong>, <strong>stridor<\/strong>, and a <strong>muffled voice<\/strong>.<\/li><li>The best method for confirming the diagnosis of epiglottitis is via <strong>indirect laryngoscopy<\/strong>, which can be done with a <strong>nasopharyngoscope<\/strong>. However, be careful as manipulation can lead to <strong>laryngospasm<\/strong> and <strong>airway obstruction<\/strong>. Make sure a <strong>surgical airway kit<\/strong> is available at the bedside.<\/li><li>The classic finding on <strong>lateral neck X-ray<\/strong> in those with epiglottitis is a <strong>thumbprint sign<\/strong>.<\/li><li>An <strong>ED thoracotomy<\/strong> would be indicated in a <strong>patient who loses vitals<\/strong> in route to the hospital or in the ED. &nbsp;<\/li><li>For <strong>intracranial hemorrages<\/strong>, treatment is first supportive with <strong>airway protection<\/strong> and <strong>maintenance of adequate perfusion<\/strong>. <strong>Elevate the head of the bed to 30 degrees<\/strong> and maintain <strong>normothermia<\/strong>, <strong>normocarbia<\/strong>, and <strong>euglycemia<\/strong>. Current data do not support the use of <strong>antiepileptics<\/strong>.<\/li><\/ul>\n\n\n\n<p><span style=\"font-weight: 400\">That wraps up RoshCast Episode 42! Be sure to also check out <\/span><a href=\"https:\/\/www.roshreview.com\/blog\/\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\">RoshCast blog&nbsp;<\/a><span style=\"font-weight: 400\">for questions from this episode and prior episodes, related images and tables, as well as bonus teaching points. There are also tons of other great free resources there to help prepare you for the boards and the wards. Don\u2019t forget to follow us on twitter <a href=\"https:\/\/twitter.com\/roshcast?lang=en\">@RoshCast<\/a>&nbsp;and <a href=\"https:\/\/twitter.com\/roshreview?lang=en\">@RoshReview<\/a>. And you can always email us at <a href=\"mailto:roshcast@roshreview.com\">RoshCast@RoshReview.com<\/a>&nbsp;with any feedback, corrections, or suggestions.&nbsp;You can also help us pick questions by identifying ones you would like us to review. Write \u201cRoshCast\u201d in the submit feedback box as you go through the question bank. Lastly, if you have a minute, make sure to rate us and leave comments on <a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"https:\/\/itunes.apple.com\/us\/podcast\/roshcast\/id1156487141?mt=2\" target=\"_blank\">iTunes<\/a>&nbsp;to help spread the word about RoshCast.<\/span><\/p>\n\n\n\n<p><span style=\"font-weight: 400\">Good luck on the in-training exam next week!<\/span><br><span style=\"font-weight: 400\">Jeff and Nachi<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>The secret of change is to focus all of your energy, not on fighting the old, but on building the new.&nbsp; \u2013Socrates Welcome back to RoshCast for Episode 42! With the in-training exam around the corner, go back and power through old episodes during commutes to pick up as many points as possible. Good luck! <a href=\"https:\/\/www.roshreview.com\/blog\/ep-42-korsakoff-syndrome-aaa-prolapsed-umbilical-cord-epiglottitis-thoracostomy-intracerebral-hemorrhage\/\">read more&#8230;<\/a><\/p>\n","protected":false},"author":11,"featured_media":2249,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"inline_featured_image":false,"footnotes":""},"categories":[2025,1999],"tags":[2031,2113,2114,2161,2175,2178,2198,2262,2369,2386,2403,2404,2425,2464,2535,2545,2559,2563,2582,2609,2623,2761,2868,2932,2940,2946,2956,2984,2994,3065,3089,3108,3127,3128,3141,3164,3242,3280,3415,3438,3439,3473,3532,3534,3585,3608,3645,3646,3653,3690,3697,3698,3774,3776,3786],"coauthors":[],"class_list":["post-2248","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-emergency-medicine","category-podcast","tag-45-xo-chromosomal-condition","tag-airway-obstruction","tag-airway-protection","tag-anti-epileptics","tag-anxiety","tag-apathy","tag-ataxia","tag-blood-pressure-differential","tag-chest-x-ray","tag-chronic-neurologic-disease","tag-coarctation","tag-coarctation-of-the-aorta","tag-confabulation","tag-ct-scan","tag-drooling","tag-dysphagia","tag-ed-thoracotomy","tag-ekg","tag-emergent-c-section","tag-epiglottitis","tag-euglycemia","tag-heart-failure","tag-indirect-laryngoscopy","tag-korsakoff-syndrome","tag-laryngospasm","tag-lateral-neck-x-ray","tag-left-ventricular-hypertrophy","tag-low-set-ears","tag-magnesium","tag-muffled-voice","tag-nasopharyngoscope","tag-neonate","tag-normocarbia","tag-normothermia","tag-nystagmus","tag-opthalmoplegia","tag-patent-ductus-arteriosus","tag-perfusion","tag-pulsatile-mass","tag-rapid-onset-of-fever","tag-rapid-vaginal-delivery","tag-rib-notching","tag-shock","tag-short-stature","tag-stridor","tag-surgical-airway-kit","tag-thiamine","tag-thiamine-deficiency","tag-thumbprint-sign","tag-turners-syndrome","tag-ultrasound","tag-umbilical-cord-prolapse","tag-webbed-neck","tag-wernickes-encephalopathy","tag-x-chromosome"],"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 42: Korsakoff Syndrome, AAA, Prolapsed Umbilical Cord | RoshReview.com<\/title>\n<meta name=\"description\" content=\"Welcome to RoshCast (Ep. 42), the first question and answer style emergency medicine podcast. 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