{"id":2790,"date":"2018-09-18T12:32:19","date_gmt":"2018-09-18T16:32:19","guid":{"rendered":"https:\/\/www.roshreview.com\/?p=2790"},"modified":"2018-09-18T12:32:19","modified_gmt":"2018-09-18T16:32:19","slug":"podcast-ep-48-pediatric-back-pain-lateral-canthotomy-parkland-formula-lung-disease-nerve-compression-tbi","status":"publish","type":"post","link":"https:\/\/www.roshreview.com\/blog\/podcast-ep-48-pediatric-back-pain-lateral-canthotomy-parkland-formula-lung-disease-nerve-compression-tbi\/","title":{"rendered":"Podcast Ep 48: Pediatric Back Pain, Lateral Canthotomy, &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_48_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 not final, failure is not fatal: it is the courage to continue that counts.<\/p><cite>\u2013Winston Churchill<\/cite><\/blockquote>\n\n\n\n<h6 class=\"wp-block-heading\">Welcome back to RoshCast for Episode 48!&nbsp;We&#8217;re going to jump right into questions this week. Remember to send us feedback for any changes you would like to see at <a href=\"mailto:roshcast@roshreview.com\">roshcast@roshreview.com<\/a>.<\/h6>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p><strong>Question 1<\/strong><\/p>\n\n\n\n<p>An 8-year-old previously healthy boy presents with back pain and fever for 4 days. He complains of pain in the low back, which is increased with bending or twisting. The pain radiates down into his left leg. He denies trauma. Physical exam is remarkable only for tenderness to palpation over the lumbar spine. What management is indicated<\/p>\n\n\n\n<p>A. Ibuprofen and follow up with his pediatrician<\/p>\n\n\n\n<p>B. MRI of the lumbar spine<\/p>\n\n\n\n<p>C. Plain radiographs of the lumbar spine<\/p>\n\n\n\n<p>D. Urinalysis<\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep48-Pediatric-Discitis.png\">Teaching Image<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p><strong>Question 2<\/strong><\/p>\n\n\n\n<p>A 40-year-old man is brought to the emergency department after being assaulted during a bar fight. He has proptosis of the right eye with a measured intraocular pressure of 50 mm Hg. A lateral canthotomy is started. Once the Kelly clamp is released from the lateral canthus, what is the appropriate next step?<\/p>\n\n\n\n<p>A. Clamp the medial canthus<\/p>\n\n\n\n<p>B. Cut the inferior crus of the lateral canthal tendon<\/p>\n\n\n\n<p>C. Cut the superior crus of the lateral canthal tendon<\/p>\n\n\n\n<p>D. Recheck intraocular pressure<\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep48-Lateral-Canthotomy.jpg\">Teaching Image<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p><strong>Question 3<\/strong><\/p>\n\n\n\n<p>A 25-year-old man presents to the emergency department after sustaining burns to the hands, legs, and chest after falling into a bonfire. On physical examination, there are partial-thickness burns on the upper half of the anterior torso along with the bilateral palms of the hands and bilateral anterior legs. He weighs 70 kg. You begin to initiate fluid resuscitation using the Parkland formula. How much fluid should this patient receive in the first eight hours?<\/p>\n\n\n\n<p>A. 10,640 mL<\/p>\n\n\n\n<p>B. 4,060 mL<\/p>\n\n\n\n<p>C. 5,320 mL<\/p>\n\n\n\n<p>D. 8,120 mL<\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep48-Parkland-Formula.png\">Teaching Image<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p><strong>Question 4<\/strong><\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><img loading=\"lazy\" decoding=\"async\" width=\"336\" height=\"363\" src=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep48-Pneumonoconiosis-Question.png\" alt=\"\" class=\"wp-image-2793\" srcset=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/sites\/2\/Ep48-Pneumonoconiosis-Question.png 336w, https:\/\/www.roshreview.com\/wp-content\/uploads\/sites\/2\/Ep48-Pneumonoconiosis-Question-278x300.png 278w\" sizes=\"auto, (max-width: 336px) 100vw, 336px\" \/><\/figure><\/div>\n\n\n\n<p>A 64-year-old man presents to the emergency department with cough and shortness of breath that has progressively been worsening over the last several weeks. He has also been more fatigued and is unable to get around the house anymore. He denies fever and night sweats. He has a past medical history of hypertension and takes lisinopril daily. He is an immigrant from Argentina where he used to work as a miner. He denies tobacco use. What is the most likely diagnosis based on this chest radiograph?<\/p>\n\n\n\n<p>A. Histoplasmosis<\/p>\n\n\n\n<p>B. Miliary tuberculosis<\/p>\n\n\n\n<p>C. Pneumoconiosis<\/p>\n\n\n\n<p>D. Sarcoidosis<\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep48-Radiographic-Characteristics-Pneumoconoisis.png\">Teaching Image<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep48-Histoplasmosis.png\">Teaching Image<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep48-Miliary-TB.png\">Teaching Image<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep48-Sarcoidosis.png\">Teaching Image<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p><strong>Question 5<\/strong><\/p>\n\n\n\n<p>A 53-year-old man presents with numbness to his right hand for three to four months. He states that he has numbness with waking up in the morning, which gets better when he shakes his hands. The patient indicates numbness to his first, second, and third digits on the right hand. Which of the following tests is most sensitive for this diagnosis?<\/p>\n\n\n\n<p>A. Finkelstein test<\/p>\n\n\n\n<p>B. Median nerve compression test<\/p>\n\n\n\n<p>C. Phalen test<\/p>\n\n\n\n<p>D. Tinel sign<\/p>\n\n\n\n<p><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep48-Carpal-Tunnel-Syndrome.png\">Teaching Image<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p><strong>Question 6<\/strong><\/p>\n\n\n\n<p>A young man is involved in a motor vehicle collision and sustains a severe head injury. In the ED, his GCS is 7. His blood pressure is 115\/70 mm Hg and heart rate is 85 beats per minute. His pupils are 3 mm and equal and reactive to light. You intubate the patient and place him on a mechanical ventilator. The FAST ultrasound is negative and there are no other obvious injuries. Which of the following is the most important principle to follow in the management of this patient?<\/p>\n\n\n\n<p>A. Administer mannitol<\/p>\n\n\n\n<p>B. Avoid hypotension<\/p>\n\n\n\n<p>C. Hyperventilation<\/p>\n\n\n\n<p>D. Initiate induced hypothermia<\/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><strong>Discitis<\/strong> presents with <strong>severe localized radiating pain<\/strong>. The <strong>lumbar spine<\/strong> is most commonly involved, and treatment is with <strong>IV antibiotics<\/strong>.<\/li><li>A <strong>lateral canthotomy<\/strong> is performed to relieve <strong>intraocular pressure<\/strong> from a <strong>retrobulbar hematoma<\/strong> or a <strong>postseptal hemorrhage<\/strong>. It is done by <strong>cutting the inferior crus<\/strong> of the lateral canthal tendon.<\/li><li>The <strong>Parkland Formula<\/strong> is used to determine the volume of fluid required for <strong>resuscitation of burn patients<\/strong>. It is <strong>4 mL x body weight in kg x % total body surface area<\/strong> of the burn. <strong>Half<\/strong> of this fluid is given within the <strong>first 8 hours<\/strong> and then <strong>other half<\/strong> over the <strong>next 16 hours<\/strong>.<\/li><li><strong>Pneumoconiosis<\/strong> is a <strong>restrictive lung disease<\/strong>&nbsp;that can be caused by <strong>inhalation of dust<\/strong>, often in <strong>mines<\/strong>. It presents with <strong>bilateral ground glass opacities<\/strong> on Chest X-ray.<\/li><li>The <strong>Median Nerve Compression Test<\/strong> is the <strong>most sensitive<\/strong> test for confirming <strong>carpal tunnel syndrome<\/strong>. It&nbsp;consists of <strong>direct pressure application<\/strong> to the median nerve at the carpal tunnel.<\/li><li><strong>Hypotension and hypoxia<\/strong> have both been shown to have a <strong>devastating effect<\/strong> on the outcome of patients with <strong>traumatic brain injury<\/strong>.<\/li><\/ul>\n\n\n\n<p>That wraps up RoshCast Episode 48!&nbsp;Be sure to also check out the rest of the&nbsp;<a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"https:\/\/www.roshreview.com\/blog\/\" target=\"_blank\">Rosh Review Blog&nbsp;<\/a>for questions from prior episodes, related images and tables, and bonus teaching points. There are also tons of other great free resources 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>. 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;<\/p>\n\n\n\n<p>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 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>&nbsp;to help spread the word about RoshCast.<\/p>\n\n\n\n<p>Megha and Nachi<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Success is not final, failure is not fatal: it is the courage to continue that counts. \u2013Winston Churchill Welcome back to RoshCast for Episode 48!&nbsp;We&#8217;re going to jump right into questions this week. Remember to send us feedback for any changes you would like to see at roshcast@roshreview.com. Question 1 An 8-year-old previously healthy boy <a href=\"https:\/\/www.roshreview.com\/blog\/podcast-ep-48-pediatric-back-pain-lateral-canthotomy-parkland-formula-lung-disease-nerve-compression-tbi\/\">read more&#8230;<\/a><\/p>\n","protected":false},"author":11,"featured_media":2637,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"inline_featured_image":false,"footnotes":""},"categories":[2025,1999],"tags":[2214,2309,2334,2519,2848,2944,2988,3013,3037,3161,3233,3265,3325,3414,3463,3678],"coauthors":[],"class_list":["post-2790","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-emergency-medicine","category-podcast","tag-back-pain","tag-burns","tag-carpal-tunnel-syndrome","tag-discitis","tag-hypotension","tag-lateral-canthotomy","tag-lung-disease","tag-median-nerve-compression-test","tag-miner","tag-ophthalmology","tag-parkland-formula","tag-pediatrics","tag-pneumoconiosis","tag-pulmonology","tag-retrobulbar-hematoma","tag-traumatic-brain-injury"],"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 48: Pediatric Back Pain, Lateral Canthotomy &amp; More | RoshReview.com<\/title>\n<meta name=\"description\" content=\"Welcome to RoshCast (Ep. 48), the first question and answer style emergency medicine podcast. 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